Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial.

INTRODUCTION: Incubation of blood with CrSO(4)-coated glass beads stimulates the synthesis of anti-inflammatory cytokines, such as interleukin-1 receptor antagonist (IL-1ra), IL-4, IL-10, and IL-13. As IL-1beta is thought to play a key role in the development of osteoarthritis (OA), this product, also known as Orthokin, might be a viable treatment for symptomatic knee OA. The aim of the current study was to evaluate the efficacy of Orthokin for treatment of symptomatic knee OA in a randomized, multicentre, double-blind, placebo-controlled trial. PATIENTS AND METHODS: One hundred and sixty-seven patients received six intra-articular injections either with Orthokin or physiological saline. The primary efficacy objective consisted of 30% superiority on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3, 6, 9, and 12 months post-treatment. Additionally, the patients completed the visual analogue scale for pain, the Knee injury and Osteoarthritis Outcome Score (KOOS) and Knee Society Clinical Rating System. RESULTS: Orthokin and placebo treatment resulted in similar improvements on the WOMAC (16.8% vs 16.5%, respectively; n.s.). Orthokin resulted in significantly more improvement for KOOS symptom (P = 0.002) and KOOS sport (P = 0.042) parameters as compared to placebo treatment. For most other outcome parameters, Orthokin-treated patients consistently showed higher improvement compared to placebo-treated patients, although none of these differences were statistically significant. Two serious adverse events were observed in the Orthokin group: one patient with repeated severe inflammatory reactions of the knee joint within hours after the injection and one patient with septic arthritis which was attributed to the injection procedure rather than the product. CONCLUSION: The statistically significant improvement of KOOS symptom and sport parameters together with the consistently higher, though non-statistically significant, improvement of most other parameters demonstrates that Orthokin clearly induces a biological response different from placebo treatment and warrant future investigations into the possible chondroprotective effect of Orthokin. However, in the current study the primary efficacy objective was not met and, therefore, the use of Orthokin currently cannot yet be recommended for the treatment of OA.

Bilateral epiphysiodesis around the knee as treatment for excessive height in boys.

Between 1987 and 1993, six boys who had been predicted to grown to an excessive height were treated with bilateral Phemister epiphysiodesis around the knee. Median predicted adult height was 210.4c (range: 207.4-213.4 c), the median observed adult height was 201.5 c (range: 195.5-206.7 c). Median height reduction was 9.3 c (range: 4.1-15.3 c). Median length of follow-up was 44 months (range: 21-84 months). At final follow-up, all patients had full range of motion, no infections, no pain, no angular deformities, equal leg lengths, and radiographic evidence of physeal closure. Bilateral Phemister epiphysiodesis around the knee is a good alternative to pharmacological treatment for boys with excessive height.

[A small hospital ... for what use? Study og the surgical activity at the Loudon hospital 1989]. / Un petit hôpital ... a quoi ça sert? Etude de l'activité chirurgicale de l'hôpital de Loudun au cours de l'année 1989.

General hospitals, even small ones, are by no means a secondary element in the French sanitary network, the authors analyze the activity of the department of surgery of Loudun Hospital to show that the part they play is far from negligible, with 1403 patients admitted within one year, 1071 surgical operations performed and 2719 patients received in the emergency unit. They ensure a highly appreciated physical and psychological comfort for the rural population. The costs of the stays are very competitive, even in comparison with private hospitals. These satisfactory sanitary conditions involve a particularly great devotion of both the medical personnel and the allied health workers.

[Adenomatoid tumor of the tunica vaginalis testis. Apropos of 5 cases]. / Tumeur adénomatoïde de la vaginale testiculaire. A propos de 5 observations.

The authors report five cases of adenomatoid tumour of the tunica vaginalis. Two cases were located on the epididymis and two on the tunica albuginea of the testis. In each case, a limited excision of the tumour without removal of the testis resulted in a cure, confirmed by a follow-up of three years. A histological examination at the time of the operation revealed the exact nature of the lesion in each case, thereby preventing the unnecessary excision of the gonad. The authors then review the literature on the subject with particular mention of the histopathology, the classification of these tumours, the clinical features and the treatment. They stress that in the majority of cases, mesotheliomas of the tunica vaginalis are benign and can be treated with limited excision and conservation of the testis. However, a few malignant forms have been described, hence the need for a careful histological examination.

[First cases of surgical pulmonary cryptococcosis in Vietnam]. / Premiers cas de cryptococcose pulmonaire chirurgicale au Vietnam

Two cases of tumoral isolated pulmonary cryptococcosis are reported. The rarity of the facts explains that diagnosis is usually surgical, the inflammatory and necrotic pseudo-tumour swarming with yeast-like micro-organisms, easily recognizable by their thick gelatinous capsules.