ABSTRACT
BACKGROUND: Dextrose injection is reported to improve knee osteoarthritis (KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. OBJECTIVE: To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. DESIGN: Case series with blinded arthroscopic evaluation before and after treatment. SETTING: Physical medicine and day surgery practice. PARTICIPANTS: Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection. INTERVENTION: Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose. MAIN OUTCOME MEASURES: Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points). RESULTS: Six participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (P = .013). Self-limited soreness after methylene blue instillation was noted. CONCLUSIONS: Positive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV KOA, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data. LEVEL OF EVIDENCE: IV.
Subject(s)
Osteoarthritis, Knee , Aged , Female , Glucose , Humans , Injections, Intra-Articular , Male , Prolotherapy , Quality of Life , Treatment OutcomeABSTRACT
INTRODUCTION: Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, represents 5% to 7% of colorectal cancers. It is an autosomal dominant inherited disorder characterized by an early onset of colorectal tumors, predominantly proximal, and multiple and microsatellite instability. We used the Amsterdam II criteria for its identification. OBJECTIVE: To analyze the case of a patient with a family history of malignant colorectal tumors at an early age of onset. CASE REPORT: A 40-year-old woman, from Valle de Punilla, Cordoba, Argentina, with no previous medical history, complained of mild changes in her bowel habits and was admitted to the general surgery department with the radiographic diagnosis of a tumor in the hepatic flexure of the colon. She underwent a right hemicolectomy for a Dukes B stenosing tumor (T3N0M0, stage IIa). CONCLUSION: In this report, we present the case of a woman with HNPCC who met the Amsterdam II criteria II. Family members who meet these criteria should be screened for the mutation in MMR genes. As genetic tests are not routinely available, an annual colonoscopic surveillance of all asymptomatic relatives older than 25 to 30 years old who meet the criteria is recommended, regardless of the availability and/or the outcome of genetic testing.
Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Adult , Antimetabolites, Antineoplastic/therapeutic use , Colectomy , Colorectal Neoplasms, Hereditary Nonpolyposis/pathology , Colorectal Neoplasms, Hereditary Nonpolyposis/therapy , Female , Fluorouracil/therapeutic use , Humans , Leucovorin/therapeutic use , Neoplasm Staging , Treatment OutcomeABSTRACT
Sobre la base de un caso tratado de seudolinfoma gástrico o hiperplasia linfoide reaccional, se hace un estudio bibliográfico, exhausitivo sobre el tema, y se halla coincidencia entre los autores que esta entidad clínico-histológica, lo más frecuente, es el resultado de un proceso inmuno-inflamatorio de hallazgo ocasional en úlceras gástricas crónicas. Si bien las evidencias histopatológicas suelen ser suficientes para un diagnóstico categórico, en ocasiones se plantean dificultades en al diferenciación con el linfoma gástrico primario. El curso evolutivo del seudolinfoma es benigno y la resección quirúrgica que involucra también la úlcera, es considerado el tratamiento adecuado. No obstante este criterio generalizado, algunos autores han alertado sobre posibilidades de evolución hacia el linfoma en algunos casos puntuales
Subject(s)
Middle Aged , Humans , Female , Lymphoma/pathology , Stomach Neoplasms/pathology , Stomach Ulcer/pathology , Diagnosis, DifferentialABSTRACT
Sobre la base de un caso tratado de seudolinfoma gástrico o hiperplasia linfoide reaccional, se hace un estudio bibliográfico, exhausitivo sobre el tema, y se halla coincidencia entre los autores que esta entidad clínico-histológica, lo más frecuente, es el resultado de un proceso inmuno-inflamatorio de hallazgo ocasional en úlceras gástricas crónicas. Si bien las evidencias histopatológicas suelen ser suficientes para un diagnóstico categórico, en ocasiones se plantean dificultades en al diferenciación con el linfoma gástrico primario. El curso evolutivo del seudolinfoma es benigno y la resección quirúrgica que involucra también la úlcera, es considerado el tratamiento adecuado. No obstante este criterio generalizado, algunos autores han alertado sobre posibilidades de evolución hacia el linfoma en algunos casos puntuales (AU)
