ABSTRACT
BACKGROUND: Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear. METHODS: Patients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient's perception of efficacy and tolerability. Patients were followed up for 90 days. RESULTS: Overall, VAS and ADL scores showed a progressive decrease during the follow-up (P < 0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P < 0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P = 0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P = 0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group (P = 0.034). Both treatments were safe and well tolerated. CONCLUSIONS: Subacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.
ABSTRACT
BACKGROUND: The purpose of this study was to evaluate the effectiveness and safety of intra-articular sodium hyaluronate (Ostenil)mini) compared to intra-articular triamcinolone acetonide (Trigon depot) in the treatment of painful hallux rigidus. METHODS: Thirty-seven patients (ages 40 to 80 years) with painful early stage hallux rigidus were enrolled in the study. One group received an intra-articular injection with 1.0 ml sodium hyaluronate (SH); the other received an intra-articular injection of 1.0 ml triamcinolone acetonide (TA). Patients were evaluated on days 0, 14, 28, 56 and 84. Effectiveness was measured using the following parameters: joint pain at rest or on palpation (VAS), with passive motion, and gait pain; AOFAS hallux metatarsophalangeal score; use of analgesics and global assessment of the treatment by the patient and investigator. Safety was evaluated by the outcome of tolerance to treatment and observation of adverse events. Statistical analyses were performed using the Chi-square test, Mann-Whitney U test, Wilcoxon test and Friedman test. RESULTS: Thirty-seven patients (40 feet) were evaluated. Pain at rest or with palpation and pain on passive mobilization decreased significantly in both treatment groups in comparison to baseline (p<0.01), but no significant between-group differences were observed (p>0.05). Gait pain improved substantially in the sodium hyaluronate group with significant differences compared to the triamcinolone group at days 28 and 56 (p<0.05). The AOFAS total score improved significantly in the SH group compared to the TA group (p<0.05). This was mainly due to improvements in the pain subscale. No between-group differences were seen regarding the use of analgesics. Global assessment of treatment by patients was good in both groups, and there was a significant between-group difference favoring SH when areas under the curves (AUC) were calculated (p < 0.05). Tolerance was good in both groups. Adverse events occurred in three patients. CONCLUSIONS: Intra-articular injections of sodium hyaluronate are effective and safe in decreasing hallux rigidus pain. The AOFAS scores in the SH group were significantly better than in the TA group.
Subject(s)
Hallux Rigidus/drug therapy , Hyaluronic Acid/therapeutic use , Triamcinolone Acetonide/therapeutic use , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Chi-Square Distribution , Female , Hallux Rigidus/complications , Humans , Hyaluronic Acid/administration & dosage , Injections, Intra-Articular , Male , Middle Aged , Pain/etiology , Pain/prevention & control , Prospective Studies , Single-Blind Method , Treatment Outcome , Triamcinolone Acetonide/administration & dosageABSTRACT
La insuficiencia cardiaca constituye unfactor de riesgo de mayormortalidad intrahospitalaria en pacientes con infarto agudo del miocardio (IAM). En el presente trabajo analizamos retrospectivamente las características clínicas y evolución alejada de pacientes que presentan congestión pulmonar durante la fase aguda del IAM y los comparamos con los que no presentaron esa complicación. Para ello utilizamos un abase de datos de 518 pacientes consecutivos con IAM, 309 de los cuales no presentaron congestión pulmonar (Grupo I, edad promedio 61 ñ 11 años) y 209 que deasrrollaron insuficiencia cardiaca Killip II oIII (Grupo II, edad promedio 63 ñ 11 años). Las siguientes características fueron significativamente diferentes entre ambos grupos (Grupo II vs Grupo I, p<0,01). Mortalidad a 30 días 17,4 vs 4,7 por ciento localización anterior del IAM 62 vs 52 por ciento , IAM transmural 83 vs 76 por ciento ; arritmias ventriculares 24,4 vs 12,5 por ciento . En la evolución alejada (promedio 44 meses) los pacienets del Grupo II tuvieron mayor mortalidad (25,9 vs 6,8 por ciento , p<0,01) al año post IAM y a los cinco años de seguimiento (34,9 vs 12,9 por ciento , p<0,01). Confirmamos así que los pacientes que presentan congestión pulmonar durante el curso de un IAM tienen una mayor morbimortalidad tanto precoz como tardía y ello se relaciona con mayor incidencia de IAM anterior y de tipo transmural
Subject(s)
Humans , Male , Female , Heart Failure/mortality , Myocardial Infarction/complications , Follow-Up Studies , Myocardial Infarction/physiopathology , PrognosisABSTRACT
La prueba de Talio con Dipiridamol constituye en la actualidad un método no invasivo de gran utilidad para evaluar a pacientes en quienes se sospecha o se ha confirmado una enfermedad coronaria. El Dipiridamol se puede administrar por vía endovenosa u oral, produce vasodilatación coronaria y puede poner en evidencia defectos de reperfusión miocárdica. Su administración puede asociarse a una incidencia variable de efectos colaterales. Comunicamos nuestra experiencia con la administración de Dipiridamol en 286 pacientes, 223 de ellos por vía endovenosa y 63 por vía oral. El 87% de los pacientes tenía evidencia previa de enfermedad coronaria. La administración de Dipiridamol se asoció a un aumento significativo de la frecuencia cardiaca y descenso también significativo de la presión arterial. Encontramos efectos colaterales en el 29,7% de los pacientes que recibieron Dipiridamol endovenoso y en el 32,3% de los que recibieron Dipiridamol oral. El síntoma colateral más frecuente, 15,4%, fue el dolor torácico, que se presentó de preferencia, 81,3%, en pacientes con enfermedad coronaria y cedió con la administración de Trinitina y/o Aminofilina. Otros síntomas colaterales fueron cefalea, náuseas y/o vómitos, pero con una incidencia menor. Concluimos en que los síntomas colaterales durante la prueba de Talio con Dipiridamol son frecuentes, la mayoría de ellos leves y no son diferentes según el tipo de administración oral o endovenosa de la droga. El síntoma colateral más severo, dolor torácico, revierte facilmente con la administración de Trinitina o Aminofilina
