Clinical results in patients affected by moderate-severe knee osteoarthritis and treated with micro-fragmented adipose tissue: the therapeutic effects on symptomatology.

Osteoarthrosis is a degenerative musculoskeletal disease that presents a major public health problem, due to the increasing average age of the active population, as well as the increasing percentage of obesity or overweight of the general population. New therapeutic approaches have been developed, such as regenerative medicine that uses mesenchymal stromal cells taken from adipose tissue. This study analyzed the clinical potential benefits of using autologous adipose tissue to treat patients with moderate-severe knee osteoarthritis.In 2021, a total of 50 knees, affected by moderate-severe knee osteoarthritis, were treated with an intra-articular injection of micro-fragmented subcutaneous adipose tissue. Patients were submitted to the KOOS questionnaire before the operation and one year after the operation and VAS pain score at time 0, 3, 6, 12 months.Of the 50 patients treated, 2 patients were excluded from the study. Of the remaining 48 patients, improvements have been achieved in all subclasses of KOOS. In particular, VAS score proves that improvements are more considerable starting from the 3rd month after surgery.The results obtained in this study show the safety and potential benefit of the use of autologous micro-fragmented adipose on people who are affected by moderate-severe knee osteoarthritis.

[Ultrasonography in the diagnosis of enterocutaneous fistula in Crohn's disease]. / L'ecografia nella diagnosi delle fistole enterocutanee nella malattia di Crohn.

INTRODUCTION: Perforation seems to be a specific pathologic aspect in some types of Crohn's disease. Fistulae are caused by a transmural extension of a fissure and/or an ulcer; they are often multiple and can be internal or external. External fistulae usually occur after surgery and along the scar incision. They are frequently complicated by associated intra-abdominal abscesses. We investigated the accuracy of fistulography by ultrasonography compared to fistulography by X-rays in the diagnosis of enterocutaneous fistulae. MATERIAL AND METHODS: Eight patients resected for Crohn's ileitis and with enterocutaneous fistulae were examined by fistulography with ultrasonography and then by fistulography with X-rays. Disease recurrence was established with ultrasonography on ileum anastomosis in all patients. A7.5 MHz linear transducer was connected to a videotape. Physiologic solution was injected into the cutaneous orifice using a thin rigid catheter to evaluate the communication with the intestinal tract by fistulography. At the same time all patients underwent fistulography with contrast agent injection through a radiopaque catheter. RESULTS: On the same day two radiologists performed the ultrasonographic and the radiologic examinations and had 100% agreement between the two methods. In five of eight patients (62%) there was no intestinal communication. Ultrasonography showed hypoechoic lines turning deeply from the cutaneous surface with no communication with the intestinal tract. Radiology confirmed the ultrasonography diagnosis. In two of five patients the fistulae ended in small abscesses. The patients had been treated with immunosuppressive or parenteral therapy; four of them improved and one underwent abscess drainage. In three of eight patients cutaneous fistulae communicated with the intestinal anastomosis. In one patient there was an abscess with multiple fistulae, one of which communicated with the third duodenal segment. DISCUSSION: The origin, anatomic course and sites of communication of fistulae should be evaluated with conventional barium studies first. These studies may be limited by the fact that the origin of the fistulae could be edematous and prevent contrast opacification, in which cases conventional fistulography or ultrasonographic fistulography should be performed. CONCLUSIONS: Our experience suggests that ultrasonography is a reliable method for detecting intestinal alterations and especially the complications typical of Crohn's disease such as enterocutaneous fistulae.

Epidemiological aspects of tuberculosis in the Padua Health District 1985-1996.

The present study was carried out in order to monitor the epidemiology of Mycobacterium tuberculosis disease in the Padua Health District over the period 1985-1996 with a view to the situation in some population subgroups. The average annual rate per 100,000 persons per year was 7.9 with a peak in 1994 (15.6 per 100,000 persons). The most significant variations are not per annum but between the periods 1985-1990 and 1991-1996 (average rates per 100,000 persons: 4.8 and 10.9, respectively). The trend shows an increasing frequency in all age groups and especially among the elderly. Immigration from endemic areas and human immunodeficiency virus (HIV) infection appear to contribute to the increase the number of notified cases among adults. In the last four years an increase of tuberculosis cases was also observed among subjects with professional exposure risk. Improvements of programs both at national and regional level are believed to be essential to the tuberculosis control.

Antibiotic use in Crohn's disease: why and how?

On the assumption that bacteria in the gut may be a cause of symptoms and/or complications of Crohn's disease, various antibiotics are efficaciously employed in some affected patients. However, we do not know exactly why and how they are helpful. A possible explanation is that one or several bacterial species may have a primary role in the aetiology of Crohn's disease, but this is not supported by the data in our possession. Another hypothesis is that intestinal bacteria may cause flare-up of the disorder, either by inducing intestinal lesions or by an interaction with the immune system, but we know today that specific pathogens can cause flares only in a minority of cases. On the contrary, there is considerable evidence that the intestinal microflora and its products may amplify and perpetuate inflammation in Crohn's disease. Despite the fact that few controlled trials have been conducted, and have shown inconclusive results, antibiotics are widely employed for improving symptoms and for inducing remission of active phases. At present, a combination of metronidazole and ciprofloxacin, active against many enteric bacteria, has proved to be effective in the treatment of Crohn's disease complications. This therapy also seems to be effective in acute flares as an alternative to, or in combination with, corticosteroids.

An antibiotic regimen for the treatment of active Crohn's disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin.

OBJECTIVES: Bacteria in the gut lumen may play a role in the etiology and/or the symptoms of Crohn's disease (CD). Although various antibacterial drugs have been employed in clinical practice, few controlled trials have been conducted, and those had conflicting results. The aim of this study was to investigate the efficacy and the safety of a combination of metronidazole and ciprofloxacin, compared with methylprednisolone, in treating 41 consecutive patients with active CD. METHODS: Eligible patients, 13 men and 28 women, mean age 38 yr, were randomly allocated to receive, for 12 wk, ciprofloxacin 500 mg twice daily plus metronidazole 250 mg four times daily or methylprednisolone 0.7-l mg/kg/day, with variable tapering to 40 mg, followed by tapering of 4 mg weekly. RESULTS: Ten of the 22 antibiotic patients (45.5%) and 12 of the 19 steroid patients (63%) obtained clinical remission (Crohn's Disease Activity Index < or = 150) at the end of the 12-wk study (p = NS). Five patients on antibiotics (22.7%) and five patients on steroids (26.3%) were considered treatment failures because of deterioration or persistent symptoms. Six patients receiving antibiotics (27.3%) and two on steroids (10.6%) were withdrawn from the trial because of side effects. One patient on antibiotics was not compliant. CONCLUSIONS: metronidazole and ciprofloxacin could be an alternative to steroids in treating the acute phase of CD.

Clinical course of inflammatory bowel disease during treatment with interferon for associated chronic active hepatitis.

Seven patients with inactive ulcerative colitis and seven patients with Crohn's disease (5 inactive, 2 mildly active) received interferon treatment for associated chronic active hepatitis. Neither relapse (except in one patient) nor worsening of the clinical course of the inflammatory bowel disease was observed during treatment. According to these results chronic active hepatitis associated with inflammatory bowel disease can be treated with interferon without the risk of deteriorating the course of the inflammatory bowel disease.

[Intestinal tuberculosis. The radiologic aspects of a disease not to be overlooked]. / Considerazioni sulla tubercolosi intestinale. Aspetti radiologici di una malattia da non dimenticare.

Intestinal tuberculosis still exists in the Western world, where it is usually underestimated and often mistaken for Crohn's ileo-colitis or cancer. The authors report the results of 4 cases of intestinal tuberculosis observed between 1983 and 1988. The cases are discussed in the light of the epidemiological data emerging from a review of recent medical literature. The danger is that the disease, which is endemic in Asian and African regions, may spread again in the Western world fostered by intensifying migrations of people and by the spreading of AIDS. According to recent experience, a negative chest film and Mantoux skin-test no longer have a negative predictive value for intestinal tuberculosis. In the radiological differentiation from Crohn's disease it is useful to keep in mind some topographic features of TBC: the systemic non-discontinuous involvement of both sides of ileocecal junctions; the unusual presence of ileal lesions, with no cecal lesions, and localizations below the transverse colon. Useful differential morphological criteria can be: star-like or transverse ring-shaped profile of isolated ulcerations, tubular ileocolic junction with retracted cecum and open valve, and uniformity of lesion in the comprehensive picture of the clinical case.

[Radiologic assessment of extent of ulcerative colitis in acute phase]. / Valutazione radiologica dell'estensione della colite ulcerosa nella fase acuta.

One of the major reference points for both prognosis and treatment of ulcerative colitis is the assessment of its extent. Plain abdominal radiographs were performed on 97 patients previously diagnosed, by means of rectoscopy and histobiopsy, as having acute ulcerative colitis. Within the following 36 hours they underwent either full colonoscopy or colectomy. The extent of colitis was evaluated by means of double-blind radiography. The results were then statistically compared with those obtained from endoscopy or from direct study of surgical colonic specimens. There was agreement between the final X-ray results and the actual extent of ulcerative colitis in 78 of 97 patients (80.4%, r = 0.86). The highest agreement was observed in those patients whose lesions were localized in the rectosigma (81%) and in those with fully extended colitis (90%). The most useful radiological findings in predicting the extent of colic lesions were irregular mucosal profile and thickening of colic wall. The presence of these two signs, together with the flattening or swelling of interhaustral folds and the impossible visualization of the right colon, are invariably suggestive of fully extended colitis. On the contrary, no abnormal findings were present on plain abdominal films in 74% of proctosigmoiditis cases. Plain abdominal radiography seems to be useful for the initial evaluation of acute ulcerative colitis. It allows the early discrimination between diffuse and localized forms, and makes it possible to postpone more invasive and dangerous investigations to a remissive phase of the disease.

Theophylline serum levels unmodified by postprandial administration of a sustained-release preparation (Teonova).

The authors studied serum theophylline levels after administration of new single-dose capsules: Teonova. Special attention was paid to possible fluctuations of serum theophylline after administration of the drug following a standardized meal. For this purpose a test was carried out on eight male patients with intrinsic asthma. The patients were given a dose able to produce a serum concentration of theophylline of between 10 mcg and 20 mcg at the tenth hour after the administration. This dose was found to be 400 mg (2 tablets of 200 mg) for one patient and 600 mg (2 tablets of 300 mg) for the remaining seven. The capsules of Teonova were administered to each patient for two subsequent days at 07h00. On the first day the patients had their capsules after fasting, and on the second day after a standardized meal. The test proved that Teonova assured a satisfactory serum theophylline level throughout the 24 hours in all patients; food in no way affected the absorption kinetics of the drug. Such features make Teonova suitable for long-term theophylline therapy.