Articular cartilage repair using autologous collagen-induced chondrogenesis (ACIC): a pragmatic and cost-effective enhancement of a traditional technique.

PURPOSE: The autologous collagen-induced chondrogenesis technique is described, and the results of a 6-year follow-up clinical study using this technique are presented. METHODS: 30 patients with International Cartilage Repair Society (ICRS) Grade III/IVa symptomatic chondral defects of the knee treated with enhanced microdrilling using atelocollagen were prospectively examined in this clinical series. The median age of the patients was 39.0 years (range 19-61 years). Patients were followed up to 72 months. Clinical evaluation was performed using functional knee scores and radiologically. Both quantitative and qualitative assessments were performed. RESULTS: Statistically significant and clinically relevant improvement was observed in 2 years and was sustained for the 6 years of the study observation. At 6 years, the mean Lysholm score was 79.7 (SD 6.8) compared to 52.6 (SD 10.7) pre-operatively (p < 0.05). The symptomatic Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 68.3 (SD 11.4) to 90.2 (SD 4.3) (p < 0.05). The subjective International Knee Documentation Committee (IKDC) also showed improvement from 39.1 (SD 4.1) to 81.6 (SD 7.8) (p < 0.05). The calculated T2* relaxation times were 26.0 (SD 4.2) seconds and 30.3 (SD 6.2) seconds for the repair tissue and native cartilage, respectively. The average magnetic resonance observation of cartilage repair tissue (MOCART) score was 78.5 (SD 9.6) for all lesions. CONCLUSION: The enhanced microdrilling using atelocollagen is an enhancement of the traditional microfracture method using an off-the-shelf product. When used to treat moderate to severe chondral lesions, this enhancement produces hyaline-like cartilage with a corresponding improvement in symptoms. LEVEL OF EVIDENCE: IV.

[Three cases of Lermoyez's syndrome and its pathophysiology].

Two cases of bilateral Lermoyez's syndrome and one case of unilateral Lermoyez's syndrome are reported. The patients had recurrent episodes of vertigo with improvement of hearing or tinnitus, which is characteristic is Lermoyez's syndrome. In case 1, a 48-year-old female, dehydration with glycerol or furosemide induced nystagmus and improved bilateral hearing and the gain of the vestibulo-ocular reflex, while overhydration with drinking water impaired bilateral hearing with disappearance of nystagmus. These findings indicate that she had endolymphatic hydrops in both ears, suggesting that simultaneous changes in bilateral cochlear and vestibular function induce Lermoyez's syndrome. In case 3, a 52-year-old female, which we already reported, endolymphatic collapse in both ears may have changed bilateral inner ear function, resulting in Lermoyez's syndrome. On the other hand, patients 2, a 47-year-old male, experienced a vertigo attack with improvement of unilateral hearing after defibrinogenation therapy. In this case, slowly developing insufficiency of the inner ear blood supply may have caused the gradual hearing loss. It seemed that decreasing blood viscosity by defibrinogenation allowed blood to rush into the labyrinth, causing vertigo but at the same time improving hearing. We proposed that there are two types of Lermoyez's syndrome, bilateral (cases 1 and 3) and unilateral (case 2).

Comparison of multiple-antigen simultaneous test and CAP systems for diagnosis of nasal allergy.

The multiple-antigen simultaneous test (MAST) is a simple system that uses no radioactive agents and allows simultaneous examination of multiple antigens. CAP is a quick new, in vitro system that is more sensitive than the radio-allergosorbent test (RAST). To evaluate their clinical efficacies, we examined the correlation between the MAST and CAP systems. Serum samples were collected from 33 patients with nasal allergies, 13 males and 20 females, mean age 31.1 years. The MAST and CAP were used for 7 inhaled allergens: house dust, Dermatophagoides farinae, Japanese cedar, timothy, sweet vernal grass, ragweed and mugwort. The correlation coefficients found for MAST and CAP were significant for all the allergens tested. In addition, high values for sensitivity, specificity and efficiency were obtained for all the allergens. The MAST system provided the same information as the CAP system. Although CAP tended to have better sensitivity, some of its positive results may clinically be false-positive. We believe that the MAST and CAP are both useful for the detection of allergens but that the diagnosis of allergy must be based on results of detailed examinations such as use of the skin test, the nasal provocation test and clinical symptoms.