Efficacy of platelet-rich plasma in the treatment of hemiplegic shoulder pain.

OBJECTIVE: The aim of this study was to examine the effects of platelet-rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. DESIGN: Forty-four patients with hemiplegia were included in this study. All patients received a total of 3 injections, 1 week apart. The first group received PRP injections while the second group received placebo injections. After 3 months of follow-up, 40 patients completed the trial. Primary outcome measure was movement-induced pain score (VAS), and secondary outcome measures were spontaneous pain score, shoulder passive range of motion (ROM), functional independence measure score, and the amount of paracetamol used. All subjects were evaluated at baseline, 1 week, 1 month, and 3 months after the completion of the last injection. RESULTS: Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p < 0.05). No significance difference was detected between groups (p > 0.05). Similarly, FIM scores improved significantly in both groups (p < 0.05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. CONCLUSION: The PRP injections were found not to be superior to placebo. Improvements in both groups can be attributed to the use of rehabilitation techniques and exercises in all patients. There is still need for further research to show whether PRP is a treatment option in the course of hemiplegic shoulder pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03931824.

Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder.

PURPOSE: The goal of this study is to investigate whether platelet-rich plasma (PRP) injections are effective in the management of adhesive capsulitis of the shoulder (AC). A triple-blind, randomized controlled trial was designed and conducted in a medical school hospital. METHODS: 32 adult patients with adhesive capsulitis (21 female, 11 male with a mean age of 57, ranging from 23 to 70) were included in this study. Patients had to have shoulder pain and restrictions in movements (at least 25% when compared to the other side, and at least in two directions) for three months minimum and nine months maximum. Patients were randomized to two groups, and one group took PRP injections for three times every two weeks, while the other group took saline injections in same frequency and volume. A standardized exercise program was also applied to all patients. Patients were evaluated with Shoulder Pain and Disability Index (SPADI), Visual Analogue Scales for pain and disability, ranges of movements, and use of analgesics in before, after, and third month after the initiation of the therapy. RESULTS: Baseline comparisons between groups showed no differences. SPADI and ranges of motion in all directions showed significant improvements with therapy, and the group which took PRP injections showed better improvements when compared to the control group (p < 0.05). Visual Analogue Scale was found to be better for the PRP group after therapy and third month, and not for the control group (0.4 ± 1.06 and 0.17 ± 0.72 vs. 2.5 ± 2.6 and 2 ± 2.2, respectively, p < 0.05). Use of analgesics was not found to be significant for both groups (p > 0.05). CONCLUSION: PRP injections were found to be effective in both pain and disability, and showed improvements in a restricted shoulder due to adhesive capsulitis. These findings might point out PRP as a therapeutic option in the management of adhesive capsulitis.

Factors influencing response to lymphedema treatment in patients with breast cancer-related lymphedema.

PURPOSE: In clinical practice, noticeable differences are seen in patient response to the treatment of breast cancer-related lymphedema. Although some factors influencing response to treatment are mentioned in the literature, there is no sufficient evidence and results are confusing. For this reason, our objective in this study is to identify predictive and response-related factors for response to treatment of breast cancer-related lymphedema. METHODS: We analyzed data retrospectively from the files of patients with breast cancer-related lymphedema between 2006 and 2012. Patient demographics, clinical variables, and patient variables were recorded. Circumference measurements of lymphedema and healthy arms were recorded. We used a computer program (Limb Volumes Professional version 5.0) to transform these values to limb volumes in milliliters. RESULTS: The average age of 331 patients was 54.4 ± 10.9. The average length of lymphedema treatment was 2.92 ± 1.3 weeks. A statistically significant positive correlation was found between postoperative weight gain and postoperative duration, number of chemotherapy (CT) cycles, duration of tamoxifen use, and duration of hormonal therapy (p < 0.05). There was a statistically significant negative correlation between posttreatment arm volume and activity level, postoperative duration, and postoperative weight gain (p < 0.05). CONCLUSION: The treatment methods used for treating breast cancer had no effect on the response to treatment of lymphedema. Weight gain during the treatment of breast cancer is important for both the development of lymphedema and the response to treatment. When treating breast cancer-related lymphedema, the relationship between activity level and postoperative weight gain may provide us guidance in clinical practice.

Effect of Blood Cell Subtypes Lysis on Routine Biochemical Tests.

BACKGROUND: The aim of this study is to establish the contribution of blood cells subtypes on hemolysis. METHODS: Separated blood cell subtype suspensions prepared with blood from 10 volunteers were serially diluted to obtain different concentrations of cell suspensions. The cells were fully lysed and cell hemolysates were added (1:20) to aliquots of serum pool. Thus, seven serum pools with different concentrations of interferent were obtained for each blood cell subtype. Biochemical parameters and serum indices were measured by an autoanalyzer. As cell lysis markers, free hemoglobin was measured by spectrophotometry while myeloperoxidase and ᵝ-thromboglobulin were measured by enzyme immunoassay. The percent changes in analyte levels of the serum pools were evaulated by Wilcoxon Signed Rank Test and compared with clinical thresholds defined for each test. RESULTS: The clinical thresholds were exceeded in lactate dehydrogenase, potassium, aspartate aminotransferase, creatine kinase, magnesium, total protein, total cholesterol, inorganic phosphate, glucose for red blood cells (RBC); lactate dehydrogenase, aspartate aminotransferase, total protein, inorganic phosphate and glucose for platelets (PLT). Free hemoglobin was significantly correlated with RBC (r=0.999; p=0.001), while myeloperoxidase and b thromboglobulin showed no significant correlation to white blood cells (WBC) and PLT, respectively. CONCLUSIONS: The effect of RBC hemolysis in serum on the routine biochemical tests are clearly established, yet, additional studies are required in order to verify this kind of effects of PLT and WBC hemolysis.