Age and synovitis affect the results of the treatment of knee osteoarthritis with Microfragmented Autologous Fat Tissue.

PURPOSE: This study aims to assess the effectiveness of Microfragmented Autologous Fat Tissue (MFAT) treatment for knee osteoarthritis and to investigate whether patients' pre-treatment clinical condition, such as synovitis, correlates with clinical outcomes, to identify potential predicting factors for the success or failure of the treatment. METHODS: In this prospective Cohort Study Level II multicentric trial, consecutive patients with a diagnosis of early/mild osteoarthritis and failure of previous conservative measures were enrolled to undergo diagnostic arthroscopy and a single MFAT injection. Patients were assessed with repeated scoring systems at baseline, 6 months, and 12 months after surgery. The demographic features, the arthroscopic findings, the immunophenotype of injected tissue and the histologic examination of synovia of failed patients were analyzed. RESULTS: Data from 91 patients showed a significant improvement in Lysholm, WOMAC scores at 1-year follow-up (p < 0.001). A significant decrease in VAS score was observed, while a significant improvement of measured flexion angle was registered at 1 year (p < 0.001). No major complications were reported. Age and synovitis were identified as significant factors influencing the clinical outcome (p < 0.05). Body mass index, previous or concomitant procedures, and specific cartilage defects had no influence. The mean number of injected adipose tissue-derived mesenchymal stem cells seem not to correlate with the clinical outcome. CONCLUSION: MFAT is effective in reducing pain when used with a single dose injection in early/mild OA of the knee, without major complications. Age over 60 and synovitis may be predictive for persistent pain at one year and should be considered before indications.

Hemodynamic estimation of chronic cor pulmonale by Doppler echocardiography. Clinical value and comparison with other noninvasive imaging techniques.

Pulmonary arterial pressure (PAP) represents an important prognostic factor in patients affected by chronic obstructive pulmonary disease (COPD). A noninvasive diagnostic approach is offered by several imaging techniques, such as chest X-ray, nuclear medicine, real-time sonography, color Doppler US, CT and MRI. However, at present a quantitative assessment of PAP is not achieved with reasonable precision with any of these techniques. Tricuspid regurgitation can be estimated by continuous wave Doppler but it may be difficult in patients with COPD. On the contrary, the severity of pulmonary hypertension can be accurately assessed with pulsed Doppler echocardiography from the subxiphoid region, using a general purpose US device. Nineteen adult patients with COPD were studied by duplex-Doppler from an oblique subxiphoid approach and right heart catheterization. The study was diagnostic in all cases with quality Doppler recordings. A significant relationship was found between AcT and pulmonary mean or systolic pressure at rest. An accurate prediction of PAP in COPD is possible by means of pulsed-Doppler also in low-grade hypertension. This technique is considered a simple and reliable adjunct to the noninvasive evaluation of COPD and represents a satisfactory alternative to the classical parasternal approach preferred by cardiologists but often not suitable for emphysematous patients. Radiologists who routinely use a general purpose US device are encouraged to try this new technique in the study of heart disease.

[The assessment of the activity of idiopathic pulmonary fibrosis by high-resolution computed tomography]. / Valutazione di attività della fibrosi idiopatica polmonare mediante Tomografia Computerizzata ad alta risoluzione.

The authors report the results of the study performed with high resolution CT (HRCT) in a group of 29 patients affected with idiopathic pulmonary fibrosis (IPF). Each patient underwent HRCT at the beginning of the study and after one year. A complete clinico-functional assessment was available in 20 cases and functional CT correlation was made in these patients; 15/20 subjects underwent immunosuppressive therapy with corticosteroids and cyclophosphamide. Disease severity was assessed with chest radiography and HRCT. On the basis of CT findings the patients were classified into three groups, according to Wells classification: predominant ground-glass pattern, mixed pattern and predominant reticular disease with honeycombing. Furthermore, a visual score was assigned to total disease extent and a different score to ground-glass and reticular opacities. Our data confirm the poor accuracy of chest radiography in assessing disease type and overall severity, versus the outstanding diagnostic accuracy of HRCT. We also found a high incidence of mediastinal adenopathies (37.9% of the patients) and signs of pulmonary arterial hypertension (62%), together with low extent of pulmonary emphysema (65.5% of the patients; mean extent: 5.4%). Ground-glass attenuation is an early sign of IPF and might suggest alveolitis activity. In our series, however, the patients with grade I disease were rare (6.8%), but likely to benefit from therapy. Different from Wells, we found no significant difference in the evolution of the patients with grade II versus grade III disease. Wells grading was useful in early disease assessment, but the visual score of total disease extent and the score of ground-glass and reticular opacities were much more useful in the follow-up because they can assess disease progression. Furthermore, in the few patients with predominant alveolitis, who improve after therapy, the relative prevalence of the reticular pattern might allocate the patient in a higher Wells group with a "paradoxical" worsening, if the visual score of the extent of the primary lesion is not used.