Tratamiento hidrocinesiterápico de la rotura parcial del ligamento cruzado anterior de la rodilla. A propósito de un caso / Hydrokinesic therapy for partial tears in the anterior cruciate ligament of the knee. A case report

Paciente de 36 años de edad, con signos clínicos de rotura crónica a traumática de ligamento cruzado anterior de la rodilla dominante, con dolor moderado, inestabilidad articular y repercusión funcional constante en la vida diaria. Se confirma el diagnóstico mediante artroscopia, proponiéndose para cirugía reconstructiva. Mientras espera la cirugía, realizó tratamiento fisioterápico clásico con cinesiterapia, sin resultados positivos. Posteriormente, realiza tratamiento de hidrocinesiterapia como monoterapia, con el resultado de la desaparición total de la sintomatología, aplazando sine die la necesidad de realizar la cirugía programada, con recuperación funcional completa de la rodilla al alta. El éxito en esta intervención es un ejemplo de tratamiento no invasivo con escasas contraindicaciones, y se necesitan nuevos estudios que confirmen los beneficios de la hidrocinesiterapia pero podría ser una forma novedosa y sencilla de tratar esta afección

A 36-year-old patient with clinical signs of chronic atraumatic rupture in the anterior cruciate ligament of the dominant knee, with moderate pain, joint instability and constant functional impact on daily life. The diagnosis was confirmed by arthroscopic technique, and reconstructive surgery was proposed. While waiting for the surgery, classic physical therapy was performed, without positive results. Subsequently, hydrokinesic therapy was performed as monotherapy, resulting in the disappearance of the symptoms. The need for elective surgery was postponed indefinitely, with full functional recovery of the knee. The success in this intervention is an example of non-invasive treatment with few contraindications. Further research is needed to obtain conclusive proof of the benefits of hydrokinesitherapy, but this could be an easy and novel way to treat this disease

Effect of source of iron on duodenal absorption of iron, calcium, phosphorous, magnesium, copper and zinc in rats with ferropoenic anaemia.

We studied the effects of iron deficiency on the in vivo absorption (by using the intestinal perfusion technique in the duodenum) of different dietary sources of iron (haem, non-haem and equal parts of both forms) and investigated the interactions between iron and calcium, phosphorous, magnesium, copper and zinc in control and iron-deficient rats. Three perfusion solutions containing a different source of iron were used: solution 1, ferric citrate; solution 2, haemoglobin; solution 3, equal parts of ferric citrate and haemoglobin. We also tested the same perfusion solution with 2,4-dinitrophenol (2,4-DNP), an inhibitor or oxidative phosphorylation (solutions 1-I, 2-I and 3-I). In control rats we observed three mechanisms of iron absorption: passive for soluble iron salts, active receptor-mediated for non-haem iron complexes, and active receptor-mediated for haem iron. In anaemic rats iron absorption was greater than in controls, except after perfusion with solution 2 (containing haemoglobin). Absorption increased as a result of both the passive and active, receptor-mediated mechanism for non-haem iron complexes. The active component was influenced by the depletion of haem receptors under severe iron deficiency. The absorption of calcium, copper and zinc in iron-deficient animals was lower than in controls, whereas phosphorus and magnesium absorption were not significantly affected. After perfusion with solution 2 or 3, calcium, copper and zinc absorption were lower than after solution 1. We conclude that ferropoenic anaemia in the rat impairs the absorptive process of those minerals that are absorbed, at the duodenal level mainly via active transport (haem iron, calcium, copper and zinc), but does not affect the active component involved in non-haem iron absorption.

Calcium absorption in rats with distal intestinal resection: influence of type of dietary fat, cholecalciferol and nature of the adaptative response.

The effects of dietary fat and supplementation with cholecalciferol on calcium absorption at different luminal concentrations (2.07 mmol/l and 2.07 mmol/l with 0.5 mmol/l 2,4-dinitrophenol and 8.20 mmol/l) were studied in vivo in the perfused duodenum, residual jejunum and proximal colon of rats with resection of 50% of the distal small intestine, as well as the nature of the adaptative response (passive or active). Changing the source of dietary fat (diet B, containing 1/3 medium chain triglycerides, 1/3 olive oil, 1/3 sunflower oil) increased calcium absorption, preferentially via active transport, in both transected and resected rats. Supplementation of diet B with cholecalciferol further enhanced intestinal calcium absorption, especially in the colon. These results suggest the importance of diet in the adaptive processes and confirm that active mechanisms of transport adapt more readily to intestinal resection than do passive mechanisms.

Effects of iron replenishment on iron, calcium, phosphorus and magnesium metabolism in iron-deficient rats.

We investigated the effect of Fe deficiency on the nutritive utilization of Fe, Ca, P and Mg in rats. Aside from the well known depletion of Fe in liver, femur and sternum with low values of Hb, Fe deficiency impaired Ca, P and Mg metabolism at different degrees. Iron deficiency altered Mg absorption, lowered the concentration of Ca in the liver, femur and sternum, raised the concentration of P and Mg in the liver, and decreased P in the femur. The altered status was not completely rectified by iron supplementation as the animals were still slightly anemic at the end of the study. The second purpose of the study was to evaluate the ability of three iron compounds (ferric citrate, ferrous sulfate and ferrous ascorbate) to correct the undesirable effects of Fe deficiency. Ten days after treatment with these diets, Fe-deficient rats still had reduced Mg absorption, especially those fed ferric citrate. The concentrations of hemoglobin approached normal values in all groups; however, serum Fe remained low, indicating that Fe reserves were still depleted. Hepatic and femoral Fe concentrations were also lower in all Fe-deficient groups regardless of the diet given, compared with their respective controls, whereas Fe concentrations in the sternum increased significantly with all three diets, suggesting an increase in erythropoiesis. The concentration of Ca, P and Mg in liver approached normal values, and appeared to normalize in the femur, except that Ca and P concentrations remained low with the citrate diet. In the sternum, a site assumed to have higher requirements for these minerals, the concentrations of Ca, P and Mg also increased. These findings indicate that Fe is involved in the bone mineralization, and that in physiological terms, Fe interacts favorably with Ca, P and Mg metabolism, since Fe deficiency altered the status of these metals. These findings also suggest that ferrous ascorbate and ferrous sulfate were more effectively absorbed than was ferric citrate.

Supplementation of a cereal-milk formula with haem iron palliates the adverse effects of iron deficiency on calcium and magnesium metabolism in rats.

Aside from the well known alteration of Fe status in Fe deficiency, this condition has also a negative effect on the bioavailability of Ca and Mg. We studied the influence of the supplementation of a commercial cereal-milk formula with bovine blood on Fe, Ca, P, and Mg metabolism in control and Fe-deficient rats to investigate whether high Fe levels in diet produce some interactions and the possibility of decreasing these latter by a haem-Fe supplementation. The bioavailability in control and Fe-deficient animals was determined as the apparent digestibility coefficient and hemoglobin regeneration efficiency, both of which are accurate estimations of total Fe utilization. Non-fortified cereal-milk formula decreased the apparent digestibility coefficient of Ca and Mg in Fe-deficient rats; the concentrations of these minerals in liver, femur, and sternum were lower than in control animals. However, when the Fe content of the cereal-milk formula was doubled by supplementation with bovine blood, the adverse effects on the digestive utilization of Ca, and especially of Mg, were palliated, the concentration of these two minerals in the organs investigated increased, and the overall Fe status improved in Fe-deficient rats.

Effects of intestinal resection, cholecalciferol and ascorbic acid on iron metabolism in rats.

The effect of dietary supplementation with ascorbic acid or cholecalciferol on Fe utilization was studied using the metabolic balance technique, in rats in which 50% of the distal small intestine was removed, or in which the mid small intestine was transected and reanastomosed (controls). Three different diets were used. The first (basal diet) contained (g/kg dry wt): protein (casein + 50 mg D,L-methionine/g) 120 and fat (medium-chain triacylglycerols, olive oil and sunflower oil, in equal parts) 40. The other diets were obtained by adding ascorbic acid (150 mg/kg diet) or cholecalciferol (0.4 mg/kg diet) to the basal diet. Apparent digestibility coefficient (ADC) and Fe retention were significantly lower in resected animals than in their respective control groups (transected rats). However, the addition of ascorbic acid or cholecalciferol to the basal diet increased the ADC and Fe retention in both transected and resected rats. Five weeks after surgery, resection also resulted in a reduced concentration of Fe in the sternum, but did not reduce the concentration of haemoglobin or serum Fe total Fe-binding capacity or the concentration of Fe in liver, testes, femur or muscle (longissimus dorsi). Supplementation with ascorbic acid increased serum Fe concentration, while the concentration of Fe in muscle was reduced by supplementation with both ascorbic acid and cholecalciferol. Neither supplementation had any effect on the Fe concentration in other tissues, on haemoglobin concentration or plasma total Fe-binding capacity. Thus, supplementation with ascorbic acid or with cholecalciferol increased Fe absorption and reduced the concentration of Fe in muscle.

Copper malabsorption after intestinal resection in rats. Effects of cholecalciferol and ascorbic acid.

Dietary modifications can partly compensate for the alterations in copper homeostasis caused by distal intestinal resection, by improving biliary function. We studied the effects of resecting 50% of the distal small intestine (DSI) on copper status in rats fed three semisynthetic diets (basal diet, and basal diet with cholecalciferol or ascorbic acid). Intestinal resection significantly decreased the digestive (apparent digestibility coefficient; ADC) and metabolic utilization (balance) of copper 1 month after surgery. However, the supplementation of the basal diet with cholecalciferol attenuated the negative impact of surgery, leading to small differences in Cu ADC and Cu balance between transected and resected rats. Ascorbic acid also enhanced copper retention. Copper status was not as markedly affected by intestinal resection as digestive utilization 1 month after the operation. The beneficial effects of cholecalciferol and ascorbic acid at the digestive and metabolic levels suggest ways to lessen the impact of intestinal resection, and to avoid possible long-term postabsorptive alterations in copper distribution.

Effects of type of dietary fat and cholecalciferol on magnesium absorption in rats with intestinal resection.

We studied the effect of type of dietary fat and supplementation with cholecalciferol on magnesium absorption in the duodenum, jejunum and proximal colon in rats with resection of 50% of the distal small intestine. Magnesium transport against the concentration gradient was found to occur in all three intestinal segments, although transport increased significantly only in the proximal colon of intestinally resected rats fed a diet supplemented with cholecalciferol at a rate of 0.425 mg/kg diet and mixture of equal parts of medium chain triglycerides, sunflower oil and olive oil as the source of dietary fat (diet B), in comparison with magnesium absorption in control rats subjected to intestinal transection and fed diet B, and in resected rats fed a diet without cholecalciferol supplementation and in which olive oil was the sole source of dietary fat (diet A). Magnesium absorption due to active and passive transport together, was greater in resected than in transected rats in all three intestinal segments, although the difference was significant only in the jejunum (the segment closest to the anastomosis), because of the greater increase in mucosal mass in resected animals. When the three intestinal segments were compared, magnesium absorption in favour of and against the concentration gradient in the proximal colon was significantly greater than in the duodenum or the jejunum, in resected and transected animals fed diet A or diet B. These findings show that the colon is the segment that most efficiently absorbs magnesium in rats with intestinal resection, especially when diet B is given.

Effect of intestinal resection, type of dietary fat and time on biliary lipid secretion in rats.

The effects of time and the type of dietary fat on biliary physiology in rats with 50% resection of the distal small intestine were investigated. The effects of ursodeoxycholic acid as an exogenous source of bile acid added to the diet were also studied. The fat composition of all diets was the same in quantitative terms (4%), and differed only in the type of lipid supplied: olive oil (diet A) or one-third medium chain triglycerides, one-third sunflower seed oil and one-third olive oil (diet B). In resected rats given diet A for 1 or 3 months, there was a decrease in biliary secretion of cholesterol and phospholipids, and in the lithogenic index, with respect to the control group. Resected rats fed diet B for 1 or 3 months showed increases in biliary secretion of cholesterol and phospholipids, and in the lithogenic index, in comparison with resected rats fed diet A. The addition of ursodeoxycholic acid to diet B led to the decoupling of bile acid and bile lipid secretion.

Influence of dietary fat components and intestinal resection on iron, zinc and copper metabolism in rats.

The effect of resecting 50% of the distal small intestine (DSI) on iron, zinc and copper nutritive utilization was studied in rats fed two different types of diet: a standard diet containing 4% olive oil (A) and a diet containing different sources of fat (1/3 olive oil, 1/3 sunflower oil and 1/3 medium chain triglycerides) (B). One month and 7 days after surgery, intestinal resection led to a deterioration in digestive (ADC) and metabolic (balance) utilization of iron, zinc and copper. To assess trace metal postresectional homeostasis, we also measured these mineral concentrations in whole blood, plasma and several organs (liver, femur, sternum, longissimus dorsi muscle and testes). Our findings showed no significant differences in iron, zinc and copper concentrations between the organs, suggesting that the observed decrease in digestive and metabolic efficiency of these minerals was not markedly reflected at the postabsorptive level, since the distribution of the trace elements in the whole organism remained unchanged. We conclude that one month and 7 days after this surgical intervention, adaptive mechanisms are well developed in resected rats fed a diet with an adequate mineral supplement.

Effect of iron deficiency on the digestive utilization of iron, phosphorus, calcium and magnesium in rats.

The influence of the source of dietary Fe (ferric citrate alone or mixed with bovine blood at a proportion of 1:1 (v/v)) on the digestive utilization of Fe, P, Ca and Mg, and on haemoglobin regeneration efficiency (HRE) was investigated in control and Fe-deficient rats. Diet A contained (by analysis) 43.5 mg Fe/kg diet (as ferric citrate), and diet B contained 44.3 mg Fe/kg diet (ferric citrate-bovine blood). In Fe-deficient rats fed on diet A or B the apparent digestibility coefficient (ADC) of Fe increased by 42.3 and 45.7% respectively. The ADC of Ca and Mg decreased significantly in Fe-deficient rats regardless of the source of dietary Fe. The HRE increased by 72.9% in Fe-deficient rats fed on diet A, and by 91.1% in Fe-deficient animals fed on diet B. In Fe-deficient rats fed on Fe for 10 d the values of haematological variables approached normality. However, serum Fe remained low, indicating that Fe reserves were still depleted. A deficient dietary supply of Fe for 30 d did not significantly modify the numbers of circulating leucocytes.