Assessment of effects of ultrasound therapy on reduction of pain in gonarthrosis.

AIM: To examine the effects of sonotherapy on the activities of daily living or as well as the reduction of pain in gonarthrosis. METHODS: A retrospective- prospective clinical study included 63 patients, 47 to 86 years old with a verified diagnosis of gonarthrosis. Subjects were divided into two groups. The first group included 26 patients treated with kinesitherapy in combination with electrotherapy; the second group included 37 patients treated with kinesitherapy combined with sonotherapy. The age, sex, activities of daily living by Barthel Index and the intensity of pain by visual pain scale (VAS) was analyzed at admission and discharge of the patients. RESULTS: Both groups were matched for age, sex, and Barthel index values at admission and discharge. There was no statically significant difference between the groups according to demogrfphic characteristics. Visual pain scale at admission was almost identical in both groups; VAS at discharge waa lower in the group treated with kinesiotherapy and sonotherapy. Visual pain scale at discharge was lower in both groups than at admission, but without statisticay difference (p more than 0.05). CONCLUSION: Sonotherapy and electrotherapy improved the activities of patien's' lives. Both types of therapy, in combination with kinesitherapy, led to a decrease of pain in patients with gonarthrosis.

Positron emission tomography/computed tomography as a method for detection and monitoring of laryngeal chondritis.

Infections of the laryngeal cartilages occur clinically as local pain, dysphonia, dysphagia or dyspnoea and may lead to destruction of the laryngeal skeleton. We present positron emission tomography/computed tomography (PET-CT) as a new method for detection and monitoring of laryngotracheal chondritis. We prospectively analyzed all patients undergoing PET-CT examination, of whom we were clinically suspicious of laryngeal cartilage chondritis. When a chondritis had been confirmed by PET, therapy was started, and the course of inflammation was monitored. Three patients were selected, where application of PET is demonstrated. We analyzed nine patients, five of them suffering from a present or past cancerous disease of the neck region. Four patients suffered from symptoms that occurred after percutaneous tracheotomy and long-term intubation. Chondritis of the laryngeal skeleton or upper parts of the trachea was diagnosed in seven of nine subjects by using PET-scan. PET-CT provides a reliable tool in diagnosis of laryngeal cartilage chondritis. Furthermore, it is an excellent tool in monitoring objectively presence and grade of an infection. This may play a decisive role in tracheal surgery or to estimate success of conservative therapy.

[Methanol extract of Celastrus orbiculatu suppresses synovial hyperplasia and cartilage erosion and degradation in rheumatoid arthritis].

OBJECTIVE: To investigate the effects of methanol extract of Celastrus orbiculatu (MECO) on synovial hyperplasia and cartilage erosion and degradation in rheumatoid arthritis (RA), and explore the possible mechanisms to provide clues for new drug development for RA treatment. METHODS: The articular synovium from patients with RA and normal articular cartilage were co-implanted into the back of severe combined immunodeficient (SCID)mice to establish the chimeric model SCID- HuRAg. Four weeks later, the mice were given MECO intragastrically at 30 mg/day, leflunomide at 500 microg/day or distilled water, respectively, for 4 consecutive weeks. After completion of the treatments, the histological scores of the grafts for synovial hyperplasia, cartilage invasion by synoviocyte and cartilage degradation around the chondrocytes were evaluated, and serum level of tumor necrosis factor-alpha (TNF-alpha) was measured with radioimmunoassay. The expression of TNF-alpha mRNA and the cell apoptosis in the synovium were detected with in situ hybridization (ISH) and TUNEL, respectively, and the results were analyzed with the image analysis system. RESULTS: The grafts survived in the mice till the end of experiment. MECO and leflunomide, in comparison with distilled water, significantly lowered the scores for synovial hyperlasia (2.00+/-0.76 and 2.25+/-0.89 vs 3.63+/-0.52), cartilage erosion (1.69+/-0.80 and 2.00+/-1.36 vs 3.75+/-0.53), cartilage degradation (1.88+/-0.83 and 2.13+/-0.83 vs 3.63+/-0.74) and serum TNF-alpha level (0.84+/-0.09 and 0.83+/-0.12 vs 0.99+/-0.11 ng/ml). Cell apoptosis of the synovium increased significantly with MECO and leflunomide treatments, but the expression of TNF-alpha mRNA in the synovium decreased significantly in MECO group. CONCLUSION: MECO can effectively suppress synovial hyperplasia and cartilage erosion and degradation SCID-HuRAg mice by reducing TNF-alpha production in the synovium and promoting synovial apoptosis. MECO can be comparable with leflunomide in their effect, but the former is more effective in suppressing TNF-alpha expression in the synovium.

The operative treatment of full thickness cartilage defects in the knee joint with autologous chondrocyte transplantation.

OBJECTIVE: The high clinical and socio-economical impact of cartilage defects and chondral degeneration is well-known. After trauma or without a known etiology, often young patients suffer from pain and a loss of function leading into a decrease of physical activity and, more severe, into long term disability and unemployment. The clinical use of autologous chondrocyte transplantation was introduced in 1994 reporting the data of a pilot study. The objective of this study is to evaluate the efficacy of this method of surgery. METHODS: Autologous chondrocyte transplantation has been established in our department since 1995 for the treatment of large, full thickness cartilage defects which can be completely covered with hyaline-like cartilage without harming the subchondral bone plate. Our first patients (n=24) all showed Grade IV lesions and an average defect size of 6.27 cm2. All but 4 of the patients had at least 1 cartilage defect related operation on the knee. RESULTS: The patients and the clinicians rating indicated an increase of a modified Cincinnati Knee score from 3.6 point pre-operation to 6.9 points after 6 months and 8.1 points at 12 months on a scale from 1 (bad) to 10 (excellent). These results support the data of an international multicenter study with almost 2000 patients. The 5 year results described by the originate authors are good to excellent in 85%-95% with an adverse event rate of 5%. CONCLUSION: Autologous chondrocyte transplantation has to be considered a safe and effective method for the treatment of large full thickness cartilage defects. Alternative treatments are symptomatical: drilling, abrasion, lavage, chondroplasty, or osteotomies. The short term results are promising but a lot of patients have to be treated for osteoarthritis as a consequence of failure with total joint arthroplasty. Osteochondral transplantations have the disadvantage of limited harvesting sites and the impairment of the subchondral bone plate.

[Physiopathology of primitive arthrosis. Problems and hypotheses]. / Physiopathologie de l'arthrose primitive. Problèmes et hypothèses.

The origin and the evolution of the so-called primitive arthrosis represent two problems that hypotheses, developed by the authors, contribute to elucidate. Primitive arthrosis begins with a prearthrosic chondropathy which looks like the changes in the joint cartilage due to aging and due both to local conditions preventing the nutrition of the cartilage and to general factors causing failure of the system regulating the synthesis and the differentiation of articular tissues. These conditions are also relevant to primitive monoarthrosis, relatively rare in comparison with the frequency of secondary arthrosis and in comparison with arthrosis disease, which is the prototype of primitive polyarthrosis. The variable mixture of different local and general factors can explain the differences in evolution of primitive arthrosis, ranging from slow chondral erosion to accelerated destruction of bone and cartilage.