Effects of intravenous iloprost therapy in patients with bone marrow oedema of the foot and ankle.

OBJECTIVE: Bone marrow oedema (BMO) is a multifactorial condition. The conservative treatment options include immobilisation of the affected region and systemic intravenous iloprost therapy. Whereas many studies confirm the positive effect of iloprost therapy in larger joints, e.g. knee and hip, there have been few studies of BMO in smaller areas such as the ankle joint or midfoot. The purpose of this study is to show that treatment with iloprost leads to positive long-term outcomes for BMO of the foot and ankle. METHODS: Twenty-three patients with BMO of the ankle joint or midfoot, Association Research Circulation Osseous (ARCO) stages 1-2, were included in this study. A questionnaire was used to record the Ankle-hindfoot, Kaikkonen, SF-36 and VAS scores before and after iloprost therapy. In addition, all patients underwent MRI for radiological follow-up monitoring 3 months after treatment. RESULTS: A significant improvement in function based on the ankle-hindfoot and Kaikkonen scale was demonstrated after iloprost therapy. In 22 patients, follow-up MRI after 3 months showed complete regression of the oedema. CONCLUSION: Based on the positive results of our study, we recommend treatment with iloprost for BMO of the upper ankle joint and foot at ARCO stages 1-2.

Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak.

BACKGROUND: Intragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI. METHODS: We retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany. RESULTS: Seven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits. CONCLUSION: Our study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.