ABSTRACT
This article describes a 69-year-old man with a bilateral total knee prosthesis in whom both knees were swollen and painful. Fever was present and the levels of inflammation markers were markedly elevated. Gout was diagnosed in the right knee and haemarthros during calcium carbasalate use in the left knee. Gout in a knee with a total knee prosthesis is rare and can mimic septic arthritis. Early diagnosis is of particular importance as the therapy of the two conditions differs considerably. Gout is treated with medication while surgical treatment is necessary in a case of septic arthritis, which may even involve removal of the prosthesis.
Subject(s)
Arthritis, Gouty/diagnosis , Arthroplasty, Replacement, Knee , Aged , Arthritis, Infectious/diagnosis , Arthroplasty, Replacement, Knee/adverse effects , Diagnosis, Differential , Humans , MaleABSTRACT
Intra-articular hyaluronic acid injections in the case of osteoarthritis of the knee may restore the viscous properties of the synovial fluid and protect the joint's cartilage. In theory the hyaluronic acid has an analgesic and anti-inflammatory effect as well as a favourable influence on chondrocyte metabolism. In six published studies which compared the effectiveness of hyaluronic acid with injection of a placebo of a non-steroidal anti-inflammatory medication, the hyaluronic acid injections had a relatively long-term favourable effect (compared with corticosteroid injections) on pain, function, serous gonitis and concomitant analgesic use. Just as for corticosteroid injections, the placebo effect was large. Intra-articular hyaluronic acid injections have few side effects. However, in general three to five injections, with weekly intervals, are needed for the effect to be achieved. Furthermore, the medication is relatively expensive. Future investigations will be necessary to provide insights into both the cost-benefit aspects and the long-term effects of the medication.
Subject(s)
Adjuvants, Immunologic/therapeutic use , Hyaluronic Acid/therapeutic use , Knee Joint/pathology , Osteoarthritis/drug therapy , Adjuvants, Immunologic/administration & dosage , Adjuvants, Immunologic/economics , Anti-Inflammatory Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cost-Benefit Analysis , Drug Administration Schedule , Humans , Hyaluronic Acid/administration & dosage , Hyaluronic Acid/economics , Injections, Intra-Articular , Netherlands , Steroids , Therapeutic EquivalencyABSTRACT
In order to elucidate the effect of ceftriaxone therapy on the morphology of gut microflora, 11 human volunteers were treated with ceftriaxone, 1 g daily, given intramuscularly in one dose. Treatment continued for 5 days. Faecal microflora was analysed by digital image processing before, during and after the treatment period. We derived simple numerical parameters which describe the morphologic composition of the flora. They were significantly influenced by the antibiotic, and returned to their baseline values more than 7 days after treatment was stopped. The procedure holds promise for clinical application.