[ ISSN : 2573-3680 ]
Patellar tendinosis; Etamsylate injection; Fibroblast growth factor
Chronic patellar tendinopathy is one of the most common overuse knee disorders. Etamsylate injection, performed in the peritendinous tissue of chronic patellar tendinosis resulted in reduction of pain and pathologic neovascularization with improvement of leg function, after four weeks of treatment.
Chronic patellar tendinopathy is one of the most common overuse knee disorders. Etamsylate injection, performed in the peritendinous tissue of chronic patellar tendinosis resulted in reduction of pain and pathologic neovascularization with improvement of leg function, after four weeks of treatment.
A 35-old year healthy Caucasian football player man presented with a 3 years history of anterior knee pain and tenderness in his right patellar tendon insertion. He referred a constant dull aching pain with walking, forcing to discontinue sport because of the severity of his pain. He has been previously treated with conservative therapy and with Platelet-Rich Plasma (PRP) injections; however his pain did not improve. At presentation, pain was rated as 7 out of 10 on Visual Analogue Scale (VAS). Color Doppler ultrasound examination revealed signs of tendinosis with significant neovascularity, formed by immature tortuous and dilated vessels into intratendinous mass (Figure 1A). Furthermore, color Doppler scans showed areas of intratendinous edema in
Figure 1: The presence of neovessels is detected in the patellar tendon using color Doppler ultrasound. Longitudinal scans taken before (A) and after two (B) and four weeks (C) of etamsylate injection. Diminution of hypervascularity is demonstrated after injection of etamsylate. Note the reduction of edema (* ) after two weeks of treatment.
the proximal patellar-tendon interface (Figure 1A). After discussing the various treatment options, the patient opted to try etamsylate injection and signed an informed consent. Lidocaine was infiltrated into the skin overlying the right patellar tendon. 4ml etamsylate (Dicynone® , Sanofi-Aventis, France) were injected under ultrasound guidance into peritendinous patellar tendon tissue. The procedure was uneventful. At 2 weeks follow-up visit, patient reported a marked improvement of his pain (VAS was rated as 2), and color Doppler ultrasound scans showed a significant reduction of neovessels and disappearance of tendinous edema (Figure 1B). Furthermore, at 4 weeks tendon hypervascularity decreased (Figure 1C) and pain strongly ameliorated (VAS = 1). Patient could return to his previous level of sport without any restrictions.
Patellar tendinosis is a common painful difficult-to-treat overuse injury of the patellar tendon with a negative impact on the carriers of many athletes. The overall prevalence of patellar tendinopathy yields to 14% in elite athletes and increases up to 45% in high-risk sports such as basketball and volleyball [1]. There are a wide variety of treatment options available, the majority of which are non-operative. No consensus exists on the optimal method of treatment. Antiinflammatories and injectable agents have shown mixed results [2]. In approximately 10% of conservatively treated patients, conservative treatment fails and surgery is required [3]. Since tendinopathy appears to be a highly active process of ongoing neovascularization, anti-angiogenic therapies could be a new approach for treating tendinopathies [4]. It has been reported that nerves appear to travel in close association to tendon neovessels [5]. This finding suggests that angiogenesis plays an important role in pain-experienced in tendinopathy condition [6,7]. These data are in accordance with clinical studies showing that strategies to destroy neovessels (i.e local injection of a sclerosing agent, polidocanol) lead to pain improvement [7]. Etamsylate, an inhibitor of Fibroblast Growth Factor (FGF), when locally applied,supresses FGF-driven angiogenesis [8,9]. Since FGF participates in nociception [10,11], injecting etamsylate into the areas of tendon neovascularization could not only decrease the number of pathologic neovessels, but also eradicate the pain-generation nerve fibres. In conclusion, therapeutic modulation of neovascularization by influencing the levels of FGF might be a promising target for new approaches in tendinopathies.
Learning points
- Neovascularization has been demonstrated in painful tendon from sport activity.
- Hypervascularity is one of the causes of tendon pain due to parallel migration of neovascular innervation.
- Etamsylate injection in pathologic patellar tendon resulted in clinical improvement.
- Etamsylate, acting as an FGF inhibitor, could destroy pathological tendon neovessels and decrease the nociceptive FGF-related activities.
Cuevas P, Rodas JA, Angulo J and Giménez-Gallego G. Short-Term Efficacy of Etamsylate Injection in Chronic Patellar Tendinopathy. SM J Clin Med. 2017; 3(2): 1029.
The purpose of this statement is none other than to highlight the importance of ethical standards and quality required in basic and applied research currently being done so we can subsequently inform health care professionals of new developments that are taking place in this area.
Ma. Esperanza Rodríguez-van Lier*
Chemotherapy is commonly used in cancer treatment. So far, chemotherapy agents can be categorized into three types: classical chemotherapeutic drugs, molecular target agents and cellular machineries target drugs.
Ziyou Wang1,2 and Zunnan Huang1,2*
Blood transfusion can cause some transfusion adverse reactions. In order to understand the incidence of adverse transfusion reactions, we performed a meta-analysis in Chinese hospitals. Of 809 literatures, seven studies involving a total of 211, 050 patients with blood transfusion treatment were included in this meta-analysis. Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), P < 0.0001]. Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), P < 0.0001] and 0.2% [95% CI (0.1, 0.3), P < 0.0001], respectively. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Yulu Gao1 , Qinyun Li2 , Zongshuai Gao2 , Yunxia Zhu4 , Yanqiu Liao5 , Changtai Zhu2 *# , Yongning Sun3 *#
Background: CT scanning remains one of the most routinely used diagnostic tools in a setting of Interstitial Lung Disease (ILD). New and improved technologies, such as High Resolution Computer Tomography (HRCT) have revolutionized the quality of imaging, leading to a prominent increase in number of incidental findings that may or may not be of any clinical significance. The aim of this study was to evaluate the prevalence of incidental findings on thoracic CT and their clinical significance.
Methods: Retrospective analysis was conducted on a cohort of 84 patients referred to our academic center as cases of ILD. Patients were referred for further evaluation between January 2000 and January 2014 and were followed over the disease course. CT scans were done annually as part of clinical management and patients were screened for any incidental findings. All incidental findings were reviewed, recorded in a clinical database and followed up on subsequent visits.
Results: 25 (30%) patients were found to have incidental findings. Liver abnormalities were found in 12 (14.29 %) patients. 11(13.10 %) patients were reported to have coronary artery calcifications. 5 (5.95 %) and 3 (3.57%) patients had thyroid abnormalities and renal cysts, respectively. A malignant lesion was found in 1 patient each in liver and thyroid abnormality subgroup.
Conclusion: Incidental findings are common on thoracic CT scans providing valuable and unexpected findings which warrant investigation by health care providers to exclude malignant processes.
Sonu Sahni1,2*, Sameer Verma1,2, Reeju S Thomas1 , Barbara Capozzi3 and Arunabh Talwar1,2
Hepatitis C Virus infection (HCV) is an increasing public health concern with an estimated 184 million people infected worldwide and approximately 350.000 yearly deaths from HCV-related complications.
Nesrine Gamal and Pietro Andreone*
We report a case of large cell undifferentiated lung carcinoma in a middle aged patient with previously treated tuberculosis and scarring. 20 pack years of smoking history was noted. He presented with metastasis at multiple sites including trochanter, liver and acute bilateral lateral rectus palsy. Chest radiography showed fibrosis of right upper zone with homogenous opacity. Sputum examination for AFB was negative. Computerized tomography of the thorax showed an irregular heterogeneously enhancing mass involving right upper lobe with cavitation, necrosis along with lymph node involvement and the erosion of the 4th rib with liver metastasis. Radiography of hip joint was suggestive of lesser trochanteric metastasis. MRI brain was suggestive of mass at base of brain in parasellar area. Fine needle aspiration cytology and CT guided biopsy confirmed undifferentiated large cell carcinoma of lung. Tuberculosis and smoking may increase the risk of lung scarring and malignancy and pulmonary scarring may be associated with increased lung carcinoma in ipsilateral lung. Clinician needs to be more sensitive to look for malignancy association particularly in patient with or previously treated for tuberculosis and even more emphasis to be laid if scarring of lung is observed.
Sreenivasa Rao Sudulagunta1 *, Shyamala Krishnaswamy Kothandapani2 , Mahesh Babu Sodalagunta3 , Hadi Khorram2 , Mona Sepehrar4 and Zahra Noroozpour1
Systemic Sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities. The rheumatic involvement of SSc is polymorphic and can reveal the disease or may appear during the course of its progression. Musculoskeletal involvement is dominated by non specific arthralgia, polyarthritis, and bony resorption especially acro-osteolysis. The diagnosis of these rheumatic manifestations is generally based on x rays examination. Musculoskeletal involvement in SSc is generally relieved with Non Steroidal Anti-Inflammatory Drugs (NSAID) or low dose of corticotherapy. The immunosuppressive therapy is used in corticoid-resistant or corticoid-dependent forms such us méthotrexate. The aim of our review is to presents an overview of the different osteoarticular and muscular involvement in SSc, their diagnosis and management.
Nessrine Akasbi*, Fatima Ezzahra Abourazzak and Taoufik Harzy
Sedigheh Mirhashemi1 , Mohammad Hosein Kalantar Motamedi1 *, Amir Hossein Mirhashemi2 and Hamid Reza Rasouli1
We encountered two autopsy cases of huge cardiomegaly with over 1000g in weight. Histochemical characteristics were examined using conventional staining including HE and Azan stains and immunohistochemical staining using antibodies against Complement Component 9 (CC9), RNA Binding Protein Motif 3(RBM3), Endothelial Type NO Synthase (eNOS) and Hypoxic Inducible Factor1α (HIF1). The reactive area with anti CC9 antibody, which presumed to be a marker of hypoxic change of myocardium, overlapped with eosinophilic area by HE and basophilic one by Azan. Although the reactive area with anti CC9 antibody showed relatively weak in the cytoplasm by anti eNOS antibody and no in the nucleus of cardiocytes with anti RBM3 antibody, outside of the reactive area with anti CC9 antibody there were intensive reactivity with anti eNOS antibody in cytoplasm and in a nucleus with anti RBM3 antibody. Anti HIF1 antibody showed weak reactivity with cytoplasm of endocardial cardiocytes and no with cytoplasm of cardiocytes in another area. The results obtained from the present cases revealed that the hypoxic change was equivalent even though the cause of cardiomegaly was deferred between two cases, and conventional staining such as HE and Azan utilized to detect hypoxic change in the heart and immunohistochemical studies seemed to be a useful tool for clarifying the cascade of hypoxic changes in the myocardium.
Satoshi Furukawa1,2*, Mayumi Kataoka1 , Satomu Morita1,2, Akari Uno2 , Masahito Hitosugi2 , Hiroshi Matsumoto1,3 and Katsuji Nishi1,2
A 45-year-old woman with multiple sclerosis was admitted to our hospital after out of hospital cardio-pulmonary resuscitation. The first ECG showed ventricular fibrillation. Following direct current defibrillation and mechanical reanimation, spontaneous circulation was restored and the ECG unremarkable without any signs of ischemia. Coronary angiography showed unobstructed coronary arteries Figure 1, (Panel A). Left ventriculography revealed apical wall obstruction, suggestive of apical aneurysm (Panel B, supplementary videos). Transthoracic echocardiography and Cardiac Magnetic Resonance Imaging (CMR) eventually lead to the diagnosis of a rare case of Apical Hypertrophic Cardiomyopathy (AHC) with ace of spades-form (Panel C,D). The patient underwent Cardioverter-Defibrillator Implantation (ICD) and amiodarone medical therapy for secondary prophylaxis. Patient’s family history and screening for HCM were unsuspicious.
Wiedemann S# *, Heidrich FM# , Speiser U and Strasser RH