Pulmonary Phialemonium curvatum phaeohyphomycosis in a Standard Poodle dog.

Phialemonium curvatum, frequently misidentified as an Acremonium species, is reported here as a new agent of pulmonary phaeohyphomycosis in a Standard Poodle dog, and added as a new species in the genus to cause mycoses in canines. In vitro susceptibility data, for both human and animal isolates, suggests resistance to amphotericin B and susceptibility to the triazole agents itraconazole, voriconazole, and posaconazole.     

Isolated endogenous endophthalmitis due to a sporodochial-forming Phialemonium curvatum acquired through intracavernous autoinjections.

We report a case of endogenous endophthalmitis due to a sporodochial-forming species of Phialemonium curvatum. The infection led to the enucleation of the affected eye, but there was no evidence of systemic dissemination. The isolated P. curvatum produced aggregates of phialides, many occurring on coils or in verticils, which eventually develop into sporodochia. The initial and post-enucleation isolates revealed they were identical to strains of P. curvatum from Israel causing disseminated disease in patients practicing intracavernous autoinjections for the treatment of erectile dysfunction. The reported case had unusual clinical and microbiological features. Despite the route of acquisition and the lack of systemic antifungal therapy, the infection did not spread beyond the eye. The morphology of the phialides aggregates was also unique, and the distinction between Volutella and Acremonium is discussed. This case expands the spectrum of infections due to Phialemonium species, and reveals a novel way of developing fungal endophthalmitis.     

Systematic review: The safety of intra-articular corticosteroid injection prior to total knee arthroplasty

BackgroundUp to 30% of patients undergoing total knee arthroplasty (TKA) have received intra-articular corticosteroid injections prior to surgery. Debate exists as to whether such injections increase the rate of post-operative infection. Given that deep infection is a disastrous complication, a systematic review of the literature was undertaken to evaluate the safety of intra-articular corticosteroid injections given prior to TKA. Other features of corticosteroid use are also discussed including mechanism of action and optimal dosage.MethodsUsing PRISMA guidelines, EMBASE, CINAHL and MEDLINE databases were searched using the search terms ‘total knee arthroplasty’, ‘replacement’, ‘corticosteroid’, ‘steroid’, ‘infection’, ‘safety’, and relevant articles critically appraised. The Newcastle-Ottawa Scale was used to assess for bias.ResultsNo level one or two studies were available for review. Two retrospective case control studies and two cohort studies (level three evidence) which specifically evaluated the risk of infected TKA in association with pre-operative steroid injection were reviewed: three showed that prior steroid injection was not associated with increased infection rates; one article showed that prior steroid injection was associated with a significantly increased risk of deep infection post-TKA.ConclusionClinicians commonly administer steroid injections to patients who are candidates for TKA but may be unaware of the potential long term complications. The included studies were underpowered and at risk of selection bias and only one study demonstrated an increased risk of infection post-operatively. We recommend that further research is required to evaluate the safety of steroid injection prior to TKA.Level of evidence: III     

Differences in the axon composition of nerves supplying the rat knee joint following intra-articular injection of capsaicin.

This study was used to examine the ultrastructure of articular nerves supplying the medial aspect of the rat knee joint following injection of capsaicin into the synovial cavity. One week after the intra-articular injection of 0.2 ml of 1% capsaicin solution there was significant reduction in the number of unmyelinated fibres. Two weeks post-injection this appeared to recover and by 4 weeks post-injection no further changes were observed. Myelinated fibres were unaffected by capsaicin injection. This procedure provides an effective means of producing short-term degeneration of unmyelinated fibres innervating the knee joint.     

Induction of acute and chronic arthritis by intra-articular injection of preformed collagen-anticollagen complexes.

Three groups of rabbits were injected intra-articularly into the knee joints with preformed complexes of hydroxamated collagen and antiserum to denatured collagen respectively, with hydroxamated collagen and normal serum, hydroxamated collagen, anticollagen serum or saline as controls. From twelve rabbits, receiving only one injection and investigated 8 h later, only the joint tissues of rabbits which received immune complexes showed acute arthritis with severe infiltration of polymorphonuclears, leucocyte thrombi in vessels and haemorrhages. From six rabbits, receiving two consecutive injections (day 0 and day 2) and investigated 12 h after the last injection, only the joint tissue of rabbits which received immune complexes showed subacute-chronic arthritis. From sixteen rabbits receiving four consecutive injections day 0, day 2, day 7 and day 14) and investigated 7 days after the last injection, only the joint tissue of rabbits which received immune complexes showed severe chronic arthritis with infiltration of plasma cells, lymphocytes and nodule-like accumulation of lymphocytes whilst their joint fluid showed additionally a distinctly increased number of polymorphonuclears (3-15 x 10(6)) which differed with P less than 0-01 statistically from all controls.     

Degenerative knee joint lesions in mice after a single intra-articular collagenase injection. A new model of osteoarthritis.

A single intra-articular injection with bacterial collagenase in the right knee joints of 10-week-old male C57bl10 mice led to osteoarthritic lesions within a few weeks in these joints. The collagenase-induced osteoarthritis was characterized by severe degenerative cartilage lesions on the medial side of the femorotibial joint associated with patellar dislocation to the medial side of the joint, sclerosis of subchondral bone below the cartilage erosions, osteophyte formation, and consequent deformity of the knee joints. The osteoarthritic alterations in the collagenase model closely resembled the changes observed in spontaneous osteoarthritis in aged mice. The intra-articular injection with collagenase probably results in damage to collagen type I-containing joint structures, such as tendons, ligaments and menisci, leading to an instable knee joint that results in the osteoarthritic joint lesions observed in this model. The collagenase-induced osteoarthritis model offers the possibility of studying experimental osteoarthritis in large animal groups of inbred strains within a restricted time span at low costs.     

Tourniquet inflation after intra-articular morphine and bupivacaine administration following knee arthroscopy

We performed a randomized doubled-blind study to evaluate whether there was a benefit in delay in tourniquet deflation with intra-articular administration of morphine and bupivacaine following operative arthroscopic surgery. In 34 patients the tourniquet was deflated immediately and in 38 patients the tourniquet remained inflated for 10 min following injection. The analgesic efficacy was assessed using pain scores and the amount of supplementary analgesia required. The results demonstrate no benefit in delay in tourniquet deflation.     

Is it safe for patients to drive after intra-articular knee injection?

BackgroundIntra-articular knee injection is a central component in the current management of knee pain. While this is a routinely performed outpatient procedure, institutional policies for driving post injection differ. This study examines brake response times (BRTs) before and after intra-articular knee injection. Our hypothesis is that BRTs would not significantly differ and thus patients driving ability/safety is unaffected.MethodsForty-five patients previously listed for right intra-articular knee injection were prospectively evaluated. Patients underwent baseline assessment of BRT prior to injection. All patients received 10 ml of fluid consisting of one milliliter of 10 mg/ml triamcinolone mixed with nine milliliters of 0.5% levobupivacaine. BRT was re-examined on the same day prior to discharge home. Pre- and post-injection BRTs were examined using the same machine and assessor.ResultsThe mean age of the cohort was 64.0 ± 12.4 and compromised of 37.8% males. There was no significant difference in the mean pre- and post-injection braking time (0.83 ± 0.29 vs 0.78 ± 0.30 s, p = .42), or in the rate of failed braking time (11.1% vs 6.7%, p = .46).ConclusionThis study found that BRT did not significantly differ before and after the intra-articular injection, nor did it cause an increased number of patients failing their BRTs. These findings suggest patients should not be prevented from driving after intra-articular knee injection.     

关节腔内注射医用臭氧对兔膝骨性关节炎模型基质金属蛋白酶-13表达的影响

目的观察膝关节腔内注射医用臭氧对兔膝骨性关节炎模型关节软骨中基质金属蛋白酶-13表达的影响。方法健康家兔30只,随机分为对照组(空气组)、骨性关节炎组(OA组)和医用臭氧组(25μg/ml),使用Hulth法复制出膝骨性关节炎(OA)模型。分别在造模成功时和处死前测定兔膝关节活动度,末次注射后3 d处死实验兔,免疫组化方法与Western blot方法检测关节软骨中MMP-13蛋白的表达变化,RT-PCR方法检测关节软骨中MMP-13 mRNA水平的变化。结果造模成功后,OA组和医用臭氧组兔膝关节活动度均显著降低,医用臭氧组兔膝关节活动度显著升高。OA组兔关节软骨中MMP-13蛋白与mRNA的表达水平显著升高,但是采用医用臭氧治疗后,臭氧组兔膝关节MMP-13蛋白与mRNA的表达水平显著降低。结论降低关节软骨中基质金属蛋白酶-13的表达可能是医用臭氧有效治疗膝关节炎的作用机制之一。     

关节腔局部注射氨甲环酸对初次全膝关节置换术后失血量的影响

目的观察关节腔局部注射氨甲环酸对初次全膝关节置换术的患者失血量的影响。方法在2016年1月至2016年8月,选取62名接收初次膝关节置换术的患者并随机分为分为氨甲环酸组(32例)和对照组(30例)。氨甲环酸组在关节置换术结束松开下肢止血带之前,关节腔周围软组织局部注射的氨甲环酸生理盐水稀释液(按15 mg/kg剂量配制成50mL),对照组则注射相同体积的生理盐水。记录患者术后12 h和48 h引流量,术后1、3、7 d的红蛋白含量、红细胞压积、术后输血量、术后深静脉血栓发生率等相关指标,并进行统计学分析。结果氨甲环酸组和对照组术后12小时的引流量分别是(182±29)mL和(311±34)mL,48 h总引流量分别是(260±41)mL和(432±67)mL,两组患者总的血量丢失分别(921±109)mL和(1270±154)mL,约16%氨甲环酸组和37%对照组的患者需要异体输血,两组患者的人均输异体血量分别是1.6单位和2.25单位。术后下肢瘀斑发生率在氨甲环酸组(15.6%,5/32)低于对照组(36.6%,11/30)。上述各组数据比较差异均有统计学意义(0.05)。氨甲环酸组出现2例肌间静脉血栓形成,对照组有3例,两组比较无统计学意义。结论氨甲环酸可以减少初次全膝关节置换术的患者血量丢失,减低异体输血的比例,但并不增加深静脉血栓形成发生率。     

The progression of arthritis following lateral unicompartmental knee replacement

In order to aid patient selection we have analysed the radiological progression of arthritis in the retained compartments following lateral unicompartmental knee replacement (UKR). Patients undergoing lateral UKR (St Georg Sled, Waldemar Link) between 1988 and 1999 were assessed. Radiographs taken post-operatively within 8 weeks and at 5 years were assessed. OA was classified using both the Altman and Ahlbach scoring systems. Identifying information on each radiograph was obscured so that the observer was blinded. Each radiograph was reviewed twice to assess intra-observer variability. Patients were assessed clinically using the Bristol Knee Score (BKS) at 1 and 5 years post-operation. Reproducibility for the Ahlbach systems was shown to be very good (kappa = 0.86) and the Altman moderate (kappa = 0.41). Thirty-two lateral UKRs were assessed at 5 years. Six out of 32 of the knees assessed showed definite progression of OA on the Ahlbäch score in the retained medial compartment and 11 out of 32 on the Altman. There was a statistically significant increase in the grade of OA, as assessed by both systems, at 5 years as compared to the post-operative radiograph (p < 0.001). The definite progression group had a mean BKS 10 points lower at 5 years. Six patients required revision to TKR for progression of arthritis in the retained compartments. Lateral compartment UKR can be a very successful procedure, but there is a greater rate of progression of arthritis in the retained medial compartment than following medial UKR.     

Five types of inflammatory arthritis following total knee arthroplasty

Joint effusion after total knee arthroplasty (TKA) is considered as a manifestation of certain inflammatory reactions within prosthetic joints. This study investigated causes of joint effusion following TKA and analyzed phenotypic characteristics of synovial fluid leukocytes for each cause. Forty-six TKAs for rheumatoid arthritis (RA) and 49 TKAs for osteoarthritis (OA) displaying joint effusion were investigated. Causes of joint effusion were clinically identified and frequencies of each cause were compared between RA and OA. Synovial fluid cell phenotypes were analyzed using a fluorescence-activated cell sorter. Clinical diagnoses for joint effusion were classified into five different groups: deep infection (DI); increased activity of RA (IRA); particle-induced synovitis (PS); metal sensitivity (MS); and nonspecific synovitis (NS). The most frequent cause of post-TKA effusion was IRA in RA, and NS in OA. Biomaterial-related arthritis such as PS and MS were more frequent with OA than with RA. Analysis of synovial fluid cell phenotypes revealed that the characteristic cells for each diagnosis were CD16(+)CD14(-) neutrophils in IRA and DI, CD14(+) macrophages in PS, and CD3(+)CD45RO(+) T cells in MS. Post-TKA joint effusion is clinically caused by five different types of arthritis. Phenotypic characteristics of synovial fluid leukocytes reflect joint pathology and contribute to diagnosis and exclusion of biomaterial-related arthritis.     

Acceleration of onset of collagen-induced arthritis by intra-articular injection of tumour necrosis factor or transforming growth factor-beta.

We examined whether tumour necrosis factor (TNF) or transforming growth factor-beta 1 (TGF-beta 1) could alter the course of collagen-induced arthritis (CIA). Injection of 100 ng TNF or 500 ng TGF-beta 1 into ankle joints of normal rats induced a very limited inflammatory response, observable only upon histological analysis. However, when injected into ankle joints of rats 9 days after immunization with bovine type II collagen (CII), identical doses of TNF or TGF-beta 1 induced a sustained, clinically obvious inflammation and oedema that began within 8 h on average, as compared to 90 h in CII-immunized control rats given no injections or intra-articular injections of buffer. The incidence of arthritis at 2 weeks post-immunization was 100% for TNF-injected hindpaws, compared with 55% for the control groups, a statistically significant difference. In rats passively immunized with a subarthritic dose of affinity purified antibody to rat-CII, intra-articular injection of 100 ng TNF or 500 ng of TGF-beta 1 also induced intense, though transient arthritis. The rapid proinflammatory effects in CIA described in this study and the synergy demonstrated between anti-CII IgG and either cytokine, suggest that these cytokines can participate locally in the pathogenesis of arthritis.     

Increased intra-articular substance P and prostaglandin E2 following injection of interleukin-1 in rabbits.

Inflammation was induced by intra-articular injection of 100 ng recombinant human interleukin-1 alpha (rhIL-1) into rabbit knees. Substance P (SP) and prostaglandin E2 (PGE2) were measured by radioimmunoassay (RIA) in the joint fluid at 4, 24 and 48 h after rhIL-1 injection. SP was increased by 4 h, further increased at 24 h and remained elevated at 48 h. PGE2 concentration was highest at 4 h and remained elevated at 48 h after rhIL-1 injection. Because of the proinflammatory activities of SP and PGE2, our studies suggest that the elevated SP and PGE2, in the joint may amplify or sustain an initial receptor-mediated inflammatory response to IL-1.     

A prospective randomised trial comparing intra-articular Hyalgan injection and arthroscopic washout for knee osteoarthritis

Thirty-eight patients with symptomatic knee osteoarthritis without mechanical symptoms were randomised after informed consent to receive either a course of intra-articular Hyalgan injections or an arthroscopic washout. The patients were prospectively assessed pre-intervention, 6 weeks, 3 months, 6 months and 1 year using a 10 cm visual analogue pain score, the Knee Society function score and the Lequesne index. There was no significant difference between the two groups at 6 weeks, 3 months, 6 months or 1 year. The use of intra-articular Hyalgan injections in patients with knee osteoarthritis without mechanical symptoms gives results comparable with arthroscopic washout. Hyalgan is an alternative to arthroscopy in this patient group. Further study is needed to confirm these findings and improve patient selection.     

氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响

目的探讨氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响。方法选取2012年6月~2014年12月在我院行单侧全膝关节置换术治疗的60例患者为研究对象。男性14例,女性46例,年龄58~77岁,平均66.7岁,病程6~15年,平均9.1年。手术及麻醉均由同一组医生完成。将符合条件的患者随机分为2组,试验组(氨甲环酸组)30例,切口缝合完毕后将氨甲环酸1 g稀释至50 m L生理盐水中,用注射器沿引流管注入关节腔内。对照组30例,直接将50 m L生理盐水沿引流管注入关节腔内。比较二组患者术后显性失血量、隐性失血量、异体输血人数、输血比率。结果术后试验组与对照组显性失血量分别为389m L(170~505m L)和628m L(225~874m L),差异有统计学意义(0.05)。术后试验组与对照组隐性失血量分别为514 m L(374~819 m L)和917 m L(542~1297 m L),差异有统计学意义(0.05)。两组术后凝血机制无显著性差异。术后试验组输血人数及输血比率明显小于对照组,差异有统计学意义(0.05)。结论膝关节腔内应用氨甲环酸能够有效地降低全膝关节置换术后患者的显性失血量和隐性失血量,减少术后异体输血的可能性,局部使用方便,未发现不良反应。     

关节腔内注射医用臭氧对兔膝骨性关节炎模型基质金属蛋白酶-9表达的影响

目的观察膝关节腔内注射医用臭氧对兔膝骨性关节炎模型关节软骨中基质金属蛋白酶-9表达的影响。方法健康家兔30只,随机分为对照组(空气组)、骨性关节炎组(OA组)和医用臭氧组(25μg/ml),使用Hulth法复制出膝骨性关节炎(OA)模型。分别在造模成功时和处死前测定兔膝关节活动度,末次注射后3 d处死实验兔,免疫组化方法与Western blot方法检测关节软骨中MMP-9蛋白的表达变化,RT-PCR方法检测关节软骨中MMP-9 mRNA水平的变化。结果造模成功后,OA组和医用臭氧组兔膝关节活动度均显著降低,但是采用医用臭氧治疗后,医用臭氧组兔膝关节活动度显著升高。OA组兔关节软骨中MMP-9蛋白与mRNA的表达水平比对照组显著升高,但臭氧组兔膝关节MMP-9蛋白与mRNA的表达显著降低。结论降低关节软骨中基质金属蛋白酶-9的表达可能是医用臭氧有效治疗膝关节炎的作用机制之一。     

关节腔内加压灌注氨甲环酸与初次全膝关节置换后失血量的关系

BACKGROUND: Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods.