Acupuncture treatment for chronic knee pain: a systematic review

Objectives. To evaluate the effects of acupuncture on pain andfunction in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlledtrials of adequate acupuncture. Computerized databases and referencelists of articles were searched in June 2006. Studies were selectedin which adults with chronic knee pain or osteoarthritis ofthe knee were randomized to receive either acupuncture treatmentor a control consisting of sham (placebo) acupuncture, othersham treatments, no additional intervention (usual care), oran active intervention. The main outcome measures were short-termpain and function, and study validity was assessed using a modificationof a previously published instrument. Results. Thirteen RCTs were included, of which eight used adequateacupuncture and provided WOMAC outcomes, so were combined inmeta-analyses. Six of these had validity scores of more than50%. Combining five studies in 1334 patients, acupuncture wassuperior to sham acupuncture for both pain (weighted mean differencein WOMAC pain subscale score = 2.0, 95% CI 0.57–3.40)and for WOMAC function subscale (4.32, 0.60–8.05). Thedifferences were still significant at long-term follow-up. Acupuncturewas also significantly superior to no additional intervention.There were insufficient studies to compare acupuncture withother sham or active interventions. Conclusions. Acupuncture that meets criteria for adequate treatmentis significantly superior to sham acupuncture and to no additionalintervention in improving pain and function in patients withchronic knee pain. Due to the heterogeneity in the results,however, further research is required to confirm these findingsand provide more information on long-term effects. KEY WORDS: Acupuncture, Systematic review, Meta-analysis, Chronic knee pain, Osteoarthritis, WOMAC, Function Submitted 4 July 2006; revised version accepted 7 November 2006.     

Association of intra-operative metaphyseal fractures with prosthesis size during hemiarthroplasty of the hip

PURPOSE: To study the possible causes of intra-operative metaphyseal fractures in elderly patients undergoing hemiarthroplasty for displaced intracapsular femoral neck fracture. METHODS: 36 men and 228 women aged 61 to 89 years with 273 displaced femoral neck fractures underwent hemiarthroplasty using a hydroxyapatite ceramic-coated Furlong bipolar prosthesis. Anteroposterior and lateral radiographs were taken immediately after surgery to evaluate the presence and type of any intra-operative fractures (classified according to the Vancouver system) and their effect on stem stability or osseointegration. Pain and clinical outcomes were evaluated using a visual analogue scale and the Harris Hip Score. RESULTS: Regarding the 273 surgeries for displaced femoral neck fracture, 28 (10%) were associated with intra-operative metaphyseal fracture (21 Vancouver type AL and 7 type AG). There was a correlation between intra-operative metaphyseal fractures and stem size. A size-9 stem was used in 64 surgeries without any fracture. A size-10 stem was used in 129 surgeries in which 11 (9%) sustained fractures, and a size-12 stem was used in 80 surgeries in which 17 (21%) sustained fractures. Postoperatively, 25 cases developed hip-related problems (thigh pain=14 and periprosthetic fractures=8) after 3 to 18 months. No patient whose metaphyseal fracture was fixed had hip problems. CONCLUSION: In elderly women with compromised bone quality, extra care is needed to achieve better fitting so as to avoid iatrogenic metaphyseal fractures. Under-sizing or cementing of the prosthesis is recommended when encountering difficulties.     

Chemically synthesized sugar-cholestanols possess a preferential anticancer activity involving promising therapeutic potential against human esophageal cancer

The understanding of the cell signaling pathways and the molecular events leading to cell death of cancer cells will provide in-depth perspective into the identification and development of potent anticancer agents. A balance between cell proliferation and cell death has been raised as a rational target for the management of malignant tumors. In the present study, the authors demonstrated that chemically synthesized sugar-cholestanols consisting of GlcNAcbeta-, Galbeta- and GlcNAcbeta1,3Galbeta-cholestanols exerted a strong inhibiting activity against cell proliferation of esophageal cancer cells, but cholestanol itself did not show such an activity against the same cancer cells at all. In addition to their predominant role as an antiproliferation agent, evidence based on the molecular analyses suggested that sugar-cholestanols played a regulatory role in multiple signal transduction pathways inducing apoptosis through both the death signal-extrinsic and the mitochondria-intrinsic pathways. Sugar-cholestanols seemed to be more susceptible to esophageal cancer cells than to non-cancerous esophageal cells at the very early event of their exposure and, further, to suppress specifically the expression of vascular endothelial growth factor. Taken together, these novel functions of sugar-cholestanols indicate that they could have promising therapeutic potential against human esophageal cancer.     

Gaseous distension of the urinary bag during CO2 laparoscopy in the usual operative settings: Does the CO2 diffuse into the urinary bladder or is it a sign of urinary tract injury?

ObjectiveTo compare the amounts of any clinically detectable gas passage into the urinary bag in laparoscopic and open surgeries.MethodsSeventy-nine women were allocated into two surgical groups; Group 1: carbon dioxide (CO₂) laparoscopy (n=37) and Group 2: gasless laparoscopy or laparotomy (n=42). All patients had urinary catheter during the surgeries. After checking the tightness of the connection of the urinary catheter and bag operations were performed. At the end of each surgery the urine volumes were recorded. The bags were immersed into a water containing container with a volume scale. The volume rise of the container was recorded. The valve of the outlet of the bag was turned on under the water and any leakage of air bubbles was observed. The final volume of the container was recorded once again while the bag was still in the water. The two groups were compared by using the Student's t or Mann Whitney U tests.ResultsWe did not observe and hence measure any gas accumulation in the urine bags of both groups. The women's ages, total intraoperative urine volume, urine production rate and total operative times of the groups were not significantly different. The mean operative time was (82.98±62.14) min in open surgeries and (73.46±52.74) minutes in CO₂ laparoscopic surgeries. The difference between the groups was not significant (P=0.468).ConclusionsAny gas accumulation in the urine bag during CO₂ laparoscopic surgery should raise the suspicion of urinary tract injury. Urinary catheterization helps to diagnose the unnoticed bladder injuries.     

MRI in subacute sclerosing panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a progressive, slow virus infection of the brain, caused by the measles virus, attacking children and young adults. We investigated 15 patients with SSPE by MRI, with 5 normal and 10 pathological results. In the early period, lesions were in the grey matter and subcortical white matter. They were asymmetrical and had a predilection for the posterior parts of the hemispheres. Later, high-signal changes in deep white matter and severe cerebral atrophy were observed. Parenchymal lesions significantly correlated with the duration of disease. A significant relationship between MRI findings and clinical stage was observed in the 1st year of the disease. Received: 17 March 1995 Accepted: 23 October 1995     

A comparison of the efficacy and safety of nonsteroidal antiinflammatory agents versus acetaminophen in the treatment of osteoarthritis: A meta‐analysis

Objective

To perform a meta‐analysis comparing the efficacy and safety of recommended dosages of nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase 2 inhibitors, versus acetaminophen in the treatment of symptomatic hip and knee osteoarthritis.

Methods

Medline and EMBASE searches were performed for original clinical trials directly comparing NSAIDs with acetaminophen. A standardized form was used to abstract all data, including outcome measures of pain at rest, walking pain, and dropouts due to adverse effects. Inverse‐variance‐weighted mean differences (WMDs) and 95% confidence intervals (95% CI) for pain measures were determined for treatment groups. Odds ratios (ORs) and 95% CIs were calculated for withdrawals due to adverse events. Results were compared using a random effects model.

Results

Seven articles met inclusion criteria with sufficient data for analysis. Participants had a mean age of 61.1 years and 71.1% were women. Test of heterogeneity was not significant for either rest (P = 0.73) or walking (P = 0.76) pain. The scores for overall pain at rest (WMD ?6.33 mm on a 100‐mm visual analog scale [VAS], 95% CI ?9.24, ?3.41) and walking pain (WMD –5.76 mm on a 100‐mm VAS, 95% CI –8.99, –2.52) favored the NSAID‐treated group. Although NSAIDs elevated the risk of withdrawals due to adverse events, the difference was not statistically significant (OR 1.45, 95% CI 0.93, 2.27).

Conclusion

NSAIDs are statistically superior in reducing rest and walking pain compared with acetaminophen for symptomatic osteoarthritis. Safety, measured by discontinuation due to adverse events, was not statistically different between NSAID‐ and acetaminophen‐treated groups.

     

Comparison and evaluation of experimental mediastinitis models: precolonized foreign body implants and bacterial suspension inoculation seems promising

Background  

Post-sternotomy mediastinitis (PSM) is a devastating surgical complication affecting 1–3% of patients that undergo cardiac surgery. Staphylococcus aureus is one of the most commonly encountered bacterial pathogen cultured from mediastinal samples obtained from patients with PSM. A component of the membrane of the gram positive bacteria, lipoteichoic acid, stimulates the blood monocytes and macrophages to secrete cytokines, radicals and nitrogen species leading to oxido-inflammatory damage. This seems to be responsible for the high mortality rate in PSM. For the evaluation of the pathogenesis of infection or for the investigation of alternative treatment models in infection, no standard model of mediastinitis seems to be available. In this study, we evaluated four mediastinitis models in rats.     

Hearing status in brucellosis.

BACKGROUND: Although brucellosis can lead to multisystem complications, involvement of the ear in brucellosis is rarely reported in the literature. The purpose of this study was to assess the hearing status of patients with brucellosis. STUDY DESIGN: Thirty-two patients with brucellosis were included in the study. Pure tone and speech audiometry and tympanometry were performed in the patients. RESULTS: The mean pure tone averages of the patients were within normal limits and were similar in both ears (P > 0.05). The pure tone averages of the patients with or without anti-Brucella treatment were not significantly different (P > 0.05) and were within the normal limits. When the hearing levels of these patients were compared at the frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, there was no significant difference as well (P > 0.05). CONCLUSIONS: Peripheral brucellosis does not appear to be associated with hearing loss.     

Supratentorial intracerebral schwannomas

A case of frontotemporal intracerebral schwannoma in a 16-year-old girl with epilepsy and progressive hemiparesis of 3 years' duration is described. The histologic diagnosis and possible sites of origin are discussed. In addition, five previously reported cases of supratentorial intracerebral schwannoma are discussed. All of the patients reviewed presented with epilepsy early in life, and there was no association with neurofibromatosis.