Biologics for tendon repair.

Two case studies are presented to demonstrate that children who experience trauma-related nightmares may benefit from cognitive-behavioral therapy for this sleep problem. The treatment was adapted from the empirically supported adult treatment for chronic trauma-related night- mares: exposure, relaxation, and rescripting therapy (ERRT). Pretreatment and posttreatment nightmare frequency and severity were measured in addition to subjective nightmare-related distress, behavioral problems, sleep quality and quantity, and symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression. Improvement in nightmare and sleep disturbance fre- quencies were found as well as reductions in parents' reports of child behavior problems. This study provides preliminary support for the use of ERRT with children.

A Case Series: Cognitive- Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children

The purpose of this study was to evaluate the efficiency of biologic augmentation of rotator cuff repair with iliac crest bone marrow-derived mesenchymal stem cells (MSCs). The prevalence of healing and prevention of re-tears were correlated with the number of MSCs received at the tendon-to-bone interface. Forty-five patients in the study group received concentrated bone marrow-derived MSCs as an adjunct to single-row rotator cuff repair at the time of arthroscopy. The average number of MSCs returned to the patient was 51,000 ± 25,000. Outcomes of patients receiving MSCs during their repair were compared to those of a matched control group of 45 patients who did not receive MSCs. All patients underwent imaging studies of the shoulder with iterative ultrasound performed every month from the first postoperative month to the 24th month. The rotator cuff healing or re-tear was confirmed with MRI postoperatively at three and six months, one and two years and at the most recent follow up MRI (minimum ten-year follow-up). Bone marrow-derived MSC injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the quality of the repaired surface as determined by ultrasound and MRI. Forty-five (100 %) of the 45 repairs with MSC augmentation had healed by six months, versus 30 (67 %) of the 45 repairs without MSC treatment by six months. Bone marrow concentrate (BMC) injection also prevented further ruptures during the next ten years. At the most recent follow-up of ten years, intact rotator cuffs were found in 39 (87 %) of the 45 patients in the MSC-treated group, but just 20 (44 %) of the 45 patients in the control group. The number of transplanted MSCs was determined to be the most relevant to the outcome in the study group, since patients with a loss of tendon integrity at any time up to the ten-year follow-up milestone received fewer MSCs as compared with those who had maintained a successful repair during the same interval. This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.

Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study

Biologic approaches to enhance rotator cuff healing after injury

Background:The mesenchymal stem cell (MSC)–based tissue engineering approach has been developed to improve the treatment of rotator cuff tears.Hypothesis/Purpose:The purpose was to determine the ef...

Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study.

Purpose
To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC).

https://link.springer.com/content/pdf/10.1007%2Fs00167-011-1607-9.pdf

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

OBJETIVO: Avaliar o valor diagnostico da ressonância magnetica (RM) do joelho. MATERIAIS E METODOS: Setenta e dois pacientes foram submetidos a RM previamente a artroscopia do joelho realizada por um unico cirurgiao e considerada como metodo padrao. Verificou-se a sensibilidade, a especificidade, os valores de verossimilhanca e a concordância entre o radiologista e o ortopedista em classificar as lesoes. RESULTADOS: O coeficiente de concordância kappa entre a RM e a artroscopia, em classificar as lesoes, foi muito bom para lesoes de ligamento cruzado anterior (0,84), bom para o menisco lateral (0,75), razoavel para o menisco medial (0,50) e baixo para lesoes condrais (menor que 0,50). A RM mostrou ter alta sensibilidade para rupturas de ligamento cruzado anterior (94%) e menisco medial (92%), boa sensibilidade para lesoes de menisco lateral (80%) e baixa sensibilidade para lesoes em todas as zonas condrais (menor que 50%), enquanto a especificidade foi excelente para todas as estruturas condrais, ligamentares e para o menisco lateral estudadas (maior que 97%) e razoavel para o menisco medial (65%). CONCLUSAO: A RM e uma ferramenta util para subsidiar o diagnostico clinico de lesoes intra-articulares do joelho, como ja foi mostrado em resultados semelhantes encontrados na literatura produzida no Brasil e no exterior.

/pdf/a-ressonancia-magnetica-para-o-diagnostico-das-lesoes-2de4iv43q7.pdf

A ressonância magnética para o diagnóstico das lesões condrais, meniscais e dos ligamentos cruzados do joelho

Hysterosalpingography is a technique used for the evaluation of the uterine anatomy and tubal patency and consequently it is primarily indicated for the diagnosis of infertility. The aim of this study was to establish the prevalence of the abnormalities observed on the hysterosalpingograms of infertile patients. All patients that underwent hysterosalpingographic evaluation in a period of four months were allocated. Of the 48 patients studied, 36 presented primary infertility and 12 presented secondary infertility. The patients with primary infertility presented a higher rate of uterine malformations whereas the patients with secondary infertility presented more often tubal obstruction. There were no significant complications during the hysterosalpingograms. This study demonstrates that hysterosalpingography is very useful for the evaluation of infertility, as it frequently diagnoses relevant abnormalities, it is an inexpensive technique and the complications are very rare.

/pdf/prevalencia-de-alteracoes-uterinas-e-tubarias-na-4rvkubnjzy.pdf

Prevalência de alterações uterinas e tubárias na histerossalpingografia em mulheres inférteis: estudo de 48 casos

The authors report a case of a white four-year-old boy with progressive neurological symptoms due to a brain stem mass lesion identified by computed tomography and magnetic resonance imaging scans. The diagnosis of gliosarcoma was confirmed by histological examination. This rare type of central nervous system tumor affects mainly patients over 40 years of age and is most commonly supratentorial. Only a few cases of gliosarcoma in children have been reported, particularly in the infratentorial region. The epidemiological data as well as the most frequent computed tomography and magnetic resonance imaging findings are discussed.

/pdf/gliossarcoma-de-tronco-cerebral-em-paciente-pediatrico-1r6pfnwdy4.pdf

Gliossarcoma de tronco cerebral em paciente pediátrico: relato de caso

A 29-year-old female presented with a long-standing history of limping and insidious pain on both hips, with no prior history of trauma. Physical examination revealed obvious bilateral hip instability. Radiograph and additional evaluation with computed tomography (CT) of the hip were performed, depicting a bilateral high hip dislocation with the femoral heads free-floating within the gluteal muscles (Fig.s 1 and 2). Hypoplastic acetabuli and shortening of both femoral necks were observed. The patient is expecting reconstructive surgery.

/pdf/congenital-hip-dislocation-a-rare-case-in-adulthood-4j5lfffzo6.pdf

Marcelo Rodrigues de Abreu

Papers

Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

A ressonância magnética para o diagnóstico das lesões condrais, meniscais e dos ligamentos cruzados do joelho

Prevalência de alterações uterinas e tubárias na histerossalpingografia em mulheres inférteis: estudo de 48 casos

Gliossarcoma de tronco cerebral em paciente pediátrico: relato de caso

Congenital Hip Dislocation: A Rare Case in Adulthood.