scholarly journals Micronized Dehydrated Amnion Chorion Membrane (mdHACM) Injection in the Treatment of Chronic Achilles Tendinitis: A Large Retrospective Case Series

Author(s):  
Jay Spector ◽  
Brandon Hubbs ◽  
Kimberly Kot ◽  
Niki Istwan ◽  
David Mason

Background: Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown that micronized dehydrated human amnion chorion membrane (mdHACM) allograft injection is an effective treatment for plantar fasciitis. Our objective is to present our experience with using mdHACM injection as a treatment for Achilles tendinopathy and report short term treatment outcomes. Methods: Included in this retrospective case series were patients diagnosed with Achilles tendinopathy treated with mdHACM by a single physician were identified from an electronic medical record system. Included for analysis were those with at least 2 follow up visits within 45 days of mdHACM injection. Outcomes examined included change in reported level of pain during the 45-day observation period and adverse events associated with treatment. Results: Follow-up data were available for 32 mdHACM-treated patients and abstracted from the electronic medical record. At treatment initiation 97% of patients reported severe (66%) or moderate (31%) pain. At first follow-up visit (mean 8.1 {plus minus} 2.7 days after injection), 84% (27/32) had reported improvement in pain levels, although 37% of patients continued to report severe (6%) or moderate (31%) pain. At the second follow-up visit (mean 23.1 {plus minus} 6.2 days after injection), no patients reported severe pain and one reported moderate pain. Within 45 days of mdHACM injection complete resolution of symptoms was reported by 66% of treated patients (n=21) with the remaining 34% reporting improvement but not complete resolution (n=11) of their symptoms. Two patients reported calf or quadricep pain or tightness post-injection. Conclusions: In a single practice mdHACM injection reduced or eliminated pain in all patients where follow-up data was available.

2017 ◽  
Vol 11 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Zachariah W. Pinter ◽  
Kenneth S. Smith ◽  
Parke W. Hudson ◽  
Caleb W. Jones ◽  
Ryan Hadden ◽  
...  

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series


2020 ◽  
Vol 10 ◽  
pp. 204512532095956
Author(s):  
Matthew Butler ◽  
Felicity Bano ◽  
Marilia Calcia ◽  
Isabel McMullen ◽  
Chun Chiang Sin Fai Lam ◽  
...  

There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. In four cases clozapine was stopped during the hospital admission. A COVID-19 pneumonia developed in four patients: three of these required intensive care unit admission for an average of 34 days. At the time of writing, three patients had died (two directly from COVID-19 pneumonia), two remained in general hospital wards, two were recovering in the community and one had been transferred to an inpatient psychiatric hospital. Follow-up length varied but in each case was not more than 104 days. Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19. We also identify areas which require larger scale hypothesis-testing research.


2012 ◽  
Vol 16 (3) ◽  
pp. 212-217 ◽  
Author(s):  
Nicolas Aubut ◽  
Jimmy Alain ◽  
Joël Claveau

Background: Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma. Objective: We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate. Methods: All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed. Results: Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur. Limitations: The follow-up period was short, and there was no histologic confirmation of the initial diagnosis. Conclusion: IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.


2019 ◽  
Vol 13 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Derek Stenquist ◽  
Brian T. Velasco ◽  
Patrick K. Cronin ◽  
Jorge Briceño ◽  
Christopher P. Miller ◽  
...  

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series


2007 ◽  
Vol 144 (6) ◽  
pp. 844-849.e1 ◽  
Author(s):  
Stacy P. Ardoin ◽  
Deborah Kredich ◽  
Egla Rabinovich ◽  
Laura E. Schanberg ◽  
Glenn J. Jaffe

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