Endoscopy and percutaneous suturing in the achilles tendon ruptures

Achilles tendon ruptures commonly occur during sportive activities and there is a tendency of increasing in the incidence of ruptures because of “weekend warriors” who are over 30 years of age. These pathologies are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures. Nevertheless, there is no consensus on the treatment method, and it is still determined by the surgeon and the patient. Open surgical repair of the Achilles tendon carries specific risks including adhesions between the tendon and the skin, infection, and particularly wound breakdown. Therefore, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia proffers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique resulted in a cosmetic wound appearance, endurable to early active mobilization and satisfactory clinical recovery without any severe complication. Furthermore, this procedure protects the paratenon and thus blood supplies of the tendon, and enhances biologic recovery. Also direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter we described our Achilles tendon repair technique under local anesthesia without tourniquet and with cooperation of the patient, and the results of our clinical experiences under the lights of literature. © Springer-Verlag Berlin Heidelberg 2012

Meniscectomy

Meniscal injury is a common cause of knee pain and major cause of functional impairment of the knee at young athletic population. Although the menisci were thought to be a vestigial tissue and treated with disrespect as an unnecessary appendage for many years; today it is known that the menisci provide mechanical support, localized pressure distribution, and lubrication to the knee joint. Therefore, a shift toward meniscal preservation has led to the development of new surgical techniques in recent decades as removal of the meniscus constitutes a risk factor for osteoarthritis. Therefore, total meniscectomy has been replaced by arthroscopic partial meniscectomy rather than total meniscectomy. Treatment choice of a meniscal pathologies also depend on patient's age, health, lifestyle, sporting activity level, and request to undergo major surgery and also the location and type of meniscal tear. In this article, we provide a general perspective on evolution of surgical management especially better understanding on meniscectomy procedures in various types of meniscal tears. Copyright © 2010 by Lippincott Williams & Wilkins

Arthroscopic patellar instability surgery

Biomechanically, knee joint as a motion complex includes gliding, rolling, translation, and rotation during its extension to flexion. A significant incidence of knee pain and disability arises from patellofemoral disorders in elderly ages. Patellar instability is a subjective term that defines pain, blockage, and twisting clinically due to deterioration of static and dynamic knee extensor mechanism. An accurate diagnosis relies both on assessing soft tissues and bony tissues together and considering pelvic and spinal stabilizers with the knowledge of distal alignment reaches from L5 to S1 vertebrae. Under the title of patellar instability, arthroscopic medial plication technique and the importance of medial patellofemoral ligament in this approach will be discussed. © Springer-Verlag Berlin Heidelberg 2012

Potential anti-tumor activity of kefir-induced juglone and resveratrol fractions against ehrlich ascites carcinoma-bearing balb/c mice

We investigated the potential influence of kefir-induced juglone and resveratrol fractions (JRK) against Ehrlich Ascites Carcinoma (EAC) bearing BALB/c male mice. Kefir yeast was grown in the cell culture supplemented with juglone and resveratrol (1:2). After 48 h incubation, JRK solution was applied (0.1 mL/day i.p.) to the EAC-bearing mice throughout five days. Molecular regulatory mechanisms of apoptotic and anti-apoptotic pathway components were evaluated in the plasma of mice and isolated EAC cells with ELISA, qRT-PCR, and immunocytchemical experiments. EAC-induced upregulation in Bcl-2 and downregulation in Caspase-3 were normalized with JRK in the plasma of mice. Additionally, JRK upregulated the expression levels of apoptotic Bax, p53, Caspase-3,8,9, and APAF-1 proteins together with BAX, CASPASE-8, and CASPASE-9 genes in isolated EAC cells. These changes were also associated with decreased expression levels of anti-apoptotic Bcl-2 and Bcl-xl proteins. Immunocytochemical studies also confirmed the activation of apoptotic pathways and repression of anti-apoptotic proteins in EAC cells with JRK treatment. JRK activates apoptotic pathway and inhibits anti-apoptotic genes and proteins in Ehrlich ascites carcinoma-bearing BALB/c mice that could be beneficial in cancer treatment. © 2020, Iranian Journal of Pharmaceutical Research. All rights reserved