Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment.

The aim of this study was to investigate the effects of intra-articular hyaluronic acid (HA) on symptoms, functional outcome, and changes in articular cartilage assessed by magnetic resonance imaging (MRI) in patients with knee osteoarthritis. Thirty patients were randomly assigned to treatment with HA (hylan G-F 20, Synvisc) or saline. The treatment group consisted of 20 patients receiving three weekly injections of HA into one or both knees (30 knees). The control group consisted of ten patients receiving three intra-articular injections of 2 ml saline at the same intervals (ten knees). To determine the effectiveness of the HA therapy, all patients were assessed prior to the injections (baseline) and after the 1st, 2nd, 3rd, and 8th weeks. Assessment comprised the following: pain at rest, at night, and on walking using a visual analogue scale (VAS); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores; 15-m walking time; need for analgesics; and evaluation of treatment by the patients. MRI of patellofemoral (PF) articular cartilage was also examined before and after the course of injections at the 8th week. When compared to placebo, a significant statistical difference was found in all clinical parameters. On MRI, although the difference in the PF joint cartilage quality in the HA group before and after the treatment was statistically significant (p 0.05). After the HA injections, a significant analgesic effect was seen as early as the 3rd week continuing up to the 8th week and functional improvement was seen at the 8th week. In conclusion, intra-articular injections of HA is an effective choice of treatment in patients with knee osteoarthritis

Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients.

The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome (FMS) and to determine if balneotherapy influences serum levels of inflammation markers, IL-1, PGE2 and LTB4. 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study. Their ages ranged between 33 and 55 years. FMS patients were randomly assigned in two groups as, group 1 (n = 12) and group 2 (n = 12). Group 1 received 20-min bathing, once in a day for five days per week. Patients participated in the study for 3 weeks (total of 15 sessions) in Denizli. Group 2 did not receive balneotherapy. FMS patients were evaluated by tenderness measurements (tender point count and algometry), Visual Analogue Scale, Beck's Depression Index, Fibromyalgia Impact Questionnaire. Ten healthy women recruited group three as the controls. Serum PGE2, LTB4 and IL1-alpha levels were measured in all three groups. The biochemical measurements and clinical assessments were performed before and at the end of general period of therapy. Statistically significant alterations in algometric score, Visual Analogue score, Beck's Depression Index and PGE2 levels (P < 0.001), numbers of tender points (P < 0.01) and Fibromyalgia Impact Questionnaire score (P < 0.05) were found after the balneotherapy between group 1 and 2. Mean PGE2 level of FMS patients were higher compared to healthy control group (P < 0.0001) and decreased after the treatment period, only in group 1 (P < 0.05). As in the group 2 and 3, detectable IL-1 and LTB4 measurements were insufficient, statistical analysis was performed, only in group 1. After balneotherapy IL-1 and LTB4 significantly decreased in group 1 (P < 0.05). In conclusion, balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms, and possibly influencing the inflammatory mediators

The difficulties encountered with embryo transfer and the role of catheter choice in clinical pregnancy success rates in an IVF cycle

Objective: The aim of the study was to compare the clinical pregnancy rates of soft catheters and catheters with stylet in according to the difficulty levels of transfer. Setting: Zeynep Kamil Women and Children's Hospital Reproductive endocrinology and Infertility division and Ferti-Jin ART center. Materials and methods: The total number of 1158 embryo transfers performed are examined retrospectively. The embryo transfer performances are divided into three groups as easy, moderately-difficult and difficult. 827 transfers were in the easy group, 284 were in moderately-difficult group and 47 were in the difficult group. Results: The pregnancy rates were % 41.4, % 36.2, and % 17, respectively. There were statistically significant difference between group 1 and group 3, p<0.05 and between group 2 and group 3, p<0.05. There were no statistically significant difference between group 1 and group 2, p>0.05. Conclusions: In case of the failure of the embryo transfer by soft catheter by detected in mock transfer, it may be replaced by catheter with stylet to achieve the transfer. But the success of IVF is the highest in the easy-transferred and soft catheter used group. In moderately difficult group, it is possible to improve the clinical pregnancy rates by choosing catheter with stylet but not in difficult transfer group. Therefore examining the cervical canal, "trying mock transfer and deciding which catheter is to be used", before the transfer is very useful