Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis

BackgroundOsteoarthritis (OA) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men. Recently, adipose-derived mesenchymal stem cells (AD-MSCs) came into focus for regenerative medicine as a promising tool for the treatment of OA. The administration of stem cells into impaired joints results in pain relief and improves quality of life, accompanied by restoration of hyaline articular cartilage. MethodsIn the present study, nine patients (including two patients with bilateral symptoms) diagnosed with osteoarthritis (International Knee Documentation grade B in 5 and grade D in six knees) were treated using a single injection of AD-MSCs at a concentration of 0.5-1.0 x 10(7) cells and were followed up for 18months. During follow-up, all the cases were evaluated clinically by Knee Society score (KSS), Hospital for Special Surgery knee score (HSS-KS), Tegner-Lysholm (T-L) score and visual analogue scale (VAS) of pain, as well as by plain radiography and by magnetic resonance imaging visualization with 2D Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score assessment. ResultsSignificant improvement of all four clinical scores was observed within the first 6months (KSS for 41.4 points, HSS-KS for 33.9 points, T-L score for 44.8 points, VAS of pain from 54.5 to 9.3) and improvement persisted throughout the rest of the follow-up. MOCART score showed significant cartilage restoration (from 43 7.2 to 63 +/- 17.1), whereas radiography showed neither improvement, nor further joint degeneration. ConclusionsThe results obtained in the present study provide good basis for prospective randomized controlled clinical trials with respect to the use of AD-MSCs in the treatment of osteoarthritis.This is the peer reviewed version of the paper : Spasovski, D., Spasovski, V., Baščarević, Z., Stojiljković, M., Vreća, M., Anđelković, M., & Pavlović, S. (2018). Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis. The Journal of Gene Medicine, 20(1), e3002. [https://doi.org/10.1002/jgm.3002

Developmental Diseases of the Hip - Diagnosis and Management

There is a long list of diseases and traumatic events that affect hip joint, but none as persistent, as elusive and with profound consequences as developmental dysplasia. For many centuries, we have been struggling with its consequences while trying to understand the reasons how and why such a stable joint eventually becomes dysfunctional and how to prevent it. Some of the greatest achievements in operative orthopaedics have been introduced in the effort to treat developmental dysplasia of the hip. This book offers a contemporary approach to developmental dysplasia of the hip, covering various clinically relevant aspects - historical and epidemiological considerations, biomechanical analysis, conservative methods and operative treatment procedures

Mineral Resources in Macedonia

Abstract: Within this paper attempt was made to present minaral potential of the Republic of Macedonia. With compilation approach is made review of the natural mineral resources, some of the data are results from the geological investigations done in the perennial period. Separate presentation was made for metalic, non – metalic and energetics mineral raw materials, and for some of them are present perspective areas and directions for further investigations

Triple pelvic osteotomy: Complications and how to avoid them

Authors reviewed their eight-year long experience with triple pelvic osteotomy. They explained the way of introduction of this procedure into everyday clinical practice. Seventy hips were operated using Tonnis-Vladimirov method in fifty nine patients of an average age of 15 years and one month. Treatment results were evaluated, both anatomically and functionally. Anatomic improvement was recorded by measuring the CE angle of Wiberg. Preoperatively, it ranged from -6 to 33 degrees (16.1±10.2 degrees), and at the end of treatment, it ranged from 15 to 68 degrees (43.1±11.1 degrees) - the difference proved to be highly significant (Student test t=-14.27, p<0.01). Functional improvement (absence of waddling gait or limp as well as better range of motion) was noted in almost all cases, although the difference was not statistically significant. In addition, the authors presented some very rare complications - asymptomatic pubic and/or ischial nonunion in seven patients

Ewing sarcoma: Analysis of epidemiological parameters and their relation to clinical characteristics

The purpose of this investigation was to evaluate epidemiologic features of Ewing sarcoma in children treated in the Institute for Orthopedic Surgery "Banjica", as well as to establish relation of these features to clinical findings. Study involved 78 patients treated over 20-year period (1980-2000). Analysis included standard epidemiologic data (age, sex, tumor localization) and diagnostic clinical features on presentation (major symptoms, time elapsed between presentation and diagnosis, presence of metastases). Most of the patients were in the age group of 15-18 years (50.0%), predominantly males. In general, the results of our study were consistent with data reported in literature. Nevertheless, this investigation revealed slightly higher incidence in patients younger than four years of age (5.1%); localization on the upper extremity was found to be more frequent (upper to lower extremity ratio was nearly 3:1 in our study), and the time lost between presentation and diagnosis was markedly reduced (average time elapsed between presentation and diagnosis was 2.5 months). The results of our study may improve efficiency and success of treatment, thus providing the basis of better prognosis in management of such a serious illness

Ewing’s sarcoma in children: Prognosis in relation to the method of treatment

Ewing’s tumor of bone is the second primary malignant bone tumor. Localized lesion is found in nearly 80% of cases and metastatic lesions are present in 20% at the time of diagnosis. Treatment protocols were analyzed, prognostic parameters were evaluated, and overall survival as well as survival until relapse of disease was studied. Prognostic features included age and sex, localization of tumor, type of applied surgical resection and treatment protocol, and presence of necrosis after neoadjuvant therapy as well as morphological characteristics of the tumor. Wide surgical resection (χ2=7.855; p<0.05), and tumor necrosis (χ2=7.855; p<0.05) were verified to be significant parameters for the outcome. Multimodal chemotherapy with local radiation and/or surgical resection is the best mode of modern treatment. Follow-up included the period from the completion of therapy to final control, with remission period defined by development of recurrence or metastatic lesions. Localization on distal parts of the extremities and axial skeleton is good prognostic feature, while localization on proximal parts of the extremities and pelvic girdle, presence of metastatic disease and low index of postchemotherapeutic necrosis, are associated with poor outcome. In Ewing’s sarcoma, prognosis of good outcome is definitely very delicate process

Spinal localization of Paget disease: Case report

INTRODUCTION Paget disease, localized on thoracal vertebrae, presents a significant challenge in diagnostics and treatment. Presenting with progressive neurological symptoms, it has a broad differential diagnostic spectrum and requires additional radiological, neurological and endocrinological evaluation. Besides drug therapy, an operative decompression of nerve elements is performed when indicated. CASE OUTLINE We present a case of an older male patient complaining of chronic progressive pain localized at fourth and fifth thoracal vertebrae, with slight but progressive hypertonus and hyperreflection of leg muscles, including no plantar response. Vertebral biopsy indicated parathyreoid disturbance, excluded by further endocrinological analyses. At that point a corporectomy of fourth and fifth vertebrae and titanium cage spondylodesis of adjacent levels was performed, with pathological findings suggesting Paget disease. Postoperatively, there was initial significant neurological improvement; unfortunately, 2.5 years after the operation a relapse of the disease developed with gibbus deformity. Further treatment was surgical in two stages (first by decompression, and later by broad laminectomy), resulting in partial neurological recovery. CONCLUSION Spinal localization of Paget disease as a monoostotic form must be considered in all cases of progressive neurological impairment accompanied by biochemical disturbances in blood and urine, and with radiologically evident deformity, pathological fracture or neoplastic destruction of vertebra. A combination of medicamentous and surgical treatment should significantly improve neurological condition

Impact of triple pelvic osteotomy on contact stress pressure distribution in the hip joint

We studied changes of contact stress distribution in the hip joint after Tonnis triple pelvic osteotomy applied in the treatment of dysplasia and hip joint incongruence in adolescents. In a group of 75 patients, 54 (72 %) female, who underwent surgery by triple pelvic osteotomy in adolescence for developmental disorder of the hip and avascular necrosis of the femoral head, a three-dimensional hip joint model was used based on the radiography of the pelvis with hips. The following biomechanical parameters were calculated: resultant hip force normalised to body weight (R/Wb), inclination of the resultant hip force (theta-R), the position of the stress pole (theta), peak contact hip stress (Pmax), and peak contact hip stress normalised to body weight (Pmax/Wb). Gait quality was also assessed. After surgery the Wiberg CE angle was increased by 17.85A degrees (114 %), resultant hip force normalised to body weight (R/Wb) was decreased by 0.107 (3.3 %), the position of the stress pole was shifted medially by 27.59A degrees (63.5 %), and peak contact hip stress normalised to body weight (Pmax/Wb) was decreased by 2249.74 (55.9 %). Waddling gait was reduced from 17 (23.9 %) to four cases (5.6 %). All changes were statistically highly significant (p lt 0.01). The effect of Tonnis triple pelvic osteotomy lies in the improvement of stress distribution across the acetabular cartilage of the hip joint, thus slowing down the degenerative damage of the hip joint

Functional movement screen proficiency of adolescent female volleyball players

Assessments and testing of young athletes often exclude the fundamental and functional movement capacity, which are critical for healthy motor development of adolescents. The aim of this study was to evaluate functional capacity of young female volleyball players and determine if participation in volleyball leads to development of movement dysfunctions. Two-hundred fifty-eight (258) adolescent female volleyball players (14.3 ± 1.7 yrs) underwent the functional movement screen. Person correlation showed no significant relationship between functional tests and playing experience, while age showed significant, but weak relationship with total functional score (r = 0.189; p < 0.005). Overall, 44% of participants scored less than 14. Paired sample t-tests show significant bilateral asymmetries in hurdle step, in-line lunge, and shoulder mobility tests. Functional movement screen was useful in identifying functional limitations and asymmetries in young female athletes. However, as neither age nor playing experience were strongly associated with functional score, more attention should be given to the qualitative movement assessment of individual tests, rather than the composite score