Symptoms and General Pathology

All Conditions

Neoplasms

Skin and Connective Tissue Diseases

Musculoskeletal Diseases

Nervous System Diseases

Rare Diseases

Syndrome

Breast Neoplasms

Ganglion Cysts

Pain

Shoulder Pain

Synovial Cyst

Breast Diseases

Skin Diseases

Arthralgia

Joint Diseases

Neurologic Manifestations

Chronic Graft Versus Host Disease

Central Nervous System Depressants

All Drugs and Chemicals

Analgesics

Bupivacaine

Ketamine

Anesthetics

Anesthetics, Local

Anesthetics, Dissociative

Anesthetics, Intravenous

Anesthetics, General

Excitatory Amino Acid Antagonists

Neurotransmitter Agents

patients were subjected to ultrasound guided SGB using 1 ml ketamine in a dose of 0.5mg/kg plus 5ml bupivacaine 0.5% in total volume 10 ml

patients were subjected to ultrasound guided SGB using 1 ml ketamine in a dose of 0.5mg/kg plus 5ml bupivacaine 0.5% in total volume 10 ml plus posterior approach shoulder injection with PRP.

combined platelet rich plasma and 1 ml ketamine in a dose of o.5 ml/kg plus 5ml bupivacaine 0.5% in a total volume 10 ml

Platelet rich plasma

1 ml ketamine in a dose of o.5 ml/kg plus 5ml bupivacaine 0.5% in a total volume 10 ml

ketamine and bupivacaine injection

Mohamed Tahan, MD

Background and Purpose: Adhesive capsulitis of the shoulder is commonly found in patients after breast cancer treatment. We aimed to determine the effectiveness of combined shoulder joint intra-articular injection of platelet rich plasma (PRP) with stellate ganglion block (SGB) with ketamine \&bupivacaine injection as a new technique for frozen shoulder (FS) management after mastectomy.

Methods: Sixty four patients with chronic post-mastectomy shoulder pain and stiffness were randomly allocated into one of two groups: group A; ultrasound guided SGB (1 ml ketamine in a dose of 0.5mg/kg plus 5ml bupivacaine 0.5% in total volume 10 ml) and group B; ultrasound guided SGB plus posterior approach shoulder injection with PRP. Visual analogue score (VAS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded.

Introduction:

Pain after breast surgery is a significant complication and can persist for several months up to years.The most common sites for pain localization are the axilla, medial upper arm and or lateral / anterior chest wall. Pain can be severe enough to cause long-term disabilities leading to shoulder adhesive capsulitis (frozen shoulder) or complex regional pain syndrome. Of course, this could also interfere with daily activities and sleep leading to negative influence on the quality of life of the affected women. Scar formation, protective posture and tension of the soft tissue after surgery can also cause alteration of the shoulder girdle alignment and immobility.

Adhesive capsulitis of the shoulder is commonly found in breast cancer patients with a prevalence can be as high as 86%.Adhesive capsulitis of the shoulder joint is one of the main producers of Post-mastectomy chronic shoulder pain syndrome , the shoulder joint becomes tight due to capsular inflammation resulting in painful and global ROM restriction. Frozen shoulder management has focused around prolonged courses of physiotherapy to maintain shoulder mobility. Corticosteroids and anti-inflammatory medications are also considered as adjuvant therapies in reducing pain and inflammation.

The stellate ganglion is a nerve bundle related to the sympathetic nervous system providing sensation to the upper body. It is present on either side of the trachea at the 7th cervical vertebrae. The stellate ganglion has second and third order neurons that modulate neuropathic pain to the central nervous system and body temperature. The stellate ganglion block (SGB) is mainly indicated for management of chronic neuropathic painful disorders of the head and neck, upper limb, and upper chest by reducing levels of nerve growth factor leading to a decrease in norepinephrine level that plays a fundamental role in pain transmission in these cases. Ketamine enhances the effect of sympathetic blockade with relief of pain, ischaemia and maintains circulation. And so, ketamine is a useful adjuvant to STGB and it clarify the need of permanent destruction of the ganglion by chemical/ radiofrequency neurolysis in patients with peripheral vascular disease.

Recently, platelet-rich plasma (PRP) have been used in treatment of many soft tissue disorders with positive results being rich in several growth factors and other cytokines that can stimulate healing of soft tissues and joints.

In current study, we aimed to clarify the effectiveness of combined intra-articular PRP injection in shoulder joint with SGB over SGB alone in the challenge of management of post-mastectomy chronic shoulder pain.

Patients and methods:

Study design and participants Our study was a randomized controlled double-blind trial conducted in Anesthesia Department of Medical Faculty and Pain Clinics of Mansoura Oncology Center, Egypt during the period from August 2017 till April 2018. The study was accepted by Institutional Research Board of Mansoura University (Code No: R∕ 17.08.44) and followed the 2008 Helsinki declaration ethical standards.

Seventy patients were assessed for eligibility. Six patients were excluded from the study (four did not meet the inclusion criteria and two declined to participate in the study) (Figure 1). Sixty four patients were included with age of 18 to less than 65 ys who showed post-mastectomy shoulder pain.

Exclusion criteria were patient refusal to participate, Patients with acute shoulder pain (trauma, acute postsurgical pain), secondary adhesive capsulitis (prior surgery or non-surgically induced states of shoulder affection by adhesive capsulitis), hypersensitivity to amide local anesthetics, general contraindications to SGB and cardiac and hepatic, renal or respiratory failure. Written informed consents were obtained from individual participants included in the study.

Sample size It was assessed using G-power analysis. Assuming α (type I error) = 0.05 and β (type II error) = 0.2 (power = 80 %) yielded a total sample size of 70.

Randomization Each patient was assigned in a double-blinded manner to one of two groups. Group A (n=32) patients were subjected to ultrasound guided SGB using 1 ml ketamine in a dose of 0.5mg/kg plus 5ml bupivacaine 0.5% in total volume 10 ml.\[9\] While group B (n=32) patients were subjected to ultrasound guided SGB using ketamine and bupivacaine in the same dose as group A plus posterior approach shoulder injection with PRP.

An individual not involved in the patient care or data collection randomly assigned the patients using Research Randomizer program into two blocks; each of block size 32 was also randomized using two lists of random numbers. Investigators were not allowed to know randomization codes and block size until all calculations and measurements had been entered into the database for all patients. All medical caregivers, investigators and patients were blinded to group allocation. One hour before the injection procedure of an enrolled patient, a nurse (not otherwise participating in the study) opened a sealed opaque envelope containing group allocation, and then filled the assigned drug injection for each patient according to the protocol of randomization. All data were entered in the database before entering the codes of randomization. The principles for intention-to-treat analysis were followed.

Level of evidence:

Level IV, clinical study

Technique Management and Equipment:

All suitable resuscitation drugs (eg. atropine and adrenaline) and equipment's were available including lipid emulsion for local anesthetic toxicity, endotracheal tubes of different sizes, ambo bag, and ventilator. Under strict aseptic technique for place, patients, and instruments, the different blocks technique done in the operative theater with IV access in place, O2 Mask 6L/minute, and full basic monitoring (Noninvasive Blood Pressure Amplifier, pulse oximeter, and ECG) attached, then all patients in this study were monitored throughout the procedure and up to one hour after the block performance.

Stellate ganglion block technique The anterior para-tracheal approach C6 was done. The patient's neck was extended using a pillow under the shoulder while lying in a supine position aiming to keep the esophagus and the transverse process away from each other. Also the patient was asked to open mouth slightly to make the neck muscles more relaxed. Under complete aseptic technique, a linear probe (5-10 MHz) of Siemens Acuson P300 ultrasound machine was initially placed at the cricoid cartilage level. The location of C6 transverse process was determined by the prominent anterior tubercle (Chassaignac's tubercle). Placement of the ultrasound transducer helped to retract the sternocleidomastoid muscle and carotid sheath laterally and the pressure applied by the transducer reduced the distance between the tubercle and skin and to depress the lung dome to avoid occurrence of pneumothorax. A typical sonographic appearance at the C6 level included the anterior tubercle and transverse process of C6, longus capitis muscle, longus colli muscle (LC), carotid artery, and thyroid gland. We inserted a 22-gauge needle and directed towards to the Chassaignac's tubercle then redirected infero-medially towards the body of C6 until reach out of LC muscle while still staying within the prevertebral fascia (figure 2). After negative aspiration for blood and cerebrospinal fluid, ultrasound guided injection of 1 ml ketamine in a dose of 0.5mg/kg plus 5ml bupivacaine 0.5% in total volume 10 ml 10ml volume was used before in a previous study, and was injected in divided doses (injectate volume of 10 ml used to ensure full ganglion blocked and effective spread of the anesthetic agents at the area of the lower cervical sympathetic chain) (figure 3). The solution was allowed to pass caudally toward the stellate ganglion by raising the head of the patient's bed. We confirmed the success of block by the development of Horner's syndrome at side of injection which included ptosis, myosis, facial anhydrosis, enophthalmos and nasal congestion.

Regulations for PRP Preparation:

At the time of treatment, PRP was obtained from a sample of patient's blood. Thirty ml venous blood was drawn to yield 3-5 cc of PRP. Citrate dextrose A (an anticoagulant) was added to prevent platelet activation prior to its use. Preparation of PRP was done by double centrifugation process; an initial centrifugation to separate red blood cells followed by a second centrifugation to concentrate platelets. The whole blood was initially collected in tubes containing anticoagulants. At the initial centrifugation step, whole blood separates into three layers: an upper layer that contains white blood cells and platelets, an intermediate thin layer (buffy coat layer) that is rich in white blood cells, and a bottom layer that consists mostly of red blood cells. For PRP production, both superficial buffy coat and upper layers were transferred to an empty sterile tube. Then the second centrifugation step was done and should be adequate to help in soft pellets formation (erythrocyte platelets) at the bottom of the tube. We removed the upper portion of the volume (platelet-poor plasma). Pellets were homogenized in lower third (5 ml of plasma) to produce PRP.

Posterior approach shoulder injection techniques:

The patient was placed in either the lateral decubitus or sitting position with the ipsilateral hand placed on the contralateral shoulder. The ultrasound probe (frequency 6-13 MHz) was placed just caudal to the acromion over the infraspinatus tendon. The important anatomical points to identify were humeral head, infraspinatus tendon, labrum, and joint capsule. The posterior approach target was between the cartilage of humeral head underneath the capsule and the free edge of labrum. Once the target was obtained, we inserted a 22 gauge needle from lateral to medial direction with in-plane technique (figure 3) then injected PRP.

The two groups were asked to do some stretching exercises at home as finger walk, cross body reach and outward and inward rotations. The patients were explained how to do these exercises and warm up the shoulder before performing the exercises by moist heating pad for 10-15 minutes.

Outcome Variables Primary outcome: Visual analogue score (VAS) was done at rest and at shoulder movement before injection, one, two and three months after injection. VAS was explained to the patients during assessment as 0 equal no pain and 10 equal worst imaginable pain. Shoulder mobility was assessed while the patient was sitting using goniometry. Secondary outcome: 1-ROM was measured in degrees in five position (extension, flexion, and abduction, internal and external rotation) before and one month after injection. 2-Disability of arm, shoulder and hand (DASH) questionnaire was done before injection, one, two and three months after injection.

Statistical analysis:

The collected data were analyzed using Statistical Package of Social Science (SPSS) program for windows (version 16) and Medcalc program. Quantitative parametric data were presented in means and standard deviations (SD) while non-parametric data were presented in median and range. On testing significance of parametric quantitative data, t-test and ANOVA test were used where the later followed by post hoc test. On testing significance of non-parametric data, Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test were used where the later followed by post hoc test. Statistically significant results were considered if p value \< 0.05. If p values \< 0.001, results were considered highly statistically significant.

Investigators were not allowed to know randomization codes and block size until all calculations and measurements had been entered into the database for all patients. All medical caregivers, investigators and patients were blinded to group allocation. One hour before the injection procedure of an enrolled patient, a nurse (not otherwise participating in the study) opened a sealed opaque envelope containing group allocation, and then filled the assigned drug injection for each patient according to the protocol of randomization.

Combined Intra-articular Shoulder Injection and Stellate Ganglion Block in Chronic Post-mastectomy Shoulder Pain

Combined Platelet Rich Plasma Intra-articular Shoulder Injection and Stellate Ganglion Block. A New Technique for Management of Chronic Post-mastectomy Shoulder Pain Syndrome

Visual analogue score (VAS) was done at rest and at shoulder movement before injection, one, two and three months after injection. VAS was explained to the patients during assessment as 0 equal no pain and 10 equal worst imaginable pain. Shoulder mobility was assessed while the patient was sitting using goniometry.

It was measured in degrees in five position (extension, flexion, and abduction, internal and external rotation) before and one month after injection.

shoulder and hand (DASH) questionnaire was done before injection, one, two and three months after injection.

Mansoura University

Principal investigator

Digestive System Diseases

Behaviors and Mental Disorders

Fecal Incontinence

Rectal Diseases

Intestinal Diseases

Gastrointestinal Diseases

Quality of Life

Anticoagulants

PRP is prepared using a special device (VS-400, Genesis Comp, Korea). For each application a kit (e+ PRP, Genesis Comp, Korea) will be used. 18 cc of venous blood will be collected from the patient into the syringe with 2 cc of anticoagulant, and will be gently inverted. The sample will be slowly injected into the e+ PRP kit. The kit will be centrifuged under 1,500G for 4 minutes, which will separate the blood components into 3 different layers. The rot at the top of the kit will be pressed until the bottom of the piston will touch the red blood cell layer, and the rot will be turned clockwise to close it. The cap will be opened and the small syringe will be connected to the cap for extracting PRP. The injection will be performed in operation room under general anesthesia with either IV sedation of laryngeal mask airway (LMA) sedation. 10 cc of PRP will be directly injected in external muscles at 8 locations under the guidance of endoanal ultrasound

PRP injection into tha anal canal in patients underwent low anterior resection for rectal cancer

Platelet Rich Plasma

Mustafa C Haksal

Mustafa C Haksal, MD

Mustafa Oncel, Prof

The treatment of fecal incontinence after low anterior resection is problematic, and not always able to increase quality of life. Biofeedback and rehabilitation therapies are harmless and easy to use; thus, generally selected as the initial treatment modalities, however may be effective in a small portion of patients. More complex treatment techniques including sacral nerve stimulation decrease the severity of symptoms, however the implantation of the device is a costly, staged procedure. Little is known about the effectiveness of other techniques such as injectable substances on incontinence observed after low anterior resection. There is no study evaluating the safety and effectiveness of platelet rich plasma (PRP) injection for incontinent patients after low anterior resection.

Rectal cancer is a common problem worldwide and the standard potentially curative treatment for locally advanced disease includes radical surgery appreciating oncological principals. Sphincter-saving procedures have been practiced in order to prevent a permanent stoma; however, patients underwent low anterior resection may suffer from several problems including incontinence particularly if the initial tumor is located too close to the anal canal. The actual frequency of incontinence is still unknown because of wide variation rates in several reports ranging between 0 to 80%; and may be a long-term problem since a series has presented an incidence of 36% 10 years after surgery.

Several mechanisms may cause incontinence after low anterior resection, thus several therapeutic instruments have been described considering the underlying reason. The most reasonable suspect is probably an injury to the sphincters at the time of surgery or secondary to preoperative radiation therapy, which is a commonly used modality in order to reduce local recurrence and increase the possibility of sphincter-saving procedures with the shrinkage of the tumor. Surgery and/or (chemo)radiation may not only generate sphincter injury, but also cause nerve damage and consequent denervation of the sphincters. Internal sphincters are responsible for resting pressure. Incontinence is more often and obvious if an intersphincteric resection with a hand-sewn coloanal anastomosis is attempted, since this procedure indicates the removal of internal sphincters. Several studies have revealed that up to 20% of patients have internal sphincter injuries after low anterior resection proven with endoanal ultrasound or manometer; and diminution in size of sphincters and decrease in resting pressure are correlated with incontinence grade. Mechanical anal sphincter injury may occur during the insertion of stapler; thus, incontinence may also be observed in patients with more proximally located tumors. The effect of radiation therapy on sphincter functions is also well-known, and a prospective randomized trial has shown that radiotherapy is significantly increasing incontinence rate. Another mechanism in incontinence may be related to the reduction of the capacity of neorectum, since descending colon, which is the reconstructing organ in most cases is narrower than rectum itself. Several reservoir techniques including coloplasty, colonic j-pouch and side-to-end anastomosis have been described in order to increase pooling volume of neorectum. Some other factors including decrease in sensitivity of anal canal and anal transitional zone, alteration in rectoanal inhibitory reflex, motility dysfunction of neorectum and incomplete evacuation may separately cause incontinence or increase the severity of symptoms. Instead of a sole origin, a combination of several reasons may be present at the same time making the problem more complex and the solution tougher. The treatment of incontinence is problematic, and not always able to increase quality of life. Biofeedback and rehabilitation therapies are harmless and easy to use; thus, generally selected as the initial treatment modalities, however may be effective in a small portion of patients. More complex treatment techniques including sacral nerve stimulation decrease the severity of symptoms, however the implantation of the device is a costly, staged procedure. Little is known about the effectiveness of other techniques such as injectable substances on incontinence observed after low anterior resection. Some patients may require fecal diversion in order to achieve a better quality of life.

Platelet Rich Plasma (PRP) is a thrombocyte enriched liquid, and it increases cell proliferation and collagen formation where it is injected. Platelets activate some growth factors, cytokines and other bioactive mediators, and consequently initiate and regulate wound-healing period. PRP has been used in several chronic diseases for initiating and fastening the reconstruction phase, particularly for the tendon, muscle, ligament and articular system related injuries and inflammatory situations. The effects of PRP on symptoms and healing rate in patients with lateral epicondylitis and its superiority over bupivacaine or steroid injections have been shown in cohort and prospective randomized trials. PRP is also tested for the treatment of perianal fistula. When PRP injection is combined with mucosal advancement flap procedure, it has been shown to decrease the recurrence rate. In an animal model, PRP injection into the gastrocnemius muscle has shown to increase the strength of the muscle healing. Although it has a potential, -to the best to our knowledge- there is no study evaluating the safety and effectiveness of PRP injection for incontinent patients after low anterior resection.

Methods:

This project is a single arm, cohort study evaluating the safety and effectiveness of PRP injection into the anal sphincter on incontinence and related quality of life in incontinent patients after low anterior resection for rectal cancer. All participating patients will be informed about the protocol and PRP application, and informed consent will be obtained. The study will be run at Department of General Surgery at Istanbul Medipol University Medical School (IMU) and be completed in 24 months. Local Ethical Committee has approved the protocol (protocol number: 66291034-29) and The Scientific and Technological Research Council of Turkey (TUBITAK) has granted the study (project number: 117s133). First patient accrual is planned to happen before August 2019. For the first year, only the patients who had their previous cancer operation at IMU will be included to the study, but in case of a shortage in number of patients by the end of August 2020, the inclusion of the patients who had their initial surgeries in other institutions will be permitted.

Local Ethical Committee and governors of TUBITAK will be free to monitor the trial progress at any time. Actual status of the study will be reported to TUBITAK for observation and for the continuity of grant imbursements annually (twice during the study period) and after the finalization of data analysis and publishing. Interim analysis will not be stated, since the design has not been classified as high risk.

The injection will be performed in operation room under general anesthesia with either IV sedation of laryngeal mask airway (LMA) sedation. In case a perfect relaxation will not be achieved, then the patient will be intubated. The patient will be positioned as gynecological position. 10 cc of PRP will be directly injected in external muscles at 8 locations under the guidance of endoanal ultrasound. The final condition of the sphincters will be pictured with the device. The same surgeon (MCH) will perform all procedures. No antibiotics will be used. Local anesthetics will not be injected. If the patient will feel pain after the operation, he/she will be free to use oral painkillers. The patient will be discharged from the hospital on the same night or the day after according to the patient's desire. Patients will be questioned for possible PRP complications during the hospitalization period, and they will be asked to report anytime during the study period.

PRP Injection Into Anal Sphincters for Fecal Incontinence

The Effect of Platelet Rich Plasma Injection Into the Anal Sphincters on Fecal Incontinence and Quality of Life in Incontinent Patients Had Treated With Low Anterior Resection for Rectal Cancer

all IPD that underlie results in a publication

This scoring system cross-tabulates frequencies and different anal incontinence presentations (Gas/Liquid/Solid/Pad use/Need for lifestyle alterations) and sums the returned score to a total of 0-20 (where 0 = perfect continence and 20 = complete incontinence). Each of the incontinence presentations is graded equally.

analyzes different incontinence situations (solid, liquid, gas) and frequencies. Lifestyle alteration, need to wear a pad, taking constipating medicaiton and Lack of ability to defer defecation for 15 minutes. Minimum score is 0 = perfect continence; maximum score is 24 = totally incontinent.

The Pescatori AI score is a grading system that combines both degree of incontinence (flatus-mucus/liquid stool/solid stool) with frequency. Incontinence ratings of A, B and C indicate AI for flatus/mucus, liquid stool, and solid stool, respectively; frequency scores of 1, 2 and 3 indicate occasional, weekly, and daily AI. A score of zero is given for normal continence. The combined score is the sum of the degree and the frequency. The minimum score is 0 and the maximum score is 6

a disease-specific tool, was designed to evaluate the impact of FI on four aspects of patients' QOL: lifestyle; coping behavior; depression or self perception; and level of embarrassment. The scale is composed of a total of 29 items; these items form four scales: Lifestyle (10 items), Coping/Behavior (9 items), Depression/Self-Perception (7 items), and Embarrassment (3 items).Each aspect is described as a score measured on a scale between 1 and 4, where 1 is very affected and 4 is not affected

The SF-36 has eight scaled scores; the scores are weighted sums of the questions in each section. Scores range from 0 - 100 Lower scores = more disability, higher scores = less disability Sections: Vitality, Physical functioning, Bodily pain, General health perceptions, Physical role functioning, Emotional role functioning, Social role functioning, Mental health

Istanbul Medipol University Hospital

Atrophy

Pathological Conditions, Anatomical

Menopause

Hyaluronic Acid

Mitogens

Adjuvants, Immunologic

Immunologic Factors

Viscosupplements

Protective Agents

15 female patients will receive 2 vaginal PRP injections one month apart.

15 female patients will receive 2 vaginal PRP-non-cross-linked HA injections spaced a month apart.

15 female patients will receive topical non-cross-linked hyaluronic acid gel applied every three days for 2 months as a control group

PRP can be considered a concentrate of autologous platelet-derived growth factors with known efficacy in tissue regeneration and wound healing.

HA filling is a known modality for rejuvenation

non cross-linked hyaluronic acid

the standard treatment of vaginal atrophy and dryness

topical HA gel

Salma Omar, MD

The goal of this clinical trial is to:

1. evaluate the efficacy of PRP injection and PRP injection mixed with non-cross-linked hyaluronic acid compared to the control group receiving standard therapy with topical non-cross-linked hyaluronic acid gel in the treatment of cancer therapy-induced or worsened vulvovaginal atrophy.
2. To evaluate the impact of vulvovaginal atrophy treatment on the sexual satisfaction of both partners.

Patients will be divided randomly into 3 groups:

Group 1: 15 female patients will receive vaginal PRP injections. Group 2: 15 female patients will receive vaginal PRP injections combined with non-cross-linked hyaluronic acid.

Group 3: 15 female patients will receive topical non-cross-linked hyaluronic acid gel as a control group.

1. The first group will receive two treatment of sub-mucosal PRP injection at the outer 3 cm of the vagina with one month interval in between. (17)
2. The second group will receive two treatment of PRP injection mixed with non-cross linked hyaluronic acid at the outer 3 cm of the vagina with one month interval in between.

9. 3-The third group will receive one applicator (5gm) three times per week of topical hyaluronic acid gel for vaginal application which will be prepared in the faculty of pharmacy for 2 months.

Clinical assessment Patients will be assessed for symptoms and signs of vulvovaginal atrophy (VVA) at baseline, one month, two months, and, three months after the end of treatment.

1. Vulvovaginal atrophy (VVA) symptoms (dryness, dyspareunia) will be assessed on a subjective 10-point scale.

   Also, patient satisfaction with each type of treatment will be assessed with a questionnaire at the end of treatment and they will be asked if they wish to repeat the treatment to maintain effectiveness over time (yes or No).
2. For assessment of VVA signs on physical examination, vaginal health index including assessment of pH, overall elasticity, epithelial mucosa, fluid secretion type, and consistency and moisture will be used as an objective method of evaluation of therapy.
3. Assessment of sexual satisfaction of both male and female partners:

Sexual satisfaction was measured using the Arabic version of the Index of Sexual Satisfaction (ISS) and female sexual function index (FSFI) questionnaire.

Management of Cancer Therapy Related Vulvovaginal Atrophy

Comparison Between Platelet-rich Plasma (PRP) and Hyaluronic Acid (HA) in the Treatment of Cancer-therapy Related Vulvovaginal Atrophy and Its Impact on Sexual Satisfaction

scores from 0-10 where 0: no symptoms, 1-3: mild symptoms, 4-6: moderate symptoms, 7-10: severe symptoms

scores range from 5-25 with lower scores signifying greater atrophy

Alexandria University

As. Prof

Osteoarthritis

Osteoarthritis, Knee

Necrosis

Arthritis

Rheumatic Diseases

Collagen Diseases

30 patients had moderate knee osteoarthritis

30 patients had severe knee osteoarthritis

The patient was put in 20 degree flexion in supine position with the knee. Under aseptic conditions, a 21-gage needle was used to inject 5 mL of PRP into the suprapatellar knee joint pouch, using a superolateral method. Local anesthetics were not used. Patients were instructed after the injection to refrain from physical exercise for at least 24 hours but no restriction was specified regarding activities of daily living. Three IA-PRP injections were administered at 2-week intervals. The same physician who was engaged in selecting and testing participants did the injections

Intra-articular injection of platelet-rich plasma

Mohammed H Hassan, MD

A prospective study was performed on 90 patients were included and categorized into mild (30 cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular (I.A) injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed using commercially available ELISA assay kits. The assays were performed pre-injection (S1), two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all included patients.

Background: Osteoarthritis (OA) is a multifactorial disease that commonly affects the knee. Tumor necrosis factor-α (TNF-α) is able to regulate inflammation in OA. Macrophage migration inhibitory factor (MIF) may be involved in the pathophysiology of arthritis. Platelet-rich plasma (PRP) may reduce pain associated with OA. The current study aimed to assess the possible therapeutic effects of PRP in patients with knee OA of various severities.

Methods: A prospective study was performed on 90 patients were included and categorized into mild (30 cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular (I.A) injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed using commercially available ELISA assay kits. The assays were performed pre-injection (S1), two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all included patients.

PRP preparation: The PRP needed for IA injection has been prepared under complete aseptic conditions. In order to avoid the effect of food intake on purified PRP, on the day of injection the patients were instructed to fast for 4 hours before blood collection. Approximately 20 mL of venous blood were drawn from the antecubital vein using an aseptic technique in an effort to avoid irritation and trauma to the platelets. Anti-coagulated blood was obtained in ten extraction tubes (2 mL each), containing sodium citrate. The tubes were then centrifuged at 2100 rpm at room temperature for 8 minutes to separate the blood in each tube into the citrated plasma, the buffy coat and the residual red blood cells ( RBCs) . Using a pipette, the PRP situated just above the selectively precipitated RBCs but not including the buffy coat was carefully aspirated from each tube. In each affected joint, 10-mL PRP samples (from the collected venous blood) were used for IA injection . For each intra-articular injection new fresh PRP samples were made from the patients.

Platelet-rich Plasma and Synovial Cytokines in Knee Osteoarthritis

Assessments of Therapeutic Effects of Platelet-rich Plasma in Knee Osteoarthritis: Possible Role of Inflammatory Cytokines

Using Visual Analog Scale (VAS) score to assess the pain score in patients with knee osteoarthritis will be done twice , pre-intra-articular injection of PRP and 2 weeks from the second I.A injection of PRP.

The VAS is a common tool that uses a 10 cm scale for pain intensity measurement, where 0= no pain and 10= unable to move.

Using ELISA assay kits, synovial fluid concentration of both TNF-α and MIF levels will be measured three times for the same patient (before injection, 2 weeks from the first injection and 2 weeks from the second injection) to explore the serial changes in their levels following IA i injection PRP.

Regarding MRI knee score will be done twice , pre-intra-articular injection of PRP and 2 weeks from the second I.A injection of PRP.

For assessment of both bone marrow abnormality or patella-femoral cartilage volume (grade I (mild if the lesion involves ˂33% of subregional volume); grade II (Moderate: if the lesion involves 33%- 66% of subregional volume), and grade III (severe: if the lesion involves ˃ 66% of subregional volume).Regarding synovitis: grade 1 (mild or small - fluid continuous in the retropatellar space); grade 2 (Moderate or medium - slight convexity of the suprapatellar bursa), and grade 3 (severe or large - evidence of capsular distension ). Meniscal desintegrity score of 0-3 applied for amount of extrusion in 4 locations: medial meniscus (medial and anterior extrusion) and lateral meniscus (medial and anterior extrusion).

Correlate visual Analog pain Scale and MRI Osteoarthritis Knee Score with the pre-injection cytokine synovial levels and synovial level values 2 weeks from the second IA injection of PRP

South Valley University

Associate Professor of Medical Biochemistry, Faculty of Medicine , South Valley University

Wounds and Injuries

Respiratory Tract (Lung and Bronchial) Diseases

Ear, Nose, and Throat Diseases

Pilonidal Sinus

Paranasal Sinus Diseases

Cysts

In this group we applied Platelet rich plasma after the surgery. The surgery was fistulotomy and curettage.

In this group, we did the surgery as fistulotomy and curettage but we did not apply a Platelet rich plasma.

After application of platelet rich plasma after surgery, the patients have examined for infection, hematoma, pain, recurrence and the time of epithelialization of the wound.

Our study was planned as a prospective controlled randomized study. The study was started after the ethics committee approval received from Dışkapı Yıldırım Beyazıt Training and Research Hospital. (23.08.2021 118/01). Two groups of patients were planned in parallel. In the treatment of pilonidal sinus disease, in patients operated on with the fistulotomy and curettage technique, one group was followed up with classical dressing, while the other group was followed up with PRP (platelet-rich-plasma) and classical dressing. Wound infection, hematoma, length of hospital stay, recurrence, pain in the first postoperative week, and time to complete epithelialization of the wound (in days) were evaluated between the two groups.

Our study was planned as a prospective controlled randomized study. The study was started after the ethics committee approval received from Dışkapı Yıldırım Beyazıt Training and Research Hospital. (23.08.2021 118/01). Two groups of patients were planned in parallel. In the treatment of pilonidal sinus disease, in patients operated on with the fistulotomy and curettage technique, one group was followed up with classical dressing, while the other group was followed up with PRP (platelet-rich-plasma) and classical dressing. Wound infection, hematoma, length of hospital stay, recurrence, pain in the first postoperative week, and time to complete epithelialization of the wound (in days) were evaluated between the two groups.

A total of 140 patients, male and female, diagnosed with pilonidal sinus disease in our hospital between November 2021 and November 2022 were included in the study. Patients with acute pilonidal sinus abscess were excluded from the study, but chronic PS(pilonidal sinus) patients who had previously undergone abscess drainage were included in the study.

Patients under 18 years of age, relapsed patients, anemic patients (Hg \< 10 mg/dl), thrombocytopenic patients (Plt˂10⁶/ml), patients with a history of radiotherapy-chemotherapy, patients with diabetes and patients using steroids were excluded from the study.

Randomization was performed using the PASS computer program, and according to this randomization, fistulotomy and curettage technique (n=70) was applied to one group and fistulotomy and curettage + PRP (n=70) was applied to the other group.

Demographic information, family history, smoking, presence of abscess drainage, post-drainage antibiotic use, comorbidities, BMI, symptom duration, phenol application, laser epilation, number of sinus pits, presence of secondary orifice, basal PLT(platelet) count, size of the defect after sinus excision, wound infection, hematoma, length of hospital stay, presence of recurrence, pain in the first postoperative week, and time to complete epithelialization were evaluated.

Effect of Platelet Rich Plasma (PRP) on Healing Time in Patients Following Pilonidal Sinus Surgery

The Effect Of Prp (Platelet-Rıch-Plasma) Application On Wound Healing In The Treatment Of Pilonidal Sinus Disease Using Unroofing And Curettage Technique

After the application of PRP the patients examined at the postoperative 2-4-6-10-15-20-25-30-35-40-45-50-55 days for the wound closure. The day of total epithelialization was noted.

Pain intensity of patients measured by Visual analogue scale (VAS) score. 0 represents "no pain" and 10 "pain as bad as it could possibly be"

Recurrence of the pilonidal disease of the patient is presence of pits in the previous surgical area and also presence a tender mass or sinus draining mucoid, purulent, and/or bloody fluid

İsmail Oskay Kaya

proffesor

Nose Diseases

Respiratory Tract Diseases

Otorhinolaryngologic Diseases

Anti-Arrhythmia Agents

Channel Blockers

Anti-Infective Agents

Vasoconstrictor Agents

Respiratory System Agents

Blood Substitutes

Pharmaceutical Solutions

Micronutrients

Other Dietary Supplements

Lidocaine

Anti-Bacterial Agents

Epinephrine

Antibiotics, Antitubercular

Povidone-Iodine

Povidone

Phenol

Racepinephrine

Epinephryl borate

Benzocaine

Iodine

Cadexomer iodine

Anti-Infective Agents, Local

Disinfectants

Sclerosing Solutions

Tannic Acid

Crystallized phenol group: The patients will undergo to crystallized phenol application.

Crystallized phenol + platelet rich plasma group. Alongside the crystallized phenol application + patients also will receive platelet rich plasma injections in the same session.

At our pilonidal care clinic, patients will undergo a comprehensive treatment regimen starting with manual or laser hair removal to reduce hair by over 90%. For pilonidal abscesses, we will perform incision, drainage, and antibiotic therapy. Treatments will include local anesthesia with lidocaine and epinephrine, thorough disinfection with povidone-iodine, and wound irrigation. Sinuses will be treated by removing hair and curettage, followed by protective ointment application and crystallized phenol to fill the cavity, ensuring precise dosing and safety.

For enhanced healing, crystallized phenol + platelet-rich plasma application patients will receive platelet-rich plasma injections to minimize infection risk and promote tissue regeneration, all under strict sterilization to maintain cleanliness and efficacy.

crystallized phenol + platelet rich plasma application

At our pilonidal care clinic, patients will undergo a comprehensive treatment regimen starting with manual or laser hair removal to reduce hair by over 90%. For pilonidal abscesses, we will perform incision, drainage, and antibiotic therapy. Treatments will include local anesthesia with lidocaine and epinephrine, thorough disinfection with povidone-iodine, and wound irrigation. Sinuses will be treated by removing hair and curettage, followed by protective ointment application and crystallized phenol to fill the cavity, ensuring precise dosing and safety.

crystallized phenol

Mustafa Azizoğlu, MD, PhD

Mustafa Azizoğlu

The use of local liquid phenol for pilonidal sinus disease was first introduced by Maurica and Greenwood in 1964. Phenol, also known as carbolic acid, has been proven to be an effective sclerosing agent for treating pilonidal sinus diseas. Its antiseptic and anesthetic qualities make it suitable for application in awake patients under local anesthesia. The treatment of pilonidal sinus diseas in children with crystallized phenol was first published by Ateş et al in 2018. However, the treatment involving only crystallized phenol can require numerous sessions, potentially extending the duration of the treatment. IIn this study, the investigators, investigated whether the application of platelet-rich plasma following crystallized phenol treatment could accelerate the healing process and reach better outcomes. This study evaluates the efficacy of PRP as a treatment modality for pilonidal sinus disease in pediatric patients.

Upon their arrival at our pilonidal care clinic, patients commenced a regimen of manual shaving of the gluteal cleft either weekly or bi-weekly. Laser epilation therapy was initiated at the earliest opportunity, conducted every 6 to 8 weeks, aiming for a hair reduction of over 90%. For patients presenting with a pilonidal abscess, an initial procedure of incision and drainage was performed, followed by antibiotic therapy. In the outpatient clinic, patients were placed in a prone position, and the area was sterilized with a povidone-iodine solution.

Anaesthesia local: The skin and subcutaneous tissues surrounding the PSD area, including the sinus openings, receive local anesthesia with 5 ml of lidocaine (20 mg/ml) mixed with epinephrine (0.0125 mg/ml).

Zone keeps clean: The area surrounding the PSD is thoroughly disinfected with povidone-iodine solution, covering a minimum area of 20 square centimeters to ensure adequate local disinfection.

Irrigation with isotonic solution: The wound is washed with sterile isotonic solution.

Zero hair (removing hair and curettage): For sinuses measuring ≤ 3 mm in diameter, dilation is performed using a mosquito clamp (BH-109, Aesculap®, Center Valley, PA, USA). Hair within the sinus is removed. After the complete removal of hair from the area, the granulation tissue is then excised through curettage.

Ointment application around the wound: To prevent skin necrosis and burns, a 0.2% nitrofurazone (Furacin® Eczacıbası İlaç San, Istanbul, Turkey) ointment is meticulously applied around the pilonidal sinus area immediately before the CP application, ensuring a protective barrier and enhancing skin safety.

Gravel-like crystallized phenol application: In this instance, the phenol applied is not in liquid form; rather, it is in a solid, gravel-like form. CP (BotaFarma İlaç Medikal İtriyat Kimya San. Tic. Ltd. Şti, Ankara, Turkey) is carefully administered into the cavity via the orifice, with the precise amount required just sufficient to fill the cavity without causing any overflow. This step necessitates meticulous attention to ensure the correct dosage and prevent any potential spillage. Typically, for an average pediatric patient and the size of the defect encountered, an amount ranging from 4 to 6 grams of phenol is deemed adequate to effectively treat the area while minimizing risk.

Local re-disinfection prior to PRP injection: Up to this point, all procedures are identical for both groups. However, the following steps and any subsequent applications are exclusively for Group 2. The area around the pilonidal sinus should be thoroughly disinfected again with povidone-iodine (care should be taken to prevent povidone-iodine from entering the sinus itself). This step is critical because, following this phase, a PRP injection will be administered into the tissue, necessitating that the skin is properly disinfected to minimize the risk of infection.

Undergo PRP injection: In Group 2, patients received a PRP injection during the same session as the CP application. The amount of PRP injected-approximately 1-2 ml, depending on the size of the pilonidal sinus-was administered around the edges and surrounding area of the wound.

The Efficacy of Combining Platelet-rich Plasma With Crystallized Phenol in Pilonidal Sinus Disease

The Efficacy of Combining Platelet-rich Plasma With Crystallized Phenol in Pilonidal Sinus Disease Treatment in Children: A Double-blind Single-center Randomized Controlled Trial

It refers to the time when patients return to their routine lives after the procedure.

Patient visual analog scale (VAS) scores will be assessed both prior to the procedure and again 10 days following the procedure.

It refers to the wound healing time of the patients after the procedure.

All patients will be assessed for cosmetic score after healing. For cosmetic evaluation, observers were asked to assess the scar in comparison to normal skin by answering the question, "What is your overall opinion of the scar compared to normal skin?" They rated the scar on a scale from 1 to 10, where 10 signifies normal skin and 1 represents a very different, worst possible scar.

The succes rate will be calculated after interventions

The recurrence rate will be calculated after interventions

Bleeding during interventions will be calculated

Infection will be defined during interventions and 10 days after intervention

Skin burn during interventions will be calculated

Total complicaitons during interventions will be calculated

Necmi Kadıoğlu Hospital

crystallised phenol will be applied to sinus cavity

crystallised phenol

platelet rich plasma will be applied to sinus cavity

Barış Sevinç, M.D.

Patients with pilonidal sinus disease will be randomised to two groups (crystallised phenol and platelet rich plasma). Sinus healing time, patient satisfaction, complications and recurrence rates will be compared.

Patients with pilonidal sinus disease will be treated by either crystallised phenol or platelet rich plasma application. Treatment results, healing time, postprocedural complications, patient satisfaction and recurrences will be compared.

Minimally Invasive Treatment Methods for Pilonidal Disease

Randomized Prospective Comparison of Crystallized Phenol and Platelet Rich Plasma Applications in Treatment of Pilonidal Sinus Disease

Time to complete closure of the sinus cavity.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Combined Intra-articular Shoulder Injection and Stellate Ganglion Block in Chronic Post-mastectomy Shoulder Pain	NCT03586154	Breast Neoplasm...	Platelet rich p... ketamine and bu...	18 Years - 64 Years	Mansoura University
PRP Injection Into Anal Sphincters for Fecal Incontinence	NCT04063293	Fecal Incontine...	Platelet Rich P...	18 Years - 80 Years	Istanbul Medipol University Hospital
Management of Cancer Therapy Related Vulvovaginal Atrophy	NCT05782920	Genitourinary S...	Platelet rich p... non cross-linke... topical HA gel	- 70 Years	Alexandria University
Platelet-rich Plasma and Synovial Cytokines in Knee Osteoarthritis	NCT04754685	Knee Osteoarthr...	Intra-articular...	25 Years - 65 Years	South Valley University
Effect of Platelet Rich Plasma (PRP) on Healing Time in Patients Following Pilonidal Sinus Surgery	NCT06206330	Pilonidal Disea... Pilonidal Sinus	Platelet rich p...	18 Years - 59 Years	Diskapi Yildirim Beyazit Education and Research Hospital
The Efficacy of Combining Platelet-rich Plasma With Crystallized Phenol in Pilonidal Sinus Disease	NCT06324656	Pilonidal Sinus	crystallized ph... crystallized ph...	1 Day - 18 Years	Necmi Kadıoğlu Hospital
Minimally Invasive Treatment Methods for Pilonidal Disease	NCT03070028	Pilonidal Sinus	crystallised ph... Platelet rich p...	18 Years -	Uşak University
Platelet-rich Plasma and Synovial Cytokines in Knee Osteoarthritis	NCT04754685	Knee Osteoarthr...	Intra-articular...	25 Years - 65 Years	South Valley University
Effect of Platelet Rich Plasma on Healing of Operated Pilonidal Sinus by Open Method	NCT04430413	Pilonidal Disea...	Platelet Rich P...	18 Years - 45 Years	Kafrelsheikh University
PRP in 2ry Spontaneous Pneumothorax	NCT03830645	Pneumothorax Sp...	Platelet Rich P...	18 Years -	Zagazig University
Minimally Invasive Treatment Methods for Pilonidal Disease	NCT03070028	Pilonidal Sinus	crystallised ph... Platelet rich p...	18 Years -	Uşak University

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