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1.
Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial
Garton, A. L. A., Oh, S. E., Müller, A., Avadhani, R., Zhang, C., Merkler, A. E., Awad, I., Hanley, D., Kamel, H., Ziai, W. C., et al
Neurosurgery. 2023
Abstract
BACKGROUND AND OBJECTIVES Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. METHODS We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. RESULTS Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. CONCLUSION Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.
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2.
Clinical effect of minimally invasive aspiration and drainage of intracranial hematoma in the treatment of cerebral hemorrhage
Deng C, Ji Y, Song W, Bi J
Pakistan journal of medical sciences. 2022;38(1):95-99
Abstract
OBJECTIVES To explore the clinical value of minimally invasive aspiration and drainage of intracranial hematoma in the treatment of cerebral hemorrhage. METHODS Seventy-eight patients with cerebral hemorrhage who were treated in the Taian City Central Hospital and the Second Affiliated Hospital of Shandong First Medical University between June 2018 and December 2019 were selected. The patients were randomly numbered and divided into two groups by drawing lots, 39 in each group. The control group was treated with the traditional internal medicine conservative therapy, and the observation group was treated with minimally invasive intracranial hematoma aspiration and drainage. The indexes of the two groups were compared. RESULTS The efficacy rate of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05). The National Institutes of Health Stroke Scale (NIHSS) score of the observation group was lower than that of the control group after treatment, and the difference was statistically significant (P<0.05). After treatment, the good recovery rate of the observation group was higher compared to the control group, and the difference had statistical significance (P<0.05). The incidence of complications in the observation group was lower than that of the control group, with a statistically significant difference (P<0.05). CONCLUSION In the treatment of cerebral hemorrhage, minimally invasive intracranial hematoma aspiration and drainage facilitates the recovery of patients, promotes the improvement of neurological function, and has a high safety profile and an ideal prognostic quality.
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3.
A prospective assessment of outcomes following the use of autologous blood for the management of recurrent temporomandibular joint dislocation
Machon V, Levorova J, Hirjak D, Wisniewski M, Drahos M, Sidebottom A, Foltan R
Oral and Maxillofacial Surgery. 2017;22((1):):53-57
Abstract
PURPOSE The objective of the study was to compare results of treatment for chronic recurrent temporomandibular joint dislocation (CRTMD) by autologous blood injection (ABI) using two different methods of administration (combination intra- and peri-articular, and peri-articular alone). MATERIALS AND METHODS Forty patients diagnosed with CRTMD were randomly divided into two groups of 20 each (A and B). Group A were treated by intra- and peri-articular blood injection, group B were treated by peri-articular injection alone. The follow-up was done at 1, 3, 6, and 12 months. The study assessed presence of dislocations, pain (VAS, 0-10), interincisal mouth opening (IMO), and the presence of sound phenomena. The treatment was considered successful in patients without the persistence of CRTMD symptoms, as well as with a VAS of 0-1. RESULT After 12 months, a beneficial therapeutic effect in group B was seen in 11 patients, while 16 patients from group A had a therapeutic effect. CONCLUSION Intra- and peri-articular ABI is more effective than peri-articular blood application alone in the treatment of CRTMD, although the difference was not statistically significant.
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4.
Double-blind randomized controlled trial: injection of autologous blood in the treatment of chronic patella tendinopathy - a pilot study
Resteghini P, Khanbhai TA, Mughal S, Sivardeen Z
Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2016;26((1)):17-23.
Abstract
OBJECTIVE To assess the efficacy of autologous blood injections (ABIs) against saline in patients with chronic recalcitrant patella tendinopathy (PT). DESIGN Double-blind randomized controlled study. SETTING Homerton Hospital Sports Medicine department. PATIENTS Those with a diagnosis of refractory patellar tendinopathy were recruited between March 2010 and March 2012. INTERVENTIONS Using 2 practitioners, patients were randomized to either receive ABIs or saline injections. MAIN OUTCOME MEASURES All patients completed the Short-Form McGill Pain Questionnaire (MPQ), a visual analog scale (VAS), and a Victoria Institute of Sport Assessment for Patella Tendinopathy scale over a 12-month period. RESULTS Twenty-two patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 22 and 61 years and were randomized to 11 in each ABI and saline groups. Autologous blood injection group had a mean duration of symptoms of 16.7 months, whereas that of the saline group was 19.2 months. The saline group mean VAS score was reduced from 7.9 to 4.5 at 1 month (P = 0.003) and 3.3 (P = 0.005) at 1 year. With ABI, the score was reduced from 7.5 to 4.5 (P = 0.005) at 1 month and 3.1 (P = 0.003) at 1 year. Victoria Institute of Sport Assessment for Patella Tendinopathy, MPQ, and VAS scores improved significantly in both groups. CONCLUSIONS This study demonstrated that both the ABI and saline groups experienced a significant improvement in symptoms. However, when the results were compared, there was no statistical difference between the 2 groups. CLINICAL RELEVANCE This research showed that tendon fenestration is an alternative cost-effective treatment for recalcitrant PT.
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5.
Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow
Branson R, Naidu K, du Toit C, Rotstein AH, Kiss R, McMillan D, Fooks L, Coombes BK, Vicenzino B
Journal of Science and Medicine in Sport. 2016;20((6):):528-533
Abstract
OBJECTIVES To compare three different ultrasound-guided injections for chronic tennis elbow. DESIGN Assessor-blinded, randomized controlled comparative trial. METHODS 44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n=14), or two injections (separated by 4 weeks) of either autologous blood (n=14) or polidocanol (n=16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks. RESULTS Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p<0.001, number needed to treat 1 (95% CI 1-2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p=0.004, number needed to harm 2 (1-6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p=0.007, number needed to harm 2 (1-4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively. CONCLUSIONS Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.
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6.
Therapeutic efficacy of autologous platelet-rich plasma and polydeoxyribonucleotide on female pattern hair loss
Lee SH, Zheng Z, Kang JS, Kim DY, Oh SH, Cho SB
Wound Repair & Regeneration. 2015;23((1)):30-6.
Abstract
Autologous platelet-rich plasma (PRP) exerts positive therapeutic effects on hair thickness and density in patients with pattern hair loss. The aim of our study was to evaluate the efficacy of intra-perifollicular autologous PRP and polydeoxyribonucleotide (PDRN) injections in treating female pattern hair loss (FPHL). Twenty FPHL patients were treated with a single session of PRP injection, followed by 12 sessions of PDRN intra-perifollicular injection, along the scalp at weekly intervals. Additionally, another 20 FPHL patients were treated with 12 sessions of PDRN injection only. Meanwhile, one half of the backs of two rabbits was injected with the PRP preparation, while the other half was injected with phosphate buffered saline as a control. Tissue samples from the rabbits were analyzed by real-time polymerase chain reaction and Western blotting. Compared with baseline values, patients treated with PRP and PDRN injections exhibited clinical improvement in mean hair counts (23.2+/-15.5%; p<0.001) and mean hair thickness (16.8+/-10.8%; p<0.001). In addition, patients treated with the 12 sessions of intra-perifollicular PDRN injection alone also showed clinical improvement in mean hair counts (17.9+/-13.2%; p<0.001) and mean hair thickness (13.5+/-10.7%; p<0.001). Comparison analyses between the two groups revealed that combined therapy with PRP and PDRN induces greater improvement in hair thickness than treatment with PDRN therapy alone (p=0.031), but not in hair counts (p>0.05). The pilot animal study revealed significant up-regulation of WNT, platelet-derived growth factor, and fibroblast growth factor expression in rabbit skin treated with the PRP preparation, compared with control skin. In conclusion, intra-perifollicular injections of autologous PRP and/or PDRN generate improvements in hair thickness and density in FPHL patients. Copyright © 2014 by the Wound Healing Society.
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7.
Autologous blood injection to treat achilles tendinopathy? A randomized controlled trial
Pearson J, Rowlands D, Highet R
Journal of Sport Rehabilitation. 2012;21((3):):218-24.
Abstract
CONTEXT Achilles tendinopathy is a common and often debilitating condition, and autologous blood injection is a promising treatment option. OBJECTIVE To determine whether autologous blood injection added to standard management was effective in alleviating symptoms of Achilles tendinopathy. DESIGN A prospective randomized controlled trial. SETTING Private sports medicine clinic. PATIENTS 33 patients (18 women, 15 men) of mean age 50 y (SD 9) with 40 cases of Achilles tendinopathy of mean duration of 11 mo (SD 7). INTERVENTION Participants were randomized to blind peritendinous autologous blood injection added to standard treatment (eccentric-loading exercises) or standard treatment alone for 12 wk. MAIN OUTCOME MEASURE Victorian Institute of Sport Assessment for Achilles (VISA-A) score and ratings of discomfort during and after the injection were measured at baseline and 6 and 12 wk. Analytically derived effect-size thresholds of 5 (small) and 15 (moderate) VISA-A units were used as the reference values for clinical inference. RESULTS Improvements in VISA-A of 7.7 units (95%CL: +/- 6.7) and 8.7 units (+/- 8.8) were observed in the treatment and control groups, respectively, at 6 wk relative to baseline, with no clear effect of blood injection. At 12 wk VISA-A score improved to 18.9 units (+/- 7.4) in the treatment group, revealing a blood-injection effect of 9.6 units (+/- 11.5), relative to a comparatively unchanged condition in control (9.4 units; +/- 9.0). Predictors of response to treatment were unremarkable, and a 21% rate of postinjection flare was the only noteworthy side effect. CONCLUSIONS There is some evidence for small short-term symptomatic improvements with the addition of autologous blood injection to standard treatment for Achilles tendinopathy, although double-blinded studies with longer follow-up and larger sample size are required.
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8.
Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy: a randomized clinical trial of efficacy
Kazemi M, Azma K, Tavana B, Rezaiee Moghaddam F, Panahi A
American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2010;89((8):):660-7.
Abstract
OBJECTIVE To compare local corticosteroid with autologous blood injections for the short-term treatment of lateral elbow tendinopathy. DESIGN A single blind, randomized clinical trial was performed in an outpatient clinic at a university hospital. Sixty patients aged 27-64 yrs with a new episode of tennis elbow were recruited. Thirty patients were randomized to methylprednisolone and 30 to autologous blood group over 1 yr. Severity of pain within last 24 hrs; limb function; pain and strength in maximum grip; disabilities of the arm, shoulder, and hand quick questionnaire (Quick DASH) scores; modified Nirschl scores; and pressure pain threshold were evaluated before injection and at 4 and 8 wks after injection. We analyzed our data with the chi and t test. RESULTS Within-group analyses showed better results for autologous blood (all P values <0. 001 except for grip strength, P = 0. 005). In the corticosteroid group, differences in severity of pain (P = 0. 008) and grip strength (P = 0. 001) were significant. At 4 wks, between-group analyses showed superiority of autologous blood for severity of pain (P = 0. 001), pain in grip (P = 0. 002), pressure pain threshold (P = 0. 031), and Quick DASH questionnaire score (P = 0. 004). There were no significant differences in modified Nirschl score, grip strength, and limb function. At 8 wks, autologous blood was more effective in all the outcomes (all P values <0. 001). CONCLUSIONS Autologous blood was more effective in short term than the corticosteroid injection.
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9.
Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver
Krajewski K, Ashley RK, Pung N, Wald S, Lazareff J, Kawamoto HK, Bradley JP
The Journal of Craniofacial Surgery. 2008;19((1):):101-5.
Abstract
BACKGROUND Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case). METHODS UCLA Patients with craniosynostosis from 2003-2005 were divided into 1) the study group (Procrit and Cell Saver) or 2) the control group (n = 79). The study group 1) received recombinant human erythropoietin at 3 weeks, 2 weeks, and 1 week preoperatively and 2) used Cell Saver intraoperatively. Outcomes were based on morbidities and transfusion rate comparisons. RESULTS The 2 groups were comparable with regards to age (5. 66 and 5. 71 months), and operative times (3. 11 vs 2. 59 hours). In the study group there was a marked increase in preoperative hematocrit (56. 2%). The study group had significantly lower transfusions rates (5% vs 100% control group) and lower volumes transfused than in the control group (0. 05 pediatric units vs 1. 74 pediatric units). Additionally, of the 80% of patients in the study group who received Cell Saver blood at the end of the case, approximately 31% would have needed a transfusion if the recycled blood were unavailable. CONCLUSION Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.
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10.
Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis
Pittler MH, Armstrong NC, Cox A, Collier PM, Hart A, Ernst E
The British Journal of Dermatology. 2003;148((2):):307-13.
Abstract
BACKGROUND Autologous blood therapy (ABT) is used for treating atopic dermatitis (AD) in some European countries and is promoted on internet sites for this condition. However, there is little evidence from rigorous clinical trials to suggest that it is effective. OBJECTIVES To test the effectiveness of ABT for the symptomatic treatment of patients with AD. METHODS Fifty subjects responded to press advertisements, and 31 were randomized within strata of severity at recruitment. Patients were included into a double-blind, placebo-controlled trial and received ABT or placebo once weekly for 5 weeks. Assessments were performed at baseline, at weekly intervals and after a 5-week follow up. The Six Area, Six Sign AD (SASSAD) severity index was predefined as the primary outcome measure. The Dermatology Life Quality Index and patient ratings of pruritus, quality of sleep and skin appearance on 100-mm visual analogue scales were defined as secondary outcome measures. Success of patient blinding and adverse events were assessed. RESULTS Data were analysed on an intention-to-treat basis. Analysis of covariance suggested a significant differential change of the SASSAD score between baseline and the end of the follow-up period in favour of ABT. The mean reduction in SASSAD score was 13. 5 points (95% confidence interval, CI 6. 6-20. 4, P < 0. 001) over and above placebo; the corresponding value at the end of treatment was 9. 6 (95% CI 4. 2-14. 9, P = 0. 001). No clear significant intergroup differences in any of the secondary outcome measures were found. Six patients in the ABT group and seven in the placebo group reported minor and transient adverse events. CONCLUSIONS These data suggest that, according to the SASSAD score, ABT has beneficial effects in the treatment of AD, although this was not confirmed by the patient-rated assessments. The improvement in observer-rated skin condition suggested by this study needs confirmation in larger trials.