• MeSH
• burzitida * diagnostické zobrazování   etiologie   klasifikace   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY The aim of the study was to evaluate the safety and efficacy of the application of platelet- and leukocyte-rich plasma (L-PRP) in the treatment of lateral humeral epicondyle (ERH) as compared to the administration of corticosteroid therapy. MATERIAL AND METHODS It was a prospective, double-blind and randomized clinical trial. It included a total of 25 cases of ERH in 23 patients aged 18 to 60 years. They were divided into two arms: L-PRP arm with 10 cases and corticosteroid arm with 15 cases. The therapy of L-PRP group: first application: 3 ml of native L-PRP without activation, second application: after 6 weeks, 3 ml of thawed L-PRP. Therapy of the corticosteroid arm patients: first and second application (both after 6 weeks) of 3.5 mg of Betamethasonum. The follow-up period was 12 months. The safety evaluation was carried out based on the number of adverse events. The efficacy was evaluated using the DASH score and the Visual Analogue Scale (VAS). The time series outcomes were analysed statistically by percentile graphs and repeated measures ANOVA. RESULTS The ascertained values of blood elements in the received L-PRP as against the original blood were the following: platelets around 400%, white blood cells around 200%, red blood cells around 30%. The differences in individual subpopulations of white blood cells: neutrophils 74%, lymphocytes 424%, monocytes 385%, eosinophils 43%, basophils 337%. The product was classified as L-PRP group based on the POSEIDO classification. Safety evaluation: both the groups reported no adverse and also no serious adverse events. One patient withdrew from the corticosteroid group on the grounds of a subjective feeling of treatment failure. Efficacy evaluation: for both the general DASH score and Work Module a statistically better effect of L-PRP was proven in the first 6 months at p < 0.05. For the general DASH score, the L-PRP group reported a decrease of difficulties from approximately 50% to 20% on DASH score and in the corticosteroid group the difficulties returned to more or less the initial value. In the Work Module, the L-PRP group showed a decline in difficulties from approximately 46% to 18% and the corticosteroid group from approximately 43% only to 38%. The Sports and Music Module was evaluated by percentile graphs only. The VAS assessment proved that an effect was achieved only after the administration of the first dose of L-PRP and corticosteroid, with a more significant effect reported in L-PRP. The overall statistical evaluation using the VAS showed no difference between these two therapies at the level of significance of p<0.05 (p = 0.08). DISCUSSION The product used by us was classified as a L-PRP subcategory. The application of the native and subsequently frozen L-PRP is rare as compared to the corticosteroid therapy. CONCLUSIONS According to our results, the application of L-PRP is suitable to treat lateral humeral epicondyle. The benefits can be foreseen in the form of a better functional score, whereas the analgesic effect equals the effect of corticosteroid. A slightly additive effect was seen in the thawed second dose. Key words: platelet- and leucocyte-rich plasma, epicondylitis radialis humeri.

• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• epizodická paměť MeSH
• fraktury humeru farmakoterapie   terapie   MeSH
• hojení fraktur účinky léků   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• leukocyty * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• plazma bohatá na destičky * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY The evaluation of efficiency of power Doppler sonography in the diagnosis of lateral humeral enthesopathy, role of correct assessment of Doppler sonographic images with the method of quantitative analysis, assessment of statistical differences between a group of patients with lateral humeral enthesopathy and a control group of healthy subjects and assessment of the diagnostic power of this test. In addition, consideration of the relevance of each area of the lateral compartment for assessment and diagnosis making in lateral humeral enthesopathy. MATERIAL AND METHODS A total of 41 subjects, aged 18 to 60 years, entered the study. Thirteen patients were diagnosed with lateral humeral enthesopathy on the basis of clinical tests and a positive reaction of the lateral humeral epicondylus to administration of local anaesthetic. The control group consisted of 28 subjects without clinical signs of lateral humeral enthesopathy and subjective complaints. Power Doppler activity was evaluated in the whole region studied and in sub-regions involving the enthesis of the common extensor tendon and the periosteum of the lateral epicondyle with the area distal to it. The evaluation was based on calculating the overall surface with power Doppler activity using the method of quantitative image analysis. Each patient was measured on three occasions and the median of values obtained was used in calculation. To assess the diagnostic power of this test, all values obtained from the whole power Doppler region measured were used. The optimal dividing criterion at which the method had a maximum of sensitivity and specificity was determined. RESULTS The most evident, statistically significant difference between the patient and the control group was recorded in the whole "Range of Interest" (ROI) region (p=1.34x10-6). A significant difference was also found in sub-regions corresponding chiefly to the tendon of the extensor carpi radialis brevis muscle and to the periosteum of the lateral epicondyle (p=0.0043). On the other hand, no significant difference was recorded in the sub-region of the proximal common extensor tendon (p=0.066). A Receiver Operating Characteristic (ROC) was performed to evaluate the sensitivity and specificity for a colour representation of each power Doppler image (a cut-off level). Calculation of the diagnostic power of the test gave a value of 0.915 (p=0.05) below the ROC curve. The optimal marginal value, at which both sensitivity and specificity were highest, was determined to be 455 pixels (sensitivity, 80.5%; specificity, 93.8%). DISCUSSION Power Doppler sonography has already been investigated in view of its potential for the diagnosis of lateral humeral enthesopathy. The results, however, have so far been assessed chiefly categorially, based on the examining physician's opinion. The problematic step in the whole procedure is the technique of power Doppler examination. It is necessary to maintain a constant setting and an examination technique eliminating artefacts. When these conditions are met, the method has both high sensitivity and specificity. In addition, because of being non-invasive, the method is convenient for routine use. CONCLUSIONS Power Doppler sonography is a method convenient to confirm or exclude the diagnosis of lateral humeral enthesopathy. Our results showed its statistical significance and diagnostic power (sensitivity and specificity). In the future, the quantitative image analysis could become a valuable adjunct method of evaluation not only for power Doppler images. Key words: Doppler sonography, quantitative image analysis, lateral humeral enthesopathy.

• MeSH
• dospělí MeSH
• entezopatie diagnostické zobrazování   MeSH
• humerus diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ROC křivka MeSH
• senzitivita a specificita MeSH
• studie případů a kontrol MeSH
• ultrasonografie dopplerovská metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH