BACKGROUND: Both endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and tumor ablation using ethanol are very common procedures, and the utility of these therapies has already been reported in prominent journals. However, their effectiveness appears temporary and insufficient, especially EUS-CPN. We therefore have to consider new reagents for improving the results. The present study examined the best concentration of ethanol and povidone iodine mixed with atelocollagen for more effective therapies. METHODS: The effects of the new reagents were confirmed in three live pigs. At first, we injected three kinds of reagents (including indigo carmine) in three separate areas of para-aortic tissue under EUS guidance in one pig. At more than 4 hours after injection, we checked ethanol injection sites after dissection. In next study, we performed EUS-guided injection of a total of six kinds of reagents (two kinds of ethanol, three kinds of povidone iodine, and control atelocollagen) into the livers of two living pigs. After 2 weeks, we examined tissue damage to the liver in the two pigs. RESULTS: The 75% ethanol (absolute ethanol 3.75 mL + 1% atelocollagen 1.25 mL + a very small amount of indigo carmine) was seen like blue gel, and still remained in the para-aortic tissue. Brownish areas of povidone iodine mixed with 3% atelocollagen exhibited clear, regular borders with greatly reduced infiltration into surrounding tissue compared to others. CONCLUSION: We concluded that 75% ethanol mixed with 1% atelocollagen appears optimal for EUS-CPN. Povidone iodine mixed with 3% atelocollagen may be suitable for small tumor ablation therapy.
Celiac Plexus* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Ethanol ; Indicators and Reagents ; Indigo Carmine ; Liver ; Povidone-Iodine ; Swine

Purpose: The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods: Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results: Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

Purpose: The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods: Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results: Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.