RESUMEN
Osteitis pubis is one of many etiologies of groin pain in athletes. It is a painful overuse injury of the pubic symphysis and the parasymphyseal bone that typically is found in athletes whose sports involve kicking, rapid accelerations, decelerations, and abrupt directional changes. Athletes most commonly present with a complaint of anterior and/or medial groin pain but also can present with lower abdominal, adductor, inguinal, perineal, and/or scrotal pain. Symptoms can be severe and can limit participation in sport until treatment is instituted. Imaging is useful for ruling out other etiologies of groin pain, identifying concomitant pathology, and confirming the diagnosis itself. Treatment is varied but usually includes nonoperative measures of rest, rehabilitation, and/or pharmacotherapy and also may include injections and/or surgical procedures. A high clinical suspicion should exist when evaluating soccer, rugby, or American football players and distance runners who present with complaints of groin pain.
Asunto(s)
Traumatismos en Atletas/diagnóstico , Osteítis/diagnóstico , Corticoesteroides/uso terapéutico , Atletas , Traumatismos en Atletas/tratamiento farmacológico , Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/rehabilitación , Femenino , Ingle/lesiones , Ingle/fisiopatología , Humanos , Masculino , Osteítis/tratamiento farmacológico , Osteítis/fisiopatología , Osteítis/rehabilitación , Dolor/diagnóstico , Dolor/tratamiento farmacológico , Dolor/fisiopatología , Dolor/rehabilitación , Sínfisis Pubiana/efectos de los fármacos , Sínfisis Pubiana/lesiones , Sínfisis Pubiana/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To obtain multisport and long-term outcome data from the use of regenerative injection therapy on career-threatened athletes. DESIGN: Consecutive enrollment of elite performance-limited athletes with chronic groin/abdominal pain who failed a conservative treatment trial. The treatment consisted of monthly injections of 12.5% dextrose in 0.5% lidocaine in abdominal and adductor attachments on the pubis. Injection of the nociceptive source was confirmed by repetition of resistive testing 5 mins after injection. RESULTS: Seventy-five athletes were enrolled. Seventy-two athletes (39 rugby, 29 soccer, and 4 other) completed the minimum two-treatment protocol. Their data revealed a mean groin pain history of 11 (3-60) mos. Average number of treatments received was 3 (1-6). Individual paired t tests for Visual Analog Scale (VAS) of pain with sport (VAS Pain) and Nirschl pain phase scale measured at 0 and an average of 26 (6-73) mos indicated VAS Pain improvement of 82% (P < 10) and Nirschl pain phase scale improvement of 78% (P < 10). Six athletes did not improve following regenerative injection therapy treatment, and the remaining 66 returned to unrestricted sport. Return to unrestricted sport occurred in an average of 3 (1-5) mos. CONCLUSIONS: Athletes returned to full elite-level performance in a timely and sustainable manner after regenerative injection therapy using dextrose.
Asunto(s)
Traumatismos en Atletas/tratamiento farmacológico , Glucosa/administración & dosificación , Ingle/lesiones , Regeneración , Tendinopatía/tratamiento farmacológico , Traumatismos en Atletas/rehabilitación , Cartílago/efectos de los fármacos , Cartílago/lesiones , Estudios de Cohortes , Humanos , Inyecciones , Ligamentos/efectos de los fármacos , Ligamentos/lesiones , Ligamentos/fisiología , Masculino , Sínfisis Pubiana/efectos de los fármacos , Sínfisis Pubiana/lesiones , Recuperación de la FunciónRESUMEN
We present two rheumatoid arthritis (RA) patients suffering from disturbances of the symphysis pubis. Radiography revealed one with pelvic ring disruption with symphysis pubis diastasis, and the other with osteolysis at both pubic rami and disruption of the superior aspect of the symphysis pubis. Both cases had received long-term corticosteroid therapy, including pulse therapy. We recommend reducing the corticosteroid dose to prevent disturbances of the symphysis pubis especially in RA patients on long-term steroid therapy.
Asunto(s)
Artritis Reumatoide/complicaciones , Síndrome de Felty/complicaciones , Osteomielitis/etiología , Osteoporosis/inducido químicamente , Sínfisis Pubiana/patología , Corticoesteroides/efectos adversos , Anciano , Femenino , Humanos , Inmunosupresores/efectos adversos , Sínfisis Pubiana/efectos de los fármacos , Sínfisis Pubiana/lesionesRESUMEN
The aim of this study was to examine the changes in collagen metabolism that occur during pregnancy and parturition and upon relaxin administration to the rat pubic symphysial interpubic tissue. Pubic symphyses were collected from non-pregnant, and intact and ovariectomised pregnant Sprague-Dawley rats at days 15, 18 and 21 of pregnancy as well as during and after delivery, and analysed for collagen content and solubility. SDS-PAGE was used to determine collagen composition. During pregnancy and particularly during birth, there was a significant reduction in both the tissue wet (57+/-3%) and dry (43+/-3%) weight (n=7), which coincided with a significant increase in water content (to 80%) and was attributed to a significant (P<0.05) reduction in overall tissue collagen content (by 47+/-2%). This resulted in both soluble (10%) and insoluble (90%) collagen levels being reduced, but gel electrophoresis demonstrated the presence of types I, II and V collagen in all samples. Western blot analysis confirmed the presence of type II collagen throughout pregnancy, confirming that the rat pubic symphysis remained a fibrocartilaginous tissue throughout gestation. In the absence of the ovaries and hence relaxin, tissue collagen content and solubility were not significantly different from control measurements. However, tissues of ovariectomised animals treated with oestrogen and progesterone (pellets) and relaxin (injection) contained collagen levels that mimicked those of late pregnancy and parturition. These results suggest that relaxin plays an important role in regulating collagen catabolism during gestation in the rat.
Asunto(s)
Colágeno/metabolismo , Trabajo de Parto/metabolismo , Preñez/metabolismo , Sínfisis Pubiana/metabolismo , Relaxina/farmacología , Análisis de Varianza , Animales , Western Blotting , Colágeno/análisis , Electroforesis en Gel de Poliacrilamida , Estradiol/farmacología , Femenino , Ovariectomía , Embarazo , Progesterona/farmacología , Sínfisis Pubiana/química , Sínfisis Pubiana/efectos de los fármacos , RatasRESUMEN
The aim of this study was to examine the effects of relaxin on collagen content, solubility, and composition in the rat pubic symphysis. Nonpregnant, female Sprague-Dawley rats were bilaterally ovariectomized and either unprimed or primed with estrogen or progesterone alone, or a combination of estrogen and progesterone. One week later these animals were given increasing doses of a synthetic human (gene-2) relaxin (0-100 micrograms) before being killed 16 h later. Their pubic symphysial tissues were then removed and analyzed for collagen content and solubility, whereas collagen composition was determined by SDS-PAGE. Relaxin administration significantly increased the length (140 +/- 6%) and weight (170 +/- 9%) of the interpubic fibrocartilage in estrogen-primed rats (n = 15). At the same time, it decreased the total collagen content by 68 +/- 6%, without altering the proportions of collagen types, which were predominantly type I (85%) and type II collagen (15%). Relaxin administered alone reduced the total collagen content by 64 +/- 4% but had no effect on collagen solubility or composition. Progesterone abolished the effects of relaxin in estrogen-primed rats. It is concluded that relaxin has a potent effect on the amount of collagen in the rat pubic symphysis that is enhanced by estrogen and antagonized by progesterone. The changes in the extracellular matrix within the pubic symphysis induced by relaxin may be important in the modifications that this tissue undergoes during pregnancy.
Asunto(s)
Colágeno/efectos de los fármacos , Estrógenos/fisiología , Progesterona/fisiología , Sínfisis Pubiana/efectos de los fármacos , Relaxina/metabolismo , Relaxina/farmacología , Animales , Agua Corporal/metabolismo , Cartílago Articular/metabolismo , Colágeno/química , Colágeno/metabolismo , Femenino , Humanos , Ovariectomía , Sínfisis Pubiana/metabolismo , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes , SolubilidadRESUMEN
The structural motif of insulin and relaxin is frequently seen in molecules of divergent functions and origins. The insect developmental factor bombyxin, the relaxin-like factor from Leydig cells, and the insulin-like factor 4 (INSL4) all are made of two disulfide-linked chains and have one disulfide bond within the A-chain. The polyclonal antibody R6, which was raised against porcine relaxin, reacts with a wide variety of naturally occurring relaxins from primates, marine and terrestrial mammals, and elasmobranchs but does not recognize insulin. The antibody binds mainly to the arginines that occur in the N, N+4 positions in the B-chains of all relaxins which also constitute the receptor-binding site. The receptor-binding haptens were incorporated by total synthesis into human despentapeptide insulin and bombyxin II, a developmental factor from the silk moth Bombyx mori. In the process the insect factor became a perfect antigen for the anti-relaxin antibody, whereas the human insulin was transformed into a bona fide relaxin. The conversion was affected by changing four critical residues so that the insulin activity was retained to the extent of 10% of the original level. This, to the best of our knowledge, is the first designer protein to incorporate two unrelated biological functions in one primary sequence, and we are therefore proposing that, analogous to zwitterion, the generic name "Zwitterhormon" (German spelling) be used for this type of construct.
Asunto(s)
Insulina/síntesis química , Neuropéptidos/síntesis química , Fragmentos de Péptidos/síntesis química , Receptor de Insulina/metabolismo , Relaxina/síntesis química , Secuencia de Aminoácidos , Animales , Bioensayo , Membrana Celular/metabolismo , Cromatografía Líquida de Alta Presión , Estradiol/farmacología , Femenino , Humanos , Insulina/aislamiento & purificación , Insulina/metabolismo , Células Intersticiales del Testículo/metabolismo , Masculino , Mamíferos , Ratones , Datos de Secuencia Molecular , Neuropéptidos/aislamiento & purificación , Neuropéptidos/metabolismo , Ovariectomía , Ovario/metabolismo , Fragmentos de Péptidos/química , Fragmentos de Péptidos/aislamiento & purificación , Primates , Sínfisis Pubiana/efectos de los fármacos , Sínfisis Pubiana/fisiología , Ratas , Ratas Sprague-Dawley , Relaxina/aislamiento & purificación , Relaxina/metabolismo , Homología de Secuencia de Aminoácido , PorcinosAsunto(s)
Osteoartritis/tratamiento farmacológico , Sínfisis Pubiana/diagnóstico por imagen , Relaxina/farmacología , Animales , Modelos Animales de Enfermedad , Estradiol/farmacología , Femenino , Cobayas , Osteoartritis/diagnóstico por imagen , Sínfisis Pubiana/efectos de los fármacos , RadiografíaRESUMEN
The concentrations of progesterone (P), relaxin (Rlx), estradiol (E2) and PRL were measured by specific RIAs in serum samples collected twice daily at 8:00 am and 3:00 pm at weekly intervals after mating and until whelping in five Labrador Retriever bitches. From weeks 3 to 6 of pregnancy, P exhibited a conspicuous and statistically significant diurnal pattern (P less than 0.05), its serum concentration being approximately twice as high at 8:00 am as at 3:00 pm. A similar but nonsignificant trend was observed weeks 2, 7, and 8, and the overall ratio of the am/pm P concentrations was 2.4 +/- 0.28 (P less than 0.001). Rlx, E2, and PRL did not show a diurnal pattern at any time during pregnancy. The glandular sources and regulation of secretion of Rlx were further investigated. Rlx bioactivity was detected in canine placentas and ovaries, providing supportive evidence that these organs may be a dual source of the hormone in canine pregnancy. Injection of ovine PRL in three pseudopregnant bitches significantly increased serum P concentration as compared with seven untreated pseudopregnant controls, but Rlx was not detectable in serum before, during or after PRL treatment. The data support the view that Rlx and P are independently regulated in the bitch; PRL may be a regulator of P, but not of Rlx secretion. However, as PRL showed no diurnal changes in concentration, it does not appear to be directly responsible for the diurnal pattern exhibited by P.
Asunto(s)
Ritmo Circadiano , Estradiol/sangre , Preñez/sangre , Progesterona/sangre , Prolactina/sangre , Relaxina/sangre , Animales , Bioensayo , Perros , Femenino , Cobayas , Embarazo , Prolactina/farmacología , Seudoembarazo/sangre , Sínfisis Pubiana/efectos de los fármacos , Sínfisis Pubiana/fisiología , Relaxina/farmacologíaRESUMEN
The effects of dose, route, regimen, and the presence or absence of a repository vehicle [benzopurpurine (BPP)] were determined for a human relaxin (hRlx) in the mouse pubic symphysis bioassay. Administration of 88 micrograms/kg hRlx sc in 1% BPP resulted in delayed, prolonged absorption. Although peak hRlx concentrations were lower, serum concentrations remained elevated longer in the presence of BPP compared to a single sc administration of hRlx in saline at the same dose. The bioavailabilities with and without BPP were similar (109 and 96%, respectively). While the pharmacodynamic effect (i.e. lengthening of the pubic ligament in estrogen-primed mice) was approximately maximum at 88 micrograms/kg hRlx sc with BPP, single sc administration of hRlx without BPP up to 264 micrograms/kg had no effect on pubic ligament length. In the absence of the BPP vehicle, manipulation of the regimen (e.g. multiple sc doses) showed that emulation of the serum concentration-time profile observed for hRlx in the presence of BPP resulted in similar pharmacodynamic effects. It appears that BPP delays the absorption of hRlx after sc administration, resulting in prolonged, elevated hRlx serum concentrations. hRlx has been shown to be effective in this model without BPP if it is administered by a multidose sc schedule. As has been observed with other protein therapeutics, the dosage regimen employed for hRlx delivery appears to be an important determinant of the expression of its pharmacodynamic effects.
Asunto(s)
Relajación Muscular/efectos de los fármacos , Naftalenosulfonatos/administración & dosificación , Sínfisis Pubiana/fisiología , Relaxina/administración & dosificación , Animales , Bioensayo , Disponibilidad Biológica , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Cinética , Ratones , Contracción Muscular , Sínfisis Pubiana/efectos de los fármacos , Relaxina/farmacocinética , Relaxina/farmacologíaRESUMEN
Serum immunoreactive relaxin (IR) was measured on days 8, 10, and 14 of gestation in intact and ovariectomized (day 8 of pregnancy) hamsters. In intact hamsters, IR increased from 3-4 ng/ml on day 8 to 20 ng/ml by day 14 of pregnancy. After ovariectomy on day 8, pregnancy failed, and IR decreased rapidly to 0.29 ng/ml on day 14. However, when pregnancy was maintained in ovariectomized hamsters by daily injections of 0.1 microgram 17 beta-estradiol and 4 mg progesterone, serum IR rose to levels similar to those in intact hamsters on days 10 and 14 of pregnancy (i.e. 15 and 20 ng/ml, respectively). Placentas were obtained from other groups of hamsters on days 11, 14, and 15 of pregnancy and homogenized for bioassay by the classical guinea pig pubic symphysis palpation bioassay. Homogenates of placentas obtained on days 14 and 15 contained, respectively, 4 and 10 micrograms eq porcine relaxin/serum relaxin/g fresh tissue. The placenta, rather than the ovary, appears to be the source of during pregnancy in the hamster.
Asunto(s)
Placenta/metabolismo , Preñez/sangre , Relaxina/sangre , Animales , Bioensayo , Cricetinae , Estradiol/farmacología , Femenino , Cobayas , Mesocricetus , Ovariectomía , Placenta/análisis , Embarazo , Progesterona/farmacología , Sínfisis Pubiana/efectos de los fármacos , Relaxina/análisis , Relaxina/farmacologíaRESUMEN
The influence of the peptide hormone relaxin on the glycosaminoglycan (GAG) metabolism was investigated in the pubic ligament of the symphysis pubis and in serum of the virgin mouse. Fresh weight DNA and GAG content per 1 ligament is significantly increased, the level of water soluble protein is not affected. A shift in the electrophoretic GAG pattern by an increasing amount of hyaluronic acid and a decreasing amount of chondroitin sulfate and dermatan sulfate can be observed. Concerning GAG-splitting enzymes (N-acetylglucosaminidase, arylsulfatase, beta-glucuronidase) the N-acetylglucosaminidase reveals a significant increase of its activity in the interpubic ligament and in the serum. The data demonstrate that relaxin treatment induces some changes in the GAG metabolism.
Asunto(s)
Glicosaminoglicanos/metabolismo , Ligamentos Articulares/metabolismo , Sínfisis Pubiana/efectos de los fármacos , Relaxina/farmacología , Acetilglucosaminidasa/sangre , Acetilglucosaminidasa/metabolismo , Animales , Arilsulfatasas/sangre , Arilsulfatasas/metabolismo , Femenino , Glucuronidasa/sangre , Glucuronidasa/metabolismo , Ligamentos Articulares/enzimología , RatonesRESUMEN
In the present work, the dose-response relationship of highly purified porcine relaxin has been examined on broadening of the pubic ligament in mice. Using the method of Steinetz et al. with 7 days of oestriol priming, higher sensitivity of the pubic ligament was attained in mice with an original weight of 10 g than in those with a weight of 20 g. S-shaped curves were obtained; by increasing the relaxin doses after maximal effect had been reached a decreased action was observed. With presomen priming, a relaxin effect was established after only 2 days instead of the usual 8 days but the action was markedly less than in the Steinetz test.
Asunto(s)
Ligamentos/efectos de los fármacos , Sínfisis Pubiana/efectos de los fármacos , Relaxina/farmacología , Animales , Peso Corporal , Relación Dosis-Respuesta a Droga , Estradiol/farmacología , Estrógenos Conjugados (USP)/farmacología , Femenino , Ratones , Útero/efectos de los fármacosRESUMEN
Using both a homologous porcine RIA and 3 bioassays, we investigated the relaxin content of human decidua from first trimester and term gestations and of placentas at term. Aqueous extracts of these tissues yielded only between 211 and 1090 pg immunoreactive relaxin/g fresh tissue. Neither acetonehexane extraction, octadecylsilica cartridge elution nor molecular sieve chromatography increased these relaxin levels. Compared with term decidua, first trimester decidua contained significantly higher levels of immunoreactive relaxin. In vitro studies did not evidence significant relaxin production by either decidual or placental tissues, even in the presence of decidual prolactin production. These results are in direct contrast to earlier reports of high concentrations of relaxin in decidua and placenta.
Asunto(s)
Placenta/análisis , Embarazo , Relaxina/análisis , Animales , Bioensayo , Endometrio/análisis , Membranas Extraembrionarias/análisis , Femenino , Edad Gestacional , Cobayas , Humanos , Ratones , Sínfisis Pubiana/efectos de los fármacos , Radioinmunoensayo , Ratas , Útero/efectos de los fármacosAsunto(s)
Decidua/metabolismo , Relaxina/metabolismo , Animales , Bioensayo , Técnicas de Cultivo , Decidua/análisis , Femenino , Técnica del Anticuerpo Fluorescente , Cobayas , Histocitoquímica , Humanos , Ratones , Embarazo , Sínfisis Pubiana/efectos de los fármacos , Relaxina/aislamiento & purificación , Relaxina/farmacología , Especificidad de la Especie , Útero/anatomía & histología , Útero/efectos de los fármacosAsunto(s)
Oligospermia/metabolismo , Relaxina/metabolismo , Semen/metabolismo , Animales , Bioensayo , Femenino , Cobayas , Humanos , Masculino , Ratones , Músculos/metabolismo , Próstata/metabolismo , Sínfisis Pubiana/efectos de los fármacos , Relaxina/farmacología , Vesículas Seminales/metabolismo , Testículo/metabolismo , Conducto Deferente/metabolismoAsunto(s)
Placenta/análisis , Relaxina/aislamiento & purificación , Animales , Bioensayo , Cromatografía en Gel , Cromatografía por Intercambio Iónico , Electroforesis en Gel de Poliacrilamida , Femenino , Focalización Isoeléctrica , Ratones , Peso Molecular , Embarazo , Sínfisis Pubiana/efectos de los fármacos , Conejos , Relaxina/farmacología , Útero/efectos de los fármacosRESUMEN
Relaxin (RLX) has been purified from the ovary of the pregnant pig and rat but not from human tissues. Our study shows that tissue extracts and incubation media of in vitro culture of human decidua contain a substance with relaxin bioactivities: the inhibition of spontaneous uterine contractions and the elongation of the interpubic ligament. After chromatography on Sephadex G-50 the bioactivity was retained in a protein fraction of approximately 6000 daltons mol wt. The yield of RLX from decidua was 15--33.5 GPU/g fresh tissue. This opens the possibility of the isolation and purification of RLX in the human species.