Tehran University Medical Journal

Background: The extracellular matrix is a complex three-dimensional network of proteins and glycosaminoglycans, which have important roles in cellular physiology and cell-cell and cell-extracellular matrix interactions. Any changes in the extracellular matrix of tumors may be implicated in cellular transformation and metastasis. The aim of the present study was to identify changes in the hyaluronic acid of the stroma of colonic carcinoma.

Methods: Paraffin blocks of 30 patients with colon carcinoma (10 patients at each histological grade) were chosen from the pathology file of Khatam-Al-Anbia Hospital in Zahedan, Iran. Tissue sections (5-6 micrometers thick) were stained with hematoxylin-eosin and the alcian blue critical electrolyte concentration histochemical technique at pH=5.8. The intensity of the staining in each section was graded as 1, 2 or 3, referring to low, moderate or severe staining reactivities, respectively. Statistical data was analyzed with nonparametric tests by SPSS (ver. 10) and histopathological reports were prepared.

Results: The results of this study showed that there is a good correlation between histopathological grading and staining intensity of tumoral stroma for hyaluronic acid (p<0.005). Analysis using the Mann Whitney test revealed significant differences between staining grades 1 and 3 and grades 2 and 3 (p<0.005 and p<0.002, respectively), although there was no significant difference between staining grades 1 and 2 for hyaluronic acid.

Conclusions: The difference in staining intensity of the stroma in colon carcinoma is a result of different amounts of hyaluronic acid in stroma, indicating that increased levels of hyaluronic acid are associated with the invasion and metastasis of neoplastic cells.

Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections.

Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology (ACR) for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid (Synocrom Forte® 1%) weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score (KOOS) self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis.

Results: The mean age of the patients was 60.68.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups (P<0.001).

Conclusion: It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA.