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Background  The first series of cobalt cardiomyopathy was described in the 60s in relation to the abuse of a cobalt containing beer. Since then, millions of metal hip arthroplasties have been performed and a small number of cobalt cardiomyopathies related to metal prosthesis have been reported. Case summary  We report a case of a 48-year-old man who developed a severe non-dilated restrictive cardiomyopathy in the setting of a systemic metallosis following several hip arthroplasties. The diagnosis was suspected by exclusion of other more common causes for restrictive cardiomyopathies and confirmed by the levels of cobalt and chromium in the serum and the endomyocardial biopsy performance that showed metal deposits in myocardial tissue. Despite the removal of the metal prosthesis and a significant decrease in serum metal levels, he suffered cardiogenic shock (CS) and electric storm that required emergency mechanical circulatory support as a bridge to heart transplant. Discussion  Cobalt cardiomyopathy is a rare condition that has been observed in patients who develop cobalt toxicity after metal hip arthroplasty. The condition may improve after diagnosis and removal of the prosthesis or get worse and progress to end-stage heart failure or CS. The concern about the metal toxicity associated with metal hip prosthesis has increased in the last few years. Orthopaedic surgeons and cardiologists should be aware of this severe complication that is probably under diagnosed.

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Few cases have been reported to date, in which a massive rhabdomyolysis causes a cardiac arrest in a male adult suffering from undiagnosed McArdle disease. Veno-arterial extracorporeal membrane oxygenation and cytokine adsorption filter (CytoSorb®) were required to reach a complete and successful recovery.

INTRODUCTION: Ozone is the best available therapeutic resource for disc herniation, but once the pain is resolved, the intervertebral disc is left with a scar as well as volume reduction, and therefore to osteoarthritis. This situation affects all the anatomical structures that are part of the intervertebral space. This is why Degenerative Disc Disease (DDD) is currently considered a disease that affects not only the intervertebral disc but also the end plates and vertebral bodies. Several years ago we began studying therapeutics for DDD. It is our challenge, to prove that the intervertebral space regains its original integrity and homeostasis. In 2010 we developed an experimental model of regeneration of the intervertebral disc with mice, and the research protocol. Today, after overcoming some legal issues in Argentina, we begun the regeneration of the intervertebral disc in humans. PURPOSE: In this paper we present the firsts patients treated with ozone therapy and pre-differentiated cartilage cells, from February 2016 to the present. MATERIALS AND METHODS: Patients with DDD who meet the inclusion and exclusion criteria. Subcutaneous cellular tissue and blood were extracted, which were processed according to the corresponding technique to obtain pre-differentiated cartilage cells. After 21 days, the cells were implanted back to the patient in the operating room under neuroleptoanesthesia and radioscopic control. During these days an oxidative preconditioning with ozone was realized to modulate the microenvironment. RESULTS: Patients showed significant improvement in their pain and RMN images by comparing VAS scales before and after treatment. DISCUSSION: The combination of pre-differentiated cartilage cells with ozone therapy is an effective, novel and minimally invasive treatment for DDD. We must increase the number of cases in order to strengthen our results.