A study on the outcome of arthroscopic synovial biopsy and synovectomy in the management of chronic synovitis of the knee

Background: Synovitis of the knee can be very difficult to treat especially when the diagnosis remains elusive. Synovitis occurs because of various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy and did a review of literature.Methods: This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2012 to January 2016. Inclusion criteria were patients presenting with persistent swelling of the knee; not responding to conservative measures. We excluded patients who had recurrent synovitis, patients who had septic arthritis. All patients underwent Arthroscopic synovial Biopsy and partial synovectomy. Preoperative and postoperative VAS score was calculated.Results: In n=6 patients the histopathological diagnosis was Tuberculosis, which improved with Anti tuberculous drug treatment. In n=1 patient the diagnosis was lipoma arborescens, in n=1 patient the diagnosis was plant thorn synovitis, in n=3 patient the diagnosis was Juvenile rheumatoid arthritis; all 5 patients improved with synovectomy and NSAIDS. In n=14 patients the biopsy report came as chronic non-specific synovitis, 8 of these patients did well with arthroscopic synovectomy while the other 6 had a recurrence. The average VAS score improved from 8.8- pre surgery to 4.7 post surgery.Conclusions: Arthroscopic synovial biopsy and synovectomy gives good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment

Interventional Pain Management in A Patient with Cardiac Implantable Electronic Device- Our Experience.

The number of patients with cardiac implantable electronic device (CIED) for pace maker dysfunction is on the rise. These patients with CIED pose unique challenges when they present for interventional pain relieving procedures. These challenges are CIED related, diagnosis related and treatment related. CIED related challenges include knowing about the type, functionality, battery life and chambers paced. The diagnosis related challenge is the inability to perform MRI and sole dependence on diagnostic blocks to arrive at the cause of pain. The treatment related challenges include the dilemma whether to change the pacemaker to asynchronous mode or not during the procedure and the inability to do radiofrequency ablation of the pain generator. Additionally in the presence of CIED (due to shortage of trained professionals and equipments for handling patients with CIED) it would be preferable to perform multiple pain relieving blocks at one sitting, thereby making it a therapeutic option rather than a diagnostic option. Considering the age and medical condition of this patient, we felt that the pain relief from low back ache would take precedence over narrowing on the pain generator. We would like to share our experience in the management of low back ache of a patient with CIED

A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score

Background: ACL injuries result in persistent recurrent instability and increased risk of meniscal tears and intra-articular damage, leading on to degenerative changes in the knee. There are many studies about ACL reconstruction using bone patellar tendon bone graft (BPTB) and its outcome, but there is not enough literature on the subjective assessment following reconstruction. We decided to do a study of the patient’s subjective outcome as per the International knee documentation committee score (IKDC) and other clinical parameters following ACL reconstruction using the BPTB graft.Methods: This was a prospective study consisting of 50 patients who presented with ACL injury and underwent arthroscopic ACL reconstruction using BPTB graft in our hospital in the period from May 2008 to July 2010.  Patients were followed at regular intervals at 4 weeks, 8 weeks, 3 months & 6 months and 1 year. Patients were assessed at every visit with clinical tests and IKDC subjective assessment score.Results: 50 patients with ACL insufficiency underwent ACL reconstruction. Postoperative knee flexion improved; the mean flexion was 131.70 with standard deviation of 6.534, which was significant. The mean preoperative IKDC was 56.97 and standard deviation of 9.188 and postoperative IKDC score was 92.33 and standard deviation 5.198 which showed a marked improvement and was statistically significant. The complications included; 8 patents with anterior knee pain, 1 case of patellar fracture while harvesting graft, which healed with wiring and 2 patients, had re-rupture of ACL due to road traffic accident.Conclusions: ACL reconstruction with BPTB graft showed a significantly good subjective outcome on assessment using IKDC score. Isolated ACL reconstruction showed a better subjective outcome compared to the patients who had associated meniscal injury

An investigation of coherent quadrupole beam--beam effects

We use a new simulation technique that allows us to calculate the beam-beam kick from non-Gaussian beams, to discriminate between the predications of two different theoretical models. Our results are in agreement with one of these models. We employ the simulation to better understand the nature of the coherent effects, and to explore their dependence on damping. We discuss the drawbacks in the other model and suggest improvements