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Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa’s triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.

An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

INTRODUCTION Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. METHODS We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre-operative and post-operative functional assessment was done using Tegner Lysholm score. RESULTS Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. CONCLUSIONS Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

A 63-year-old man who was known to have chronic liver disease underwent a CT of the abdomen for evaluation of liver morphology. In the CT abdomen, he was coincidentally found to have an osteolytic lesion of the left proximal femur. He did not have any problems involving his left hip or thigh. On

Introduction: In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes. Methods: We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission. Results: Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], P = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings. Conclusions: Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.

Summary Cyclosporin is an immunosuppressant that acts by selectively inhibiting the activation of T lymphocytes. Its effects on monocytes and neutrophils are not well explored. We investigated the in vitro effects of cyclosporin on these cells, harvested from venous blood from nine healthy, non-smoking volunteers. In vitro incubation of monocytes with increasing concentrations of cyclosporin (5, 25 and 625 μg) depressed their phagocytosis by 22%, 32% and 49%, respectively, compared to the control values. The intracellular killing capacity of monocytes decreased by 26%, 31 % and 43% with these doses, and neutrophil phagocytosis was depressed in a similar manner (16%, 30% and 40%). Patients receiving cyclosporin are susceptible to infections, and inhibition of these phagocytic cells by cyclosporin may be partly responsible for this. Neutrophil chemotaxis is reduced in patients with impaired renal function. Treating these patients with cyclosporin may in addition suppress the phagocytic function of these cells.

To evaluate and compare the safety and effectiveness of laparoscopic application of the spring-loaded clip and the tubal ring 300 immediate postabortion patients were studied in Bombay India. The 2 groups were randomly assigned to the study subjects and to minimize interoperation variability performed by the same operator. Another physician unaware of the procedure used evaluated and cared for ther patient after surgery. All but 1 of these women returned for follow-up 7-21 days after sterilization and 74.7% and 81.3% respectively of the clip and tubal ring groups reported for the 6- and 12-month follow-up visits. There was 1 technical failure among the tubal ring cases. Surgical difficulties were encountered in 7.3% of the clip and 8.0% of the ring procedures. The incidence of complications until the 1st follow-up visit was significantly higher for the clip (9.3%) than for the ring (4.7%) cases although none of a serious nature were reported. There were significantly more immediate postoperative complaints among subjects sterilized with the ring than with the clip but the incidence of early postoperative complaints was similar for the 2 groups. The rate of pelvic pathology was low at 6 and 12 months after sterilization and none of these patients required surgery within a year of sterilization. 3 of the women sterilized with the spring-loaded clip but none of those sterilized with the tubal ring became pregnant. Thus while both devices were associated with clinically acceptable morbidity the tubal ring was found to be the more effective.(AUTHORS)

Von Storch has induced headache by the sudden intravenous injection of minute amounts of histamine phosphate in three groups of persons—the first group consisting of those subject to migraine, the second group composed of those suffering from chronic recurrent non-migraine headache, and the third group consisting of those not subject to headache. He has found that in persons subject to migraine the headache produced by histamine is frequently similar in character to their habitual headache (though bilateral), while in those subject to chronic recurrent non-migraine headache the experimental headache is only occasionally similar to their usual headache. From the evidence presented by him, linking migraine and histamine, the latter would appear to be a useful drug for distinguishing migraine from other forms of recurrent headache. Using a technique similar to his, experiments were performed at this centre to determine the relation of histamine headache to post-contusional and psychogenic headaches, and the results are worth recording.

In a rural Puerto Rican area the Trujillo Alto contraception program offered condoms diaphragm and jelly foam tablets jelly and syringe and suppositories; between 1951-1958 1097 couples participated. The mean age of the women was 26.2 years. Prior to admission to the contraception service and after their first pregnancy the pregnancy rate of the participating couples was 83/100 years of exposure. After an average period of 17.1 months of participation 330 couples underwent surgical sterilization while 74 couples chose to abandon protection altogether. For participating couples there was a pregnancy rate of 31.6/100 years of exposure during the entire period of residence in the study area. Acceptance measured by low rates of change to other methods was higher for the condom and diaphragm than for suppositories foam tablets and jelly and syringe. Pregnancy rates for all 5 prescribed contraceptive methods ranged from 28.3 to 42.3 per 100 years of exposure with the condoms offering significantly greater protection than the other methods combined.(AUTHORS MODIFIED)