Ganglionectomy without Repairing the Bursal Defect: Long-term Results in a Series of 124 Wrist Ganglia

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.

Neutron source design for boron neutron capture synovectomy

Se diseñó una fuente de neutrones para la Sinovectomía por Captura de Neutrones en Boro. La fuente utiliza una fuente isotópica de 239PuBe que se inserta en el centro de contenedor cilindrico con un arreglo heterogéneo de dos moderadores. Los moderadores estudiados son agua ligera/agua pesada, grafito/agua pesada, lucita/agua pesada y polietileno/agua pesada. La fluencia total y la de los neutrones térmicos producidas se emplearon para seleccionar el mejor embalaje. Así, el espectro que produce una fuente de 239PuBe dentro del moderador con polietileno/agua pesada se utilizó como término fuente para calcular los espectros de neutrones dentro de un modelo de rodilla. La composición elemental utilizada para modelar el saco y el líquido sinovial fue la del agua, la del tejido sanguíneo y la de este último con dos concentraciones de boro. Encontramos que cuando la composición elemental del saco sinovial se asume igual a la del tejido sanguíneo con 0.278 por ciento en peso de boro el kerma debido a los neutrones es 7351 veces mayor al que se obtiene cuando la composición del saco sinovial es la del agua.