Ultrasound-guided monopolar versus bipolar radiofrequency ablation for genicular nerves in chronic knee osteoarthritis pain: A randomized controlled study.

Background: This study compared between monopolar and bipolar radiofrequency (RF) ablation of the genicular nerves using ultrasound guidance (USG) in chronic knee osteoarthritis pain. Material and methods: This was a prospective, randomized, double-blind study. Fifty patients with knee osteoarthritis pain were equally randomized to either monopolar or bipolar groups. The primary outcome was visual analogue score (VAS). The secondary outcomes were the proportion of successful responders with a reduction of 50% of VAS score at 12 and 24 weeks, the procedure time and pain and oxford knee score (OKS).VAS and OKS were recorded at 1, 4, 12, 24 weeks after intervention. Any complications were reported. Results: Mean VAS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [4.84 ± 0.62 Vs. 3.56 ± 0.71] and 24 weeks [5.44 ± 0.82 Vs. 3.96 ± 0.79]. The Proportion of successful responders with a reduction of at least 50% of VAS score were more in bipolar group than monopolar group at 12 weeks (80% Vs. 12%) and 24 weeks (44% Vs. 4%). Mean OKS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [26 ± 3 Vs. 34 ± 3] and 24 weeks [27 ± 3 Vs. 35 ± 3].The procedure time and pain were (p < 0.05) lower in monopolar than bipolar group. The complications were similar in both groups. Conclusion: USG bipolar RF ablation is more effective than monopolar RF ablation in controlling knee osteoarthritis pain as for the duration and severity of pain without fluoroscopic confirmation.

Outcome of Patients with Cervical and Vaginal Stump Carcinomas Treated with More Conservative Surgical Approaches: a 9-Year Experience of a Tertiary Oncology Center.

The surgical management of stump carcinoma includes the gold standard pelvic exenteration and more conservative approaches. This study aimed to investigate the outcome among a cohort of vaginal and cervical stump carcinomas that were treated with an intent of organ preservation. This is a prospective study of 60 patients with a biopsy confirmed stump carcinomas at a tertiary care oncology center in Egypt. The demographic, surgical, and pathological data were collected and patients underwent radical surgery with an intent of organ preservation guided by margin negativity. The pathologic data were correlated with the postoperative mortality. Correlation coefficients were calculated for simple correlation and regression analysis was used to investigate the independent predictors of survival. Pelvic exenteration was conducted in 30/60 (50%), while wide local excision with safety margins was possible in 26/60 (43%) and in two cases, resection was precluded. Mean hospital stay in days was 19 ± 9 (range 4-61). Overall operative morbidity was 83.3% (50/60). Perioperative mortality was 6.7% (4/60). Five-year disease-free survival was 40% (24/60). Five-year overall survival was 50% (30/60). The resection margin status and the perioperative therapy were independent prognostic factors of DFS (p = 0.003 and 0.02, respectively. Only the resection margin status was significantly associated with overall survival (p = 0.009). There was no increased mortality with introduction of more conservative surgical approaches. The resection margin status is the most important determinant of recurrence free and overall survivals.