The influence of synovial inflammation and hyperplasia on symptomatic outcomes up to 2 years post-operatively in patients undergoing partial meniscectomy.

OBJECTIVE: Synovitis is associated with pain and other symptoms in patients with knee osteoarthritis (OA), and in patients with meniscal tears even in the absence of radiographic OA. Patients undergoing arthroscopic partial meniscectomy were followed for 2 years to determine whether synovitis predicts post-operative symptoms. DESIGN: Thirty-three patients scheduled for arthroscopy were recruited for this pilot study. Symptoms were assessed using a knee pain scale, the Lysholm score, and the short form-12 (SF-12(®)) pre-operatively and at 16 weeks, 1 year and 2 years post-operatively. Synovial inflammation and hyperplasia were graded on surgical biopsies. Linear mixed effects models were tested to determine whether inflammation or hyperplasia is associated with outcome scores over time. RESULTS: Lysholm scores and SF-12(®) physical component sub-scores were worse pre-operatively in patients with inflammation (Lysholm: 52.42 [95% confidence interval (CI) 42.37, 62.47] vs 72.38 [66.03, 78.72], P < 0.001; SF-12: 36.81 [28.26, 45.37] vs 46.23 [40.14, 52.32], P < 0.05). Up to 2-years post-operatively, patients with inflammation achieved mean scores similar to those without inflammation. As a result, the mean improvement in Lysholm scores was 13.01 [1.48-24.53] points higher than patients without inflammation, P = 0.03. 33% (4/12) of patients with inflammation still had fair to poor Lysholm scores 2 years after surgery compared to 7% (1/15, P=0.14) without inflammation. No association between hyperplasia and symptoms was noted. CONCLUSIONS: In this pilot study of patients undergoing partial meniscectomy, synovial inflammation was associated with worse pre-operative symptoms, but not with poorer outcomes in the first 2 years post-arthroscopy. Larger cohorts and longer follow-up should be pursued to confirm this relationship, and determine if the initial response is sustained.

Primary psoas abscess--diagnostic and therapeutic considerations.

OBJECTIVE: To present our experience of the diagnosis and treatment of primary psoas abscess in India. PATIENTS AND METHODS: Between July 1993 and December 1995, five men (aged 24-67 years) presented with suspected primary psoas abscess. All five patients had fever with or without rigors and upper/lower abdominal pain of varying duration (2-6 weeks). RESULTS: The presentation in all patients was conspicuous by the absence of the classical signs of limping and positive psoas symptoms. Computed tomography (CT) was the best method of diagnosis, being accurate in every case. Antibiotics alone (two patients), or in combination with percutaneous aspiration, were curative. CONCLUSIONS: This small series of five patients of primary psoas abscess was remarkable in that all the patients were men and three were elderly. The classical symptom of limping was absent in all. The urologist can be misled by loin pain and irritative lower urinary symptoms in the patients, resulting in a delay in diagnosis and management.

Low-dose direct fibrinolysis in peripheral vascular disease.

One hundred thirty patients underwent low-dose, catheter-directed fibrinolytic therapy for arterial and graft occlusions present for various periods of time. In 65 consecutive patients the therapeutic parameters were identical, and a careful hematologic evaluation was performed. In the subsequent 65 patients, varying doses of fibrinolytic agents were employed. Fibrinolytic therapy was found to be beneficial in a diverse group of clinical situations and in patients whose occlusions had occurred at varying lengths of time. Early study demonstrated that effective fibrinolysis can be achieved at approximately one-twentieth of the systemic level and that systemic effects could be avoided in all patients during 24-hour infusions and in many patients infused up to 96 hours. Bleeding complications occurred only in patients in whom concomitant heparinization was employed, and this was thought to be the causative factor. Therapeutic success and avoiding complications are strongly dependent on close monitoring of patients and joint decision making by the vascular surgeon and radiologist.