Pigmented villonodular synovitis: keys to early diagnosis.

Pigmented villonodular synovitis is a synovial proliferative disorder that remains a diagnostic difficulty. Many clues in the history, physical examination, and radiographic studies can aid in the diagnosis. A patient in the third or fourth decade of life often will present with vague monoarticular complaints. Symptoms include intermittent, extreme deep pain localized to the hip, occasionally relieved by position. Decreased active and passive range of motion may be found. Small erosions in the head of the femur and acetabulum may occur early in the course of the disease. Magnetic resonance imaging is the imaging modality of choice and will show the characteristic findings of a joint effusion, synovial proliferation, and bulging of the hip. The synovial lining has a low signal on T1- and T2-weighted images, secondary to hemosiderin deposition. Pigmented villonodular synovitis should be included in the differential diagnosis of young patients with unexplained hip pain.

Preparing international relief workers for health care in the field: an evaluation of organizational practices.

The growth of the humanitarian aid industry has led to the proliferation of relief programs and the rapid rise in the number of relief personnel working in the field. One major necessity in developing successful international programs is appropriately trained field personnel. The purpose of this study was to evaluate the educational practice and training methods for field workers by non-government organizations (NGO). Of the 53 organizations surveyed, 64% responded that they sent health care workers to acute human emergencies. A majority of organizations, 31/53 (59%), used manuals as the primary method of training for workers before going into the field. Eighty-five percent of organizations (45/53) supplied their workers with trip briefings from prior personnel before going into the field, and 91% (48/53) had an on-site coordinator. Only 34% (18/53) provided classroom teaching or orientation prior to departure. The average number of months spent by workers abroad was < or = 1 for nearly half (49%) of the NGOs. Only 34% (18/53) of the NGOs required that personnel had previous international experience. Training of humanitarian workers varies significantly between non-governmental organizations. Lack of standardization in training programs and wide variation of provider preparedness indicates the need by NGOs for enhanced training for field personnel.

Pigmented villonodular synovitis of the hip and knee.

Pigmented villonodular synovitis is an uncommon disease that remains a diagnostic challenge. Presenting complaints commonly involve one joint, most often the knee or hip. Symptoms of pain and swelling characteristically have an insidious onset and are slowly progressive. The physical examination may be completely normal. Radiographs of the knee may appear normal or may show a periarticular soft tissue density, expansion of the suprapatellar pouch and local osseous changes confined to the patellofemoral articulation. Radiographs of the hip may show erosions in the head and neck of the femur and acetabulum. Magnetic resonance imaging usually demonstrates key diagnostic features, which include joint effusion, elevation of the joint capsule, hyperplastic synovium and low signal intensity resulting from hemosiderin deposition. The diagnosis of pigmented villonodular synovitis is confirmed by biopsy, and the treatment of choice is synovectomy.