Introduction: Joint disease is a common orthopaedic problem. They often occur in younger people and tend to be destructive. This can lead to widespread disability and morbidity. Diagnosis is clinical aided with conventional radiological and laboratory investigations. They are sometime equivocal and treatment is empirical and symptomatic. The evaluation of synovial fluid and synovial biopsy should be an important part of investigative procedure in patients presenting with joint effusion. Materials and Methods: Fifty patients with joint diseases visiting orthopaedic OPD and admitted at orthopaedic wards of BGS Global Institute of Medical Sciences, Bangalore formed the material of present study. Patients were informed about study in all respects and informed written consent was obtained. The period of study was from August 2013 to September 2016. Detailed clinical and radiological screenings were done. This was followed by synovial fluid analysis and closed needle biopsy in each case. The result of this study was then compared with that of previous studies. Results and analysis: A complete correlation between clinico-radiological, synovial fluid findings and closed needle biopsy for diagnosis of the definite pathology was seen in 34 (68%) cases. In 8 cases (16%) where the clinico-radiological and synovial analyses were equivocal and inconclusive, synovial biopsy only gave conclusive diagnosis of definite pathology. In another 8 cases (16%) the clinical radiological, synovial fluid findings and even the histologic study by closed needle biopsy were inconclusive for any definite disease and were labeled as chronic nonspecific synovitis. These cases were proved chronic nonspecific synovitis also by open biopsy. Conclusion: Synovial fluid analysis and synovial biopsy will help in coming to a conclusive diagnosis in cases where radiological and laboratory investigations are equivocal. This can be done simultaneously through same site of aspiration with Parker Pearson needle. The significance of the result of the study outweighs the effort of the procedure. Thus it can be stated that evaluation of synovial fluid and synovial biopsy in joint diseases will stimulate its use as routine investigative procedure in the diagnosis of various puzzling joint disorders.
Background: Surgical site infctions is one of the frequently seen complication following instrumented spinal surgeries. Although numerous prophylactic measures have been tried out to prevent surgical site infections, it still remains a concern. Local use of powdered vancomycin is one of the newer method which is being tried all over the world to reduce the rates of infection. Materials and methods: The study was conducted in our Institute in a prospective manner from January 2012 to June 2017. A total of 80 patients who underwent spinal instrumentation for various indications were included in the study. Patients were divided into two groups, first group a Control Group(CG) and second group-Vancomycin Group (VG). Both the groups comprised of 40 patients each. One gram of powdered vancomycin was impregnated below the fascial layer after completion of surgery in patients who belonged to Vancomycin Group. Results: There found to be no statistical significant difference between the groups for the following variables: age, sex, operating time and blood loss. Infection rates in the two groups were compared. There were total 6 cases of infection. 5 out of 40 (12.5%) patients in the control group had either superficial or deep infections. While only one patient (2.5%) belonged to vancomycin group had infection, that too it was a superficial infection. Threre was a statistically significant reduction in the rate of infection in the vancomycin group on comparing with the control group when 'p' value was calculated, with a value of < 0.001. Conclusion: Use of local powdered form of vancomycin following spinal instrumentation surgeries is an effective prophylactic method in reducing the rates of infection. However, further randomized double blind studies with larger sample size is needed.
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