A RANDOMIZED CONTROLLED STUDY OF POST-INJECTION REST FOLLOWING INTRA-ARTICULAR STEROID THERAPY FOR KNEE SYNOVITIS

In order to assess the effect of 24 h observed bed rest followingintra-articular steroid injection of the knee joint in patientswith an inflammatory arthritis such as RA, AS or colitic arthropathy,91 patients with inflammatory arthritis of one knee joint wererandomized to receive 24 h bed rest in hospital following intra-articularsteroid injection or were injected in outpatients. The clinicaland laboratory assessments such as pain and stiffness on a 10-cmvisual analogue scale, knee circumference (cm), 50 ft walkingtime (s), CRP and ESR were measured before receiving the steroidinjection and at 3, 6, 12 and 24 weeks. Both groups of patients improved clinically and serologicallyat 3 weeks. By 12 weeks the degree of improvement in the painscore, stiffness score, knee circumference, 50 ft walking timeand CRP was better in the rest group and these differences persistedto 24 weeks. For each outcome variable the summary measure ofresponse was significantly better in the rest group comparedto the no rest group. Intra-articular steroid injection of the knee joint followedby strict inpatient bed rest for 24 h results in a greater degreeof clinical and serological improvement, compared to routineoutpatient injections for up to 6 months. It is therefore possiblethat 24-h post-injection rest will result in a prolonged durationof clinical response and reduce the need for frequent steroidinjections and the risk of complications. KEY WORDS: Steroid injection, Knee joint, Rest, Inflammatory arthritis     

Amebic Granuloma—An Experimental Study

The etiopathogenesis of granuloma formation in amebiasis is not known. An experimental study was carried out in 48 guinea pigs arranged into four groups, to assess the role of hypersensitivity in formation of amebic granuloma. Repeated intracecal inoculations of saline in Group I and mixed amebic and bacterial suspension in other groups were made. Animals in Group III were sensitized by amebic antigen and in Group IV by bacterial antigen before inoculations. Lesions produced in the amebic hypersensitive group of animals were notably different from those in other groups. A higher frequency of cecal ulceration and a significantly severe grade of cecal damage was seen in these animals. Extensive pericecal adhesions and marked thickening of the wall produced nodular lesions. Granulomas were formed with dense chronic inflammatory cell infiltration including fibroblasts.     

Congenital Absence of Superior Vena Cava: Unusual Anomaly of Superior Systemic Veins Complicating Pacemaker Placement

Congenital anomalies of the superior systemic veins can complicate placement of transvenous pacemaker electrode leads. Persistent left superior vena cava is the most common congenital anomaly; in this paper, we describe the case of a patient who had con-genital absence of both superior venae cavae, which has not been reported pre-viously. The superior syslemic veins drained into persistent double ozygos veins subdiaphragmatically. The anomaly was verified by venography. Temporory car-dioc pacing was established by passing the electrode lead through the femoral vein, and a permanent epicordial pacemaker lead was placed thereafter. This appears to be the first recorded case of such an anomaly.     

雾化治疗中气溶胶在深层肺泡输运特性 的数值模拟研究

目的 基于计算流体动力学的方法,模拟计算单个肺泡中的气体与气溶胶颗粒输运情况,研究深层肺泡内气体流动和气溶胶颗粒输运特性。方法 采用一端有周期性扩张/收缩半球形壁的长直导管作为单一肺泡及肺泡管的简化近似,建立二维数学模拟模型。考虑呼吸气体在半球边界上的扩散,采用欧拉 欧拉方法对肺泡管中气体以及气溶胶颗粒的输运方程进行求解。结果 整个呼吸过程中,管道中空气的成分比率以稳定的周期方式随时间变化。气溶胶在管道输运主要依赖于颗粒的扩散系数,平流输运只有微小的影响。气溶胶颗粒尺寸减小时,气溶胶的扩散速度与深度均有提高,粒径小于4 μm时该现象尤为明显,且呼吸频率和幅度的增大可以显著提升颗粒的输运能力。结论 雾化治疗中,粒径较小的气溶胶颗粒可以增强药物扩散速度。深呼吸有助于提升颗粒的输运效果,治疗中应鼓励患者深呼吸。     

END OF LIFE CARE DECISIONS AND THE HOSPICE MOVEMENT

Inspite of spectacular technological advances made in the recent years, modern medicine has not been able to deny the inevitability of death. Slowly but surely, the approach towards death is changing with increasing emphasis on various end of life care decisions. Many of these decisions are being actively discussed, debated and practised all over the world. Palliative care in hospice has become an accepted mode of management of terminally ill patients, for whom the prognosis is limited. Increase in life expectancy of the Indian people and a strong movement to authorise ex-servicemen for treatment of malignant and other chronic diseases in service hospitals, requires the Armed Forces to consider these end of life care decisions and plan for terminal care in hospice.KEY WORDS: End of Life Care Decision, Hospice, Palliative Care     

TOTAL QUALITY MANAGEMENT - THE NEW PARADIGM IN HEALTH CARE MANAGEMENT

Hospitals are by nature complex organisations and the complexity is compounded in service hospitals with perceived notion of service deficiencies. Quality has emerged as a major issue in health care sector and TQM has been accepted as a major long-term strategic initiative towards continuously improving quality of health care. Key concepts of TQM start with top management leadership with emphasis on process and customer focus. Implementation of TQM in service hospitals will require Quality Management awareness, training and framework development as well as development of customer awareness. TQM has been widely applied in clinical field with successful outcome. TQM is not a short-term solution, it has to be understood and practised as a long-term strategic commitment.Key Words: Quality in Health Care, Total Quality Management(TQM)     

FATAL NEUTROPENIC ENTEROCOLITIS ASSOCIATED WITH SULPHASALAZINE THERAPY FOR RHEUMATOID ARTHRITIS

Neutropenia is a recognized complication of sulphasalazine therapyin patients with rheumatoid arthritis. It is usually mild, transientand rarely associated with serious sequelae. We describe a patientwith rheumatoid arthritis who developed fatal neutropenic enterocolitiscomplicated by tracheo-oesophageal fistula following treatmentwith sulphasalazine. KEY WORDS: Neutropenic enterocolitis, Rheumatoid arthritis, Sulphasalazine