Introduction: Young active patients with significant pain from knee osteoarthritis are a challenging group of patients to treat. For patients with symptomatic osteoarthritis involving both medial and lateral compartments, total knee arthroplasty (TKA) would traditionally be their only surgical option. Knee joint distraction (KJD) is a novel procedure in Asia that offers a joint preserving alternative for this cohort of patients. This study aims to evaluate patients with knee osteoarthritis treated with knee joint distraction (KJD). Materials and methods: Patients were included in this study if they had medial and lateral knee pain refractory to conservative treatment for more than 6 months, aged less than 50 and radiographs confirmed osteoarthritic changes in both the medial and lateral tibio-femoral compartments. An external fixator was placed in the distal femur and proximal tibia, and the knee joint was progressively distracted over a period of 3 days, to a total distance of 5mm. After six weeks, the external fixator is removed. Manipulation under anaesthesia was performed for patients who experienced stiffness post external fixator removal to achieved desired range of motion. Results: A total of three patients underwent KJD from 2020 to 2021. The patients’ age ranged from 44 to 49 years. The mean pre-operative Oxford Knee Score (OKS) was 37.6. At final follow-up at 2 years, the mean post-operative OKS was 17.6. All patients managed to attain the minimal clinically important difference in the OKS. Conclusion: In young patients with symptomatic bicompartmental knee osteoarthritis, KJD can be considered before doing a total knee replacement.

Persistence and eventual integration of high-risk HPV (hrHPV) into the cervical cell is crucial to the progression of cervical neoplasia and it would be beneficial to morphologically identify this transformation in routine surgical pathology practice. Increased p16INK4a (p16) expression is a downstream event following HPV E7 binding to pRB. A study was conducted to assess the correlation between hrHPV detection using a commercial in-situ hybridization assay (Ventana INFORM HPV ISH) and p16 immunoexpression (CINtec Histology Kit) in cervical squamous intraepithelial lesions and squamous carcinoma. 27 formalin-fixed, paraffin-embedded cervical low-grade squamous intraepithelial lesions (LSIL), 21 high-grade squamous intraepithelial lesions (HSIL) and 51 squamous carcinoma (SCC) were interrogated. hrHPV was significantly more frequent in HSIL (76.2%) and SCC (88.2%) compared to LSIL(37.0%). p16 expression was similarly more frequent in HSIL (95.2%) and SCC (90.2%) compared to LSIL(3.7%). That the rates of hrHPV when compared with p16 expression were almost equivalent in HSIL and SCC while p16 was expressed in only 1 of the 10 LSIL with hrHPV, are expected considering the likelihood that transformation has occurred in HSIL and SCC but does not occur in majority of LSIL.

BACKGROUND: Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery. METHODOLOGY: A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days. RESULT: Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P<0.01). Intra-abdominal pain was also lower in Group B at day 0 and day 1 (P= 0.04). VAS score was similar at day 7 although analgesia requirement is higher in Group A (P>0.05). CONCLUSION: Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than postincisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.
Cholecystectomy, Laparoscopic