A study of sixty well selected cases of synovitis of the knee joint, treated by timely adequate synovectomy, followed up over a period of four years is presented. We have stressed the importance of therapeutic and diagnostic value of synovectomy. The results are found encouraging and the procedure useful in preventing damage to the articular structures of the knee joint. The best results are obtained in non-specific, traumatic and very early cases of rheuma­toid arthritis while infective arthritis benefits to fair extent.

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An unusual case of Ehlers-Danlos syndrome with monostotic fibrous dysplasia of the humorus is presented. The other orthopae­dic manifestations, its complications and associated features are re­viewed and summarised.

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A combination of trimethoprim and nitrofurantoin was tried against 100 bacterial strains isolated from cases of urinary tract in­fection. The combinations in varying ratios have shown a good syn­ergistic effect against the common urinary pathogens. However, the results will have to be corroborated by conducting trials in a large number of patients.

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Choledochal cyst, a cystic dilatation of a part of biliary system, is a rare clinical problem. Three such cases are reported. The etiology, clinical manifestations, diagnostic problems and the Management are discussed.

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An unusual case of Herpes Generalisata with diabetes mellitus and pulmonary tuberculosis is reported. This condition has beer, regularly reported in various immunologically suppressed states like Hodgkin's disease, other lymphomas and leukaemias, but its occur­rence with diabetes mellitus has been described for the first time in our case.

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Two cases of synovial ehondromatosis are presented of which one falls in a rare group o f extra-articular ehondromatosis develop­ing in a bursa. Awareness of this rare lesion is important to prevent radical treatment owing to overdiagnosis. The histologic changes may mimic chondrosarcoma causing diagnostic problem.

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Serum histaminase and SGOT were estimated in 35 cases of acute myocardial infarction and 34 cases of ischaemic heart disease (Other than acute myocardial infarction) and 30, age and sex match­ed, healthy subjects which served as controls, to evaluate the com­parison of time relation activity, diagnostic and prognostic value of histaminase and SGOT. The enzymes were estimated within 6 hours, then repeated -within 24 hours, 2nd day, 3rd day, 5th day, 10th day and 15th day, ascertained from the time o f pain in the chest. Raised histaminase levels were found in 97.14%; cases, while SGOT levels were found elevated in only 91.4% cases of acute myo­cardial infarction of which 30 were electrocardiographically proved and 5 had equivocal electrocardiographic evidence of acute infarc­tion like LBBB, complete heart block, ventricular tachycardia and old myocardial infarction. Furthermore elevation of histaminase was 6.2 times whereas of SGOT only 5.2 times above the mean normal value. Serum histaminase was found elevated in all the 6 cases who presented within 6 hours of infarction, while SGOT did not rise in any of these cases. Both histaminase and SGOT reached the peak levels on the 2nd day and persisted for whole of the first week. Higher levels of these enzymes were found associated with worse prognosis. Above observations show that the serum histaminase rises earlier than SGOT and can prove the diagnosis of myocardial infarction even when SGOT and ECG fail to reveal the diagnosis. It is a more sensitive index and has higher peak rise of levels than SGOT. How­ever its pattern of rise, fall and prognostic values are similar to that of SGOT.

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Chest injuries constitute a large number of patients admitted in our Intensive Trauma Care Unit. The maximum incidence is in the age group of 20-40 years. Contusions, fracture ribs, pneumo­haemothorax constitute major thoracic injuries. Visceral injuries were always kept in mind while treating these patients with critical condition. Most of the patients could be treated with only active conservativemanagement with proper use of respirators in selected patients. Surgical intervention was required in the patients mostly with visceral injuries. The mortality rate in pure chest injuries is very low. The as­sociated head injuries and abdominal injuries increased the overall mortality rate.

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Administration of different doses of isoprenaline in albino rats produced varying grades of myocardial necrosis with concomitant changes in euglobulin clot lysis time which is a measure of plasma fibrinolytic activity (PFA). A positive and strong correlation was observed between changes in PFA and severity of myocardial necrosis. Experiments in young rats and propranolol pre-treated animals rule out the possibility of isoprenaline being responsible in bringing about changes in PFA. The measurement of PFA appears to be of prognostic significance in myocardial infarction as discussed.

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Abdominal crepitus over the gastric trichobezoar in the diag­nosis of the same is elucidated and documented radiologically

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A case of retroperitoneal malignant schwannoma is reported. A brief review of the literature is given.

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In two hundred and twenty eight parous women between thirty and forty years o f age, Medroxyprogesterone acetate 150 mg depot injection every three months proved to be a one hundred per cent contraceptive agent. Minimal side effects were noted with some spotting and amenorrhoea. No significant increase in blood coagula­tion and tendency to thrombosis was noted as tested by the platelet aggregation test during medication.

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Seventy cases of mid-trimester pregnancies were terminated by using 200 ml. of 40% intra-amniotic urea, over a 13 month period from 1st August. 1977 to 31st August, 1978. The success rate was 88.7% and the mean induction-abortion interval was 30.7 hours. No major complications were observed.

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A case of chronic renal failure with hypokalaemia presenting electrographically as tall `U' waves simulating tall `T' waves of hyperkalaemia is described. The differentiating points between hypokalaemia and hyperkalaemia on ECG have been highlighted.

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