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Arthrocentesis Video

Arthrocentesis Video correspondence To the Editor: In the video of arthrocentesis of sues. In: Harris ED Jr, ed. Kelley’s textbook of rheumatology. 7th 1 ed. Vol. 1. Philadelphia: Elsevier Saunders, 2005:704-5. the knee by Thomsen et al. (May 11 issue), a folded towel is placed under the patient’s knee to keep it semif lexed during the procedure. This in- the authors Reply: We agree with Disla that po- tervention is likely to decrease the aspiration suc- sitioning the knee in full extension may be bene- cess rate in the case of small effusions. f icial in certain patients. The patient in our video Patients with large knee effusions feel more had a rather large effusion, and the procedure comfortable in semiflexion because it increases was performed without difficulty with the knee the volume capacity of the joint, therefore de- held in slight f lexion. creasing the intraarticular filling pressure. Full We might add that although the medial ap- passive extension of the knee has the opposite proach to the knee joint was depicted in the effect. In large effusions, placing the knee in video, entry from the lateral side may be chosen semif lexion, as shown in the video, will increase as well. The lateral approach may result in a suc- the patient’s comfort without greatly affecting cessful aspiration if an attempt from the medial the procedure. But in small effusions, such as side is hindered by the presence of a medial plica common noninf lammatory cases of osteoarthri- or thick medial fat pad. tis, placing the knee in semif lexion will decrease Certainly, experienced clinicians will have their the intraarticular filling pressure and could own preferences about how to perform any given make the difference between a difficult and an medical procedure. Nonetheless, knowledge of easy knee arthrocentesis. alternative techniques (and the principles and anatomical underpinnings on which they are Eddys Disla, M.D. based) will often lead to successful results if ini- Cabrini Medical Center tial difficulties in carrying out the procedure are New York, NY 10003 edisla@cabrininy.org encountered. 1. Thomsen TW, Shen S, Shaffer RW, Setnik GS. Arthrocente- Todd W. Thomsen, M.D. sis of the knee. N Engl J Med 2006;354:e19 (Web only). (Avail- Gary S. Setnik, M.D. able at http://content.nejm.org/cgi/content/video_preview/354/ Mount Auburn Hospital 19/e19.) Cambridge, MA 02238 Alexander C, Caughey D, Withy S, Van Puymbroeck E, Mu- tthomsen@mah.harvard.edu noz D. Relation between f lexion angle and intraarticular pres- sure during active and passive movement of the normal knee. 1. Roberts WN, Hayes CW, Breitbach SA, Owen DS Jr. Dry taps J Rheumatol 1996;23:889-95. and what to do about them: a pictorial essay on failed arthrocen- Wise C. Arthrocentesis and injection of joints and soft tis- tesis of the knee. Am J Med 1996;100:461-4. Severe Anomaly of Coronary-Artery Development To the Editor: A three-week-old boy was admit- Postmortem examination revealed a dense net- ted to the hospital because of cardiac failure with work of coronary veins (Fig. 1B) and a very short diffuse ventricular hypocontractility and normal coronary arterial segment in the posterior atrio- cardiac anatomy on echocardiography. Coronary ventricular sulcus (Fig. 1C). The right ventricle, and ventricular angiography failed to show any tricuspid valve, and pulmonary valve were of nor- coronary arteries from the aortic root, the pulmo- mal size and anatomy and had a subpulmonary nary arteries, or the ventricular cavities (Fig. 1A). conus. The left ventricle was dilated with uni- No coronary artery was visible on the surface of formly thin walls. There were fibrous zones on the heart at the time of exploratory sternotomy. the left ventricular surface and on the papillary The baby died suddenly afterward. muscles, which suggested the presence of ante- n engl j med 355;6 www.nejm.org august 10, 2006 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The New England Journal of Medicine The New England Journal of Medicine

Arthrocentesis Video

The New England Journal of Medicine , Volume 355 (6): 1 – Aug 10, 2006

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Publisher
The New England Journal of Medicine
Copyright
Copyright © 2006 Massachusetts Medical Society. All rights reserved.
ISSN
0028-4793
eISSN
1533-4406
DOI
10.1056/NEJMc061540
pmid
16899789
Publisher site
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Abstract

correspondence To the Editor: In the video of arthrocentesis of sues. In: Harris ED Jr, ed. Kelley’s textbook of rheumatology. 7th 1 ed. Vol. 1. Philadelphia: Elsevier Saunders, 2005:704-5. the knee by Thomsen et al. (May 11 issue), a folded towel is placed under the patient’s knee to keep it semif lexed during the procedure. This in- the authors Reply: We agree with Disla that po- tervention is likely to decrease the aspiration suc- sitioning the knee in full extension may be bene- cess rate in the case of small effusions. f icial in certain patients. The patient in our video Patients with large knee effusions feel more had a rather large effusion, and the procedure comfortable in semiflexion because it increases was performed without difficulty with the knee the volume capacity of the joint, therefore de- held in slight f lexion. creasing the intraarticular filling pressure. Full We might add that although the medial ap- passive extension of the knee has the opposite proach to the knee joint was depicted in the effect. In large effusions, placing the knee in video, entry from the lateral side may be chosen semif lexion, as shown in the video, will increase as well. The lateral approach may result in a suc- the patient’s comfort without greatly affecting cessful aspiration if an attempt from the medial the procedure. But in small effusions, such as side is hindered by the presence of a medial plica common noninf lammatory cases of osteoarthri- or thick medial fat pad. tis, placing the knee in semif lexion will decrease Certainly, experienced clinicians will have their the intraarticular filling pressure and could own preferences about how to perform any given make the difference between a difficult and an medical procedure. Nonetheless, knowledge of easy knee arthrocentesis. alternative techniques (and the principles and anatomical underpinnings on which they are Eddys Disla, M.D. based) will often lead to successful results if ini- Cabrini Medical Center tial difficulties in carrying out the procedure are New York, NY 10003 edisla@cabrininy.org encountered. 1. Thomsen TW, Shen S, Shaffer RW, Setnik GS. Arthrocente- Todd W. Thomsen, M.D. sis of the knee. N Engl J Med 2006;354:e19 (Web only). (Avail- Gary S. Setnik, M.D. able at http://content.nejm.org/cgi/content/video_preview/354/ Mount Auburn Hospital 19/e19.) Cambridge, MA 02238 Alexander C, Caughey D, Withy S, Van Puymbroeck E, Mu- tthomsen@mah.harvard.edu noz D. Relation between f lexion angle and intraarticular pres- sure during active and passive movement of the normal knee. 1. Roberts WN, Hayes CW, Breitbach SA, Owen DS Jr. Dry taps J Rheumatol 1996;23:889-95. and what to do about them: a pictorial essay on failed arthrocen- Wise C. Arthrocentesis and injection of joints and soft tis- tesis of the knee. Am J Med 1996;100:461-4. Severe Anomaly of Coronary-Artery Development To the Editor: A three-week-old boy was admit- Postmortem examination revealed a dense net- ted to the hospital because of cardiac failure with work of coronary veins (Fig. 1B) and a very short diffuse ventricular hypocontractility and normal coronary arterial segment in the posterior atrio- cardiac anatomy on echocardiography. Coronary ventricular sulcus (Fig. 1C). The right ventricle, and ventricular angiography failed to show any tricuspid valve, and pulmonary valve were of nor- coronary arteries from the aortic root, the pulmo- mal size and anatomy and had a subpulmonary nary arteries, or the ventricular cavities (Fig. 1A). conus. The left ventricle was dilated with uni- No coronary artery was visible on the surface of formly thin walls. There were fibrous zones on the heart at the time of exploratory sternotomy. the left ventricular surface and on the papillary The baby died suddenly afterward. muscles, which suggested the presence of ante- n engl j med 355;6 www.nejm.org august 10, 2006

Journal

The New England Journal of MedicineThe New England Journal of Medicine

Published: Aug 10, 2006

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