Biopsy of the liver is considered the 'gold standard' and is often necessary for histopathological characterization of hepatic disease processes. The techniques to obtain liver specimen are percutaneous liver biopsy, transjugular liver biopsy and mini-laparoscopic liver biopsy. Percutaneous route is the preferred method for its simplicity, ease and safety. Transjugular biopsy of the liver has become an accepted alternative method of obtaining hepatic tissue in patients with an established contraindication to percutaneous liver biopsy viz. coagulopathy, ascites, extreme obesity, small shrunken liver etc. A total of 67 transjugular liver biopsies were performed between January 2004 and February 2012 in a tertiary care hospital. The procedure was performed on in patient basis after thorough pre procedure work up with jugular puncture under ultrasonography guidance and fluoroscopy guided liver biopsy using LABS 100 liver access and biopsy set. The commonest indication for liver biopsy was work up for indeterminate chronic liver disease and the most common contraindications for percutaneous biopsy that led to biopsy by transjugular route were coagulopathy and ascites. Technical success of the procedure was achieved in 96% cases and no major complications were encountered in this group. Transjugular liver biopsy is a valuable tool for clinical decision making in a specific sub set of patients in whom percutaneous biopsy is contraindicated. Transjugular approach with jugular access under real time USG guidance and liver biopsy using automated core biopsy needle is safe, well tolerated, effective and provides adequate tissue for histological assessment.

Twelve male patients with non-union of fracture neck femur of 6-12 months duration were managed by open reduction and internal fixation and tensor fascia lata or gluteus medius muscle pedicle bone grafting through the anterior route. Internal fixation was done with Knowles pins and Asinis screws or combination of both. !1nion could be achieved in II out ofthe 12 cases. Functional recovery of hip was good in 9, fair in 2 and poor In one.

Floating Knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia The fractures range from simple diaphyseal to complex articular types. The word floating knee was introduced for the first time by Mc Bryde in 1965. The incidence of these injuries is increasing. They are associated with potentially life threatening injuries of the head, chest, and abdomen. Not less frequently these injuries cause infection, excessive blood loss, fat embolism, mal union, delayed or non-union, knee stiffness, prolonged hospitalization, and inability to bear weight. Malunion is one complication which drastically affects the functional outcome. Hence we tried to find the factors that may result in malunion more often than not which will help to prepare us in a more suitable manner in treating these injuries We analysed 30 cases of floating knee which were surgically treated regarding the pattern of injuries, type of injuries, closed/open, fixation methods, associated injuries, union rates, malunion and functional outcome. All cases were followed up to a minimum of 1 year. We found that malunion in a floating knee injury which was surgically treated drastically affected functional outcome. The mechanism of injury, type of fracture, open/closed injury, level of fracture whether diaphyseal or juxta articular or intraarticular, type of initial fixation all had a significant correlation with occurrence of malunion.

The present study was undertaken to evaluate the results of 50 total knee replacements performed at Military Hospital Kirkee, Pune, India, using Indian-manufactured prostheses, from November 2001 to November 2005. The study group consisted of 18 males and 28 females in the mean age of 63 years for osteoarthritis and 48 years for rheumatoid arthritis (RA): 41 knees of osteoarthritis and RA in 9 knees. The followup period was 6 months to 2 years, with a mean of 14 months. Good correction of deformities was achieved for all the knees. Postoperatively, there was improvement in Knee Society Score by 69 points for osteoarthritic knees and 65 points for rheumatoid knees. Excellent results were achieved in 88% of the cases. Average postoperative range of movements achieved was 90°. The results are comparable with those following use of far costlier imported prostheses.

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