My experience with Pigmented Villonodular Synovitis – PVNS

The Symptoms

It was late in 2012, I felt that my knee cap was moving out of place occasionally when I walked. This started happening frequently. One morning when I woke up I felt a sharp pain on my right knee just below the knee cap towards the left side. The pain subsided in about 10 minutes after a vigorous rub to the affected area. I walked normally that day. A couple days later, I was working in my office. When I got up from my chair, I felt a sharp and terrible pain on my right knee and it was as though my knee was giving away and my leg would collapse in the wrong direction. I rushed home and scheduled an appointment with the local doctor for the next day. I biked back home and walked to the clinic which was two streets away from home. I had pain all the while I walked and it turned unbearable on my way back. However, I was able to bike more than comfortably. When I was back home, I noticed that there was a huge swelling on top my right knee.

First visit to the doctor

I visited the doctor the next day. He performed some tests to diagnose the condition of my knee. He said my knee was stable,  but wasn’t sure what caused the pain and the swelling. He wanted me to wait for a couple of days to see if the swelling subsided. He also advised me to take pain killers if that helped reduce pain.

Second visit to the doctor

I visited the doctor again in a couple of days. In the meantime I researched online to find ways to reduce pain. I started applying ice packs and kept my leg raised over a pillow. The ice pack only stiffened my knee. I continued with it for a while to help any internal injury to heal. On my second visit, the doctor still wasn’t sure about the reason for the swelling and the pain. So he suggested I go for an X Ray and Ultrasound scan of the affected area.

After a wait of about a week, I had my X Ray and Ultrasound done. Five days later, I visited the doctor again to learn about the results.

Third visit to the doctor

Fortunately, the X Ray was normal and there was no damage to the bones. The Ultrasound said there was lot of fluid, but was inconclusive on the cause of pain. The doctor advised me to go for an MRI scan. I had to wait for about 2 weeks to get my MRI done.

First MRI Results

A week after the MRI, my doctor called me to discuss the MRI results. He told me that I had a rare disease called Pigmented Villonodular Synovitis (PVNS). He told me not to worry as the tumor was benign and not malignant and also it was localized and was not going to spread like cancer. He also suggested I go in for another MRI, this time with a contrast agent injected, so that he can confirm PVNS. He also fixed up an appointment with a Orthopedic specialist.

Second MRI Results and Ortho Visit

Ten days after my second MRI, I visited the specialist. He told me that PVNS was confirmed and it has to be treated with surgery. The size of the tumor was 9.4 x 15 x 17mm and it was present behind Hoffa’s fat pad. He also told me that the causes for the disease were unknown and hence no medication exists. He suggested I go in for an open synovectomy and advised that I do it as quickly as possible. This is what the second MRI report said

The mass in the joint of the dorsal fat pad of Hoffa shows hemosiderin artifacts and there is strong staining of the synovium of the knee. The image fits best with PVNS

MRI showing localized PVNS on right knee

MRI showing localized PVNS on right knee

I was living abroad and working on a contract. It was impossible for me to take a month off and go in for surgery. So, I decided to wait and review the condition after I return home.

Nine months later…

Nine months later, I returned to my home country and headed straight to hospital. I must mention that in these 9 months, I had no great pain but slight discomfort for a couple of times which lasted for about 4 – 5 days. The doctor had a look and ordered an MRI. The MRI report came in the same afternoon and the existence of the lesion and PVNS was confirmed. Luckily, it had not grown much and the size remained almost the same. The size mentioned in this MRI was 1.4 x 0.7 cm. The report said

Small circumscribed hypo-intense lesion interposed between Hoffa’s fat pad and femoral condyle – suggestive of localized nodular synovitis (localized pigmented villonodular synovitis)

With that, I was recommended to go in for surgery to remove the lesion. A couple of days later, I underwent an arthroscopic procedure to remove the lesion and was out of hospital in two days.

Post surgical recovery and biopsy

The removed lesion was sent for biopsy as I recovered from surgery. Right after the surgery, my leg was swollen just above the knee. I was prescribed pain killers, antibiotics, anti platelets and some vitamin tablets. I was also advised to apply ice pack every 3 hours. My knee was stiff and applying ice pack only increased the stiffness. I was also asked to do some exercises to improve muscle strength and improve circulation.

Ten days later, I had the stitches removed. My leg is a still stiff but I have regained about 50% of my normal action and I am able to climb stairs with both legs with some support. The swelling and stiffness still persist. Keeping the leg raised has helped reduce the swelling to a large extent.

Meanwhile, the biopsy report has come in.

Thin layer of synovial lining cells and underlying Stroma with diffuse fibrosis. Scattered pigmented macrophages are seen. Giant cells or foamy macrophages are not present

When I went in for review, a surgeon raised the specter of PVNS turning to cancer. The earlier diagnosis clearly said that was not the case. The absence of giant cells in the biopsy report is another positive point. I am waiting for some questions to be answered and am also seeking second opinion in this regard. I will post and update once I have a confirmation.

There is not a lot of online literature on PVNS, let alone localized PVNS. I hope this helps someone who is looking for information or someone who has gone through localized PVNS to provide me tips on what I should watch out for. If someone has had localized PVNS and got it treated, I would like to know if there was a recurrence and how you feel after the treatment.

Keukenhof

Keukenhof – undeniably one of the most beautiful spring gardens in the world. The amazing colours of the millions of tulips is a treat and if you are a photographer, you will love the opportunities that this place presents. The day I was there was a bit cloudy, but that did not take away the charm of the place. The fields around the park were equally impressive with tulips of all colours.

Tomorrow is the last day for visitors to this park. If you have missed it this year and are in the Netherlands next year, make sure you visit Keukenhof. It is one of the must see places in the Netherlands.

Barcelona – Part 2

The second day, we visited the Sagrada Familia in the morning and Park Guell, the beautiful beach and not to forget FC Barcelona in the afternoon. The weather was really pleasant and we spent a lot of time at the beach.

FC Barcelona

FC Barcelona

Road from Park Guell

Road from Park Guell

Sagrada Familia

Sagrada Familia – The other facade

Sagrada Familia

Sagrada Familia

Colon Columbus

Colon Columbus

Yacht at the beach

Yacht at the beach

The beach

The beach

Barcelona – Part 1

After two weeks in the Netherlands, it was time to head to a place with some sunshine. A few of my friends had planned on visiting Barcelona and so I hopped on. We were told it was raining in Spain but to our relief, it was not the case and the sun was out in all its glory.

Barcelona is a beautiful city, which is best admired on foot. It has a much relaxed feel and the people are friendly. The architecture is gorgeous here with almost every building having plants and flowers on the facade. The food was fantastic and we had our fill of tapas.

Pictures are better than words and so here we go.

La Rambla

La Rambla

Utrecht, The Netherlands

Three weeks ago, I arrived in this small cold country from our large and really hot country. Fortunately, the winter is behind us and spring is in the air. There have been some really sunny days. I couldn’t get as many pictures as I would have liked to, but here are a few

Fedora 16 KDE – First Impressions

A few days ago Fedora 16 was released. As a Fedora 15 user, I was eagerly awaiting this new release. The download is available here. This post captures my experience with the latest and greatest of Fedora.

Live System

This time, I had a pretty new computer at hand to try the live system on – an Intel Core i5-2310 2.9GHz Sandy Bridge processor with Intel HD Graphics 2000, 4 GB RAM and an LG DVD drive. I burnt the image on a DVD-RW and booted it. The boot process was a bit slow, the limitation being the DVD-RW. Once the live system was up, it was an absolute delight to use. It was fast and really stable, but with one problem. The supported screen resolution of 1280×1024 was not detected but rather set to 1024×768. Apart from this, there were no other problems.

On my laptop, a 4.5+ year old Dell Inspiron 6400 with an Intel Core 2 Duo T5300 1.73GHz with Intel 945 GMA and 2.5GB RAM, there was an error during boot stating that a bookmark couldn’t be saved. Not sure what this was, but, the desktop loaded successfully.

Installation

I went ahead and installed Fedora 16 on my Dell. The now familiar and straight forward installation took about 20 minutes to complete. This time I made one small change to the partitions and formatted my home partition with btrfs. I wanted to try first hand what the new file system is all about, despite being aware that it is not production ready, yet. Post installation, to my surprise, there were updates worth 175 MB. I went ahead and installed them.

Boot up and Shutdown

Boot time: 53 seconds with auto login.
Shutdown time: 13 seconds.

Software

KDE Platform version 4.7.3 is what this release is about, with Kernel version 3.1.1 (after the update) under the hood.

Fedora is known to provide only free software. The included software  reflects this philosophy. There is no Adobe Flash, Java or codecs. we have

  • KOffice
  • Konqueror
  • K3B
  • Kopete
  • Dragon Player
  • Amarok
  • Gwenview
  • Apper

However, adding the RPM Fusion repository, enables the installation of codecs and other non free software.

Desktop & Activities

The desktop in Fedora 16 is clean and refreshing with a wallpaper to match its code name – Verne. The default desktop just has Home and Trash icons. On the panel there is the Kickoff menu and to its right is the Show Activity Manager  icon. To the far right are the notification area, system tray and the clock .

Clicking on Show Activity Manager icon reveals four pre-defined activities with what seems to be a welcome effort to simplify the understanding of Activities.

1. Desktop – The regular KDE desktop with a Folder View widget at the top left. This is the default activity.

Desktop

Desktop

2. Photos Activity – Displays the photos in the Pictures folder or any user defined folder.

Photos Activity

Photos Activity

3. Desktop Icons – The classic desktop which allows icons to be placed on the desktop.

Desktop Icons Activity

Desktop Icons Activity

4. Search and Launch – A netbook like interface with large icons allowing the user to – as the name suggests – search and launch applications. Favourite applications are displayed at the top bar.

Search And Launch

Search And Launch

The currently selected activity is displayed to the right of the Plasma (cashew) icon.

Another small but effective change is the introduction of breadcrumbs within Kickoff. Earlier it was necessary to navigate the menus and sub menus one level at a time. Now I can jump from any level to the top level with one click thus saving time.

Kickoff - Breadcrumbs

Kickoff - Breadcrumbs

There is an interesting change in Dolphin which deserves mention. The menu bar is hidden by default. I guess the aim here is to allow the user to focus on files rather than being distracted with menus and options. Those who cannot live without the menu bar, can enable it from the Configure and control Dolphin menu.

Dolphin

Dolphin

I am yet to try out desktop effects, so no comments on that area.

There were a couple of problems when booting into the desktop. At the first boot after installation, the splash screen just froze. I rebooted once again and everything was back to normal and the desktop loaded as it should. There were a few crashes immediately after, without any major interruption to my work. However, a day later, I am yet to see a crash.

Connectivity

The wi-fi connectivity set up during the live system carried over after the installation which was nice. In Fedora 15, sometimes wi-fi wouldnt connect automatically after boot, but that issue seems to have gone away now.

Bluetooth worked fine and I was able to browse the folders on my phone in no time.

Conclusion

Fedora 16 has delivered yet another smooth, stable, sleek and solid desktop experience with KDE.

On distributions which support the live system, it would be great if the files created on the live system home folder were carried over to some sort of guest user account valid for the next day or so. One example where this is especially helpful is taking screen shots during the installation and not losing them accidentally after the reboot ;)

Fedora 15 – Network Manager Update & Broken Wireless

An innocent update this weekend to my Fedora 15 (KDE) system broke the Wireless Connection. The culprits –  NetworkManager 0.8.9997-4.git20110620.fc15 and NetworkManager-glib 0.8.9997-4.git20110620.fc15. To make matters worse, anything I did within Network Manager crashed Plasma.

To fix this problem, I first setup a wired connection and then reverted both packages to their previous versions 0.8.999-2.git20110509.fc15, using this command

yum downgrade NetworkManager*

There is a forum link here which discusses this problem.

The official bug report: https://bugzilla.redhat.com/show_bug.cgi?id=716591