A Rare Case of Partially Ossified Sacrospinous Ligament Causing Sciatic Nerve Compression.

Ossification of sacrospinous ligament induces a great risk for maintaining the stability of the pelvis. The sacrospinous ligament, along with the sacrotuberous ligament, plays a distinct role in the sacroiliac joint and pubic symphysis stability. The ossification may cause compression of neurovascular structure traversing through the greater and lesser sciatic foramen. Here we report a case of unilateral heterogenous ossification of the left sacrospinous ligament causing sciatic nerve compression and sciatic pain. A 22-year-old Bangladeshi woman, mother of one child, presented with complaints of pain in the lower back, left buttock and back of the upper thigh. Clinical examination and investigations revealed a diagnosis of the partially ossified sacrospinous ligament with sciatic nerve compression. Total excision of heterotrophic calcification and partial excision of left sacrospinous ligament through posterior approach by a left paramedian incision over the lower back was performed under general anaesthesia. On outpatient follow-up visits at 2 weeks and 6 weeks post-surgery, complete disappearance of pain was observed, and the patient was able to return to regular productive life activity. In this report, we presented a rare case of ossified sacrospinous ligament causing sciatic nerve compression with unknown etiology. The surgical approach performed, total excision of heterotrophic calcification and partial excision of left sacrospinous ligament through the posterior approach helped to preserve the pelvic stability with a good clinical outcome.

Image Registered Gastroscopic Ultrasound (IRGUS) in human subjects: a pilot study to assess feasibility.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) is a complex procedure due to the subtleties of ultrasound interpretation, the small field of observation, and the uncertainty of probe position and orientation. Animal studies demonstrated that Image Registered Gastroscopic Ultrasound (IRGUS) is feasible and may be superior to conventional EUS in efficiency and image interpretation. This study explores whether these attributes of IRGUS will be evident in human subjects, with the aim of assessing the feasibility, effectiveness, and efficiency of IRGUS in patients with suspected pancreatic lesions. PATIENTS AND METHODS: This was a prospective feasibility study at a tertiary care academic medical center in human patients with pancreatic lesions on computed tomography (CT) scan. Patients who were scheduled to undergo conventional EUS were randomly chosen to undergo their procedure with IRGUS. Main outcome measures included feasibility, ease of use, system function, validated task load (TLX) assessment instrument, and IRGUS experience questionnaire. RESULTS: Five patients underwent IRGUS without complication. Localization of pancreatic lesions was accomplished efficiently and accurately (TLX temporal demand 3.7 %; TLX effort 8.6 %). Image synchronization and registration was accomplished in real time without procedure delay. The mean assessment score for endoscopist experience with IRGUS was positive (66.6 ± 29.4). Real-time display of CT images in the EUS plane and echoendoscope orientation were the most beneficial characteristics. CONCLUSIONS: IRGUS appears feasible and safe in human subjects, and efficient and accurate at identification of probe position and image interpretation. IRGUS has the potential to broaden the adoption of EUS techniques and shorten EUS learning curves. Clinical studies comparing IRGUS with conventional EUS are ongoing.

Comparison between topical honey and mafenide acetate in treatment of burn wounds.

Histological and clinical studies of wound healing were performed in comparable cases of fresh partial-thickness burns treated with honey dressing or mafenide acetate in two groups of 50 randomly allocated patients. Of the patients with honey-treated wounds, 84% showed satisfactory epithelialization by day 7 and 100% by day 21. In wounds treated with mafenide acetate, epithelialization occurred by day 7 in 72% of cases and in 84% by day 21. Histological evidence of reparative activity was observed in 80% of wounds treated with honey dressing by day 7 with minimal inflammation. Fifty-two per cent of the mafenide acetate treated wounds showed reparative activity with inflammatory changes by day 7. Reparative activity reached 100% by day 21 with the honey dressing and 84% with mafenide acetate. Thus, in honey-dressed wounds, early subsidence of acute inflammatory changes, better control of infection, and quicker wound healing were observed, while in mafenide acetate treated wounds a sustained inflammatory reaction was noted even on epithelialization.

Prevalence of hepatitis E virus (HEV) antibody in pregnant women of Karachi.

BACKGROUND: This study was aimed at determining the prevalence of HEV in Karachi. METHODS: Prevalence of hepatitis E antibody in pregnant women was carried out in 65 pregnant women. They had history of acute viral hepatitis while 15 control pregnant women were included having no history of jaundice. RESULTS: The statistical outcome of the present study indicates prevalence of HEV as 57% in pregnant women with jaundice. Majority of the patients (85%) were from lower socio-economic strata., with mean age of 25 years. All these patients had hemoglobin less than 10 gm%. The mean ALT level in HEV positive cases was 452 IU/L over a range of 102-5328. It was also observed that HEV affected more women in the last trimester (62%) and in primigravida (67%). It was observed that it was more common in last trimester and in primigravida. Majority of the patients (85%) were from lower socio-economic strata. CONCLUSIONS: The findings of the present study proved the presence of HEV in pregnant women and confirmed that HEV is endemic in Karachi. The study confirms that it occurs in last trimester and in young adult.

Dynamic measurement of the torque-speed characteristics of dental high speed air turbine handpieces.

The first requirement for adequate performance of an air turbine handpiece is sufficient power. Suppliers of such handpieces do not provide data on the power produced by their equipment. A method for determining the torque, speed and hence power during simulated operation is described. Forty-one new and used handpieces were tested. Maximum speeds up to 500,000 rpm, maximum torques up to 2.33 N.mm and maximum power up to 29.6 watt were observed. The maximum power was produced at between 49 and 79 per cent of the free-running speed. A relationship between maximum power and stall torque was noted. The maximum torque is at stall for ball-bearing units. The stall torque can be easily determined by a simple stall torque test which is described. Using this test, the performance of handpieces can be easily checked in the clinic. The one air-bearing handpiece tested performed in a manner similar to the others, except that stall occurred below 60,000 rpm.