Meningeal Rosai-Dorfman Disease Presenting as an Intracranial Mass - Report of a Case with Review of the Literature.

Meningeal Rosai-Dorfman disease, a type of sporadic Rosai-Dorfman disease, is a rare occurrence. A few cases are reported in the English literature with an adequate immunohistochemical workup. This entity clinically and radiologically mimics either a meningeal or a parenchymal neoplasm with meningeal extension, warranting a thorough histopathologic evaluation. A broad histologic differential necessitates a detailed immunohistochemical characterization to render a correct diagnosis that has significant therapeutic and prognostic implications. Herein, we report a case of isolated meningeal Rosai-Dorfman disease in a 50-years-old human immunodeficiency virus-positive male patient with an emphasis on the histopathology, immunoprofile, and differential diagnoses.

A Step Toward the Exploration of Better Spirometric Parameters for Early Diagnosis of Pulmonary Dysfunction in Persons With Type 2 Diabetes Mellitus.

OBJECTIVES: This study aims to determine the forced vital capacity (FVC) and slow vital capacity (SVC) along with other pulmonary functions in Indian diabetic patients for early diagnosis of pulmonary function reduction and to compare the ratios of forced expiratory volume in one second (FEV1) with FVC and SVC (FEV1/FVC and FEV1/SVC) in diabetic patients. MATERIALS AND METHODS:  A prospective observational study was carried out in the physiology department for two years after the approval of the institutional ethics committee. The study included 90 type 2 diabetes mellitus patients previously diagnosed by the physician and 90 age and sex-matched controls for spirometric tests. Medspiror having Helios 401 software (Recorders & Medicare Systems Pvt. Ltd., Panchkula, India) was used to assess the pulmonary function in all subjects. A comparison of dynamic pulmonary function parameters among non-diabetic and diabetic groups and non-obese vs. overweight/obese individuals of the diabetic group has been done. FEV1/FVC ratio vs. FEV1/SVC ratio comparison was conducted between the non-obese vs. the overweight/obese group in diabetic patients. RESULTS: A significant variation in FEV1 and FVC was observed in the type 2 diabetic group as compared to the non-diabetic group. However, in the case of type 2 diabetic subjects, FEV1/FVC ratio was almost constant in both BMI groups, whereas the FEV1/SVC ratio increased in the overweight/obese group. CONCLUSION: Type 2 diabetes mellitus accounts for a predictive factor for worsening pulmonary function. SVC, particularly the FEV1/SVC ratio, can be an earlier diagnostic marker for pulmonary dysfunction in diabetic subjects as this ratio changes even with a constant FEV1/FVC ratio.

Management of Chronic Subdural Hematoma: Burr Hole versus Twist Drill - A Prospective Study.

INTRODUCTION: Incidence of chronic subdural hematoma (CSDH) is about 5/100,000/year in the general population and still rising. Two surgical techniques, namely, burr-hole evacuation (BHE) versus twist-drill evacuation (TDE) are commonly used to manage such patients but the preferred surgical method continues to attract debate, and the time for an evidence-based approach is now overdue. In vogue with recent trends, a minimally invasive surgical approach is considered as best; therefore, we tried to establish the hypothesis that TDE is as safe and as effective as BHE for CSDH treatment. MATERIALS AND METHODS: A prospective, randomized, controlled study including forty patients was conducted. The primary outcome variable studied was clinically significant recurrence rate. The secondary outcome variables in postoperative period and follow-up assessment of the patients include Glasgow coma scale (GCS), Markwalder grade, postoperative complication, and operative mortality rate. RESULTS: In our study, results of BHE seem to be superior than TDE in terms of recurrence rate (5% vs. 15%), complication rate (15% vs. 20%), and mean Markwalder neurological grading score and mean GCS at time of discharge (0.16 vs. 0.45 and 14.95 vs. 14.65, respectively). TDE seems to be better than BHE in terms of duration of hospital stay (7.4 vs. 8.05). However, these differences were not statistically significant. TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and least invasive. Overall results were comparable across both techniques without any significant difference. CONCLUSION: Although both techniques appear to be similar in respect of their primary and secondary outcome variables, but TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and small incision.

Minimally Invasive Total Hip Replacement in an Ipsilateral Post-traumatic above-knee Amputation: A Case Report.

INTRODUCTION: Total hip replacement (THR) is a highly successful operation in alleviating pain and improving the overall function of the hip, in end-stage arthritis of the hip, in otherwise fit patients. However, THR as a surgical option in post-traumatic hip arthritis with ipsilateral above-knee amputation is rarely reported. CASE REPORT: We are presenting a case report of a 30-year-old male, who had previously underwent an above-knee amputation due to road-traffic accident, presenting 24 h after the injury with segmental fracture femur and popliteal artery laceration, for which the limb could not be salvaged. He had an impacted anteroinferior dislocation of the ipsilateral hip with significant cartilage damage of the femoral head which required open reduction. Subsequently, he developed traumatic arthritis of the involved hip which required conversion to an uncemented THR, using a minimally invasive (MIS) anterolateral approach. The preoperative management, surgical technique, and postoperative rehabilitation are described to highlight the technical challenges, these lower limb amputees may present along with review of literature of such rare cases. CONCLUSION: THR in an above-knee amputee with posttraumatic hip arthritis using MIS technique is an encouraging surgical option for early functional recovery and minimizing surgical complications.

Neglected Recurrent Scalp Sinus: Calvarial Tuberculosis with Intracranial and Extracranial Extension.

BACKGROUND: Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions. CASE PRESENTATION: A 43-year-old man presented with a generalized seizure, altered mental state, scalp swelling, and pus-discharging sinus over the scalp. Magnetic resonance imaging of the brain indicated a conflicting diagnosis of anaplastic meningiomas and chronic osteomyelitis with intracranial extension. Débridement and drainage of intracranial pus was performed. Histopathologic examination revealed TB. After surgery, the patient's general condition improved, and he was started on antitubercular drugs. CONCLUSIONS: Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.

Intramuscular Arteriovenous Hemangioma of Thigh: A Case Report and Review of Literature.

INTRODUCTION: Skeletal muscle hemangiomas are uncommon soft tissue tumors; more than 90% are misdiagnosed initially. They present as chronic pain and swelling in a muscle with or without a history of trauma. Magnetic resonance imaging is the investigation of choice. Many treatment modalities for the symptomatic hemangiomas are available of which surgical excision is the most preferred. CASE REPORT: We present an unusual case of pain, swelling, and restriction of movements in the right knee following an episode of trauma in an 8-year-old boy diagnosed to have intramuscular arteriovenous hemangioma in the vastusmedialis and vastusintermedius for which he was treated by surgical excision and followed for 2 years and found to have no recurrence. CONCLUSION: Skeletal muscle hemangiomas are completely treatable; the knowledge of their natural history, clinical findings, and imaging appearances are of great importance for proper diagnosis and treatment.

Craniocervical junction tuberculosis: Usual pathology at an unusual site.

BACKGROUND: Tuberculosis (TB) of the craniocervical junction is rare even where the condition is endemic. It poses problems in both diagnosis and management if not managed in time it may cause life-threatening complications. CASE DESCRIPTION: An 18-year-old male patient presented with pain in the nape of the neck since 12 months duration which was not improving with medication. After magnetic resonance imaging of cervical spine, he was diagnosed as craniocervical junction TB. We did a transoral decompression of abscess with biopsy along with posterior decompression of cord and occipitocervical fusion. Biopsy of pathological material came as TB. He was advised for anti-tubercular therapy for 18 months. CONCLUSION: Although craniocervical junction TB is a rare disease, the outcome of treatment is good. Antituberculous drug therapy remains the mainstay of treatment after confirming the diagnosis. The surgical management options include transoral decompression with or without posterior fusion, depending upon the presence and persistence of atlantoaxial instability.

Complex Primary Total Knee Replacement (TKR) Using Prophylactic Gastrocnemius Flap and Rotating-Hinge Knee in Post-traumatic, Infective Arthritis of the Knee - A Case Report.

INTRODUCTION: Prophylactic gastrocnemius flap with primary rotating hinge knee is technically demanding in a case of neglected post-traumatic, infective arthritis of the knee, with challenges of compromised skin and soft tissues, articular bone defect, limb mal-alignment, gross instability, retained hardware and a contracted extensor mechanism with the patella fixed in the lateral gutter all in combination, is rarely reported. We report such a complex case in this study. CASE REPORT: We report a 48 year male patient with a history of fracture lateral femoral condyle of right knee due to road traffic accident 10 years back, for which he got operated with open reduction and internal fixation with cancellous screws, which subsequently got infected. Primary procedure undertaken was removal of implants, debridement, placement of antibiotic-cement spacer followed by prophylactic medial gastrocnemius flap and a temporary joint spanning external fixator. Definitive procedure undertaken, after clearance of infection in 12 weeks was conversion to a rotating hinge TKR using a lateral para-patellar arthrotomy & tibial tubercle osteotomy to address the challenges of fixed patella in the lateral gutter and contracted ligamentum patellae. At one year follow up, the knee was painless, stable, with satisfactory range of motion and improved function without any infection or aseptic lysis. CONCLUSION: Prophylactic Gastrocnemius flap cover along with rotating hinge knee arthroplasty using a lateral para-patellar approach and tibial tubercle osteotomy in a case of neglected post-traumatic, infective arthritis of knee with the complexities of limb mal-alignment, compromised skin and soft tissue, articular bone loss and ligamentous instability is a satisfactory bail out option in such a highly complex joint scenario.

Ankle and foot tuberculosis: a diagnostic dilemma.

AIM AND OBJECTIVE: To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population. MATERIALS AND METHODS: Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases. RESULTS: During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases - three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year. CONCLUSION: AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.