Infective endocarditis still remains a dreaded illness among treating physicians because of the disease course, its need for meticulous antibiotic management, complications, and overall morbidity. Peripheral mycotic aneurysms are a rarely reported complication of infective endocarditis. Mycotic aneurysms occur in about 5%–10% of cases of infective endocarditis, and most of them involve the intracranial vessels. Here, we report a case of native valve endocarditis in a 74-year-old man caused by Kocuria rosea. He presented with septic shock and acute kidney injury. His illness was complicated by a right popliteal artery mycotic aneurysm. He was treated with intravenous ceftriaxone and vancomycin. The mycotic aneurysm needed aneurysmectomy and anastomosis with a graft.
A 64-year-old man presented with blackish pigmentation of skin and tongue for more than 2 years that did not improve with local remedies. He had no history of comorbid medical or surgical illnesses. General examination showed severe hyperpigmentation of skin and mucosa and also showed anaemia. Systemic examination was unremarkable except for Romberg sign and mild hyperreflexia. Adrenal insufficiency was ruled out by normal cortisol levels and haemogram showed macrocytosis with hypersegmented neutrophils suggestive of severe vitamin B12 deficiency which confirmed by low serum B12 levels. After 3 months of parenteral vitamin B12 treatment, the pigmentation and anaemia improved significantly. The mechanism of hyperpigmentation due to B12 deficiency is postulated to be increased melanin deposition in the basal layer of the epidermis. Since vitamin B12 deficiency is not uncommonly encountered in general practice, atypical presentation of this easily diagnosable and treatable condition is emphasised.
There are few reported cases of flexor tendon sheath ganglion arising from the A2 pulley. We report a case of a flexor tendon sheath ganglion in a 17-year old female who presented with pain, triggering and a swelling at the base of her right ring finger. During the excision biopsy, a ganglion measuring 0.5×0.8×0.4 cm in size was removed from the A2 pulley area.
Complex fractures of proximal and distal femur often difficult to treat. Plating of segmental femoral shaft fractures is also an option, particularly when associated with peritrochanteric fractures, but associated complications. Although technically difficult, intramedullary nailing has been recommended by several studies and has demonstrated good results. The purpose of this review was to analyse our results with the interlocked nailing of complex fractures of the femur.
Heterotopic ossification (HO) is defined as the presence of lamellar bone at locations where bone normally does not exist.This syndrome is most commonly seen following neurological disorders such as traumatic brain or spinal cord injury, or following joint surgery or severe burns. Patients with neurogenic HO develop lesions around larger joints. The hip is the most common location, followed by the knees and elbows but complete ankylosis is a rare presentation. Radiation therapy, surgical resection, biphosphonates and various non-steroidal anti-inflammatory drugs (NSAIDs) have been reported and advocated as efficacious methods for management of HO. We report a case of ankylosing pelvitrochanteric HO in a patient with spinal tuberculosis (TB) treated successfully with surgical excision, postoperative radiation therapy and indomethacin.
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