The mainstay of management of tuberculosis of the craniovertebral junction is prolonged antitubercular treatment with a rigid external immobilization. Surgery is not necessary, even in patients with advanced stages of disease. Complete clinical and radiological healing occurs in all patients with conservative treatment.

The diagnosis of mesenteric cysts should be kept in mind in any patient presenting with acute abdominal symptoms. Small bowel volvulus with mesenteric cyst constituted a significant number in children with acute abdominal symptoms. Early diagnosis and treatment yields excellent outcome.

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Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients.

In light of the results of most recent studies showing better survival of surgical patients with tight glycemic control the preservation of intraoperative normoglycemia gains clinical relevance.1 Epidural anesthesia in the absence of general anesthesia has long been recognized to suppress the hyperglycemic and endocrine responses to pelvic surgery. 2 The failure of epidural anesthesia combined with inhalation anesthesia to maintain glucose homeostasis during major abdominal surgery was traditionally ascribed to incomplete inhibition of the counterregulatory endocrine response. 3Studies demonstrating that inhaled agents per se, in contrast to iv anesthetics such as propofol, 4 provoke hyperglycemia, however, indicate that the use of inhaled anesthesia may be, at least in part, responsible. 5 We thus speculated that combining epidural anesthesia with iv propofol anesthesia would prevent the hyperglycemic response to colorectal surgery.After obtaining patient consent we studied six consecutive ASA II patients (three male, three female, mean age 69 ± 12 yr) who underwent resection of colorectal cancer (three hemicolectomies, three sigmoid resections) by the same surgeon (S.M.). An epidural catheter was inserted immediately before the operation between T10 and T12. Afferent neural blockade was established with bupivacaine 0.5% to achieve a bilateral sensory block from T4 to L2, and epidural anesthesia was maintained during the operation by boluses of bupivacaine 0.25%. General anesthesia was induced with propofol administered at a dose to abolish the eye reflex. Tracheal intubation was facilitated by rocuronium 0.6 mg·kg -1 iv and the lungs were ventilated to normocapnia with oxygenenriched air. General anesthesia was maintained by continuous infusion of propofol at 6 to 10 mg·kg . Blood losses were replaced by normal saline in a ratio of 3:1. Phenylephrine boluses (100 µg iv) were given to maintain a mean arterial pressure above 60 mmHg. Arterial blood glucose concentrations were measured before anesthesia, 80 min and 120 min after surgical skin incision using the Accu-Chek™ glucose monitor (Roche Diagnostics, Basel, Switzerland).Differences in blood glucose concentrations were determined using analysis of variance for repeated measures.The blood glucose concentration increased from 5.5 ± 0.6 mmol·L -1 prior to surgery to 6.7 ± 1.2 mmol·L -1 at 80 min (P < 0.05) and 7.1 ± 1.3 mmol·L -1 at 120 min of surgery (P < 0.05). The intraoperative values were numerically greater than values previously obtained in patients undergoing colorectal surgery under combined epidural and inhalation anesthesia. Our data suggest that a clinically modest hyperglycemic response to colorectal surgery occurs in patients receiving epidural anesthesia during propofol anesthesia.

Development of a contralateral epidural haematoma during or immediately after cranial surgery is a well-described entity. However, in a case of acute subdural haematoma where the brain is usually tense, postoperative development of contralateral extradural haematoma is uncommon. We report two cases of contralateral extradural haematoma after decompressive surgery for acute subdural haematoma. We recommend routine postoperative CT immediately after cranial surgery for head trauma. This would help in timely detection and treatment of such a complication.

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IntroductionEvidence on new-onset endocrine dysfunction and identifying whether the degree of this dysfunction is associated with the severity of disease in patients with COVID-19 is scarce.Patients and MethodsConsecutive patients enrolled at PGIMER Chandigarh were stratified on the basis of disease severity as group I (moderate-to-severe disease including oxygen saturation &lt;94% on room air or those with comorbidities) (n= 35) and group II (mild disease, with oxygen saturation &gt;94% and without comorbidities) (n=49). Hypothalamo-pituitary-adrenal, thyroid, gonadal axes, and lactotroph function were evaluated. Inflammatory and cell-injury markers were also analysed.ResultsPatients in group I had higher prevalence of hypocortisolism (38.5 vs 6.8%, p=0.012), lower ACTH (16.3 vs 32.1pg/ml, p=0.234) and DHEAS (86.29 vs 117.8µg/dl, p= 0.086) as compared to group II. Low T3 syndrome was a universal finding, irrespective of disease severity. Sick euthyroid syndrome (apart from low T3 syndrome) (80.9 vs 73.1%, p= 0.046) and atypical thyroiditis (low T3, high T4, low or normal TSH) (14.3 vs 2.4%, p= 0.046) were more frequent in group I than group II. Male hypogonadism was also more prevalent in group I (75.6% vs 20.6%, p=0.006) than group II, with higher prevalence of both secondary (56.8 vs 15.3%, p=0.006) and primary (18.8 vs 5.3%, p=0.006) hypogonadism. Hyperprolactinemia was observed in 42.4% of patients without significant difference between both groups.ConclusionCOVID-19 can involve multiple endocrine organs and axes, with a greater prevalence and degree of endocrine dysfunction in those with more severe disease.