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Background: Skeletal tuberculosis constitutes about 1% of all tubercular cases. It usually affects the spine and long bones. Tubercular osteomyelitis of skull is a rare entity and therefore diagnosis is not suspected. Skull bones usually involves secondarily from the lung or lymph node focus. Biopsy in these cases confirms the diagnosis. Case Report: A 20 year male patient presented with gradually progressive headache, with multiple episodes of seizures. Magnetic resonance imaging (MRI) brain revealed heterogeneously enhancing extra-axial bi-frontal convexity mass lesion. Histopathology showed necrosis and many caseating as well as non-caseating well defined epithelioid granulomas. Conclusion: A high index of suspicion is important to recognize tuberculous involvement of the skull. Biopsy confirms the diagnosis.

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Background: Pulmonary alveolar proteinosis (PAP) poses a risk of opportunistic infections with a variety of organisms with Nocardia being the most common pathogen followed by mycobacteria and fungi. Case presentation: A 7-year-old female child, presented with headache and multiple episodes of vomiting. There was no fever or altered sensorium. On examination, there were no focal deficits or cranial nerve palsies. An MRI brain showed a small T2 hyperintense lesion in the left superior parietal lobe suggestive of an abscess. She was diagnosed as PAP based on CT chest and bronchioloalveolar lavage 7 months earlier and treated with corticosteroids. A left parietooccipital craniotomy was done with drainage of abscess and abscess wall excision. Histopathology revealed a suppurative lesion with slender septate acute angle branching hyphae which were positive on fungal stains. Culture done on the pus was positive for Aspergillus fumigatus. The patient was treated with voriconazole and stable at 1 year follow-up. Conclusion: Opportunistic infections are common in patients diagnosed with PAP. High index of clinical suspicion and early diagnosis are important for favorable outcome.

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INTRODUCTION:Tracheostomy is a life-saving procedure involving incision on trachea followed by insertion of a tube which maintains the patency of the opening in trachea either temporarily or permanently. In recent years there has been a considerable shift in emphasis regarding the indications for tracheostomy with recognition of more physiological and functional indications where in normal respiratory efficiency is impaired because of patient's inability to maintain normal ventilation and control of secretions in addition to those of a strictly obstructive nature. OBJECTIVES: To study various indications, intra and post-operative complications of emergency tracheostomy. METHODS: Present study is a prospective study conducted in the patients attended to causality and ENT op with stridor in S. V. R. R. Government General Hospital, Tirupathi during 2009-2011 over a period of two years. Patients of all ages & both sexes are included in this study. All the patients were subjected to detailed ENT, Head & Neck examination and operated by emergency tracheostomy. Intra operative and post-operative complications were noted during the follow up period of 3-6 months. RESULTS: Most common indication of emergency tracheostomy was laryngeal malignancy followed by poisoning, head injury, subglottic stenosis and bilateral abductor palsy. Hemorrhage is the most common complication observed followed by surgical emphysema, apnoea etc. CONCLUSSION: Emergency tracheostomy is a safe and reliable method of restoring the airway and also gives ample time for the specialist to plan & execute further management of underlying cause.

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