Large myofascial fibromatosis involving the shoulder girdle.

An 11 year old girl presented with gradually increasing swelling over left scapular region and limitation of movements. On examination, a mass with firm to hard consistency was found fixed to the scapula. Clinical diagnosis of fibromatosis was confirmed by needle biopsy. Radical excision of the tumor was carried out and the resultant large exposed area was covered by transpositional rotation of trapezius myocutaneous flap. Microscopic examination of excised tumor revealed spindle shaped elongated cells in the form of whorls and trabeculae. The post operative course of the patient was uneventful with no evidence of recurrence at the end of 22 months.

Epithelioid sarcoma of the upper extremity with cerebral metastases.

A forty year old male patient presented with swollen, deformed right hand with multiple irregular ulcers. The axillary lymph nodes were enlarged, firm and tender. The biopsy of nodules present on the hand revealed areas of haemorrhage and necrosis. The histopathological examination confirmed the clinical diagnosis of epithelioid sarcoma. Following below-elbow amputation, patient failed to regain consciousness and expired. On autopsy, distant metastases were found in the regional lymph nodes, pleura, kidney and cerebrum.

Natural course of hematogenous pyogenic osteomyelitis (a retrospective study of 110 cases).

Hundred and ten consecutive cases in acute and various stages of chronicity were studied. Incidence regarding age, sex, bone affected and complications was established. The optimum way to manage osteomyelitis in different stages was sought. It was found that in acute stage early decompression of bone leads to resolution of disease. Hip involvement leads to necrosis of capital epiphysis and should be treated on an emergency basis. In the sub-acute stage it is necessary to protect the weakened bone. In chronic stage, we suggest sequestrectomy only after adequate involucrum has formed properly. Antibiotics in acute stage should be instituted as early as possible and should be continued for three weeks after the fever subsides. Antibiotics in sub-acute and chronic stage are given only in cases of reactivation of infection and around the time of surgery. Surgery, when required should be performed without too much soft tissue damage especially the covering periosteum. But repeated surgery should be avoided as they lead to cicatrization of muscles and further sequestration of bone.

An unusual case of hip disability--(a case report).

An unusual case of postero-superior periarticular irritation of the hip joint of six months' duration due to an extension of a pre-sacral foreign body granuloma in an 18 year old unmarried girl is presented. Two wooden sticks which probably were inserted pervaginally by a village midwife to induce an abortion for an unwanted pregnancy had found its way to presacral region. The scanning of the vaginal fornix indicated a possible route through which the sticks might have been migrated.