Ultrasonographic diagnosis of tumoral calcinosis in End-Stage renal disease

We report the case of a young 25-year male, a known case of end-stage renal disease [ESRD], undergoing irregular dialysis sessions, who presented with multiple swellings along the extensor surfaces of large joints of body including shoulders, sacrum, wrists and elbows. The swellings were initially painless, but later became painful on movements alone, were causing hindrance in movement and the sacral lump was causing difficulty in lying supine. On evaluation by laboratory investigations, he revealed borderline hyperphosphatemia and hypocalcemia. The patient was referred by the treating physician to radiology department for assessment and evaluation of the periarticular swellings. Musculoskeletal ultrasound revealed multiple, large, hypoechoic shadows in subcutaneous location around both shoulders, elbows, wrists and sacrum. The needle aspirate showed thick whitish liquefied material which revealed amorphous, basophilic, clumps of dystrophic calcification on cytology. He was on irregular treatment and dialysis sessions. He was diagnosed as a case of tumoral calcinosis on the basis of history, examination and investigations. He was recommended surgical excision of the large swellings which were causing hindrance in his activities of daily living. He was put on phosphate lowering drugs and diet. Regular hemodialysis sessions were scheduled, but the patient had a fast downhill course and died within a month of diagnosis of tumoral calcinosis

role of intraarticular platelet rich plasma [PRP] injection in patients with internal knee derangements

Platelet Rich Plasma [PRP] is an emerging biotechnology which uses patient's own blood components to create healing effect to their own injured tissues. This study was carried out to evaluate the clinical effects, adverse reactions and patient satisfaction after intraarticular injection of platelet rich plasma in a small group of patients with internal derangements of knee at Combined Military Hospital, Panoaqil, Pakistan. In this single center, open study, 10 patients with internal derangements of knee fulfilling the inclusion criteria received two doses of 3 ml of platelet rich plasma as intraarticular knee injection at two weeks interval. All patients were evaluated at 0, 4 and 12 weeks after treatment using IKDC, TEGNER, KOOS and VAS. Adverse events and patient's satisfaction was recorded. There was significant improvement in all scores. Intraarticular PRP injection is safe and effective method in the conservative treatment of internal knee derangements

pattern of peripheral nerve injuries among Pakistani soldiers in the War against terror

To determine the pattern of peripheral nerve injuries in Pakistani soldiers in the War against terror. Case series. Department of Electrodiagnosis at Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi, Pakistan, from June 2008 to June 2011. All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 +/- 8 years. Blast was the main cause of nerve injury in 244 [48.5%] cases followed by gunshot in 215 [42.7%] and 45 [8.9%] cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six [17%] cases had multiple nerve injuries. Most commonly injured nerve was ulnar [20.6%] followed by sciatic [16.7%], median [16.5%], radial [16.3%], peroneal [8.7%], brachial plexus [8.5%], axillary [4.8%], tibial [2%], femoral [1.8%], long thoracic [0.4%] and others [3.8%]. Axonotmesis was seen in 459 [91.1%] cases, 44 [8.7%] cases revealed neurotmesis and 1 [0.2%] case had neuropraxia. Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services