Isolated hydatid cysts at unusual sites

In this case report we highlight the difficulty in clinical diagnosis of hydatid disease at unusual sites. In 12 years 4 months period six cases of hydatid cyst found at unusual sites. This included two cases involving breast [one male and other female], and one each involving spleen, omentum, neck and thigh muscles. All were removed at surgery without any difficulty

Intestinal parasitic infections in children from Northern Pakistan

Intestinal parasitic infections cause significant morbidity in children of developing countries, where the vicious cycle of infections and malnutrition impairs their physical growth and development. A community based cross-sectional study on randomly selected children under 15 years of age was performed in two towns of Northern Pakistan. Information on hygiene, sanitation, waste disposal, water supply and maternal education was collected and the nutritional status of these children was assessed. Stool samples of the subjects were collected, immediately preserved and later examined for parasites, with severity of infection being quantified. Of the 89 samples examined, 91% contained one or more parasites. The lowest prevalence of infection was in children less than one year old. Majority of those infected in both towns were girls. Fifty-one percent of the infected children from Yasin and 38% from Singal suffered from malnutrition. Maternal education, family income and drinking water treatment did not affect the prevalence of infection in either town. The most frequent parasites isolated were Ascaris lumbricoides [66.3%], Entamoeba histolytica [27%], Blastocystis hominis [27%], Giardia lamblia [24.7%], and Trichuris trichiura [15.7%]. The results of this study indicate that parasitic infections in northern Pakistan have a high prevalence but low intensity. Programs for early detection and interventional strategies, along with improved hygiene, sanitation and waste disposal facilities are urgently needed to improve the health of these children

Bilateral Symmetrical osteomyelitis

Chronic multifocal symmetrical osteomyelitis is a rare condition. To our knowledge, only 30 cases have been reported in the literature; 25 of them occurred in patients of Europe, 2 in Middle East and 3 in Zambia [Africa]. We also present such a case from this part of world with diagnosis of tuberculosis

Immobilization of cross-leg flap by external fixator

This is a study of 34 patients having Gustilo type III i.e. open fracture with soft tissue defect that cannot be filled by simpler methods like partial thickness skin grafting but requires cross leg flap with stabilization. In this study, stabilization was done with a relatively new method i.e. by an external fixator which allows easy access to the flap and readjustment if necessary together with early mobilization. The flap grafts were accepted in all cases. Age [minimum 3 years] and site [exposed heel, dorsum of foot, exposed tibia] are not a restriction for the use of external fixator. Complications were minimum and easily treated e.g. pin-tract infection [17.65%], joints stiffness [20.59%, etc. this flap was used for 24 tibial fractures out of which 21 united giving a nonunion rate of 12.50%. We feel that management of cross-leg flap with external fixator is simpler and gives better results