Young adult and giant cervical exostosis

Degenerative changes in the spine can result in the formation of osteophytes on the anterior surface of the cervical spine. Depending on their site, osteophytes can bring on clinical manifestations such as dysphagia, hoarseness, and stridor. We discuss an interesting case of a young adult patient who presented with dysphagia along with neck discomfort, and on investigation was found to be suffering from diffuse idiopathic skeletal hyperostosis. Here, we briefly portray the presenting features, radiographic findings, and management options

Post-cholecystectomy Mirizzi's syndrome: magnetic resonance cholangiopancreatography demonstration

A long cystic duct remnant may be found after laparoscopic cholecystectomy. Stone may form in the remnant cystic duct and can cause postcholecystectomy syndrome. Remnant cystic duct calculus may rarely result in postcholecystectomy Mirizzi's syndrome. Traditionally, Mirizzi's syndrome has been diagnosed with endoscopic retrograde cholangiopancreatography [ERCP] and treated with open surgery. We report a case of postcholecystectomy Mirizzi's syndrome that developed 3 years after laparoscopic cholecystectomy. A non-invasive diagnosis of Mirizzi's syndrome was made comprehensively by magnetic resonance cholangiopancreatography. Endoscopic stone removal was achieved successfully with ERCP without any complication

Aneurysmal bone cyst of pubis a rare presentation

Aneurysmal bone cyst is a benign usually expansile, solitary lytic lesion of bone; with blood filled cystic cavities, which tend to grow eccentrically. Such eccentric growth may, on occasion, attain considerable size before it is clinically recognized, particularly if the tumor arises in a deeply situated bone. Aneurysmal bone cyst of pubis is a rare entity. In the following case report, an aneurysmal bone cyst, originating from the superior pubic ramus, expanded into the groin and first manifested itself as a gradually increasing fullness in groin and pain especially with weight bearing. The size and location of this vascular tumor posed difficulties in treatment. It was managed by curettage with high speed burr and reconstruction of the defect with an iliac crest cancellous bone graft

Specific evoked motor response for supraclavicular brachial block

To assess and evaluate the accuracy of individual types of evoked motor responses [EMRs] for prediction of successful surgical anesthesia following peripheral nerve stimulator [PNS] assisted supraclavicular block. A prospective study was carried out over a period of one and half years from August 2004 to January 2006, at J. N. Medical College, Aligarh Muslim University, Aligarh, India, in 60 patients who underwent various elective operative procedures on the upper limb. Any of the EMR, such as forearm flexion or extension, carpal flexion, or extension, prono-supination, or finger flexion, at a definite current of 0.25 mA for 2 ms was taken as an end point for prediction of successful block, and a local anesthetic solution [0.375% Bupivacaine, 30 ml] was administered at that level. Complete surgical anesthesia was observed in those cases where EMR included: flexion of only second and third fingers [n=15/15] or flexion of all 4 fingers with thumb opposition [n=14/14] or uncommon flexion of all 4 fingers without movement of any other joint of the upper limb [n=2/2], suggesting a sensitivity of 100%. However, thumb opposition to the tip of the flexed little finger revealed a success rate of only 83% [n=5/6], and other EMRs were followed by high rates of inadequate surgical anesthesia or total failure. Specific EMR of flexion of second and third fingers, or all the 4 fingers are reliable predictors of complete surgical anesthesia following PNS assisted single injection supraclavicular nerve block with no incidence of pneumothorax and nerve damage