Terrible triad of the elbow: a case report of a new variant.

The usual terrible triad of the elbow consists of posterior dislocation of the elbow, radial head fracture and coronoid fracture. We describe a new variant of the terrible triad of the elbow consisting of fracture of the capitellum involving the full length of the trochlea and posterolateral dislocation of the elbow associated with coronoid fracture (type 1 Regan-Morrey). A 25-year-old girl was brought to the emergency ward with the history of having jumped from the third floor with an intention of committing suicide. She sustained multiple fractures, i.e, fracture ribs, bilateral intra-articular fracture of the lower end of the radius, left-side elbow injury, left subtrochanteric fracture femur and left zygomatic fracture with head injury. The elbow was stable after stabilization of the capitellum fracture through a collateral approach. Coronoid fragment was left alone, as it was a very small fragment.

Polymerase chain reaction for the rapid diagnosis of tuberculous meningitis.

(i) AIM OF THE STUDY: The study was carried out with the aim to evaluate a polymerase chain reaction (PCR) based on the amplication of a 169 bp DNA fragment specific for the Mycobacterium tuberculosis complex for the rapid diagnosis of tuberculous meningitis (TBM). (ii) METHODOLOGY: A total of 105 CSF specimens from clinically suspected cases of TBM were studied. Clinical details of the cases and cytochemical parameters of the CSF specimens were recorded. In addition to the 105 specimens, 10 CSF specimens from cases other than TBM, 4 non-mycobacterial culture isolates (1 strain of E. coli, 1 strain of Proteus species and 2 strains of Salmonella species) and 1 sample of sterile distilled water were processed as negative controls. For positive control standard culture of Mycobacterium tuberculosis H37Rv was processed with every batch of specimens. Besides PCR, smear for AFB by the Ziehl Neelsen Carbol Fuchsin (ZNCF) and the fluoro chrome method and culture on LJ medium was also carried out. (iii) RESULTS: By PCR, 31.42% specimens were found positive, whereas by conventional culture on LJ medium only 3.8% specimens were positive. Only 1.9% specimens were found to be smear positive by the fluorochrome staining method, while none was positive by the ZNCF method.The PCR results showed complete correlation with the clinical findings of the patients. (iv) CONCLUSION: The PCR was found to be superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and could play a critical role in the diagnosis of suspected cases.

Primary plasma cell leukaemia.

A rare form of plasma cell dyscrasia, primary plasma cell leukemia is presented. The clinical picture resembled an acute leukaemia with a fulminant course and a rapidly fatal outcome.