Mass: The Conundrum in Spine.

Introduction: Immunoglobulin (Ig)G4-related disease belongs to a rare compilation of conditions in rheumatology and may involve a multitude of organs. Amidst the central nervous system (CNS) presentation, involvement of spinal cord is rarer still. Case Report: Case 1: A 50-year-old male came with chief complaints of tingling sensation over both soles since 2 months associated with lower back ache and gait disturbance in the form of spastic gait. X-rays of spine were suggestive of a growth at the level of D10-D12 compressing the spinal cord with no focal sclerotic/lytic lesions, and MRI dorsolumbar spine showed dural tail sign. The patient underwent excision of dural mass, and histopathology revealed majority of plasma cells positive for IgG4. Case 2: A 65-year-old female came with complaints of cough, shortness of breath, and fever on and off since 2 months. No history of hemoptysis, purulent sputum, weight loss. On examination: There were bilateral rhonchi in the left upper zone. MRI spine showed focal erosion with soft-tissue thickening at the right paravertebral region extending from D5-9. The patient underwent surgery (fusion D6-8 and ostectomy D7 posterior rib resection D7 right side) with the right pleural biopsy and transpendicular intracorporal biopsy D7. Histopathology was compatible with findings of IgG4 disease. Conclusion: IgG4 tumors presenting in CNS itself is rare and rarer in spinal cord. Histopathological examination is central to diagnose and prognosticate the disease further as IgG4-related disease manifestations may recur without proper treatment.

The management of psoas abscess.

The presentation and management of psoas abscess was studied prospectively in 5 patients and retrospectively in 4. 3 patients had bilateral abscesses. All patients had back pain and a mass in loin or iliac fossa. 7 patients had no hip findings. One patient had a perinephric abscess and another had radiological features of tuberculosis of the spine. In the other seven no cause for the abscess could be identified. Ultrasonography demonstrated the abscess in all patients; CT scanning done in 5 patients was confirmatory. Drainage was done by an extraperitoneal route. Biopsy of the abscess wall in 2 patients demonstrated tuberculosis. They, the patient with TB spine and 3 others put empirically on anti-tuberculosis chemotherapy responded well. The perinephric abscess grew Pseudomonas sensitive to gentamycin, but she and two other patients died due to multiorgan failure.

Impalement injuries.

Impalement injuries are still seen today and constitute a challenging form of trauma. Our experience with four cases is presented. The management of each case has to be individualised. It may not be necessary to lay open the tract taken by the impaling object in every case.

Subtrochanteric fractures of the femur--an analysis of the results of operative and non-operative management.

In this retrospective study, 38 subtrochanteric fractures of the femur, managed by operative and non-operative methods were analysed and the results compared. Excluding three pathological fractures, 12 fractures were internally fixed and 23 were treated in traction. In 83.3 per cent of fractures treated operatively and 82.6 per cent treated non-operatively, excellent or good results were obtained. Poor results in traction were due to associated head injury and failure to comply with the position required to maintain alignment. Poor results in the operative group were in the Seinsheimer Type 3A with poor medial buttress. We conclude that both operative and non-operative management give acceptable results in subtrochanteric fractures of the femur but the latter is indicated in Seinsheimer Type 3A fractures.