Ovarian dermoid cyst presenting with unusual complaint of hair coming out of the anal orifice - A case report.

Dermoid cyst of the ovary is a common benign condition. It is usually asymptomatic but can present with pain, mass, hormone related symptoms or paraneoplastic syndrome. Hair is a common morphological component of the dermoid cyst; however, it rarely manifests as a presenting complain. We report a case, who presented with the complaints of hair coming out through her anal orifice for a year. Ultrasound and computed tomography scan revealed a dermoid cyst of the right ovary adherent to the rectum. Surgical removal showed hair coming out of the cyst. Primary repair of the defect in rectal wall was performed which resulted in resolution of the symptoms.

Localized Injection of Streptomycin, Kenacort and Lidocaine combination for Symptomatic Pain Management of Knee Osteoarthritis.

OBJECTIVE: To determine the frequency of reduction of pain in symptomatic knee osteoarthritis by using combination injections. METHODS: The experimental study was conducted from January 1, 2010, to December 31, 2016,at Al-Noor Surgery Hospital, Chakwal, Pakistan, and comprised patients suffering from symptomatic knee osteoarthritis. All patients were injected intra-articularly and peri-articularily with a combination of streptomycin, kenacort and lidocaine. The effects of this injection were recorded immediately after injection, after a month and after a year. Data was analyzed using SPSS 21. RESULTS: Of the 169 patients, there were 70(41.40%) males and 99(58.60%) females. The overall mean age and pain duration was 59.27±7.79 years and10.5±5.1 years respectively. No patient had pain immediately after the injection and after a month of follow-up. After a year, 145(86%) had a complete loss of pain compared to the baseline. Three (1.77%) patients required repetition of injection after a year. None of the patients suffered from septic arthritis or localised flare-ups and no one opted for knee joint arthoplasty. CONCLUSIONS: Combination of streptomycin, low-dose corticosteroids and lidocaine hadimmediate and prolonged effect in reducing pain in patients with knee osteoarthritis.

Revascularization Of Late-Presenting Acute Limb Ischaemia And Limb Salvage.

BACKGROUND: Late-presenting acute limb ischaemia represents a challenging vascular emergency. The purpose of this study was to evaluate the outcome in patients following revascularization and management of existing or impending reperfusion injury of ischaemic limbs over a 12-year period (2002-2014). METHODS: Routine procedural codes were used to label consecutive patients admitted 72 hours following onset of symptoms for surgical revascularization of an acutely ischaemic limb. Data collected included demography, clinical presentation, synchronous morbidities, procedural specifics and outcomes of surgical management of all patients. RESULTS: The study sample included 206 patients, (117 male and 89 female, average age =49.4±14.6 years) presenting with a diagnosis of acute limb ischemia. The most frequent cause of acute thromboembolic limbs was cardiac disease (n=148). Femoral artery exploration with embolectomy was the most common procedure and was used for aortic, iliac, infrainguinal and distal occlusion. Thirty-four patients required additional vascular surgery due to failure of revascularization by embolectomy. Fasciotomy was performed in 45.6% of cases for existing or impending compartment syndrome when the patient presented very late. Surgical site infection occurred in 8.25% of cases, repeat embolectomy was required in 10.68% of cases; amputation in 13.1% and mortality was 5.8%. Predictors of morbidity and mortality included age of the patient, time of presentation and specific comorbidities. The 5-year amputation-free and survival estimate was 80%. CONCLUSIONS: Our study suggests that late revascularization of acute leg ischaemia improves blood supply to the limb, thereby reducing the number of amputations. The results suggest that revascularization is clinically warranted, even one week following the onset of acute ischaemia. Additional surgical procedures including fasciotomy further reduce the morbidity and mortality.