Elemental Mercury Poisoning by Self-Injection - A Report of Two Cases.

Injection of mercury into the upper limb is a rare method of self-harm. We report two patients with varied clinical presentations - a 19-year-old male student who injected himself with mercury extracted from a sphygmomanometer bulb and reported to our emergency department 24 hours after the event and a 34-year-old industry worker who presented 2 years after injecting himself with elemental mercury. The management of mercury poisoning is described along with a brief review of literature. Mercury is a toxic element and adequate safety precautions must be taken by the surgical team in the management of such patients. Level of Evidence: Level V (Therapeutic).

A Rare Case of Ewing's-like Adamantinoma of Tibia Managed by Limb Salvage Surgery Using Long Segment Ilizarov Bone Transport: A Case Report and Review of Literature.

INTRODUCTION: Adamantinoma is a rare low-grade malignant tumor in young adults. Recent advances in molecular techniques have shown different variants with discordance between genotype and phenotype. This poses a challenge in diagnosis and management. Ewing's-like adamantinoma is one such variant. The appropriate treatment protocol for this dedifferentiated tumor remains to be established. Here, we present a rare case of Ewing's-like Adamantinoma treated with limb salvage surgery using three step Ilizarov technique with good results. CASE REPORT: A 38-year-old lady presented at our OPD complaining of recent onset pain and gradual increase in size over a long standing swelling in the right lower tibia. Radiologically was diagnosed as Ewing's but was not responsive to chemotherapy. A Tru-Cut biopsy showed histological picture of dedifferentiated adamantinoma. Immunohistochemistry showed CD99 positivity. FISH revealed (11;22) translocation confirming Ewing's-like adamantinoma. She was managed with wide excision followed by staged Ilizarov distraction-osteogenesis and bone transport to correct the 13 cm discrepancy in bone length. There have been no signs of recurrence on post-resection follow-up of 2 years. Patient attained full range of knee and ankle movements. CONCLUSION: The controversy as to what constitutes the difference between adamantinoma-like Ewing's and Ewing's-like adamantinoma persists despite technological advances. The appropriate treatment protocol remains to be established. Ilizarov three step techniques provide a feasible alternative to amputation while circumventing the difficulties of large bone reconstruction in the distal tibia.

Two rare cases of Giant cell tumor of Distal Ulna.

Giant cell tumours, though benign, are locally aggressive bone tumours with a relatively high recurrence rate. These usually occur in distal radius, distal femur, proximal tibia and humerus. Treatment options for contained lesions at these sites include joint preservation procedures such as extended curettage with cementing or bone graft. GCT in spine, calcaneum and distal ulna are rare, with no uniform consensus regarding the ideal treatment. Here we report two cases of GCT distal ulna managed with extended curettage and polymethylmethacrylate cementing showing good functional and radiological outcomes without signs of recurrence during 2 years follow up.