Unlocking a locked knee by ultrasound guided anesthetic injection.

Twenty-three-year old male patient with a background of mild cerebral palsy (with limited effect on mobility) presented with 36 hours history of pain on the lateral aspect of his left knee. On examination his knee was locked and there was no associated history of trauma. A detailed MRI scan required in extension and unlocked leg to elucidate the cause. This was achieved by administration of local anesthetic under ultrasound guidance to the lateral aspect of the knee with successful results. This case is important as it looks at minimally invasive management of the acutely locked knee prior to more detailed imaging. Pseudolocking of the knee is a well-known cause of knee locking. Performing a magnetic resonance imaging (MRI) scan to diagnose cases of pseudolocking can prevent unnecessary intervention such as arthroscopy. In our case, the orthopedic team was reluctant to take the patient to theatre without more detailed imaging, given his medical history. There are very few case reports in the literature which address this issue and there is no case in the literature using this technique in cerebral palsy with muscle spasm.

Trichobezoar with and without Rapunzel syndrome in paediatric population: A case series from a tertiary care centre of Northern India.

INTRODUCTION: Trichobezoars are concretions formed by accumulation of hair in stomach. Usually, trichobezoar is confined to the stomach, but rarely it may extend from the stomach to the small intestine and even colon. This is an unusual form called Rapunzel syndrome. Our experience with this rare entity of Rapunzel syndrome and interesting entity of trichobezoar is being presented with review of literature. PRESENTATION OF CASES: We, at our institute, encountered four cases of trichobezoar in last five years, out of which two were found to be of Rapunzel syndrome. All of these cases were managed successfully by open surgical intervention in view of the very large size of the mass in all the cases. DISCUSSION: The clinical presentation is highly variable ranging from asymptomatic cases diagnosed incidently to serious gastrointestinal symptoms and complications. Cases of trichobezoar have been reported in literature very infrequently but Rapunzel syndrome is extremely rare and less than 50 cases have been reported in medical literature till date. CONCLUSION: Trichobezoar leading to Rapunzel syndrome is an extremely rare entity. The clinical presentation is usually vague and non-specific. Treatment is mainly surgical because of delayed presentation in majority of the cases. Psychiatric illness is the usual association.

ANCA negative eosinophilic granulomatosis with polyangiitis: sometimes it really IS vasculitis.

A 21-year-old woman, with a background of asthma, presented to medical admissions ward, with diarrhoea and vomiting; the clinical picture during her admission evolved to include acute shortness of breath, seizures, unsteadiness, low mood and apathy. Investigations revealed pericardial, pleural effusions, myocardial infiltration and vasculitic lesions in the brain. Although serological tests for autoantibodies were negative, an eventual diagnosis of eosinophilic granulomatosis with polyangiitis, formerly known as Churg-Strauss syndrome, was performed based on the clinical picture. The multiorgan involvement meant that the initial diagnosis and effective management required multidisciplinary input from cardiology, neurology, rheumatology, psychiatry, immunology and occupational and physiotherapy.

Neuroborreliosis: the Guillain-Barré mimicker.

A 34-year-old woman presented to the medical admissions unit with progressive ascending weakness of her limbs and areflexia. Diagnosis of Guillain-Barré syndrome was suspected and she was started on intravenous immunoglobulins. Owing to a poor initial response, further exploratory history revealed travel to the New Forest and a possible tick bite; subsequent investigations confirmed positive serology for antibodies against Borrelia. The patient's weakness improved with intravenous ceftriaxone for neuroborreliosis, a manifestation of Lyme disease. With inpatient neurorehabilitation, she made good recovery and was able to mobilise with a stick from being completely bed bound 6 weeks after completion of her antibiotics.

Uterine lipoleiomyoma.

We report a case of a patient who was found to have a uterine lipoleiomyoma on ultrasound and MRI, which was later confirmed with histological evidence. Uterine lipoleiomyomas are rare benign tumours that are often misdiagnosed on imaging, leading to unnecessary invasive procedures. Increased awareness of the tumour and its characteristics on imaging can aid future preoperative diagnosis.