A Hyperflexion Hallux Mallet Injury: A Case Report.

Injuries of the extensor hallucis longus (EHL) tendon are a rare phenomenon, with most occurring due to lacerations or penetrating injuries. Closed traumatic ruptures of the EHL are described as "Mallet injuries of the toe". These can be classified as bony or soft mallet injuries depending on the presence or absence of a fracture at the insertion site of the EHL tendon in the distal phalanx. We present a case of a 33-year-old woman who presented with a hyperflexion injury to the left big toe with inability to extend the big toe. Ultrasound showed complete rupture of the EHL tendon with retraction proximal to the hallucal interphalangeal joint of the big toe. The patient was treated through transarticular pinning and repair using the Arthrex Mini Bio-Suture Tak with a 2-0 fibre wire. Six months post-operatively, the patient had symmetrical EHL power and full range of motion of the toe. The lessons to be drawn from this case report are that isolated hallux mallet injuries are rare and can be easily missed in the absence of penetrating wounds. Patients who have such injuries should be investigated early with the appropriate imaging techniques such as ultrasound or MRI and treated surgically.

A True Mimicker to Plasmacytoma Clinically, Radiologically, and Pathologically - A Rare Case Report.

Lympho plasmacytoma is distinct type of diffuse large B cell lymphoma predominantly seen in HIV-positive patients. The diagnosis of lympho plasmacytoma could be a challenge due to its overlapping characterizes with those of myeloma and lymphoma. We report a case of a 50-year-old man who initially presented with a painful solitary destructive lesion at the second lumbar vertebra. Clinico-pathological findings were consistent with a solitary plasmacytoma, and he was treated with definitive radiotherapy. Eight months after completing radiotherapy, he was found to have similar lesions at D4 vertebral body, multiple ribs, and pelvis. Subsequent biopsy confirmed lympho plasmacytoma. Because of its rarity and heterogeneous presentations, lympho plasmacytoma could easily be overlooked clinically and pathologically in immunocompetent patients. The diagnosis of lympho plasmacytoma should be considered when there is coexpression of myeloma and lymphoma immune markers.

Comparative evaluation of fracture toughness and marginal adaptation of two restorative materials in nonendodontically and endodontically treated teeth: An in vitro study.

OBJECTIVE: To evaluate and compare the fracture resistance and marginal adaptation of Zirconomer and bulk fill posterior restorative material (Surefil SDR) in nonendodontically and endodontically treated teeth. MATERIALS AND METHODS: The sample consisted of 52 caries-free extracted human premolars which were individually mounted in polyvinyl chloride (PVC) ring filled with acrylic resin up to 1.0 mm below the cementoenamel junction. The teeth were then divided into four groups according to the restorative material used as group I: Zirconomer + Operative only, Group II: Zirconomer + Endodontic treatment, Group III: SDR + Operative, and Group IV: SDR + Endodontic treatment. Fracture strength was tested using a universal testing machine and was expressed in Newtons. The marginal gap was measured at its maximum using a scanning electron microscope and expressed in micrometers. One-way analysis of variance followed by Tukey's post hoc test was used to compare the mean fracture resistance (N) and marginal adaptation (µm) between the four groups. Statistical significance was determined at α = 0.05. RESULTS: Group 3 exhibited significantly highest mean fracture resistance than Group 1 (P < 0.001), Group 2 (P < 0.001), and Group 4 (P < 0.001). Group 4 had significantly higher mean fracture resistance than Group 1 (P = 0.008) and Group 2 (P < 0.001). Group 1 exhibited significantly highest mean marginal gap than Group 3 (P < 0.001) and Group 4 (P < 0.001). Group 2 had a significantly higher mean marginal gap than Group 3 (P < 0.001) and Group 4 (P < 0.001). CONCLUSION: The fracture resistance and marginal adaptation of Zirconomer are significantly lower than Surefil SDR in both nonendodontically and endodontically treated teeth.

Treatment of thyroid eye disease.

OPINION STATEMENT: Thyroid eye disease (TED) is an autoimmune disease characterized by varying degrees of proptosis, congestion and inflammation of the extraocular tissues, and eyelid retraction. It is usually seen in the setting of Graves' disease, but the severity of TED does not necessarily correlate with the level of systemic disease in a given patient. It is very important, nonetheless, to try to achieve a euthyroid state to minimize the chances of exacerbation of TED. Treatment of TED is based on the signs and symptoms displayed by the patient; there is no "one size fits all" approach. Generally, it is advisable to start with conservative measures, such as ocular lubrication with artificial tears, to manage symptoms of chronic irritation and redness. It is also imperative that the patient be advised to quit smoking, because there is a clear link between smoking and disease activity. Medical treatment with systemic oral or pulsed intravenous corticosteroids should be reserved for patients with active inflammation resulting in increased orbital pressure, compressive optic neuropathy, severe periorbital edema, or similar presentations. Once there is significant improvement in the acute inflammation, it is useful to treat patients who have residual inflammation with external beam radiation in order to be able to wean the patient off steroids and avoid their well-known complications.If there is significant corneal exposure due to lid retraction, and the lid position has been stable for at least 6 months, eyelid surgery can be considered. If exposure is minimal, this may consist of a lateral tarsorrhaphy. For larger amounts of exposure, recession of the levator muscle, Müller's muscle, or both can be performed. Those patients who have stable diplopia for at least 6 months are candidates for strabismus surgery. Patients who progress to severe proptosis or compressive optic neuropathy may need orbital decompression surgery. Generally, if more than one type of surgical procedure is necessary, orbital decompression is performed first, followed by strabismus surgery; eyelid surgery is performed last.

Intraorbital heroin injection resulting in orbital cellulitis and superior ophthalmic vein thrombosis.

A 47-year-old man with decreased vision, ophthalmoplegia, proptosis, and chemosis of his right eye admitted to injecting heroin directly into his orbit. He was placed on intravenous antibiotics for orbital cellulitis, and computed tomography and magnetic resonance imaging were performed. Superior ophthalmic vein thrombosis (SOVT) was noted on magnetic resonance imaging. The patient responded well to intravenous antibiotics, and his symptoms resolved with minimal deficits. Steroids and anticoagulants were not administered. We review the pathogenesis of septic SOVT and briefly discuss the role of anticoagulants and steroids in this setting.

Bilateral periorbital ecthyma gangrenosum.

We describe a case of bilateral periorbital ecthyma gangrenosum in a diabetic patient with renal failure. Ecthyma gangrenosum is a cutaneous manifestation of Pseudomonas sepsis. We briefly review the pathogenesis of ecthyma gangrenosum and discuss previous reports of periocular involvement. In our patient, conservative measures and supportive care of the periorbital tissue resulted in a good outcome.

Massive subcutaneous emphysema mimicking necrotizing fasciitis after dacryocystorhinostomy.

We present a case of massive subcutaneous emphysema mimicking necrotizing fasciitis after uncomplicated dacryocystorhinostomy surgery. Subcutaneous emphysema progressing down fascial planes of the head and neck after dacryocystorhinostomy has not been reported in the literature. Using the clinical presentation and radiographic imaging, we briefly review the underlying cause of subcutaneous emphysema after dacryocystorhinostomy.

Jaw-winking ptosis in a patient with Kabuki syndrome.

We present a case of a child with Kabuki syndrome and jaw-winking ptosis. Kabuki syndrome is rare and consists of a constellation of findings including mental retardation, characteristic oculofacial features, and skeletal abnormalities. The association of Kabuki syndrome and jaw-winking ptosis has not been previously reported.

Subdural haematoma with spontaneous resolution--rare manifestation of idiopathic thrombocytopenic purpura.

Spontaneous intracranial haemorrhage presenting as subdural haematoma is an extremely rare presentation in adults due to idiopathic thrombocytopenic purpura. There are only five such case reports available in the literature and four had surgical evacuation of haematoma, while only one had spontaneous resolution. We report the case of a middle aged female who presented with bilateral papilloedema and later diagnosed to have subdural haematoma as a complication of idiopathic thrombocytopenic purpura, which had a spontaneous resolution.