Result of conservative management in central fracture dislocation of hip.

The central fracture dislocation of hip involves displacement of medial wall and superior weight bearing dome of acetabulum. The management of this type of fracture is to be planned after meticulous clinical and radiological planning of the personality of fracture along with status of the patient. Ideally displaced fracture should be treated by anatomic reduction, stable internal fixation and early non-weight bearing exercises. But considering the complications of open reduction and internal fixation we must take into account the "risk benefit equation" ie, to measure the benefit gained against the risk of surgery. Dynamic stress fluoroscopic examination under general anaesthesia was performed to assess the need for surgical treatment for central fracture dislocation of hip. Stable hips were treated nonoperatively, and unstable hips were treated by open reduction and internal fixation. Every patient had routine clinical and radiographic follow-up at one week, three weeks, six weeks, three months, six months, and one year after the injury and then on yearly basis. Harris' hip score was used for evaluation. Institutional review board approval was obtained prior to initiation of this study. All 14 patients in this study were evaluated radiologically and functionally for a minimum of two years after the injury (average 2 years; range 2 to 5 years) and were graded as excellent, good, fair and poor using the Harris' hip score. Excellent results were obtained in 6 cases (42.85%), good results in 3 cases (21.42%), fair results in 4 cases (28.57%) and poor result in one case (7.14%). Central fracture dislocation of hip is an intra-articular fracture of weight bearing joint, so it is supposed to be managed better by open reduction and stable Internal fixation followed by early movement. But with meticulous evaluation and selection of cases, proper conservative management gives comparable results to the open reduction and internal fixation group even in young patients where secondary congruency is achieved. To conclude conservative management is an effective modality of treatment in appropriate cases of central fracture dislocation of hip.

Giant mass conjunctival rhinosporidiosis causing severe mechanical ectropion.

Rhinosporidiosis is a granulomatous disease of the mucous membrane caused by Rhinosporidium seeberi, an organism of uncertain taxonomic position, most probably a fungus. It usually infects mucous membrane of the nose and nasopharynx but may infect mucous membrane of all other parts even the skin. Inoculation of the eye and related structures are grouped as oculosporidiosis. In this case of a 50 years old male agriculturist from remote village had complaints of a mass protruding out from the palpebral fissure since last one year. It was gradually increasing in size and shape. There was recurrent redness, watering and discharge. This mass caused dragging of lower lid to produce mechanical ectropion. On examination there was a pedunculated polypoidal broad based conjunctival mass originated from inferior bulbar conjunctiva. It is chemosed with the evidence of necrosis and old haemorrhagic spot, engorged conjunctival vessel and in the exposed pert there is keratinisation. Conjunctival rhinosporidosis has predilection for agriculture workers so that contact with contaminated soil may be the causative factor. The only effective treatment is radical surgical excision followed by thermal and chemical coagulation, nevertheless relapse is the rule rather the exception. No such medical treatment has proved to be effective. Griseofulvin and amphotericin have been used without success.

Bactibilia due to enterococcus species in a case of periampullary carcinoma.

Biliary obstruction due to pancreaticobiliary malignancy is often accompanied by bactibilia and cholangitis; which are associated with postoperative septic complications and may adversely affect the clinical course. The enterococcus species is most responsible for postoperative complications in patients with malignant biliary obstruction. Here a case of bactibilia in a 60-year-old male patient, admitted with peri-ampullary carcinoma is reported. The bile sent for Gram-stain showed the presence of pus cells and Gram-positive cocci in pairs and the bacteriological culture revealed the growth of Enterococcus faecium. The patient developed fever with chills on the second postoperative day. The blood cultures of the patient showed growth of Enterococcus faecium for which he was given vancomycin. The patient went on to develop a surgical site infection, the wound swab of which revealed the growth of klebsiella species. The patient was treated for the wound infection and was later on discharged after three weeks of hospital stay. The patient was doing well during follow-up with the subsidence of the jaundice and Iiver enzymes.

Change of patellar height with age and sex.

Patellar height is one of the important parameter in patellar stability. Growth spurt or excessive physical strain can lead to high-riding patella or patella alta. But this is not yet proved. This study was mainly targeted at eliciting the influence of age on Insall-Salvati index, one of the important index to measure patellar height. As the present study is meant for measuring the patellar height separately in male and female, it is also to find out the effect of gender on patellar height if any. The study was been conducted in North Bengal Medical College and Hospital among 93 subjects covering both adult and adolescent age groups. Patellar height of respective subjects was measured radiologically using Insall-Salvati Index; results were extrapolated for statistical analysis. It revealed that value of Insall-Salvati index was higher in adult compared to adolescent group but the difference was not statistically significant. Statistical tests shows no significant difference in Insall-Salvati index according to sex. While screening the athletes patella alta must be kept in mind as this can be associated with patellofemoral pain syndrome, chondromalacia patellae, knees with apophysitis of tibial tubercle (Osgood-Schiatter disease). Not only that, significant cause of recurrent patellar dislocation can be associated with patella alta