A Rare Presentation of Spinal Schwannoma Causing Conus Medullaris Syndrome: A Case Series on Surgical Outcome.

INTRODUCTION: Spinal schwannoma can occur anywhere along the spinal cord but is predominantly seen in the cervical and thoracic region.It composes mainly of well-differentiated schwann cell and is benign in nature. It is typically seen in the peripheral nerves and is commonly associated with neurofibromatosis. Up to 80% of cases, spinal schwannoma is reported to be intradural in location and 15% of cases have both intradural and extradural components. Spinal schwannoma rarely causes conus medullaris syndrome. CASE REPORT: In this case series, all three female patients in their 4th and 5th decades of life presented with conus medullaris syndrome. Lower back pain, radiculopathy, lower limb weakness, and urinary incontinence are their main clinical presentation. Magnetic resonance imaging shows a well-defined intradural, extramedullary mass compressing onto the conus medullary region. These patients undergone microscopic assisted excision of the tumor and had remarkably good early outcome despite the advanced presentation of neurological deficit. CONCLUSION: Despite the late presentation with significant neurological deficit, surgical excision of spinal schwannomas carries a good prognosis postoperatively due to their benign nature and extramedullary location.

Microbiology of diabetic foot infections in three district hospital in Malaysia and comparison with South East Asian Countries

@#Introduction: Diabetic foot infection, a complication that is associated with lower-limb amputation, incurs a huge economic burden to the hospital and health care system of Malaysia. The bacteriological profile of pathogens in diabetic foot infections in Malaysia has been sparsely studied. We investigated the microbiology of diabetic foot infections in patients admitted to the district hospitals on the east coast of Malaysia. Methods: A retrospective analysis was conducted in three district hospitals (Hospital Kuala Lipis, Hospital Bentong and Hospital Raub) in Malaysia from 1st of January 2016 to 31st December 2016. The clinical specimens were cultured using Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic sensitivity testing to different antibiotics was carried out using the disc diffusion method. Result: A total of 188 pathogens were isolated from 173 patients, with an average of 1.09 pathogens per lesion. Majority of the pathogens isolated were gram negative pathogens (73.4%). The most commonly isolated pathogens were Staphylococcus aureus (17.5%). This was followed by Klebsiella spp. (17%), Pseudomonas spp. (15.4%) and Proteus spp. (13.8%). Gram positive pathogens were sensitive to most of the antibiotics tested except penicillin and fusidic acid. Gram negative pathogens were sensitive to all antibiotics tested except ampicillin and amoxicillin/clavulanic acid. Amikacin provide coverage for all gram negative pathogens in DFI. Conclusion: For the management of patient with infection in diabetic foot, the choice of antibiotic therapy depends on the sensitivity of the pathogens, the severity of the infection, the patient’s allergies history, toxicity and excretion of the antibiotics.

Isolated Regan-Morrey Type III Fracture of the Ulnar Coronoid Process: A Report of Two Cases.

INTRODUCTION: Fracture of the ulnar coronoid process is uncommon. It is commonly associated with posterior dislocation of the elbow, but it may also present as an isolated fracture. In general, all ulnar coronoid process fractures with elbow joint instability and large fracture fragments are fixed surgically. We report two cases of the rare isolated Regan-Morrey type III ulnar coronoid process fractures and their outcomes. CASE REPORT: Case Report 1: Mrs P, a 27-year-old right-hand dominant female, was involved in a motor vehicle accident (MVA) and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. In view of the large coronoid process fragment causing elbow joint instability, she underwent an open reduction and internal fixation when the elbow swelling had subsided. An anterior approach was used to identify the fracture fragment and it was fixed with two half-threaded cancellous lag screws with washers to achieve an anatomical reduction. Postoperatively, she recovered with excellent outcome based on the Mayo elbow performance score (MEPS).Case Report 2: Mr M, a 23-year-old right-hand dominant gentleman, was involved in a MVA and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. During examination under general anesthesia, passive range of the movement of his right elbow was noted to be <90°due to the impaction of the fracture fragment. An open reduction through an anterior approach was performed and Kirschner wires were inserted to fix the coronoid process fracture. Kirschner wires were opted for the ease of post-operative removal as the patient was not keen to have a retained implant after recovery. He recovered with good outcome based on the MEPS. CONCLUSION: Isolated fracture of the ulnar coronoid process is rare. Open reduction and internal fixation is mandatory for patients with coronoid process fracture and unstable elbow joint to achieve good functional outcomes.

Cervical vertebral fracture: A report of two cases of “Near-Miss” C6 fractures

ervical spine injury is commonly associated with road-traffic accidents. The true incidence of cervical spine injuries is unknown due to under-reporting of such injuries. Cervical spine injury is associated with high morbidity and mortality if it is missed. With the advancement of imaging modalities, the number of missed cervical injuries has reduced. Nevertheless, some clinicians are dependent solely on imaging tools to rule out cervical spine injury in a trauma victim. We report two cases of “near miss” C6 fracture to highlight the importance of a detailed clinical history and clinical examination with imaging as an adjunct to rule out cervical injury.