Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma

A 13-year-old female presented at her pediatrician’s office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.

Human Primary Olfactory Amygdala Subregions Form Distinct Functional Networks, Suggesting Distinct Olfactory Functions

Three subregions of the amygdala receive monosynaptic projections from the olfactory bulb, making them part of the primary olfactory cortex. These primary olfactory areas are located at the anterior-medial aspect of the amygdala and include the medial amygdala (MeA), cortical amygdala (CoA), and the periamygdaloid complex (PAC). The vast majority of research on the amygdala has focused on the larger basolateral and basomedial subregions, which are known to be involved in implicit learning, threat responses, and emotion. Fewer studies have focused on the MeA, CoA, and PAC, with most conducted in rodents. Therefore, our understanding of the functions of these amygdala subregions is limited, particularly in humans. Here, we first conducted a review of existing literature on the MeA, CoA, and PAC. We then used resting-state fMRI and unbiased k-means clustering techniques to show that the anatomical boundaries of human MeA, CoA, and PAC accurately parcellate based on their whole-brain resting connectivity patterns alone, suggesting that their functional networks are distinct, relative both to each other and to the amygdala subregions that do not receive input from the olfactory bulb. Finally, considering that distinct functional networks are suggestive of distinct functions, we examined the whole-brain resting network of each subregion and speculated on potential roles that each region may play in olfactory processing. Based on these analyses, we speculate that the MeA could potentially be involved in the generation of rapid motor responses to olfactory stimuli (including fight/flight), particularly in approach/avoid contexts. The CoA could potentially be involved in olfactory-related reward processing, including learning and memory of approach/avoid responses. The PAC could potentially be involved in the multisensory integration of olfactory information with other sensory systems. These speculations can be used to form the basis of future studies aimed at clarifying the olfactory functions of these under-studied primary olfactory areas.

Bilateral dorsal rotation of the talus with tibiotarsal, talocalcaneal, and proximal intertarsal joint subluxation in an alpaca

CASE DESCRIPTION A 14-month-old female alpaca presented with a 3-week history of acute left hind limb lameness and swelling of the left tarsal region. CLINICAL FINDINGS Radiography revealed intermittent dorsal rotation of the talus with tibiotarsal, talocalcaneal, and proximal intertarsal joint subluxation. TREATMENT AND OUTCOME In an attempt to stabilize the talus, screws were placed in the distomedial aspect of the talus and the plantaromedial aspect of the central tarsal bone, and a stainless-steel wire was placed around the screws in a figure-eight pattern. The screw head of the proximal screw broke within 4 weeks after surgery, but subluxation did not recur, and the lameness resolved. Seven months later, the same condition was diagnosed in the opposite hind limb and was treated similarly. Implants remained intact on this side, but the animal started to show signs of pain and inability to flex the tarsal joint, prompting removal of the distal screw. Subsequently, the animal became sound and produced 2 healthy crias, but was euthanatized 4 years after the second surgery because of coccidiosis. CLINICAL RELEVANCE Dorsal rotation of the talus with tibiotarsal, talocalcaneal, and proximal intertarsal joint subluxation is a sporadic condition in New World camelids. This report provides the first account of successful treatment by surgical stabilization of the medial aspect of the proximal intertarsal joint.

Burn injury from filling balloons with nitrous oxide

We present the case of a female teenager who sustained nitrous oxide burns to the medial aspect of both thighs from contact with a nitrous oxide canister being used to fill balloons. There was a delay in presentation as the injury was not initially recognised. These burns were initially assessed as being superficial partial-thickness burns but took a prolonged time to heal despite regular wound care. This was complicated by a lack of adherence to recommended treatment for much of the patient care as well as the patient testing positive for COVID-19 during their management, which prevented surgery and significantly extended time to healing. While small numbers of similar cases have been previously described this is the first reported case outside of the Netherlands and in a child. Being aware of such cases ensures early referral to specialist burn care for appropriate management to give patients the best possible outcome.

Physiotherapy Rehabilitation in Operated Case of Patellar Fracture and Medial Malleolus Fracture- A Case Report

Introduction: Road traffic accidents (RTA) are responsible for a considerable amount of global death and morbidity, particularly in developing nations. 'Hidden pandemics,' such as mortality from RTA, often go unnoticed over the world.(1) These days traffic road accidents lead to many fractures included patellar fracture. Patellar fractures account for about 1% of all skeletal fractures and are most common in people between the ages of 20 and 50. 1–3 Men have nearly twice as many cases as women. Clinical Findings: On physical examination respiratory system, cardiovascular system and central nervous system are normal and on local examination of left lower limb demonstrate attitude of limb in hip and knee in extension and foot in external rotation and multiple abrasions are present over the knee and there were abrasion of 10*2cm present over medial aspect of great toe and abrasion of 5*2cm present over the postero-medial aspect of distal 3rd leg, lacerated wound on medial malleolus.In this case patient was on 8 week protocol for physiotherapy management. Discussion: In this case report we are discussing a case of 36 year old male with fracture of patella and medial malleolus managed with tension band wiring and nailing respectively. The primary goal of physiotherapy management was to prevent secondary complications and make the patient independent for which rehabilitation protocol was planned which included isometric exercises, dynamic quadriceps bed mobility exercises and ambulation. Conclusion: Physiotherapy plays an important role in rehabilitation of patient with medial malleolus and patella fracture.

Hibernoma of Thigh: A Case Report of 39-Year-Old Male

Introduction: Hibernoma is an uncommon benign lipomatous tumor that originates from residual brown fat. It commonly affects adult patients aged between 30 and 40 with a slight predominance in male more than female and usually seen in the thigh, shoulder, back, chest, axilla, and neck. The present report aimed to highlight on a viable differential diagnosis of thigh mass including liposarcoma and atypical lipoma. Case Presentation: This is the case report with detailed history, examination of 39-year-old male patient with hibernoma over medial aspect of thigh. Marginal surgical resection was carried and sent to histopathology to confirm the diagnosis of hibernoma. Conclusion: Hibernoma is a rare benign lipomatous soft tissue tumor with no known risk for malignant transformation or metastasis. Based on imaging examination, it can mimic malignant tumors such as, liposarcoma, in which we believe that biopsy is required in order to reach the diagnosis in most of the cases. Keywords: Soft tissue tumor, hibernoma, brown fat, liposarcoma.

Identification of Isocitrate Dehydrogenase 2 (IDH2) Mutation in Carotid Body Paraganglioma

Carotid body paragangliomas (PGLs) are rare neuroendocrine tumors that develop within the adventitia of the medial aspect of the carotid bifurcation. Carotid body PGLs comprise about 65% of head and neck paragangliomas, however, their genetic background remains elusive. In the present study, we report one case of carotid body PGL with a somatic mutation in the gene encoding isocitrate dehydrogenase 2 (IDH2). The missense mutation in IDH2 resulted in R172G amino acid substitution, which exhibits neomorphic activity and production of D-2-hydroxyglutarate.

Management of Non-Healing Ulcer by the Use of Crushed Raw Papaya along with Leeching: A Case Study

The incidence of non-healing ulcer is 1-2 percent in developed countries. In Indian community its prevalence reported in year 2004 was 4.8 per 1000 populations. It may increase many folds in future because of increase in number of old persons, diabetes mellitus and vascular diseases A male patient aged 63yrs. came to surgery OPD Majeedia Unani Hospital, Jamia Hamdard, New Delhi, in October 2019, with the complain of ulcer on antero-medial aspect of right foot. The ulcer was painful and movement was limited on affected side. After required investigations and local examination of wound, treatment was started by local application of meshed papaya and combination of oral Unani drugs formulations along with leech therapy as described in texts of Unani System of Medicine. It was observed that Unani treatment of non-healing ulcer with papaya and leech therapy is an option to avoid amputation and its complications. The ulcer completely healed without any locomotor disturbances. Recovery was very fast and the condition of leg totally resolved without any complications and side effects. Keywords: Non-healing ulcer, Unani medicine, leech therapy, Qurooh-e-Aseeratul Indemal.

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review

Purpose Elder abuse is a worldwide problem with serious consequences for individuals and society. The recognition of elder abuse is complex due to a lack of awareness and knowledge. In this systematic review, types, characteristics and anatomic location of physical signs in elder abuse were identified. Methods Databases of MEDLINE, COCHRANE, EMBASE and CINAHL were searched. The publication dates ranged from March 2005 to July 2020. In addition to the electronic searches, the reference lists and citing of included articles were hand-searched to identify additional relevant studies. The quality of descriptive and mixed-methods studies was assessed. Results The most commonly described physical signs in elder abuse were bruises. The characteristics of physical signs can be categorized into size, shape and distribution. Physical signs were anatomically predominantly located on the head, face/maxillofacial area (including eyes, ears and dental area), neck, upper extremities and torso (especially posterior). Physical signs related to sexual elder abuse were mostly located in the genital and perianal area and often accompanied by a significant amount of injury to non-genital parts of the body, especially the area of the head, arms and medial aspect of the thigh. Conclusions Most common types, characteristics and anatomic location of physical signs in elder abuse were identified. To enhance (early) detection of physical signs in elder abuse, it is necessary to invest in (more) in-depth education and to include expertise from a forensic physician or forensic nurse in multidisciplinary team consultations.

Unilateral Obturator Hernia in Elderly Male: A Case Presentation

OBTURATOR HERNIA is a rare condition of pelvic hernia in which abdominal contents protrude through the obturator canal. This condition can lead to bowel obstruction with relatively high mortality and morbidity due to bowel ischemia/gangrene. Most commonly presents in elderly thin females. It is primarily asymptomatic unless there is compression of the obturator nerve. Therefore, obturator hernia in the differential diagnosis of intestinal obstruction of unknown origin. Computed tomography is the modality of choice for preoperative diagnosis as obturator hernia. Sometimes mistakenly diagnosed as femoral or inguinal hernia on Ultrasonography. Its early diagnosis is challenging since the signs and symptoms are non-specific make a preoperative diagnosis difficult. We present a case of obturator hernia in an 81-year-old male with a known prostate carcinoma who presented with a painless soft swelling in the medial aspect of the right upper thigh and a negative Howship-Romberg sign.