Primary extra-skeletal Ewing's sarcoma presenting as an epidural Soft Tissue Lesion causing cauda equina syndrome in an adolescent girl: a case report.

Introduction: Primary epidural Ewing's sarcoma in the lumbar spinal canal is a rare condition and very few cases are reported in the literature.

Case Report: A fifteen-year-old girl presented with low backache associated with sudden onset of weakness and radiculopathy of both lower limbs for 10 days, bowel and bladder involvement for 3 days. Physical examination revealed grade 0/5 power and absent sensations below L4 dermatomal level and perianal region (ASIA A).

Report of isolated epidural extra-nodal Rosai-Dorfman disease of cervicothoracic spine.

Introduction: Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a nonneoplastic lymphoproliferative disorder which commonly presents with painless massive cervical lymphadenopathy along with fever and weight loss. Isolated extra-nodal disease involvement, especially isolated central nervous system disease without lymph node involvement is rare.

Case Presentation: A 35-year-old man presented with upper back pain and paraparesis of 2 months duration.

Pediatric recurrent aggressive spinal fibromatosis with progressive kyphosis and neurological deficits.

Aggressive fibromatosis is a benign, locally invasive fibroblastic proliferation that can cause compressive effects on adjacent structures. The primary cure of this disease rests in wide excision of the tumor. Unfortunately even when surgical margins are clear of tumor, recurrence rates are high.

Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis.

Study Design: Retrospective radiographic study.

Objective: To assess whether flexibility as revealed by the supine radiograph, predicts in-brace curve correction.

Summary Of Background Data: Currently there is no consensus regarding a standard method to assess curve flexibility and immediate brace effectiveness in treating adolescent idiopathic scoliosis (AIS).

Formulation and Evaluation of Controlled Release Floating Microballoons of Stavudine.

The aim of this study was to formulate and evaluate stavudine floating microballoons for controlled drug release. Initially, the drug-loaded low-density granular pellets were prepared with hydroxypropyl methylcellulose E5 grade and by using isopropyl alcohol as a granulating fluid. Further, the low-density granular pellets were subjected to microencapsulation by an emulsion evaporation technique using ethyl cellulose 7 cps and Eudragit S 100 as coating polymers and 1% w/v polyethylene glycol 400 as aqueous phase.

Formulation of rizatriptan benzoate fast dissolving buccal films by emulsion evaporation technique.

Aim: The present study deals with the formulation of fast dissolving films of Rizatriptan benzoate that is used for the treatment of Migraine. The concept of fast-dissolving drug delivery emerged from the desire to provide patient with more conventional means of taking their medication.

Materials And Methods: In the present research work, various trials were carried out using film forming agents such as maltodextrin, gum karaya and xanthan gum to prepare an ideal film.

Rationale in the management of 4-level lumbar spondylolyses with or without instability and/or spondylolisthesis.

Study Design: Case report.

Objective: To report the first case of 4-level lumbar spondylolysis in the literature.

Summary Of Background Data: Although there are quite a few reported cases of 2- or 3-level spondylolysis, none reported on 4-level spondylolysis.

Design and development of polyethylene oxide based matrix tablets for verapamil hydrochloride.

In the present investigation an attempt has been made to increase therapeutic efficacy, reduced frequency of administration and improved patient compliance by developing controlled release matrix tablets of verapamil hydrochloride. Verapamil hydrochloride was formulated as oral controlled release matrix tablets by using the polyethylene oxides (Polyox WSR 303). The aim of this study was to investigate the influence of polymer level and type of fillers namely lactose (soluble filler), swellable filler (starch 1500), microcrystalline cellulose and dibasic calcium phosphate (insoluble fillers) on the release rate and mechanism of release for verapamil hydrochloride from matrix tablets prepared by direct compression process.

Development and evaluation of diltiazem hydrochloride controlled-release pellets by fluid bed coating process.

The aim of the present study was to develop controlled-release pellets of diltiazem HCl with ethyl cellulose and hydroxylpropyl methylcellulose phthalate as the release rate retarding polymers by fluid bed coating technique. The prepared pellets were evaluated for drug content, particle size, subjected to Scanning Electron Microscopy (SEM) and Differential Scanning Calori metry (DSC), and evaluated for in vitro release. Stability studies were carried out on the optimized formulations for a period of 3 months.

ISSLS prize winner: a study of effects of in vivo mechanical forces on human lumbar discs with scoliotic disc as a biological model: results from serial postcontrast diffusion studies, histopathology and biochemical analysis of twenty-one human lumbar scoliotic discs.

Study Design: A comprehensive study of 21 lumbar scoliotic discs by in vivo serial post contrast diffusion magnetic resonance imaging (MRI), histopathological, and biochemical analysis.

Objective: To investigate the in vivo effects of compressive and tensile mechanical stress on the lumbar discs with scoliotic disc as the biologic model.

Summary Of Background Data: Most studies implicating mechanical stress in degenerative disc disease (DDD) are on animals, in vitro conditions and cadavers.

Coupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment.

Study Design: Prospective clinical-radiographic study.

Objectives: To investigate the natural coupling behavior between frontal deformity correction and the simultaneous changes in thoracic kyphosis, and to examine how the postoperative thoracic sagittal realignment relates to this natural coupling behavior.

Summary Of Background Data: Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery.

Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: can restoration of biomechanics and stabilization alone heal?

Introduction: Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further.

Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur--one or two femoral neck screws?

This was a prospective study of 43 consecutive cases of combined ipsilateral femoral neck and shaft fractures treated with cephalomedullary nails. Sequential clinicoradiological evaluation of all high-energy femoral shaft fractures to detect associated ipsilateral neck fracture improved diagnosis. All but 1 of 35 cases included in the study achieved union of both fractures and excellent or good functional outcome.

Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion.

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further.

Use of Ponseti's technique in recurrent clubfeet following Kite's method of correction.

We report the results of 18 recurrent clubfeet in 13 children after Kite's method of casting treated successfully by Ponseti's technique. The average age was 8.3 months.

Iso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of Hangman fracture: a case report.

Direct pedicle screw fixation of the C2 is rarely performed in trauma owing to the risk of damage to the neurovascular structures. Computed tomography-based navigation has the problem of change in intersegmental anatomy after positioning for surgery. Iso-C-based computer navigation acquires the intraoperative real-time images after patient positioning and thus avoids registration errors and improves accuracy.

Intra-operative Iso-C3D navigation for pedicle screw instrumentation of hangman's fracture: a case report.

Pedicle screw instrumentation of the upper cervical spine is rarely performed in trauma surgery because of the risk of damaging neurovascular structures. We report successful treatment of an unstable hangman's fracture with posterior pedicle screw fixation using Iso-C3D fluoroscopy-based computer navigation guidance. Postoperative computed tomographic images confirmed accurate placement of the pedicle screws.

Uncemented primary press-fit total hip arthroplasty: a 3 to 6 years of experience.

Purpose: To analyse the 3 to 6 years' clinicoradiological outcome of 45 uncemented total hip arthroplasties performed in 37 patients using cementless Spotorno stem and St Nabor cup.

Methods: The main indications for surgery were avascular necrosis of the femoral head and rheumatoid arthritis. Younger patients with good bone quality and a trumpet-shaped femur were eligible.

Congenital pseudarthrosis of the ulna.

We report a case of congenital pseudarthrosis of the ulna along with generalized neurofibromatosis (type I). The patient had a good clinical outcome after single-bone forearm reconstruction. In the setting of radial head dislocation following long-standing congenital pseudarthrosis of the ulna, single-bone forearm reconstruction is a viable option.

Widespread metastases from acinic cell carcinoma of parotid gland.

Acinic cell carcinoma metastasising to the spine is rare and has been described only once before in the literature. Its metastasis to other organs such as the regional lymph nodes, lungs and orbit have all been described, but the simultaneous occurrence of lymph nodal, pulmonary and spinal spread in a single patient has not been recorded. We believe this 40-year-old man to be the first reported case of incompletely resected acinic cell carcinoma of the parotid gland metastasising simultaneously to regional lymph nodes, upper lobes of both lungs, sphenoid bone and dorsal spine with neurological deficits.

Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries.

Study Design: Randomized clinical trial (level I evidence).

Objective: To compare the accuracy of non-navigation and Iso-C based navigation in pedicle screw fixation in thoracic spine deformities.

Summary Of Background Data: Thoracic pedicle screw insertion for spinal deformity correction can be associated with increased pedicle breaches.

One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly--randomised clinical trial.

Intramedullary nailing has been the gold standard in the management of lower limb fractures by virtue of advantage of early joint mobilisation and weight bearing. They are being increasingly used in the peri-trochanteric fractures of femur. Biomechanical studies have proved the supremacy of single femoral neck screw construct over two femoral neck screws along with the intramedullary nails in osteoporotic bones due to lower incidence of complications.

Spontaneous rapid osteolysis in Paget's disease after internal fixation of subtrochanteric femoral fracture.

Rapidly-progressive spontaneous progression of the osteolysis following internal fixation of pathological fracture in patients with Paget's disease has not been previously reported. We describe two patients, aged 59 and 65 years, respectively, who had pathological subtrochanteric fractures in Pagetic femora fixed internally using an interlocked intramedullary nail, and who developed spontaneous rapid osteolysis. Both patients responded favourably to long-term treatment with alendronate, with resultant fracture union and resolution of osteolysis.

Global reconstruction of type IIIA open comminuted femoral shaft fracture with segmental bone loss in an 11-year-old girl.

An 11-year-old girl with type IIIA open fracture of the femoral shaft and 4.5 cm bone loss, was treated by global reconstruction using a reamed, interlocking, intramedullary titanium nail, following meticulous primary debridement with pulsed lavage irrigation. The nail entry was carefully chosen at the lateral transtrochanteric point in order to avoid any vascular damage to the head of femur.

Thorn prick osteomyelitis of the foot in barefoot walkers: a report of four cases.

Walking barefoot is common in developing countries and the feet are therefore exposed to a variety of trivial injuries, some of which lead to cellulitis or abscess formation. If left untreated or improperly managed, osteomyelitis or septic arthritis, usually involving the heel or metatarsals, may follow. In countries with limited resources, the emphasis should be on clinical assessment for diagnosis, and good surgical technique for treatment.