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Introduction: Diagnosis of orofacial pathologies is difficult with the 2 dimensional (2D) images taken from conventional radiography. Cone-beam computed tomography (CBCT) has been developed with 3 dimensional (3D) modalities and has become a better alternative to conventional radiography. Highre solution axial, coronal, and sagittal sections are the most revealing, noninvasive techniques for assessing the maxillary sinus anatomical variations, pathology, and its adjacent structures and areas. Aim: This study aimed to analyze the prevalence of pathological changes in the maxillary sinus of asymptomatic cases using CBCT for diagnostic purposes. Materials and Methods: This study was evaluated among 200 patients for hidden pathologies in the maxillary sinus. Pathological findings were categorized as a mucosal thickening, polypoid mucosal thickening, radiopacification, and no pathological findings. Results: In the present study, the overall prevalence of the mucous retention cyst was found to be 30.25%, the polyp was 4.25%, the mucocele was 0.50%, and the overall mucosal thickenings was 35%. Conclusions: In our study, the mucosal thickening has a very high rate of incidental maxillary sinus pathologies in asymptomatic patients. Therefore, a detailed three-dimensional imaging using CBCT is stated in most patients for proper treatment planning. A careful review of the entire CBCT scans is essential to avoid under-or overestimation of potential complications in providing comprehensive health care.

A systematic review was conducted to identify the best management for acute proximal interphalangeal joint fracture-dislocations. A study protocol was designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Due to limited data in the primary assessment, the hypothesis was tested in a secondary analysis of articles that marginally met the inclusion criteria (i.e. studies that included patients under 18 years of age). A further tertiary analysis was conducted by dividing the studies into closed reduction techniques, open reduction internal fixation and 'other studies' and a narrative synthesis was performed. The study found a higher rate of complications and arthritis in the closed reduction group compared to open reduction internal fixation, suggesting that operative management should be considered for acute PIP joint fracture-dislocations. Level of evidence: III.

Clinical assessment of the upper limb and hand requires a detailed history of the symptoms, or, in cases of trauma, the circumstances of the injury. Examination should be systematic and guided by a thorough knowledge of anatomy and the likely pathology. Various modalities of imaging can be applied to confirm or characterize the pathology. Each has particular indications and should be applied carefully so as to obtain the most accurate result.

Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love’s pin test and Hildreth’s test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.

Aim: This study was done to evaluate the alteration in serum lipid profile pattern in patients with oral submucous fibrosis, with various histological grades of Oral Sub Mucous Fibrosis along with controls. Materials and Methods: The study included 150 participants, out of those 120 were having oral submucous fibrosis, and 30 cases of controls matched for age and sex were selected from the routine patients attending the Department of Oral Medicine and Radiology. Serum lipids, including total cholesterol (TC), LDL cholesterol (LDLC), HDL cholesterol (HDLC), VLDL cholesterol (VLDLC), and triglycerides (TG) were analyzed using kit ACCUREX [Bio-medicals limited, India] as per the instructions provided by manufacturer using SEMI AUTO ANALYSER [Tulip Coral 3000 Indian]. Statistical Analysis Used: Data were summarized as Mean ± SD (standard deviation). Groups were compared by Student's t-test. Groups were also compared by one way analysis of variance (ANOVA) and the significance of mean difference between (inter) the groups was done by Tukey's HSD (honestly significant difference) post hoc test after ascertaining normality by Shapiro–Wilk's test and homogeneity of variance between groups by Levene's test. A two-tailed (α = 2) P < 0.05 was considered statistically significant. Analyses were performed on SPSS software (windows version 17.0). Results: All the cholesterol showed a significant decrease in patients with OSMF than controls, and as the severity of disease increases the decrease in plasma lipid becomes more significant. Thus, this study proves the alteration in plasma lipid in patients with OSMF. Conclusions: This study concluded that the lower serum lipid levels may serve as a diagnostic indicator or marker in the early diagnosis of oral premalignant and malignant lesions.

Objectives: To carry out a survey among dentists to assess the awareness about radiation protection, attitude of the practitioner toward radiation protection, methods of radiation protection being used, and type of radiographic equipment being used in dental practice. Materials and Methods: A research was conducted among 1000 dentists who were using dental radiology. A review of literature of several articles related to the research was done. After analysis of these articles was done, a 33 question-long questionnaire was prepared. The questionnaire was then distributed among the dentists. The dentists were informed about the anonymous processing of the questionnaires. Once the questionnaires were completed, they were collected in person, the answers were tabulated, and were then sent for statistical analysis. Results: A total of 1394 dentists were approached for this study; however, only 1000 dentists returned our questionnaire. The overall correct knowledge of dentists regarding safety standards of dental radiology was found to be 29.9%. The overall correct attitude of dentists regarding safety standards of dental radiology was found to be 76.3%. The overall correct practice of dentists regarding safety standards of dental radiology was found to be 19.8%. Conclusion: On the basis of the result of the study conducted, we concluded that the dentists should be made aware about the adverse effects of radiation exposure, and as the overall compliance of the dentist is low, Continuing Dental Education programs should be conducted in order to educate dentists who are already using X-ray machines and to keep them updated with the latest technology.

Ectopic tooth eruption in a non-dental area is a rare entity, and is most common in oral cavity. There have been a few case reports of teeth erupting in mandibular condyle, chin, palate, coronoid process, and maxillary sinus. Ectopic tooth in the maxillary sinus are found incidentally on routine radiological examination, same time they can be symptomatic and associated with pathologies usually dentigerous cyst or odontogenic keratocyst. Facial pain, purulent rhinorrhoea, epistaxis, headache, swelling, and epiphora-related naso-lacrimal duct obstruction can also be seen. By Caldwell-Luc procedure the ectopic teeth within the maxillary sinus are often removed. In this study, a case of ectopic maxillary third molar tooth on right maxillary sinus is presented.

Laser first came into light in 1960 and had been used extensively in various fields of medicine. Laser has been experimented in the various dental field, and its utility is being recognized and established well in the dentistry. Lasers are widely used for a number of procedures such as cavity preparation, scaling, and root planning, surgical procedures like excision of soft tissue growths, etc., Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia (PVL), because of its many advantages over conventional methods. It presents very specific characteristics, mainly a more aggressive biological behavior than other forms of leukoplakia expressed by: A tendency toward multifocality (field cancerization); a high prospect of recurrence; and a high rate of malignant transformation, which can range between 40% and 100% in a follow-up period of 4.4-11.6 years. In this case, we evaluated the advantages of diode laser for the treatment of verrucous leukoplakia, where the results that we obtained were excellent. The patient had come for evaluation till the time of complete healing.

Purpose We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord. We assessed whether more severe contractures respond less well or recur more frequently. Methods From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum 1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin tears, and any adverse events were noted. Recurrence was defined as a failure to maintain any prior correction to within 20°. Results There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected completely, with approximately half remaining corrected at 1 year. We achieved 43° (95% confidence interval, 40°–46°) correction of combined deformity, with 11° (95% confidence interval, 9°–13°) correction attrition over 1 year. Sixteen percent of treated digits experienced a recurrence with no difference between Tubiana grades, and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures improved by 78% in comparison with higher grade contractures (55%–67% relative correction). By 1 year, all grades had a similar mean 46% relative correction. A complete correction was seen in 61% of grade 1 contractures, with more severe contractures less likely to correct completely (9%–24%). A 31% skin tear rate had no impact on outcome, recurrence, or long-term morbidity. Conclusions CCH may treat any Dupuytren cord regardless of severity. Although contracture may recur, few patients pursue further treatment within 1 year. Type of study/level of evidence Therapeutic IV.

Background: The mental health and well-being have been severely impacted by the COVID-19 crisis. People are distressed due to the immediate impacts as well as the consequences of physical isolation, which could have lasting effect on overall well-being. The study aimed to assess the psychological effect of the pandemic on the general population of India using COVID-19 specific scales.Method: An online, cross-sectional study was conducted from 20th June 2020 to 4th July 2020 on persons of both sexes and aged 18 years or more. A convenient sampling method was used for recruiting participants. An online Google form was designed and distributed using social media platforms. The psychological effect of the pandemic was assessed using validated scales of coronavirus anxiety scale, obsession with COVID-19 scale, and fear of COVID-19 scale respectively.Result: The study received responses from 2004 participants from 31 states and union territories of India. The overall prevalence of psychological disorder due to COVID-19 was 53.3% (n=1068). The prevalence of anxiety was found to be 3.29% (n=66), obsession 13.47% (270) and fear 46.9% (1045). Around 2.8% (55) of the participants suffered from all three psychological disorders. Pearson correlation test showed a significant positive correlation between all the three psychological morbidities.Conclusions: The study findings showed high prevalence of mental health problems among Indian population during the COVID-19 outbreak with a positive correlation between them.

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

Introduction: Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system. Methods: A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed. Results: Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not. Conclusion: Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band.

A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965–2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all interventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (+19%; n = 45) and worsened in tenodesis (−6%; n = 45). Grip strength was better in capsulodesis (+31%; n = 64 versus + 11%; n = 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to heterogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regarding the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised.Level of evidence: II

We have been practicing surgical management of adult upper limb spasticity for the past 5 years. So far, we have evaluated 20 patients, and we have operated on nine patients with spasticity of the upper limb in Cyprus and the United Kingdom. We aim to present the setup and running of a new service, which is devoted to Surgery for Spasticity of the Upper Limb. We present our structure, organisational processes and service provision as well as our results in the nine cases that had surgical treatment as a part of their management (as well as our preferred techniques). We discuss our outcomes as well as our learning points from these cases. We also believe that selective neurectomy procedures can be very useful in the surgical management of upper limb spasticity. Tendon transfers to augment finger extension have a limited role and provide no significant benefits in adult spasticity cases. In addition, we found that the extensor carpi ulnaris transfer to extensor carpi radialis brevis has in our experience, reliable results regarding concentric wrist extension as well as easier rehabilitation. Furthermore, in severe cases, where no functional improvement is expected, joint fusions have a more predictable outcome. Spasticity reduction surgery does gain ground with the increase in survival of stroke patients as well as traumatic brain injury patients. Therefore, up to date methods for assessing, operating and evaluating postoperatively this category of patients need to be vigorously checked.

A 29-year-old female had presented to surgical out patient’s department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised and histopathology confirmed it to be ‘ancient’ schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. Key words: Schwannoma, abdominal wall, magnetic resonance imaging.

The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy.Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up.After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2-8.7), and mean follow-up length was 6.5 years (2.9-9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up.Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.

OBJECTIVES: Dermoid cysts are common periorbital lesions in children. Traditional surgical approaches have included incisions over the mass; above, below, or through the brow; and parallel to the superior orbital rim and the Lynch incision, as well as lateral canthotomy. We aimed to present experience of Alder Hey Children's Hospital on frontozygomatic dermoid removal through a blepharoplasty incision. In this article, we also aimed to review the current literature, describe the operative technique clearly, and offer reasonable explanations for the operative choices made based on our experience of the clinical anatomy and pathology. METHODS: Thirty-four children were operated on (19 girls and 15 boys), aged 1 to 11 years, between 2005 and 2008. The lesions were left sided in 14 patients and right sided in 20 patients. Preoperative computed tomographic/magnetic resonance imaging scan was generally not used, except in cases where the cyst was more than 1 cm away from the brow margin. RESULTS: All cysts were completely excised. At surgery, all cysts were adherent to the periosteum, and 3 were subperiosteal. None extended through the bone into the orbit. The average operating time was 30 minutes. The average follow-up duration was 1 year. The only complications were early mechanical ptosis in 3 children, which completely resolved; the majority had an uneventful postoperative course. There were no recurrences, and in all patients, scar camouflage was described as excellent. CONCLUSIONS: This interesting and extremely effective technique provides excellent scar camouflage with no lid or ocular dysfunction.

Summary Background Infantile Digital Fibromatosis (IDF) is a benign, often asymptomatic nodular proliferation of fibrous tissue occurring almost exclusively on the extremities. Conventional treatment has included radical surgery but this is associated with a high level of recurrence. Whilst some authors suggest a strictly conservative approach, this is unacceptable when lesions become symptomatic from pain, contracture formation or functional deformity Methods We present a retrospective analysis of 12 symptomatic lesions of which 7 were treated with a novel technique of intra-lesional steroid. From 2004–2009, a total of ten patients received treatment for symptomatic IDFs. Patients were followed-up for an average of 5 years 9 months (range 8–131 months). Results Corticosteroid was well tolerated with no significant complications and was associated with lower morbidity that compared with surgery. There was no significance difference between rate of recurrence (1/7 vs. 5/10) for those treated with corticosteroid than compared to those patients who underwent surgery ( p =0.3) but the study is underpowered. Conclusions This is the first ever study to look at the role of intra-lesional steroid in the management of IDF. Whilst the majority of asymptomatic Infantile Digital Fibromatoses can be safely observed until natural resolution, intra-lesional corticosteroid is a safe and well-tolerated alternative to surgery for all symptomatic digital fibromatoses of infancy. We suggest it replaces surgery as first-line treatment but look forward to a large multicentre trial to allow comparison.

Treatment options for severely damaged finger joints include amputation, arthroplasty, arthrodesis, and reconstruction using nonvascularized or vascularized joint transfers. The thumb contributes significantly to global hand function, and functioning metacarpophalangeal and interphalangeal joints are crucial. When 2 adjacent joints are damaged by trauma, vascularized joint transfer from an injured index finger to the thumb is an option to maximize remaining thumb function. Complex composite injuries involving joints, soft tissues, and tendons require customized reconstructive solutions to retain and optimize hand function. We present a case of component separation of an injured index finger as the donor area for 2 flaps to reconstruct a complex bone, joint, and soft tissue thumb defect, which resulted in a high level of patient satisfaction and a return to heavy manual work.

Objective The aim of this study was to establish a successful living related kidney transplantation program in Libya and to bring down health care costs in management of patients with end-stage renal disease. Patients and Methods Since the transplantation program was launched on August 17, 2004, 135 patients have been transplanted up to August 17, 2007. The donors and recipients were screened prior to transplantation. Our immunosuppressive protocol was cyclosporine-based. Both donors and recipients were followed in the transplant outpatient clinic. Results Among 135 accepted pairs, 133 cases (98.5%) were genetically related donors and recipients and 2 cases were emotionally related. Mean donor age was 37 ± 9.5 years (range, 18–56 years). Recipient age was significantly lower, namely, 37 ± 13.6 years (range, 7–67 years). Among the recipients, 95 (70.4%) were males and 40 (29.6%) females, while among the donors, 102 (75.6%) were males and 33 (24.4%) females. The most common donor-recipient relationship was brother-to-brother. There was no early or late surgical mortality among donors. Delayed graft function was observed in 3 patients (2.2%), acute rejection in 6 (4.4%), and posttransplantation infections in 8 (5.9%). Urinary tract infections were diagnosed in 6 patients (4.4%) and pneumonia in 3 (2.2%). Postsurgical complications included ureteric kink in 2 patients (1.5%) and an anastomotic urine leak in 4 (3.0%). At 36 months, graft survival was observed in 130 patients (96.3%) and patient survival in 126 (93.3%). Conclusion The Libyan National Organ Transplant Program has been successful with results comparable to international levels.

We report US, CT and MR findings in a case of Castleman's disease mimicking a parathyroid mass in a middle-aged woman. Color Doppler Ultrasound showed a hypervascular mass with central cavitation. On CT scan, a well-marginated, homogeneous, and densely enhancing mass was detected in the right parathyroid space. The mass was isointense to muscle on T1-weighted MR images and hyperintense to muscle on T2-weighted MR images. The linear arborizing hypointense signal was seen in all pulse sequences.

Ureteropelvic junction (UPJ) obstruction may be caused by the presence of an aperistaltic dysplastic segment at the UPJ. Besides this intrinsic etiology, extrinsic factors, mainly crossing vessels, may be the causative factor. The controversy regarding the functional significance of vessels crossing at the UPJ is not a new one, though this debate has been resurrected in recent years because of improved detection due to advent of advanced imaging techniques like multidetector row computed tomography (MDCT) and fast magnetic resonance imaging. We present two similar cases where MDCT proved the crossing renal vessel (CRV) to be the cause for UPJ obstruction.

Visceral artery aneurysms are an uncommon form of abdominal vascular disease and represent a rare clinical entity; however, 10–20% will rupture and this is accompanied by a significant mortality rate of 20–70% depending on the location of the aneurysm. Antiphospholipid antibody syndrome (APS) was originally described in patients with systemic lupus erythematosus and usually presents with deep venous thrombosis, recurrent abortion and stroke. The development of vaso-occlusive disease in APS has been well documented, but the presence of concurrent aneurysms in few patients may cause diagnostic and therapeutic confusion. We present a case with primary APS who presented unusually with multiple visceral large aneurysms.

A large number of patients suffer from Stage 5 chronic kidney disease (CKD). One of the treatment options used in these patients is continuous ambulatory peritoneal dialysis (PD), which is known to improve patient quality of life. 15-50% of Stage 5 chronic kidney disease patients are on PD in the USA. The PD catheter maybe inserted into the abdominal cavity by a surgeon, an interventional radiologist or a nephrologist. We report the most unusual case of an adult patient who reinserted the slipped PD catheter himself leading to an "unseen before" complication.

Purpose To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft. Methods In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors. Seven wrists in 6 patients were available for follow-up at a mean of 28 months (range, 17–37 mo). Results There was an overall meaningful improvement in function (mean preoperative Disabilities of the Arm, Shoulder, and Hand score, 49 preoperatively, 28 postoperatively). There was a significant increase in grip strength from 15 to 21 kg. At final follow-up, 2 patients had moderate pain. The others had mild or no pain. Four patients returned to their previous occupation or activity. Patients retained full pronation and supination. When compared with the normal side, flexion was reduced to 71%, extension to 81%, radial deviation to 90%, and ulnar deviation to 65% of the opposite side. Although the mean results show an improvement, one patient had a poor result with deterioration in Disabilities of the Arm, Shoulder, and Hand score in spite of a clinically stable wrist, and another had clinical evidence of recurrent instability during pregnancy. One patient had residual symptoms from a prominent bone anchor. Conclusions Overall, this technique showed good medium-term results in most of our patients. It retained some midcarpal mobility, eliminated clunking in most patients, and provided a noteworthy improvement in grip strength and function. We continue to use this technique for patients with symptomatic midcarpal instability, but it requires further evaluation with larger patient numbers and a longer follow-up to assess its overall value. Type of study/level of evidence Therapeutic IV.

Spontaneous appendico-cutaneous fistula (SACF) has been described in literature as a complication of acute appendicitis. However, scrotal abscess originating from appendicitis has rarely been described and, to our knowledge, co-existence of scrotal abscess, pelvic abscess and appendico-cutaneous fistula at the base of the scrotum complicating acute appendicitis has never been reported in the literature. We describe one such case where the patient presented with a discharging sinus at the base of the scrotum. Condition like this poses a pre-operative diagnostic challenge. Multislice computed tomography (CT) fistulogram proves a valuable aid in this regard.

Infantile haemangioma is the commonest childhood tumour and approximately 10% requires treatment.(1,2) Recent reports have highlighted the impressive efficacy of propranolol in treating rapidly proliferating haemangioma. The aims of our study were to prospectively assess the efficacy of propranolol as a first line treatment for problematic haemangioma, and develop a treatment regime. 31 consecutive patients with rapidly proliferating infantile haemangioma with functional impairment or cosmetic disfigurement were treated with propranolol as a first line treatment. All patients had cardiovascular pre-treatment work-up and commenced on propranolol at 3 mg/kg/day. A rapid halt in haemangioma proliferation was seen in 100% of patients and significant regression in 87% of patients. This treatment is well tolerated and has little side effects. Since this study, our unit has adopted the policy of using propranolol as a first line treatment for all problematic proliferative infantile haemangiomas.

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication of abdominal surgery, recurrent peritonitis, and continuous ambulatory peritoneal dialysis with a high morbidity and mortality. The etiology of this condition is largely unknown. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating, small bowel obstruction. We report a case of a patient who presented with intestinal obstruction and who showed typical CT findings of SEP which was diagnosed pre-operatively on a CT scan and confirmed at surgery. The interest of this case lies in its rarity and difficult pre-operative diagnosis. Keywords: sclerosing encapsulating peritonitis; abdominal surgery; peritoneal dialysis (Published: 15 March 2010) Citation: Libyan J Med 2010, 5: 4901 - DOI: 10.3402/ljm.v5i0.4901

We would like to report a 20-year-old female presented with gradually progressive left renal angle tenderness for two years. Examination revealed fullness in the left renal angle and the ultrasound scan showed severe left hydronephrosis with a normal caliber ureter. (Published: 15 March 2010) Citation: Libyan J Med 2010, 5: 4902 - DOI: 10.3402/ljm.v5i0.4902

A37-year-old male patient presented to the surgical outpatients department with undefined lower abdomen pain for a period of seven months associated with mucoid diarrhea. For the last two months, he had severe dysuria with suprapubic pain, and he also noticed air in the urine during micturition. He was admitted to the urology department two months ago for urinary tract infection which was treated with antibiotics. He also gave a history of perianal abscess drainage one year ago. The patient admitted to taking a course of antibiotics whenever he had an attack of urinary tract infection. There was no history of diabetes, hypertension, or any other chronic illness. There was no family history of the same illness or complaints. Physical examination showed suprapubic tenderness. His routine biochemical tests and tumor markers were normal except for evidence of pus cells, RBCs, epithelial cells, and mucus in urine examination. Ultrasound, computed tomography (CT) scan, MRI, and colonoscopy were performed. (Published: 11 January 2010) Citation: Libyan J Med 2010, 5: 4634 - DOI: 10.4176/090727

Summary Introduction and aims Mirror-foot abnormalities are distinctly uncommon entities and represent extreme forms of congenital duplication. We present a reflection on three different cases of mirror foot and discuss their surgical management. Patients and methods The first patient had a right-sided mirror foot with a central great toe and three complete medial rays. The second patient had quadruplication of the left great toe ray. The third had a full complement of metatarsals associated with two extra complete rays placed medial to the great toe of the right foot. All patients underwent complex ray resection and concurrent reconstruction of the medial arch of foot. All three cases of mirror foot presented and were operated on in the pre-ambulatory period. Results All three patients recovered with good functional and aesthetic results. Follow-up duration ranged from 3 to 5 years. Conclusion Surgical treatment of the mirror foot is less complicated than that of its upper limb equivalent. Essentially, there must be an initial surgical reduction in the number of digits, coupled with tendon transfers as necessary to maintain foot arches.

We report a case of a 20-year-old girl who presented to the out-patients’ department with congenital, progressive unilateral proptosis and reduced vision. Ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed. Diagnosis of orbital lymphangioma was made on imaging. Authors highlight the crucial role of imaging in diagnosis and to plan therapeutic approach. This case is reported because of its extreme rarity and unusual presentation. Key words: Orbital, Lymphangioma, Proptosis, Ptosis.

A 4-year-old boy (forward-facing, restrained front-seat passenger) was involved in a road traffic accident resulting in the deployment of the ipsilateral airbag. During activation, airbags expel sodium azide, which oxidizes immediately on exposure to the air producing sodium hydroxide. This potent alkali, in combination with the high-temperature gases released, can cause burns. In this case, both chemical and thermal burns were sustained to the left side of face. An element of mechanical friction burn was also apparent. On admission, the child had oedematous lips and facial swelling, in addition to 2% superficial partial thickness burns confined to the face. The eyes were erythematous, oedematous, and the conjunctival surface had a pH of 8. This injury necessitated intubation for a total 48 h, with 24 h on PICU. The eyes required copious irrigation with normal saline to reduce the pH. The burns healed in 7 days with conservative management (Bacitracin ointment). Fortunately, there were no long-term sequelae. For over 10 years, airbag design has been modified to reduce the risk of injury to occupants whilst maintaining their life-saving function. It would be of benefit to consider further changes to these devices as they continue to pose a threat to children and adults, inflicting unnecessary injuries over and above those that might be expected in a high-speed collision scenario. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. It would seem appropriate that vehicles should have a mandatory performance standard which requires the suppression of automatic airbag deployment if a child is located in the front passenger seat.

Basal cell carcinomas (BCC) are often seen by plastic surgeons and dermatologists in the outpatient setting. Treatment usually necessitates excision of these lesions with an appropriate margin guided by published recommendations, often resulting in less than ideal cosmetic outcomes, especially if local flaps or skin grafts are required for reconstruction. Photodynamic therapy (PDT) and CO(2) laser when used as monotherapy have been successfully used to treat BCCs, with greatest success in the superficial histologic subtype. These modalities when used alone have a number of limitations when compared with surgical excision, including a limited depth of penetration of PDT (2-mm absorption), which potentially limits the efficacy of treatment of nodular BCCs greater than this thickness or which are deeply invasive. We describe our positive experiences of combination therapy with both modalities in 12 patients, with the aim of improving treatment efficacy.Twelve patients with 13 biopsy-proven nodular BCCs on the head and neck were treated with combined therapy using an Ultra Pulse CO(2) and PDT using Methyl Aminolevulinate (METVIX) and the Aktilite 16 LED lamp.A total of 12 patients (13 lesions) were treated using combined CO(2) laser/PDT. Nine were male and 2 female; 1 had gender reassignment. The mean age was 67, with a range of 54 to 85. The mean follow-up period was 18.1 months, with a range of 7 to 26 months. All lesions responded to treatment as assessed by clinical evaluation, with regular follow-up on a 3-month basis. There were no recurrences during this time period. The only complications encountered were mild hypopigmentation in 2 cases and mild discomfort experienced with PDT.In this study, CO(2) laser and PDT appear to play a synergistic role in the treatment of nodular basal cell carcinomas. Both the surgical team and the patients have been pleased with the results. The mean recurrence-free follow-up was 18.1 months. This apparently synergistic treatment appears most appropriate for patients who value excellent cosmetic outcome over the inconvenience of making additional visits to the clinic or where avoidance of an invasive procedure is an important factor.

Acne vulgaris is one of the commonest skin disorders that can affect individuals from childhood to adulthood, most often occurring in the teenage years. Regarding its management, what’s still true is that a wide range of treatment options are available, ranging from the commonly used topical treatments like benzoyl peroxide, azelaic acid, sulfur, antibiotics, retinoids and superficial chemical peels while the systemic treatments available include the use of systemic antibiotics, retinoids, and antiandrogens. What’s new in the management of acne vulgaris is the use of laser and light devices and other newer technologies. The present article reviews the use of above mentioned agents in the current scenario.

Objective To evaluate the efficacy of multidetector (16-row) computed tomography (MDCT) in imaging the upper and lower limb arterial tree in trauma and peripheral arterial occlusive disease (PAOD). Methods Thirty-three patients underwent MDCT angiography (MDCTA) of the upper or the lower limb on 16-row MDCT scanner between November, 2004 and July, 2005. The findings were compared with the surgical outcome in cases with trauma and suspected arterial injuries or color Doppler correlation was obtained for patients of PAOD. Results MDCTA allowed a comprehensive diagnostic work-up in all trauma cases with suspected arterial injuries. In the 23 cases of PAOD, MDCT adequately demonstrated the presence of stenosis or occlusion, its degree and extent, the presence of collaterals and plaques. Conclusion Our experience of CT angiography (CTA) with 16-row MDCT scanner has clearly demonstrated its efficacy as a promising, new, fast, accurate, safe and non-invasive imaging modality of choice in cases of trauma with suspected arterial injuries and as a useful screening modality in cases of PAOD for diagnosis and for grading.

Background A wide range of foreign bodies has been retrieved from the gut and reported. The presentation may be in the form of complications like intestinal obstruction, perforation and formation of abscesses etc but there is no case report of a half open clasp knife being retrieved from the ileum, the patient having thrived, in spite of its presence for a period of eight months. Case presentation A 30-year-old administrative clerk had undergone emergency abdominal surgery eight months previously under mysterious circumstances at a remote district hospital and had recovered completely. Later the blade of a knife was accidentally detected when an X ray of the abdomen was done during a routine follow-up visit to his family physician. Surgery revealed a clasp knife in the ileum, which was retrieved. The presence of an entero-enteric fistula short circuiting the loop was the secret of his earlier survival. Conclusions To the best of our information this is the first case-report of a clasp knife in the gut and of the patient thriving in spite of its presence. We report here the dramatic sequence of events.