An Intraneural Ganglion Cyst causing Foot Drop: A Case Report

A 46 year old male with a past medical history of HTN and chronic pancreatitis presented to clinic with a chief complaint of right leg weakness and numbness/tingling that developed suddenly two months prior to presentation. He denied history of trauma or surgery to the right lower extremity. Physical exam revealed a right foot drop on ambulation with slight circumduction of right leg. Further neurological exam was remarkable for 2/5 muscle strength in right ankle dorsiflexion and eversion, with decreased sensation noted on right foot dorsal surface and lateral calf. EMG demonstrated a right common peroneal mononeuropathy at the knee with demyelinating and axonal features with active denervation. Ultrasound of the right knee showed enlargement of the right common peroneal nerve at the level of the fibular head with a1.1 x 0.5 x 1.6 cm hypoechoic collection in the region of the tibiofibular joint, possibly representing a ganglion cyst from the adjacent joint or an intraneural ganglion cyst. Follow-up MRI re-demonstrated a cystic lesion just medial to the common peroneal nerve and posterior to the proximal tibiofibular joint, which is suspected to arise from the articular branch of the common peroneal nerve. Patient had symptomatic improvement with physical therapy and use of a AFO boot for 2 months. The most common cause of foot drop is a compression peroneal neuropathy, often at the location of the neck of the fibula. In rare instances, the compression can occur due to a ganglion cyst, which is a benign tumor consisting of gelatinous material that is typically asymptomatic. Ganglion cysts compressing the peroneal nerve can be either intraneural or extraneural, with differentiation occurring via imaging. Intraneural ganglion cysts are non-neoplastic mucinous cysts located within the epineurium of a nerve. Although the exact pathogenesis of these cysts are unknown, it has been show in multiple case reports that as these cysts expand within the epineurium, they can cause compression of the adjacent nerve fascicles. Diagnosis is primarily via MRI; although an EMG study may assist in correlating clinical findings by distinguishing the extent of sensory and motor impairment. Treatment guidelines of peroneal intraneural ganglia are controversial. Current first line treatment recommendations endorse surgical removal of the ganglion cyst; however, it may be less invasive and beneficial to start with a conservative approach to minimize unwarranted procedures in patients. Ultimately, successful outcomes are based on early diagnosis and treatment.https://scholarlycommons.henryford.com/merf2020caserpt/1092/thumbnail.jp

Forward Body Biased Low Power 4.0-10.6 GHz Wideband Low Noise Amplifier

A forward body biased low power Low Noise Amplifier (LNA) is designed using Common Gate (CG) topology. By using current reuse technique between the first stage and second stage Common Source topology accompanied with forward body biasing leads to low power dissipation. A series to parallel tank circuit at this stage leads to wideband design. A shunt peaking inductor at the drain terminal of second stage causes the higher frequency peak to increase leading to wide bandwidth. Two CS cascade stages are used to increase the overall gain of the proposed LNA with a buffer stage at the output for output matching. The proposed LNA attained maximum gain of 26.39 dB with a gain greater than 16 dB over entire range. The circuit gives reflection coefficient less than – 10 dB with NF 2.7 dB. With Vdd of 0.925 V, a DC current of 8.32 mA is consumed giving 7.7 mW power consumption

Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management

An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

Background: The management of severe lower limb injury is one of the most controversial subjects in the field of Orthopedic surgery. While the advancement of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. The aim of study was to analyze and ascertain the clinical utility of mangled extremity severity score (MESS) in severely injured lower limbs.Methods: The current study was undertaken in the Department of Orthopedics among 50 patients who sustained high-energy injuries and approached a tertiary care center to seek care. The study design included both retrospective and prospective evaluation. Retrospectively 25 and prospectively 25 lower limbs in 54 patients with high-energy injuries were evaluated using mangled extremity severity score to assist in the decision-making process for the care of patients with such injuries. MESS served as study tool. Differences between the mean MESS scores for amputated and salvaged limbs were explored.Results: Crush injury of leg with fracture of tibia and fibula was observed in 78% of injured limbs. The most common mechanism of injury was high-energy trauma. Road traffic accidents accounted for 72% of patients. Mean hospitalization for primary amputation was 19.3 (8-26) days and for delayed amputation limbs was 36.6 (15-62) days and for salvaged limbs was 45.5 (14-128) days. In the prospective study, out of 7 injured limbs with a MESS score of equal or more than 7, 6 limbs were amputated and 1 limb was salvaged. Out of the remaining 18 injured limbs with a MESS score of less than 7, 17 limbs were successfully salvaged and one limb was amputated. In the retrospective study, 10 injured limbs with a MESS score of equal or more than 7 were amputated (mean score 8.4 with range of 10-8) and the remaining 15 injured limbs with a MESS score of less than 7 were salvaged (mean score 4.57 with range of (4-6)); suggesting a significant difference in the mean scores.Conclusions: MESS is a cost-effective, relatively simple and readily available scoring system, which assists the surgeon to identify variables that may ultimately influence the outcome of a severely traumatized extremity with arterial compromise due to high-energy injury.

Potential of Complementary and Alternative Medicine in Preventive Management of Novel H1N1 Flu (Swine Flu) Pandemic: Thwarting Potential Disasters in the Bud

The emergence of novel H1N1 has posed a situation that warrants urgent global attention. Though antiviral drugs are available in mainstream medicine for treating symptoms of swine flu, currently there is no preventive medicine available. Even when available, they would be in short supply and ineffective in a pandemic situation, for treating the masses worldwide. Besides the development of drug resistance, emergence of mutant strains of the virus, emergence of a more virulent strain, prohibitive costs of available drugs, time lag between vaccine developments, and mass casualties would pose difficult problems. In view of this, complementary and alternative medicine (CAM) offers a plethora of interesting preventive possibilities in patients. Herbs exhibit a diverse array of biological activities and can be effectively harnessed for managing pandemic flu. Potentially active herbs can serve as effective anti influenza agents. The role of CAM for managing novel H1N1 flu and the mode of action of these botanicals is presented here in an evidence-based approach that can be followed to establish their potential use in the management of influenza pandemics. The complementary and alternative medicine approach deliberated in the paper should also be useful in treating the patients with serious influenza in non pandemic situations

Cheiloscopy: A Deterministic Aid for Forensic Sex Determination

Background: Cheiloscopy, the study of lip prints, is an upcoming tool for the identification of persons. The lip print of every person is unique and can be used to fix personal identity. Aim: The prime objective of the present study was to ascertain whether the lip prints behold the potential for determination of sex of the individual from the configuration. Methods: The lip prints were recorded by applying lipstick on the lips, then cellophane tape was applied on the lips and the prints were taken. These prints were studied and classified according to Tsuchihashi′s classification. Results: No two lip prints matched with each other, thus establishing the uniqueness of lip prints, Type I and I′ were most common in females: type IV and V were seen most commonly in males- Around 48 females and 45 males were correctly recognized on the basis of their lip prints. Conclusion: The present study is able to convey that lip prints behold the potential of determination of the sex