Osteoid Osteoma of the Scapular Neck: A Cause of Long-lasting Unexplained Pain

Introduction: Osteoid osteoma (OO) is a common tumor of the diaphysis of long bone, where the reported incidence is up 10% of all benign bone tumors. Its presence in flat bone is seldom mentioned in literature and can be misleading when the bone involved is in proximity to a zone of wide variety of possible pathology. We report a case of a young patient with OO in a very rare location of the body –the scapular neck – that was misdiagnosed for a long period of time before receiving adequate therapy. Case Report: A 20-year-old female patient presented to the clinic with chronic left shoulder pain. During the past 2 years, she received medical and physical therapy, to deal with different diagnosis such as cervical spine pathology, muscular spasm, and rotator cuff disease. However, she did not improve. At time of presentation to our clinic, radiographs of the shoulder were done and turned to be inconclusively normal. After negative magnetic resonance imaging of the cervical spine, a computed tomography scan of the shoulder was done and showed a round well-defined lesion localized in the scapular neck with a focal lucent nidus within surrounding sclerotic reactive bone measuring 8.5 mm in largest diameter, compatible with OO. Bone scan showed increased uptake. The patient was given aspirin in an intention to test and treat. The patient had dramatic pain relieve at first, which confirmed the diagnosis of OO. But then, pain became unremitting, so a decision was made for radiofrequency ablation of the lesion which gave excellent results. Conclusion: OO is a common benign neoplasm with high variable clinical picture and anatomic localization. Despite being more common in long bone, flat bone OO localization should be always kept in mind. Careful history and physical examination should be done for each patient presenting with unexplained pain; night pain should always raise suspicion of this condition. Radiographs are not always conclusive, and the patient with high suspicion

Quadriplegia as a Rare Complication of Black Widow Spider Envenomation

Introduction: The bite of Latrodectus tredecimguttatus, generally known as the Black Widow Spider (BWS), can cause a variety of symptoms, including muscular spasm, back pain, abdominal pain, severe sweating, and shivering. The bite brings weakness, too; however, quadriplegia has not been mentioned in the literature. Case Presentation: Here, we present a 42-year-old male with BWS bite who developed muscle weakness and paralysis in the four limbs. The patient needed mechanical ventilation. Nerve conduction velocity showed myopathy in the patient. The patient could eventually walk after 45 days of supportive treatment. Conclusions: It can be hypothesized that quadriplegia may happen due to the vast acetylcholine depletion.

Phytochemical evaluation of Celastrus paniculatus seed oil extracted by a method used by ‘Uraanv’ tribe of Chhattisgarh

More than 35,000 plant species are being used in various human cultures around the world for medicinal purposes. Medicated oil plays an important role for prevention and cure of diseases in Ayurveda. Celastrus paniculatus seed oil is such wonderful medicinally useful oil. It is commonly known as Black-Oil tree, Intellect tree, Climbing-staff plant and Jyotishmati and “Tree of life” in Ayurveda. It possesses Anti-depressant, Anti-Parkinson, Anti-Alzheimer’s, Neuroprotective, IQ improving activity. In tribal district (Jashpur) of Chhattisgarh, Indian people uses traditional method to extract C. paniculatus oil. It is commonly used by the tribes for the treatment of various diseases like headache, muscular spasm and local inflammations. The present study aim is documentation of traditional method of oil extraction used by ‘Uraanv’ tribe. This paper also dealt with the Physicochemical and qualitative phytochemical evaluation of C. paniculatus seed oil. Oil yield by traditional method was 25%. Carbohydrate, reducing sugar, monosaccharide, protein, amino acid, steroid, flavonoid, alkaloid, fixed oil, phytosterols, saponin, diterpenoid and cardiac glycoside were found in the oil sample.The GC-MS analysis shows the presence of 47 compounds in the oil. These phytochemical might be responsible for the therapeutic effect of C. paniculatsus seed oil.

Acute onset trismus in a 15-year-old

Trismus can be a common complaint encountered in general dental practice. A 15-year-old female presented to the Emergency Department with a history of acute onset and worsening trismus, pain and extra-oral swelling following placement of a restoration in the lower right first molar tooth. An initial diagnosis of trismus associated with either muscular spasm or a haematoma following an inferior alveolar nerve (IAN) block was assumed. The patient was reviewed the following week, the trismus and swelling having increased. An urgent MRI scan showed a large heterogeneous mass in the right masticator space. A biopsy under general anaesthetic diagnosed a rhabdomyosarcoma. The patient was referred to the oncology team for chemo/radiotherapy treatment. CPD/Clinical Relevance: Although ‘common things occur commonly’, it is important to remember that common symptoms and presentations can lead to more rare diagnoses. Prompt referral for specialist advice needs to be sought should first line management of trismus prove to be unsuccessful.

Anaesthetics

Anaesthesia is a state of reversible unconsciousness that comprises some or all of the ‘triad of anaesthesia’— hypnosis, analgesia, and muscle relaxation. Safe and ef­fective anaesthesia requires information of the drug’s potency at effector sites and knowledge of administration concentrations, as well as an understanding of the degree of noxious stimulus and how a patient’s physiology may modulate drug actions. Historically, the first compounds used as anaesthetics were diethyl ether, nitrous oxide, and chloroform. Diethyl ether was demonstrated to the wider medical commu­nity in 1846 by William Morton in the removal of a jaw lump from Gilbert Abbot, and the introduction of chloro­form followed within the year. It was noted by James Simpson, Professor of Obstetrics in Edinburgh in 1847, that chloroform was much more potent, but had a ten­dency to precipitate death in the anxious and could cause severe liver damage. This tendency demonstrates clearly that the depth of anaesthesia is critical. Too much cir­culating drug can lead to respiratory depression, cardiac arrhythmias, and death, while too little permits persistent consciousness, pain, and muscular spasm. This is of particular concern with regards to laryngospasm, which when combined with an unsecured airway can rapidly lead to hypoxia and death. Nowadays, death is incredibly rare, with signs of hypotension, tachy- , or bradycardia detected early and easily reversed by controlling drug dosage. The risk of drug- induced side effects when using anaesthetic drugs means that the depth of anaesthesia must be closely monitored. This is achieved subjectively with experience and training, in combination with ob­jective clinical assessment, such as pulse, BP, and mean alveolar concentration. See Table 8.1 for ideal properties of anaesthetic agents. There are many approaches to the application of gen­eral anaesthesia, and these depend on clinical situation, depth, and length of anaesthesia required, the type of sur­gical or interventional procedure to be undertaken and as­sociated patient risk factors. The stages of anaesthesia (outlined in Table 8.2) was a concept introduced at a time when induction was rou­tinely achieved through the use of inhalational anaes­thetics. More recently the use of IV induction agents has meant that transition between these stages is smoother, resulting in a rapid induction with minimal excitation responses, compared with inhalation agents. Inhalation agents also carry the risk of airway irritation.

Back Pain Treatment: A Review of the 2018 Recommendations

In 2018, published works that focus on European and American recommendations for the treatment of chronic back pain, where using opioid analgesics, it is recommended to take into account their complexity in multimorbid pathology in patients, since there is no effectiveness of pain reduction due to polypharmacotherapy. The peculiarity of the treatment is that the prevalence of musculoskeletal pain more often reaches its peak in elderly patients and is about 60%, which allows to establish an important direction in therapy - taking into account multimorbid pathology. It is necessary to take into account the accompanying chronic pathology because in patients with back pain hypertension occurs in 58.7%, chronic kidney disease occurs in 29.1% of patients, diabetes mellitus occurs in 23.1% of patients, depressive disorders occur in 15 , 3% of patients. Today it is proved that the common use of NSAIDs is critical for adverse events on the part of their use in patients with multimorbid pathology. In a number of clinical studies, the significant effect of tolperisone has been proven to relieve muscular spasm in acute and chronic back pain compared to tizanidine, where tolperisone is more often used in multimorbid pathology as a relaxant of skeletal muscles. The combination therapy strategy potentially represents a paradigm shift in rehabilitation therapy and can be very important for early intervention in spasticity management processes. In order to expand the scope of potential therapeutic use, the basic requirement for safe treatment is the quantitative basis of evidence of safety and efficacy, which, for example, is now presented in full on tolperisone hydrochloride. The new therapeutic options include a progressive addition of convergent therapy, where it is assumed that the potential for therapeutic purposes will be strengthened in view of the multimorbid pathology in the patient with back pain.

Baclofen Toxicity in a Chronic Kidney Disease Stage 5D Patient

The toxicity of Baclofen is extremely unusual. However, its predominant renal clearance makes its vulnerable in patients with impaired renal function. Clinical manifestations may begin as early as 2-3 days after starting the drug, even with a smaller dosage.A 73-year-old man with end-stage renal disease on maintenance hemodialysis was admitted to our emergency department with progressive confusion, hallucination and a generalized decrease in muscular tone. There was no significant metabolic or infectious etiology that could have clarified his condition. A thorough laboratory and imaging workup was negative too. A detailed history of his medication revealed that he had recently been prescribed baclofen for neck muscular spasm (10mg twice daily). He was then diagnosed with baclofen toxicity and was treated with intensive hemodialysis. During his admission, few sessions of hemodialysis on consecutive days, eventually produced expected clinical improvement and a complete return to his previous baseline mental status.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 54-56

MANAGEMENT OF GRUDHRASI WITH UNIQUE COMBINATION OF AYURVEDIC HERBAL KWATHA & AGNIKARMA

Today people are predisposed to various diseases based on their way of living and occupational habits called life style diseases. Orthopedic disorders are one of the mostly exposed to such life style habits. physical inactivity, wrong body posture, occupational posture, long sitting jobs, stresses activity, exposure to continue vibration, post-operative causes, gym, athletes muscular spasm are main contributing factors to orthopedic disorders. One of the most common orthopedic health problems today is lower back pain which is accompanied most of the time by Sciatica. The present case study is successful Ayurvedic management of a case of “GRUDRASI”.