A 5-month-old child was admitted to the paediatric intensive care unit with status epilepticus and cardio-respiratory arrest. Due to difficulty with obtaining intravenous access, an intraosseous infusion was started in the left proximal tibia. This was discontinued after two days. On examination there was swelling of the left leg with minimal redness. The site of infusion did not show any abnormality. A radiograph of the left leg performed on the ninth day did not reveal any abnormalities. A repeat radiograph performed on the twentieth day is shown above (Panel). What is the diagnosis? Answer: refer to page 237

(Refer to page 209) Answer: Osteomyelitis of the tibia following intraosseous infusion In critically ill or injured paediatric patients, intraosseous infusion (IO) provides rapid access to the systemic venous circulation. This has replaced venous cut-down and central line insertion in emergency situations, being included in standard protocols and training procedures recommended by most specialty associations and societies.

Introduction: Glomus tumour is a rare benign neoplasm of the normal neuroarterial structure called glomus body. They present with obscure symptoms making diagnosis difficult and delayed. Though classical symptoms and signs such as pain, temperature sensitivity, and point tenderness are described, imaging such as magnetic resonance imaging is increasingly being used for diagnosis. The aim of this study was to review the current understanding of glomus tumours of the hand in the context of the cases treated in Brunei Darussalam emphasising the importance of detailed clinical examination over imaging modalities. Materials and Methods: We present a series of seven patients diagnosed as glomus tumour and operated in our hospital from Sept 1997 to Sept 2009. Data was collected from the clinical and operative records regarding preoperative history and workup, intraoperative details, postoperative follow up and histopathology. Results: There were three male and four female patients with a median age of 37 years. All patients had severe fingertip pain on touch with positive Love's test. One patient had hypersensitivity to cold. Presumptive diagnosis of glomus tumour was made in six patients and foreign body granuloma in one patient based on detailed history and clinical examination alone. Histopathology confirmed glomus tumour in all the patients. All are asymptomatic after surgery. One patient had increased mitotic activity on histopathological examination and is on close follow up. Conclusion: High suspicion, detailed history and careful physical examination can significantly decrease the pre-operative morbidity of the patient with glomus tumour. An imaging study may not always be required for diagnosis.
Glomus Tumor ; Hypersensitivity ; Diagnosis ; Diagnostic Imaging