Healing of the injured site is a complex biological process of carefully orchestrated cellular events. Presence of any foreign body at the site of injury delays the healing along with inducing biological response such as inflammation, infections, allergic reactions, toxic events and tissue alterations. Such body reactions against an exogenous materials depends upon the mode of entry, chemical composition of material, quantity of material its physical form and also depends upon the body site. A careful history, clinical examination and imaging techniques should be considered for patients with any suspected penetrating injuries.

Objective: Mesial temporal sclerosis with associated extra hippocampal pathology is considered ‘dual pathology’ that could influence the progression and clinical outcome of complex partial seizures. This study is undertaken to evaluate and compare the clinical outcome and pathology of the temporal lobe and hippocampus in cases of mesial temporal sclerosis (MTS) alone and MTS with associated pathological changes in the extrahippocampal temporal lobe (dual pathology). Methods: The clinical and presurgical evaluation data and post surgical follow up (2 years) were reviewed retrospectively from medical records of 15 cases with MTS alone and 11 cases having dual pathology. Specific pathological changes were recorded after reviewing the material from hippocampus and temporal lobe and immunostaining with antibodies to synaptophysin, and neurofilament to delineate dystrophic neurons and synaptic pathology and S-100 protein for glial elements. Results: Among the 11 patients with dual pathology, 2 patients had mild cortical dysplasia (MCD) and 9 had focal cortical dysplasia (FCD) in the adjacent temporal cortex, as described by Palmini et al. High resolution MRI (1.5 Tesla) did not detect the presence of the second pathology reported in this series. Thirteen of the 15 patients with MTS alone and 6 of the 11 patients with dual pathology had good post surgical outcome. Six (2 MTS + 4 dual pathology) out of 7 patients who failed to show good clinical outcome had significant loss of neurons in CA3 sub-field of Ammon’s horn, whereas only 12 out of 19 patients who had good outcome had CA3 neuronal loss. Various types of cytoskeletal and synaptic pathology are found in the dysplastic neurons in the zones of cortical dysplasia. Conclusion: Two types of structural lesions underlie complex partial seizures, MTS with or without associated extrahippocampal lesions of neuronal cytoarchitectural abnormality may influence the prognosis. Neuronal loss in CA3 subfield of Ammon’s horn seems to have a role in negative clinical outcome, though this feature needs to be further validated.

Introduction: The acromioclavicular joint (ACJ) is a major link connecting the upper limb to the torso. The acromioclavicular and coracoclavicular (CC) ligaments help in stabilising the joint. We feel it is prudent to address both these ligament injuries, to achieve optimum result. This study was undertaken to analyse the results of a simple frugal surgical technique we used to deal with this injury considering stabilisation for both these ligaments. Materials and methods: In this retrospective study, skeletally mature patients with Type III, IV or V ACJ dislocations who underwent open reduction and stabilisation of the joint with temporary K-wires, repair of the capsule and augmentation of CC ligaments with suture anchors were included. Clinico-radiological and functional outcome was evaluated. Functional assessment of the upper limb was analysed using the Disabilities of Arm, Shoulder, and Hand Score (DASH), Constant shoulder score (CSS) and Oxford shoulder score (OSS). Results: Clinical and radiological evaluation of the 32 patients who had completed two years from the index surgery, was done. Out of the 37 patients included initially, five were lost in follow-up. Majority of the subjects included were males and type V was the most common injury. Mean pre-operative CC distance on the affected side was 13.92±4.94mm. In the immediate post-operative radiograph, it was 7.63±2.08mm and in the final follow- up was 9.36±2.75mm. Measurements were taken by two independent investigators and inter, and intra-observer reliability were analysed by Interclass correlation coefficient. Excellent functional outcome was noted despite the 1.81±1.50mm average loss of correction. At final followup, mean DASH score was 4.67±4.18, Oxford shoulder score was 44.06±2.44 and Constant shoulder score was 86.37±5.81. The severity of the injury had no significant effect on the functional outcome post our method of stabilisation and rehabilitation. Conclusion: Bifocal fixation restores the multidirectional stability of the disrupted ACJ. Adequate radiological reduction, good functional outcome and simplicity of execution make this technique an undemanding one for use in regular practice.