Primary tumors of the heart are rare. However, among them cardiac myxoma is the most common tumor accounting for half of the primary cardiac neoplasms. About 75% of cardiac myxomas are located in the left atrium, and 25% are located in the right atrium. These are thought to be arising from remnants of subendocardial vasoformative reserve cells or multipotential primitive mesenchymal cells in the fossa ovalis and surrounding endocardium, which can differentiate along a variety of cell lineages including epithelial, hematopoietic, and muscle cells. Although some cases are discovered incidentally by echocardiographic examination, it was recognized in most of the patients by various symptoms caused by the release of inflammatory cytokines such as interleukin-6 (IL-6), obstruction of intracardiac blood flow, or embolization. Cardiac myxoma has many undetermined interesting issues regarding its origin, nature as a tumor, varying clinical manifestations, and the presence of both sporadic and familial types. Recent evidence revealed that cardiac myxomas are benign neoplasms and slowly proliferating lesions. The existence of its malignant counterpart is controversial. However, recurrence after surgical excision or metastasis has been reported. We hereby present a case report of a young gentleman who presented with history of sudden onset of weakness and cerebellar signs. Urgent CT scan revealed hypodensities of bilateral occipital lobes and cerebellum suggestive of infarcts. Urgent echocardiography denoted large left atrial myxoma. The tumor was excised and the patient recovered well.

This study is quite representative. Most patients older men in accordance with previous studies. The left side is dominant according to the literature. The elbow side is dominant, after hemodialysis performed and double lumen catheter improvement requires further research.

The commonest procedure for adult diaphyseal femoral fractures is intramedullary nailing. A thorough preoperative examination of facture pattern and its morphology are necessary. Previous studies are non-homogenous and with conflicting results. So the study was planned to find out, any relation between femur and forearm plus little finger length and its association with height/ arm span and upper segment/lower segment ratios in an individual, with its statistical validity. The study was carried on 75 male and 75 female students of more than 18 years of age, studying at AIIMS Rishikesh after taking their informed consent and ethical approval. The forearm plus hand length and the length offemur were measured as per protocol, by simple measuring tape. The mean forearm plus hand length and the length of femur were 42.85 (SD, ±1.87) and 45.88 (SD, ±2.95) cm, respectively with the mean difference between these 2 measurements of -3.03 (95% CI, -3.83 to -2.22) cm, in male and 39.56(SD, ±1.68), 40.96 (SD, ± 2.75) cm and -1.400 (95% CI, -1.917 to -0.883) cm in female volunteers. The Pearson correlation co efficient and p value 0.575, 0.0001 and 0.585, 0.0001 in male and female respectively. There was no significant variation with height, upper segment and lower segment ratios. So we conclude that there is extremely significant correlation between the forearm plus hand length and the length of femur of the individuals. The forearm plus hand length represents the maximum length of the nail to be used in femur. The length of the femur nail can be definitely predicted by the forearm plus hand length in both sexes but it has to be different in both, for the same femoral fracture and there is no significant variation in the femur length with height, upper segment and lower segment variation in the same individ

Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was freeof pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known.

We report on a rare case of a child with persistent right upper lid eversion with conjunctival prolapse since birth that failed various attempts in repositioning the right superior fornix at other centre. He was found to have a right supero-temporal orbital mass above the prolapsed area. Computerized tomography (CT) scan of orbit confirmed a right lacrimal gland tumour with thinning of the right lesser wing of sphenoid. An excision biopsy of the tumour via anterior orbitotomy and eyelid reconstruction were performed. Histopathology report reviewed plexiform neurofibroma of the lacrimal gland. Further physical examination confirmed presence ofmultiple café-au-lait spots. He was diagnosed as Neurofibromatosis Type 1

A 55-year-old healthy lady withhistory of regular contact lens (CL) use presented with 10 days history of progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60, pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis. Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci growth. Her ulcerimproved with the treatment and preservative-free dexamethasone 0.1% once daily was commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to improve her vision. Although it has not been previously reported, Pasteurella multocidacan cause CL related corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial contact or no history of exposure to domestic animals.

Orbital cellulitis is a relatively common disease affecting predominantly the paediatric population. Most cases occur as a result of spread from the nearby sinuses. Other causes include penetrating trauma or extension from infected adjacent structures.If left untreated, this condition may result in devastating sequelae such as orbital apex syndrome, cavernous sinus thrombosis, meningitis, cranial nerve palsies, intracranial abscess formation and even death.A 47 year old immunocompetent Burmese lady presented with left eyelid swelling of 2 days duration associated with eye redness, blurring of vision and diplopia. Previously, there was history of right maxillary sinusitis and parapharyngeal abscess 9 months prior to presentation. On examination, she was afebrile with vision of 1/60 for the left eye with positiverelative afferent pupillary defect (RAPD). The eye was proptosed and swollen with restricted extraocular movements in all gazes. Conjunctiva was injected with chemosis and there was corneal epithelial bedewing. Otherwise anterior chamber was quiet and intraocular pressure was 51mmHg. Bilateral fundus examination was normal. Computed tomography (CT) scan of the orbit and paranasal sinus showed dense sinusitis and periosteal abscess at the lateral orbital wall.She was started on intravenous (IV) Cefuroxime and Metronidazole and underwent Functional Endoscopic Sinus Surgery (FESS) and orbital decompression. Intra-operatively there was pus and debris at the left anterior ethmoid, maxillary and sphenoid air sinuses and cultures revealed Klebsiella pneumoniaewhich was sensitive to Cefuroxime. Despite medical and surgical treatment, left orbital swelling only reduced minimally. However after starting intravenous Dexamethasone the swelling dramatically improved. She completed 10 days of intravenous Dexamethasone. Upon discharge, she was given oral Dexamethasone 2mg daily for 2 weeks and completed 2 weeks of oral Cefuroxime and Metronidazole. Intraocular pressure normalised and vision recovered to 6/9. A repeat CT orbit 3 weeks later showed resolving preseptal and periorbital collection.

Parathyroid carcinomas are rare neoplasms, with a reported incidence of less than 1% of cases of primary hyperparathyroidism. Diagnosis and treatment of parathyroid carcinoma remains a challenge, as many of the pathologic features are neither sensitive nor specific in differentiating from benign parathyroid lesions. The rule of 3’s (serum calcium of more than 3mmol/L and size of the adenoma being more than 3cm) is helpful in risk identifying a cancer. Ultrasound of the neck and Tc-99m pertechnetate/Tc-99m sestamibi (MIBI) scan remains the two main modalities of investigation of parathyroid disease. Although en-bloc treatment is recommended for parathyroid cancer, it is only performed in up to 12% of cases. This review illustrates the challenges in diagnosis and treatment of parathyroid carcinoma.

During induction of general anaesthesia, the act of laryngoscopy and tracheal intubation stimulates the sympathetic nervous system resulting in an increase in blood pressure and heart rate which may be harmful especially in elderly patients with pre-existing ischaemic heart disease. Several drugs have therefore been used to obtund this increase including esmolol, nicardipine, magnesium sulphate and lignocaine. This prospective, double blind randomised clinical trial compared the efficacy of magnesium sulphate and esmolol in attenuating haemodynamic responses to laryngoscopy and tracheal intubation. One hundred and twenty six ASA I-II patients scheduled for elective surgery requiring general anaesthesia with tracheal intubation were enrolled and randomised into two groups: Group 1 (n = 67) received MgSO4 40 mg/kg diluted in 100 ml normal saline administered over ten minutes, whereas Group 2 (n = 59) received a bolus of esmolol 1.0 mg/kg diluted to 10 ml. Systolic and diastolic blood pressures and heart rate were recorded every minute for subsequent 10 minutes following laryngoscopy and tracheal intubation. Attenuation of the mean systolic and diastolic blood pressures following laryngoscopy and tracheal intubation was significantly larger in Group 2 compared to Group 1. Patients in Group 2 had significantly better suppression of heart rate response compared to Group 1 during the first four minutes after laryngoscopy and tracheal intubation (p<0.05). Attenuation of the haemodynamic response to laryngoscopy and tracheal intubation by esmolol 1.0 mg/kg was more pronounced compared to MgSO4 40 mg/kg in normotensive patients undergoing general anaesthesia for elective surgery.