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Clinical Findings A 20 years old woman presented to the emergency department with an 8 month history if swelling and pain in the right thigh . Investigational Findings . MRI of the right leg reveled a large periosteal femoral mass and thrombus in the right femoral vein , for which she recieved anticoagulant therapy . The patient subsequently experienced dyspnoea and pleuritic chest pain , a chest x ray was done . What is likely the diagnosis ..? 1. Pulmonary embolism 2.Pulmonarg Sarcoidosis 3.Eosinophilic granulomatosis with polyangiitis 4.chondroblastic osteosarcoma 5.milliary tuberculosis

A 47 year old male presented with the foot ulcer near the great toe since 3 months. Took medicines but not relieved. Patient is diabetic. How can we treat this ulcer.

ABC OF : BONE TUMORS. MAY BE USEFUL. ** A bone tumor is an abnormal growth of cells within the bone that may be noncancerous (BENIGN) or cancerous (MALIGNANT)....... CAUSES :- The cause of bone tumors is UNKNOWN. They often arise in areas of rapid growth. POSSIBLE CAUSES INCLUDE : INHERITED GENETIC MUTATIONS RADIATION TRAUMA But in most cases no specific cause is found....... OSTEOCHONDROMAS are the MOST COMMON noncancerous (BENIGN) bone tumors, and occur most often in people between the ages of 10 and 20. Some benign bone tumors go away on their own and do not require treatment. These benign tumors may be monitored periodically by x-ray....... CANCERS that start in the bones are referred to as PRIMARY bone tumors. Cancers that start in another part of the body (such as the breast, lungs, or colon) are SECONDARY OR METASTATIC BONE TUMORS that behave very differently from primary bone tumors. MULTIPLE MYELOMA often affects or involves the bone, but is also not considered a primary bone tumor. CANCEROUS (malignant) bone tumors INCLUDE :- Chondrosarcoma Ewing's sarcoma Fibrosarcoma Osteosarcomas *** THE CANCERS THAT MOST OFTEN SPREAD TO THE BONE ARE CANCERS OF THE : BREAST KIDNEY LUNG PROSTATE THYROID These forms of cancer usually affect older people....... ** Bone cancer was once very common among people who PAINTED RADIUM ON WATCH FACES (to produce glow-in-the-dark dials). The painters would "tip" the brush with their tongue (in order to produce fine work) and absorb minute amounts of radium, which deposited in the bone and caused cancer. The practice of using radium paint was ABANDONED in the middle of the 20th century....... The incidence of bone cancer is higher in families with familial cancer syndromes....... The incidence of bone cancer in children is approximately 5 cases per million children each year....... SYMPTOMS :- Bone FRACTURE, especially fracture from slight injury (trauma) Bone PAIN, may be worse at night Occasionally a mass and SWELLING can be felt at the tumor site NOTE : Some benign tumors have NO SYMPTOMS. EXAMS AND TESTS :- ALKALINE PHOSPHATASE blood level BONE BIOPSY BONE SCAN MRI OF THE BONE AND SURROUNDING TISSUES X-RAY OF BONE *** THIS DISEASE MAY ALSO AFFECT THE RESULTS OF the FOLLOWING TESTS :- ALKALINE PHOSPHATASE ISOENZYME BLOOD CALCIUM LEVEL PARATHYROID HORMONE BLOOD PHOSPHORUS LEVEL TREATMENT :- BENIGN BONE TUMORS may not require treatment, but may be looked at regularly to check if they grow or shrink. Surgical removal of the tumor may be necessary. TREATMENT FOR MALIGNANT TUMORS that have spread to the bone DEPENDS ON the PRIMARY TISSUE or ORGAN INVOLVED....... RADIATION THERAPY can be used locally to prevent a fractures or to relieve pain. TUMORS THAT START IN THE BONE (PRIMARY MALIGNANT tumors of the bone) are RARE and require treatment at centers with experience treating these cancers. After BIOPSY, a COMBINATION OF CHEMOTHERAPY AND SURGERY is usually necessary....... RADIATION therapy MAY be NEEDED before or after surgery.......

New Case 81 yr , M, Diabetic 6 yrs, on single oral med , well under control , developed back pain 3 months, progressive difficulty in walking 3 weeks . Denied having any sensory / bowel/ bladder symptoms. No fever / loos of weight Or appetite.No symptons suggestive of upper limbs / bulbar involvement/ head ache / vertigo. Examination : general - normal.Intact peripheral pulses. Higher function , cranial nerves & upper limbs - normal. positive beevors sign.Lower limb power gr 3/ 5 with spsticity , hyper-reflexes with extensor plantars . Intact sensations. possible diagnosis ?

A 25 year female history of RTA 5 years back followed by Incised injury on rt ankle (medial side) which was repaired with suture. After 2 month back patient complaint of pain pain and inflammation on rt ankle (same spot which was repaired). Patient referred to orthopedic surgeon ,he was diagnosed as acute osteomyelitis and advised for d & c. it was done under LA. After 1 year again Patient complaint of pain and pus discharge from repaired area. Orthopedic surgeon again advised for MRI rt ankle, which was revealed as chronic osteomyelitis. Surgeon suggest for d & c and biopsy of osteomyelitis area. D & C done and biopsy sent , report shows no growth. Patient came to me yesterday and complaint of pus discharge from 5-6 month also bloody red coloured discharge from 4-5 days with pain and discomfort. Patient doesn't want and d & c. Please suggest the treatment.