This is the last issue of the Journal for this year (2016). This issue, as usual has a good assortment of articles from various specialities. The original article on the factors predicting the need for chest tube for pneumothorax following needle biopsy has revealed some interesting conclusions.

While transthoracic needle biopsy (TTNB) is a well-established method for diagnosis of lung lesions, pneumothorax is a frequent complication, with an estimated incidence between 12-45%. Up to 53% of post-TTNB pneumothorax require chest tube placement. This has wide implications, particularly for the elderly patient with pre-existing respiratory disease and multiple comorbidities. This study aims to determine the premorbid respiratory factors that predict chest tube insertion for pneumothorax post TTNB.

Esophageal varices are considered as one of the major complications of Decompensated Chronic liver Disease. The gold standard for diagnosis has been Esophagogastroduodenoscopy. Early diagnosis of esophageal varices is vital as dreadful complications like bleeding from the varices can be avoided with prophylactic medications.

The autopsy based study on the profile of medico - legal cases in any hospital which includes both natural and unnatural deaths reflects not only the rate and pattern of crime and natural deaths prevailing in that area but also helps us to curb their incidence and handle the preventable casualties in a better way in future.

“Posterior reversible encephalopathy syndrome (PRES)” is a clinico radiological entity, the characteristic neuro-imaging features and non-specific symptoms including headache, confusion, visual disturbances and seizures. Vasogenic edema, which is the most probable underlying pathology results in detectable Parieto-occipital white matter changes in imaging. Vasogenic edematous changes of PRES are reported to be reversible with appropriate clinical management. Eclampsia is one of the underlying etiologies of PRES and prompt diagnosis and treatment of eclampsia are important as cerebrovascular damage caused by eclampsia may result in permanent neurologic sequelae. Termination of pregnancy by caesarean section is the mainstay in the management of PRES. Patients with eclampsia and PRES for caesarean section are a challenge to the anesthesiologist that involves management of airway, arterial oxygenation, control of blood pressure & seizure, hydration, correcting electrolyte disturbances and coagulopathy. This is a case report of anesthetic management of a pregnant woman with PRES due to eclampsia.

42 year old woman complained of swelling in the back of her right wrist for two months. Examination showed a fluctuant swelling on the dorsum of her wrist. X-rays, blood counts and ESR were normal. Rheumatoid factor was positive. Anti - CCP was negative. MRI showed tenosynovitis of Extensor digitorum communis. After conservative measures failed to relieve pain, synovectomy was performed. Biopsy finding was consistent with rheumatoid tenosynovitis. After remaining symptom free for four weeks, she developed synovitis of both wrists and hand joints. Therefore Tenosynovitis may present primarily in rheumatoid disease before other manifestations become evident clinically, radiographically or serologically.

Intrahepatic cholestasis of pregnancy is a reversible type of hormonally influenced pregnancy-specific liver disorder. It is a severe form of cholestasis in pregnancy and is associated with an increased risk of perinatal mortality. Delayed delivery can lead to fatal fetal outcome even though maternal prognosis might be good. Early diagnosis and intervention may yield better perinatal outcome. This is a case report of anesthetic management of a primigravida with intrahepatic cholestasis of pregnancy posted for elective caesarean section.

Beta - Thalassemia (β-Thalassemia) trait is a heterozygous state for abnormal β gene and is clinically asymptomatic. Co-inheritance of β-Thalassemia trait with other abnormal globin gene or any other mutation may alter the course of disease in the subject .Here we report 2 cases, one with the co-inheritance of β-Thalassemia trait with haemoglobin S & the other with co-existence of iron deficiency anaemia and β-Thalassemia. In case 1, Thalassemia trait has ameliorated the clinical course of sickle cell disease & in case 2, β-Thalassemia trait has further aggravated the symptoms caused due to Iron deficiency anaemia. These two cases emphasize the need to search for additional clues if there is no complete correlation between diagnostic investigation results and clinical condition of patient.

Distal humerus physeal fracture separation is a rare occurrence. It is a commonly missed condition, due to absence of ossification centre in the distal humerus. In radiographs, it is commonly misinterpreted as dislocation of the elbow joint. Ultrasound and MRI are useful in diagnosing the condition. Primary diagnosis of this condition is purely based on the clinical knowledge and high degree of suspicion about the condition along with imaging studies for acute management with closed reduction and immobilization so that complications are avoided. In this case report, we bring you our experience of two rare cases with late diagnosis of physeal separation of distal humerus which was managed effectively at our institute with conservative methods and had good functional outcome.

Epidural anesthesia is one of the most commonly employed type of anesthesia for patients who undergo surgeries of thorax, abdomen or lower extremity and is also considered for perioperative management of analgesia. Epidural catheters can undergo misplacement or migration into subarachnoid space, vessels, subdural space and thoracic cavity. This is a case report of misplaced epidural catheter. There is a disadvantage of epidural catheters getting misplaced during perioperative period. Therefore, it requires a continuous monitoring and observation of these patients in order to prevent and minimize the adverse events related to the misplacement of epidural catheters.

Distal Fibula is an extremely rare site for a Giant Cell Tumor. Tumors at this location, especially active and aggressive ones are difficult to manage. In most situations en bloc resection is required and thus subsequent reconstruction of the ankle anatomy becomes essential to provide a stable ankle with pain free mobility. Here we report a successful management of such a tumor with a long term follow-up of seven and a half years.

An Odontogenic Keratocyst (OKC) first described by Philipsen in 1956, commonly affects body and ascending ramus of mandible with maxillary sites and anterior mandible being very rare. It is a locally aggressive tumor often but not always associated with an impacted tooth. Hereby, we are presenting a case of OKC with an uncommon clinical presentation.

Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor. It often presents a diagnostic challenge to the pathologist and the clinician. Due to the rarity of the disease, there are no large studies available to guide the management of this disease. Most of the available data is based on case reports and series. In the past FDCS has been treated as a lymphoid malignancy but recent evidence suggests that FDCS is actually a mesenchymal tumor. Regimens such as gemcitabine-docetaxel have been tried and found to benefit patients. Here we present the case of a lady with an abdominal mass arising from the ileum for which she underwent R1 resection elsewhere, which was diagnosed as FDCS and treated with sunitinib. She was treated with sunitinib for several months until she had significant clinical and radiological evidence of disease progression. Additionally disease biology, clinical features, histopathology and therapeutic options are discussed.

Acute renal failure is an uncommon complication among children with Diabetic keto acidosis. This has been recently reported from developing countries. Prerenal uremia which improves in few hours is common in DKA and this is fluid responsive, however intrinsic renal failure with increasing urea creatinine and anuria is associated with high mortality and is uncommon. Sepsis, shock, severe dehydration, rhabdomyolysis and thrombotic microangiopathic syndrome are the underlying factors for acute renal failure in children with DKA. The incidence of acute renal failure varies from 3.7% to 11.5%. Management includes change in fluid electrolyte therapy, insulin dose, bicarbonate infusion and renal replacement therapy in the form of hemodialysis or peritoneal dialysis. Mortality in acute renal failure is mandatory for a better outcome.

The introduction of oral and parenteral bisphosphonates (BPs) into routine clinical practice has reduced the number of cases of pathological fractures, bone metastasis, and has significantly reduced the risk of hypercalcemia in oncologic patients. It has been shown in vitro that BPs promotes proliferation and differentiation of human osteoblast-like cells and inhibits osteoclast. Diagnosis of Bisphophonate related osteonecrosis of the jaw (BRONJ) should be based mainly on radiographic and clinical findings. Currently, the treatment is done based on staging and guidelines by American Association of Oral and Maxillofacial Surgeons.