We report the case of a 66-year-old woman with tumor-induced osteomalacia (TIO) caused by fibroblast growth factor 23 (FGF-23) secreting mesenchymal tumor localized in a lumbar vertebra and review other cases localized to the axial skeleton. She presented with nontraumatic low back pain and spontaneous bilateral femur fractures. Laboratory testing was remarkable for low serum phosphorus, phosphaturia, and significantly elevated serum FGF-23 level. Magnetic resonance imaging (MRI) of the lumbar spine showed a focal lesion in the L-4 vertebra which was hypermetabolic on positron emission tomography (PET) scan. A computed tomography (CT) guided needle biopsy showed a low grade spindle cell neoplasm with positive FGF-23 mRNA expression by reverse transcriptase polymerase chain reaction (RT-PCR), confirming the diagnosis of a phosphaturic mesenchymal tumor mixed connective tissue variant (PMTMCT). The patient elected to have surgery involving anterior resection of L-4 vertebra with subsequent normalization of serum phosphorus. Including the present case, we identified 12 cases of neoplasms localized to spine causing TIO. To our knowledge, this paper represents the first documented case of lumbar vertebra PMT causing TIO. TIO is a rare metabolic bone disorder that carries a favorable prognosis. When a lesion is identifiable, surgical intervention is typically curative.

Femoral Hernia constitutes a small percentage of groin herniae,but have always been associated with significantly high morbidity.This is partly due to the difficulties in diagnosing the hernia and also due to its propensity for incarceration because of its anatomy. We report a rare case of De Garengeot Hernia which is the herniation of the appendix into a femoral hernia.While this is rare in itself, acute appendicitis in a strangulated femoral hernia is even more uncommon.

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Subarachnoid block is a safe and effective regional anesthesia technique. It is usually carried out in sitting or lateral position but it can also be performed in prone position. Here we report two cases of flame burn over bilateral gluteal region extending to the posterior and lateral aspect of both thighs, who were planned for debridement and split skin grafting. Both patients had difficulty in siting and lying on either side of lateral position. We had administered subarachnoid block in prone position taking into consideration of patient’s comfort and the nature of the procedure. Both patients remained hemodynamically stable throughout the procedure and their post-operative periods were uneventful.Keywords: Burn; prone position; subarachnoid block