Floating clavicle, bipolar dislocation, sternoclavicular.

<p>Pilonidal sinus is widely associated with disease involving the gluteal cleft. Derived from the Latin word (Pilus=hair; nidus=nest), it was first described by Herbert Mayo in 1833. The pathognomonic finding of the pilonidal sinus is the presence of loose hairs in the sinus tract or cavity. We report a case of a fit middle age policeman who developed an unusual chronic discharging sinus over the tip of the nose. A computed tomography (CT) sinogram showed a localized blind subcutaneous tract over the nose. The course of management is discussed with reference to other reported works of literature. The patient was diagnosed to have a subcutaneous sinus over the tip of the nose with the aid of CT sinogram. Surgery was performed to excised the sinus tract through external rhinoplasty approached. Histopathological examination confirmed a sinus tract lined by keratinized stratified squamous epithelium with a tuft of hair. Patient was follow up for another year with no evidence of recurrence.</p>

No abstract

Melioidosis is a community-acquired infectious disease that is caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia countries, and its clinical spectrum is broad, often mimicking other illnesses, which make diagnosis challenging. The hallmark of its presentation is formation of abscess most commonly in the lungs. The overall mortality rate owing to melioidosis is extremely high especially in the bacteremia form. A 54-year-old woman presented with fever, limited mouth opening, and painful left preauricular swelling for 3 months. Premorbidly, she was well without underlying medical illnesses particularly diabetes or autoimmune disease. Local examination revealed a tender diffuse swelling at the left preauricular region. Her mouth opening was limited to two fingerbreadths. Hematological test showed raised total white cells, erythrocyte sedimentation rate and C-reactive protein. Computed tomography and MRI showed presence of significant left masseteric collection with erosion of left temporomandibular condyle. Other incidental findings from the imaging were multiple liver abscesses and right lower lung abscess. Her indirect immunofluorescence enzyme-linked immunosorbent assay and enzyme-linked immunosorbent assay diagnostic test was positive with significant titre ratio of 1 : 320, which established the diagnosis of melioidosis. Full recovery was attained following surgical drainage of the abscess, together with antibiotics for 6 months (intravenous ceftazidime for a month, followed by oral augmentin for 5 months). Melioidosis involving the TMJ joint is a rare entity. This is the second reported case of melioidosis affecting TMJ joint worldwide, from extensive literature search. This case highlights the importance of suspecting melioidosis in individual presenting with abscess at uncommon and atypical site. Enzymelinked immunosorbent assay is a rapid test as compared to the gold standard blood culture, and it helps in reaching the diagnosis early with its advantages of high sensitivity and specificity.

<p class="abstract">Bilateral vocal cord paresis is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP) with no case reported prior to this. We present a case of a 38 years old gentleman who suddenly developed aphonia and aspiration symptoms following ERCP. A rigid laryngoscopy done showed adductor paresis of bilateral vocal cords causing his symptoms, which was presumed to be a complication of the ERCP. He was treated conservatively and clinically improved with time. The present case report emphasizes that bilateral vocal cord paresis could occur as a complication of ERCP.</p>