From July 2000 to July 2012, we have treated 48 cases with neglected Achilles tendon ruptures in Government General Hospital, Kurnool, India, with modified flexor hallucis longus (FHL) transfer. Thirty-three patients had achillodynia and 29 had local steroid infiltration. Thirty-six patients presented with ruptures in hypovascular zone II and, in 31, repair was after 3 weeks, graded as late (Inglis). The patients were managed based on a standardized evaluation and surgical protocol. The technique of FHL transfer was simplified by anchoring the tendon in a vertical transcalcaneal tunnel. The results were evaluated by Quigley's method, 100 point scoring system of Leppilahti, and recently updated with AOFAS hind foot score. The follow-up ranged from 2.5 to 12.2 years. The follow-up suggested that patients with FHL transfer showed significantly lower mean wound healing times and weight-bearing time and functional recovery times when compared with patients who had peroneal transfer, for neglected ruptures. The results are presented, analyzed and discussed.

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Pheochromocytomas are rare chromaffin cell tumors of adrenal medulla (90%) that secrete catecholamines. Among children, the average age of presentation is 11–13 years, with a male preponderance of 2:1. Symptoms may be caused by catecholamine overproduction, local pressure, or metastasis. Sustained hypertension is the most common symptom. Elevated circulating catecholamines can cause cardiovascular alterations such as coronary vasospasm, ventricular and supraventricular arrhythmias, and dilated cardiomyopathy, precipitating in cardiogenic shock. We present a rare case of cardiogenic shock as the initial presentation of a bilateral pheochromocytoma in a child.

The coexistence of gastrointestinal (GI) stromal tumors (GISTs) and other malignancies, both synchronous or metachronous, has been discussed extensively in literature. It has also been described that the frequency of malignancies among patients with GIST is significantly higher than that in the general population. We present a case report of a patient with synchronous occurrence of myelodysplastic syndrome (MDS) and a GIST who presented with chronic fatigue and an episode of syncope and was found to have obscure GI bleed. Laboratory investigations revealed severe anemia, marrow picture was suggestive of MDS, and magnetic resonance imaging of the abdomen revealed a proximal small bowel neoplasm. She underwent resection of the diseased segment and anastomosis. The histopathology of the specimen confirmed the diagnosis of a GIST arising from the jejunum. She was started on imatinib on postoperative day 21 and is presently well preserved and on regular follow-up. The possibility of small bowel neoplasm, especially GIST, must be considered in patients diagnosed with chronic anemia secondary to obscure GI bleed and the possibility of a synchronous GIST, although uncommon must be considered in patients with myeloproliferative disorders and leukemia.