Sickle cell disease (SCD) is a hereditary blood disorder characterised by an abnormality in the oxygen carrying capacity of haemoglobin molecule in red blood cells. WHO has recognised 14 communities in South Gujarat amongst the tribal groups with high prevalence of SCD. Traumatic brain injuries (TBI) can lead to increased secondary damage due to presence of hypoxia and hypotension; which are worsened in the presence of SCD leading to grave outcomes. In one of this rare kind of study; 11 patients of TBI with SCD were analysed. 5(45.45%) patients had history of no trauma or minor trauma with a mortality of 3(27.27%) patients out of 11. All (100%) patients had hypoxia and hypotension at the time of presentation. Aresearch on bigger scale is needed to identify specic interventions that may improve outcomes in this population.

Neurofibromatosis type 1 is an autosomal dominant genetic disorder with an estimated birth incidence of 1 in 3000-4000. The major diagnostic criterion includes multiple cutaneous neurofibromas, axillary or inguinal freckling, and café au lait spots. Gastrointestinal neoplasms have a reported occurrence of 2-25 % of which neurofibromas are the most frequently diagnosed benign neoplasm. Periampullary tumors in patients with neurofibromatosis are usually carcinoids and very rarely adenocarcinoma. We report a case of 40-year old woman with neurofibromatosis type 1 who presented with epigastric pain and jaundice. She was diagnosed to have ampullary tumor after investigations, and she underwent pancreaticoduodenectomy. The resected specimen histologically showed adenocarcinoma of the ampulla.

Introduction: The C2 (second cervical) laminar screws were considered for rigid fixation of the axis because the use of pars or pedicle screws posed a risk to the vertebral artery with C2. Though considered to be a relatively safe method, ventral spinal canal violations have been reported in laminar screws fixations. Fluoroscopy-based image guidance may increase the accuracy and safety of the technique. Aim: To report the use of fluoroscopy technique in the detection of ventral wall violation during C2 intralaminar screw insertion. Materials and Methods: This descriptive study reports seven dry axis vertebrae from the adult south Indian population for which fluoroscopic analysis was done from January 2013 to December 2013. True lateral views were taken before and after applying a vertical line of barium paint on the ventral surface of the lamina at two points: at the centre of the lamina and close to the facet joints at the face to-laminar junction. Results: In the total seven dry axis vertebrae analysed, the mean ratio of the distance from the spinolaminar junction to the barium line (drawn on the ventral surface of the lamina just next to face to laminar junction) to the distance between the spinolaminar junction and uppermost part of inferior articular facet of C2 vertebrae was 0.465±0.0389 mm. Conclusion: Even though considered a relatively safer technique, laminar cortical violations have been reported in C2 translaminar screw fixations. Fluoroscopy-based imaging guidance can improve the accuracy of C2 translaminar screw insertion, as this technology provides real-time imaging during the process of screw insertion and helps in accurate screw sizing.