Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia for lower extremity anesthesia. Such blocks can be used additionally as a source of postoperative pain relief.

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Introduction: Chondrosarcoma (CHS) of the toes is very rare and the involvement of phalanges is extremely rare. The osteolytic destruction of this tumor severely affects limb function and carries the risk of distant metastasis. These tumors are removed surgically to minimize local recurrence and distant metastases, maximize limb function with better prognosis. The main objective of this report is to present the case of a CHS that invaded the phalanx of the left great toe and formed a large phalangeal mass with osteolytic destruction of the distal bone. Case Report: This case report includes a 60-year-old man suffering from swelling of his left great toe for 2 years, with pain and swelling for 6 months. Serial hematological, radiological and tumor investigations were done. Magnetic resonance imaging revealed a well-defined peripherally enhancing multilobulated soft-tissue mass with central necrotic component involving the entire proximal phalanx of left great toe extending to distal phalanx and head of first metatarsal. The patient was planned for operative intervention due to the possibility of invasion into the adjacent bones. The tumor was excised and sent for histopathological examination, which was reported as Grade 2 CHS (PT, Nx, and Mx) and was S100 positive. The patient has been followed-up for 5 months. Results: There were no signs of local recurrence or distant metastasis on radiological investigations or clinical assessment during follow-ups. Conclusion: CHS occurring in toes is extremely rare. In this case, extensive surgical resection of the large low-grade CHS was safe and effective. Keywords: Chondrosarcoma, phalanges, excision

This case report highlights about rice grain bursitis- rare manfiestation of TB in wrist joint. Subacromial-subdeltoid bursitis of a shoulder with rice bodies is relatively uncommon. The understanding of the pathogenesis of rice body formation is yet approximate only but some clinical conditions like rheumatoid arthritis, tuberculous arthritis, seronegative inflammatory arthritis, juvenile rheumatoid arthritis and osteoarthritis are related to it. A 30yr Male patient presented with complaints of pain and swelling in the wrist joint , which was insidious in onset. It was associated with evening rise in temperature. Frequenetly erosion of the underlying bone, secondary osteomyelitis and median nerve encasement are present.

Pneumocephalus is a commonly encountered entity in patients of head trauma and post-op cases of neurosurgery, however it is rarely observed after spinal anaesthesia. It commonly presents orthostatic hypotension associated with severe headache, nausea and vomiting. We report a case of pneumocephalus following spinal anaesthesia administered for open hernia repair. The proposed mechanisms of pneumocephalus secondary to spinal tapping are the ball-valve mechanism (1) and the inverted soda-bottle effect (2).