Objective of the study was to report the clinical spectrum, investigative profile and management of breast tuberculosis patients attending a tertiary care hospital. Breast tuberculosis is an uncommon form of tuberculosis. Knowledge of its varied clinical presentation and diagnostic modalities help in diagnosing this easily treatable disease. Retrospective data of 63 consecutive patients with breast tuberculosis was analyzed and information regarding demographic details, clinical presentation, cytology, histopathology and management was noted. Breast tuberculosis is essentially a disease of females (98.41%). 49.20% patients were below 30 years of age and 68.25% were from rural areas. Incidence of tubercular mastitis increases with parity (71.42% with p > 2). Commonest presentation was with painless lump (73%). Nodulocaseous tubercular disease was found in 74.60% patients whereas, 6.3% were of disseminated variety. Primary focus was detected in lungs in 11.1% patients, while 46.03% presented with loco-regional lymph nodes. FNAC was found to be a sensitive tool of diagnosis in 74.60% patients; however 25.39% cases were diagnosed with biopsy. ATT remained mainstay of treatment with surgical intervention as and when required. Breast tuberculosis despite being uncommon is not rare. Although diagnosis is not difficult but one should know where to suspect. Once confirmed treatment outcome is often rewarding.

Cutaneous horn (cornu cutaneum) is a relatively uncommon lesion consisting of a projectile, conical, dense, hyperkeratotic nodule which resembles the horn of an animal. Cutaneous horns most frequently occur in sun-exposed parts and are typically found in the face and the scalp, but may also occur on the hands, eyelids, nose, chest, neck, shoulder and penis. Their occurrence on the penis is uncommon. We report a 42-year-old man presenting with penile cutaneous horn. The association with malignancy on the penis makes proper identification of these lesions essential. Standard treatment involves local excision, but the presence of malignancy mandates a partial penectomy.

BACKGROUND: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tramadol or Ketorolac in reducing the dose of lignocaine used for intravenous regional anesthesia thereby decreasing the chances of systemic toxicity of lignocaine. PATIENTS AND METHODS: Sixty adult patients of ASA grade I and II were divided into three equal groups of twenty each in randomized double blind manner. Group I patients received 40ml of 0.5% lignocaine. Group II and III received 40 ml of 0.25% lignocaine with addition of 2 mg Atracurium and 50 mg tramadol while in Group III, tramadol was replaced with 30 mg of Ketorolac. Onset of sensory and motor block, intraoperative degree of analgesia, intraoperative and postoperative complications were recorded in all the three groups. RESULTS: There was no significant difference between the groups with respect to age, weight and sex distribution. Mean time of onset of motor block in group I, II and III was 4.15+0.81, 11.7+0.86 and 14.2+0.69 minutes respectively which was statistically significant (p < 0.001). Mean time of onset of sensory block in groups I, II and III was 2.95+0.82, 8.75+1.20 and 11.05+1.04 minutes respectively which was also statistically significant. Intraoperative degree of analgesia in group II and III was comparable to group I. CONCLUSIONS: The use of 0.25% lignocaine and Atracurium with tramadol or Ketorolac provides comparable analgesia to 0.5% lignocaine used alone. This decreases the concentration and total dose of lignocaine required but delays the onset of both sensory and motor block.