Introduction Evidence for the efficacy of distal corticosteroid injection compared with proximal injection in carpal tunnel syndrome (CTS) is inadequate. Methods We conducted a randomized, double‐blind noninferiority trial of 131 wrists with CTS. Forty milligrams of methylprednisolone was injected medial to the palmaris longus tendon 2 cm proximal to the wrist crease, or at the volar aspect, 2 to 3 cm distal to the wrist crease. Proximal & distal groups received a placebo. The primary outcome was difference in CTS Symptom Severity Scale (SSS) score at 1 month. Secondary outcome measures included the difference in SSS score at 3 months, Functional Status Scale (FSS) score at 1 and 3 months, and pain of injections. Results No significant differences were noted between groups in scores on the SSS and FSS. Pain was lower in the proximal group compared with the distal group. Discussion Corticosteroid injections for CTS distal to the wrist are not inferior to proximal injections, yet they are more painful.

Context:The study was designed to evaluate the effect of a hypofractionated, palliative conformal radiotherapy regimen of 5250 cGy in 15 fractions in inoperable/incurable oral cavity carcinoma.Aims:The primary objective was to assess the change in the quality of life (QOL) with respect to pain and mouth opening pre- and post-radiotherapy using standardized questionnaires. The secondary objective was to assess overall QOL using the same questionnaires and also to assess response rates, survival, compliance, early and late toxicity.Settings and Design:This was a single-arm, prospective trial. Patients with incurable oral cavity cancer referred for palliative intent radiotherapy to the Department of Radiotherapy, RCC, JIPMER were recruited into the study.Subjects and Methods:Forty-eight patients were recruited and twenty-five patients were given conformal radiotherapy to a dose of 52.5 Gy in 15 fractions. QOL was assessed using the European Organization of Research and Treatment of Cancer (EORTC) questionnaires before and 2 months after the completion of radiotherapy. The response assessment was made using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria 2 months after radiotherapy. The early and late toxicities were assessed at 2 months and 6 months after radiotherapy completion, respectively.Statistical Analysis Used:Sample size was calculated to be 53. The Wilcoxon signed-rank test was used to compare QOL scores pre- and post-radiotherapy. Median survival was assessed using the Kaplan–Meier method.Results:There was a significant improvement in the pain, mouth opening, speech, social contact, social eating, felt ill items of the EORTC QLQ-H and N35 questionnaire and role functioning, emotional functioning, social functioning, fatigue, pain, insomnia, appetite loss, financial difficulties, and Global QOL subscales of the QLQ-C30 questionnaire. 72% of the patients had grade 3 acute radiation oral mucositis and 36% had grade 3 acute radiation dermatitis. There were no significant treatment breaks due to toxicity. There were no grade 3 late toxicities observed. Overall median survival was 5.1 months. The overall response rate was 47%. The median time to treatment completion was 24 days.Conclusions:The improvement in QOL parameters suggests that the regimen of 52.5 Gy in 15 fractions is suitable for palliative intent radiotherapy in late-stage oral cavity cancer for effective palliation for short periods.

Fetal intra-abdominal umbilical vein varix is an uncommon antenatal finding defined as focal dilatation of umbilical vein >9 mm or more than two standard deviations above the mean for the gestational age. We report the case of a 28-year-old gravida 2 diabetic lady, who presented at 35 weeks of gestation, whose antenatal ultrasonography showed a cystic lesion of size 4 × 3.8 cm showing turbulent venous flow in the fetal abdomen in continuity with the umbilical vein, diagnosed as umbilical vein varix without any other anomaly. Postnatal ultrasonography showed size reduction and thrombosis of varix. Isolated umbilical vein varix has a favorable outcome, whereas those associated with other structural anomalies have a variable prognosis. This case was reported because of the unusually large size of varix with a good outcome and also to stress the importance of detailed sonography and close fetal monitoring in the presence of umbilical vein varix.

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DesCripTionA 45-year-old man with history of chronic renal failure had sudden onset of severe pain in both his knees following which he was unable to walk and had severe pain in both lower thighs and knee joints. On examination he was pale looking and asthenic. Local examination revealed swelling of bilateral knee joints with restricted extension of knee joints. On palpation small defect was noted in the suprapatellar region, indicating the discontinuity of quadriceps tendon. MRI of bilateral knee joints was done, revealing patella baja (low-lying patella), moderate-joint effusions and full-thickness defect in quadriceps tendons at site of patellar attachment (figures 1 and 2). The patient did not have any other tendon ruptures at the time of presentation to hospital. Due to poor renal function status, the patient was not fit for surgical repair and was immobilised with long leg cast in extension for 8 weeks followed by crutch walker support and advised for follow-up.Bilateral quadriceps tendon tear is a very rare clinical entity. In 1949 Steiner and Palmer first reported a case of quadriceps tendon tear in a patient with renal failure. Trivial trauma can rupture bilateral quadriceps in patients with chronic renal failure, systemic lupus erythematosus, gout, diabetes, secondary hyperparathyroidism, pseudogout, alkaptonuria, severe osteomalacia and in patients with systemic steroid treatment. The cause of tendon tear has not been well established and various causative factors have been proposed like diminished local circulation, disturbed collagen synthesis, repeated microtrauma and reduced tendon elasticity by calcification.