A 49-year-old Chinese man, who was a psychiatric in-patient, self-inserted a wooden chopstick into his A B S T R A C TWe report the first case of a transnasal penetrating intracranial injury in Hong Kong by a chopstick. A 49-year-old man attempted suicide by inserting a wooden chopstick into his left nose and then pulled it out. The chopstick caused a transnasal penetrating brain injury, confirmed by contrast magnetic resonance imaging of the brain. He was managed conservatively. Later he developed meningitis without a brain abscess and was prescribed antibiotics for 6 weeks. He enjoyed a good neurological recovery. This case illustrates that clinician should have a high index of suspicion for penetrating intracranial injury due to a nasally inserted foreign body, even though it had already been removed. In such cases left nose and then pulled it out in November 2012. He was subsequently assessed by an ear, nose and throat surgeon. No nasal foreign body was seen and there was no epistaxis. Brain computed tomography (CT) 6 hours after the injury showed a trace amount of haemorrhage over the right gyrus rectus and a small amount of pneumocephalus over the right anterior fossa (Fig 1), and hence the neurosurgical unit was consulted. Six hours after the incident his vital signs were stable and he was afebrile; his Glasgow Coma Scale score was E4M6V4. His speech appeared confused, as if in a premorbid state. There was no neurological deficit, and no cerebrospinal fluid (CSF) rhinorrhoea upon stress testing. Contrast magnetic resonance imaging (MRI) of the brain was performed on the next day, which showed a long haemorrhagic tract extending from right paramidline anterior skull base, coursing postero-superiorly across medial right frontal lobe, closely adjacent to the right frontal horn, and ending at the vertex region (Fig 2), and a trace of intraventricular haemorrhage. On the same day he developed fever. Lumbar puncture yielded turbid CSF, with the presence of Gram-positive cocci, as well as low CSF glucose and high CSF protein concentrations. Conservative management was adopted. On an empirical basis, intravenous ceftriaxone, vancomycin, and metronidazole were prescribed. Prophylactic anticonvulsant therapy (phenytoin) was also given. The CSF culture grew Staphylococcus aureus and Citrobacter koseri. The antibiotic regimen was switched to intravenous ceftriaxone and oral metronidazole. The patient's recovery was excellent, as reflected by normalisation of body temperature and inflammatory markers. On

Background/Purpose Carpal tunnel syndrome caused by gout is rare. We presented our experience in treating these patients. Methods We conducted a retrospective review of cases treated from 2010 to 2013. Eight patients were identified out of 348 carpal tunnel releases performed. Results All patients were male. All patients had gouty tophi on the same hand and other locations on the body. Open carpal tunnel release was performed on all patients. There was gouty tenosynovitis in all patients but no encasement of the median nerve. The mean follow-up was 16 months. Numbness improved in seven out of eight patients. Conclusion Gout should be considered a cause of carpal tunnel syndrome, particularly in patient with a history of gout. Early surgical outcome is promising. Longer follow-up is needed to detect recurrence.

Background/Purpose: There are two common diagnoses for exostosis occurring in the footdosteochondromas and subungal exostoses. Methods: A retrospective study of patients with a diagnosis of exostosis receiving surgery from 2000 to 2011 was conducted. Sixty-five patients were reviewed. Fourteen cases of exostosis on the foot were identified. Results: Out of fourteen cases of exostosis on the foot, nine had a subungal location and five were located on the foot. Four out of five cases on the foot showed histology of hyaline cartilage cap while fibrocartilage was shown in seven out of nine cases with lesions on the toes. In cases of subungal exostosis, excision was done via a transungal approach or wedge excision. Surgical outcome was satisfactory in terms of improvement in pain, cosmetic concern, and functional disturbance. Conclusion: Osteochondroma and subungal exostosis are not uncommonly encountered diagnoses for bony outgrowths occurring over the foot region. Surgical outcome was satisfactory.