We describe a young Indian male patient who developed a large solitary tumor following an intramuscular injection at the same location. The tumor was histologically proven to be a pilomatricoma. It was treated by surgical excision and there was no recurrence until one year after the operation. An alarming phenomenon following intramuscular injection is presented here for its novelty.

Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

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Aim: To observe the results and complications of lateral internal sphincterotomy in anal fissure. Materials & Methods:The study was carried out as a prospective observational study of 40 patients at surgery department of a medical college & tertiary health care center, over a period of two years that included cases of anal fissure in the age group of 16 years and above for conservative & surgical management. Results: The recovery of the patient after this marvellous operation was fast and the pain relief was dramatic. On follow-up at 2 weeks post-operatively pain and other symptoms were present only in 11 patients (27.5%). On follow-up at 8 weeks post-operatively all 40 patients (100%) were symptom-free in this study. The complications that were observed within time frame of this study were Soiling in 4 patients (10%) and incontinence to flatus in 1 patient (2.5%). There was no recurrence of anal fissure observed in this study group within the time frame of this study. Conclusion: It is very evident from the above study that 'Lateral Internal Sphincterotomy' is by far the best operation for an indolent anal fissure.

Aim: To observe the results and complications of lateral internal sphincterotomy in anal fissure. Materials & Methods:The study was carried out as a prospective observational study of 40 patients at surgery department of a medical college & tertiary health care center, over a period of two years that included cases of anal fissure in the age group of 16 years and above for conservative & surgical management. Results: The recovery of the patient after this marvellous operation was fast and the pain relief was dramatic. On follow-up at 2 weeks post-operatively pain and other symptoms were present only in 11 patients (27.5%). On follow-up at 8 weeks post-operatively all 40 patients (100%) were symptom-free in this study. The complications that were observed within time frame of this study were Soiling in 4 patients (10%) and incontinence to flatus in 1 patient (2.5%). There was no recurrence of anal fissure observed in this study group within the time frame of this study. Conclusion: It is very evident from the above study that 'Lateral Internal Sphincterotomy' is by far the best operation for an indolent anal fissure.