A document by Shritik Devkota. Click on the document to view its contents.

A document by Shritik Devkota. Click on the document to view its contents.

INTRODUCTION:Fahr’s disease or Fahr’s syndrome is characterized by the calcification of basal ganglia and cerebral cortex, which is usually transmitted in an autosomal dominant manner. It is a rare neurological condition and most of the patients with the disease condition present with movement disorders, tremors, dyskinesia, and sometimes gait disturbances, cognitive impairment, speech disturbances, psychiatric changes such as mania, sensory changes or even pain [1-3]. Fahr’s disease should be differentiated from Fahr’s syndrome, which is usually secondary to underlying systemic pathology, this could be differentiated with blood tests for serum calcium, iPTH, along with other routine blood investigations. Moreover, basal ganglia calcification seen in CT scans could radiologically mimic the disease condition, thus clinical correlation with radiological investigations are the key in the diagnosis of Fahr’s disease [2, 4, 5]. Here, we present a case of a 65-year-old male, with Fahr’s syndrome secondary to hyperparathyroidism which initially mimicked as Parkinson’s disease and later improved after starting the patient on vitamin D and calcium carbonate therapy.

A Rare Case Report of Marjolin Ulcer of the Lower Limb Managed with AmputationDr Suraj KC1*, Dr Rakesh Kumar Gupta1, Dr Abhijeet Kumar1, Dr Bhawani Khanal1, Dr Samiksha Lamichhane2 ,Dr Sanjok Bartaulla1 , Dr Raghav jindal1, Dr Injmamul Haque Raki1* Corresponding Author: Dr Suraj KCDepartment of General Surgery, BPKIHS, Dharankcsuraj1122@gmail.comDr Rakesh Kumar Gupta:Department of General Surgery, BPKIHS, Dharanrakesh154@yahoo.co.inDr Abhijet Kumar:Department of General Surgery, BPKIHS, Dharanabhijeetkr639@gmail.comDr Bhawani Khanal:Department of General Surgery, BPKIHS, Dharanitsmebhawanikhanal@gmail.comDr Samiksha Lamichhane:Department of Radiodiagnosis and imaging, BPKIHS, Dharanslamichhane215@gmail.comDr. Rahul Shrestha:Department of General Surgery, BPKIHS, DharanShrestharahul1522@gmail.comDr. Sanjok Bartaulla:Department of General Surgery, BPKIHS, Dharansanjok.bartaula.sb@gmail.comDr Injmamul Haque Raki:Department of General Surgery, BPKIHS, DharanInjmamulhaqueraki@gmail.comDr Raghav JindalDepartment of General Surgery, BPKIHS, Dharandrraghavjindal@gmail.comAbstract:Marjolin ulcers are known to develop on chronic wounds and ulcers. Biopsy is indicated for chronically suspicious ulcers with no signs of healing. Metastatic workup is necessary before considering any type of surgery. Amputation, as in our case, is indicated when wide local excision or Mohs surgery cannot be performed. Chemotherapy and radiotherapy are reserved for advanced disease and patients who are not fit for surgery. Introduction: Post-burn wounds or scars have the potential to become chronic and may progress into Marjolin ulcers. While rare, it is important to be vigilant with suspicious wounds that do not show signs of healing. We present a case of a 55-year-old woman who developed a non-healing ulcer on the back of her right foot, covering the Achilles tendon, which ultimately required below knee amputation.Case Report:A 55-year-old woman with a history of hypertension and a flame burn on her right foot two years ago presented to the General Surgery Outpatient Department with a non-healing ulcer and foul-smelling discharge. The ulcer had grown from the size of a coin to 5cm x 5cm, located on the posterior aspect of her right ankle. The ulcer was painless with minimal bleeding, and she had intact distal neurovascular function. She denied any respiratory symptoms, chest pain, cough, or similar ulcers elsewhere on her body. Physical examination and vitals were stable. Upon local examination there was 5 x 5cm ulcer over the lateral malleolus and mass on the posterior aspect of the right Achilles tendon ( figure 1). Routine tests were normal, and a biopsy revealed squamous cell carcinoma. Imaging showed no signs of metastasis. The patient underwent a right below knee amputation, and the postoperative period was uneventful (figure2). She was discharged on the 4th post-operative day. The margins were negative for squamous cell carcinoma. On a follow up, stump was healthy, and she was referred for a prosthesis and rehabilitation. Regular follow-ups were advised under the General Surgery Department.\sout