Dorsal Spine Pedicle Screw Trajectory and entry Point

 

A patient with Trichotillomania

 Yesterday in the outpatient department (OPD), we encountered a patient presenting with noticeable areas of hair loss. On further evaluation and discussion, the patient was diagnosed with Trichotillomania (TTM), commonly known as hair-pulling disorder. This condition involves a recurring urge to pull out one’s own hair, most often from the scalp, eyebrows, eyelashes, or other parts of the body.

Trichotillomania has been recognized since ancient Greece, although the term itself was introduced in the late 18th century. The repeated hair pulling can lead to visible hair loss and changes in appearance, which may cause emotional distress and social stigma for those affected.

This case highlights the importance of recognizing trichotillomania in clinical practice. Early identification and a supportive, multidisciplinary approach can help patients receive appropriate care and improve their overall well-being.

The Man with a Champagne Bottle and "Nas Problem"

The man, in his early forties, a journalist by occupation, complained of pain in his legs.

He had already visited a few hospitals with no much relief in the symptoms. But all of them told he had a "Nas Problem", a local term used equivocally for both "nerves" and "blood vessels" alike, confusing them to visit a neurosurgeon, vascular surgeon, or a general surgeon.

This image, taken today in Neurosurgery OPD, was a classical representation of a complicated case of varicose veins with venous ulcers over medial aspect of the leg, lipodermatosclerosis with induration and hyperpigmentation of the skin, a characteristic "inverted champagne bottle" appearance.

 

 

The management includes life style modification, medical treatment and surgical intervention in advance cases.

The patient was explained about the nature of the disease and referred to the vascular surgeon for further follow-up.

Dr. Mohammad Amir

05-11-2025

 

 

 

 

 

The "Black Hole" in the chest- A Case of Fungal Sinusitis with Fungal Granuloma of Lung Presenting with Headache and Diplopia

 

"The Black Hole" in the Chest.

The patient with twisted fingers- Hand Deformities in Rheumatoid Arthritis

The patient presented with back pain, the investigations revealed problems with her spine but the hands had different story to tell.

                        

Her hands suggested that she has been suffering with Rheumatoid Arthritis, undiagnosed and untreated for long. It requires years of suffering to develop this kind of deformity.

On enquiring retrospectively she revealed that, yes, she has been told to be suffering with "Gathiya Bai" a local term for literally all kind of arthritis, with no regular treatment and follow up.

As the saying goes, "eyes don't see what mind doesn't know", here is quick recap of hand deformities in Rheumatoid Arthritis.

Hand deformities in rheumatoid arthritis (RA) are the result of joint inflammation and the common ones are:

Ulnar drift: 

Fingers bend toward the side of little finger of the hand due to inflammation and instability in the knuckle joints.

Swan-neck deformity: 

The joint closest to the palm (MCP) bends down, the middle joint (PIP) becomes straight or bends backward (hyperextends), and the joint closest to the fingertip (DIP) bends down. This can make it difficult to make a fist. 

Boutonniere deformity: 

The opposite of the swan-neck deformity, the middle joint (PIP) bends down toward the palm (flexes), while the joint closest to the fingertip (DIP) straightens out (hyperextends). 

Hitchhiker's thumb: 

Also called the Z-deformity of the thumb, this is caused by a bend in the joint where the thumb meets the palm, with the tip of the thumb also bending back. 

Rheumatoid nodules: 

These are firm lumps that can appear under the skin, often on the back of the hand or elbow. 

Trigger finger: 

This occurs when the tendon sheath becomes inflamed, causing a finger to get stuck in a bent position and then snap straight with a painful "triggering" sensation. 

Timely diagnosis, adequate treatment, regular follow up and physiotherapy can prevent the progression of disease and development of deformity, however very rarely surgical intervention may be required. 

Dr. Mohammad Amir

Date: 4 November 2025