The Prevalence of Undetected Vertebral Fracture in Patients with Back Pain by Dual-Energy X-ray Absorptiometry (DXA) of the Lateral Thoracic and Lumbar Spine

STUDY DESIGN: This is a prospective study. PURPOSE: This study is conducted to determine the prevalence of unrecognized vertebral fracture (VF) in patients who present with back pain. OVERVIEW OF LITERATURE: VF is often unrecognized, and significantly increases the risk of further fractures. Unfortunately, the patients at a high risk for VF usually do not receive adequate therapy to reduce the fracture risk. METHODS: This is a prospective study of 344 patients who presented with back pain from April 2008 to May 2009. The patients underwent dual-energy X-ray absorptiometry (DXA) evaluation and vertebral fracture assessment from T4 to L4 using a hologic densitometer. RESULTS: Three hundred forty four of 386 patients who presented with back pain were included. Forty two patients were excluded because of a prior history of VF or the lack of written consent. Most of the patients were female (95.3%). The mean age of the patients was 58.21 +/- 11.74 years. According to the World Health Organization definition (based on the T-score), 13.4% of the patients had normal lumbar spine bone mineral density (BMD). 27.9% of them were osteopenic and 58.7% were osteoporotic. The overall prevalence of VF, as established by lateral vertebral assessment, was 39% (n = 134). Moreover, 62.6% (n = 84) of the patients with VF had more than one fracture and 64.1% (n = 86) of them had Grade 2 or 3 fracture. CONCLUSIONS: We recommend performing not only DXA scanning for BMD evaluation, but also VFA by DXA in old patients with back pain.

effect of oxygenation technique in general anesthesia on postoperative nausea and vomiting

To evaluate the effect of routine positive pressure mask ventilation [PPV] for preoxygenation on the occurrence of postoperative nausea and vomiting [PONV]. Double-blind randomized clinical trial. Teaching Hospital of Birjand University of Medical Sciences, Iran. One hundred sixty elective surgical patients undergoing general, urologic, and orthopedic surgeries between 2007 and 2008. Patients were divided into two groups [A and B]. All patients underwent the same method of general anesthesia using sodium thiopental, fentanyl and suxamethonium. Both groups received 100% oxygen for three minutes before induction of anesthesia. Patients in group A received positive pressure oxygenation for 30 seconds after induction of anesthesia whereas group B patients did not. The incidence of PONV and decrease in SPO[2] [saturation <89%] was compared in the two groups. Out of 160 patients, 20 patients were excluded [abdominal and laparoscopic surgeries or operation time >1 h]. Group A had 73 and group B had 67 patients. There was no decrease in SPO[2] saturation observed in the two groups. The prevalence of PONV was significantly higher in group A [45.2 Vs 28.4% for group A and B, respectively, p<0.05]. Thirty seconds of additional oxygenation with PPV after induction of anesthesia resulted in a higher incidence of PONV. There was no de-saturation in group B patients. Therefore, in non-emergency cases when a short- acting muscles relaxant drug [e.g., suxamethonium] is used, PPV before intubation can be avoided

[Laparoscopic evaluation for chronic post operative abdominal pain]

Approximately 20% of patients undergoing laporotomy experience chronic postprandial abdominal pain for months after operation. Most surgeons are wary of re-operation in this condition, and opt for conservative treatment with analgesics and sedatives. This study was performed to determine the cause of this chronic abdominal pain by means of laparoscopy. Elective laparoscopic surgery was performed on 76 patients suffering from chronic post-operative abdominal pain. They did not have any signs and/or symptoms of acute intestinal obstruction; the most common complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was performed and cases with positive findings were treated by laporoscopic surgery. In 81% of patients the cause of pain was obvious intestinal adhesions, 10% had adhesions without any correlation to patient's symptoms and the remaining 9% did not have any positive finding on diagnostic laparoscopy. Adhesiolysis, [sharp release with scissors] is the treatment of choice. 95% of those patients who underwent Adhesiolysis became pain free for a mean average of 11 months follow up [pre-operative average of pain episode was 4 time per week]. Laparoscopic diagnosis and treatment of chronic post-laparotomy pain is the gold standard method, it is minimally invasive and has good results