Role of Dual Energy X-ray Absorptiometry (DEXA) Scan in the Diagnosis of Chronic Low Back Pain - a Prospective Randomized Controlled Study in Osteoporotic Patients Hospitalized in a Tertiary Care Institute.

OBJECTIVES: Osteoporosis is a skeletal disorder characterized by a decrease in bone mass, with accompanying microarchitectural damage that increases the risk of bone fracture. The aim of this study is to evaluate various risk factors for osteoporosis and the role of DEXA scan in diagnosing the problem in an earlier stage. MATERIALS AND METHODS: About 100 patients who presented with complaint of low back pain in our outpatient department were studied and subjected to a DEXA scan. RESULTS: The age range of patients included in this study was between 35 and 70 years. Of all subjects, 85.10% (n=57) were females and 78.80% (n=26) males. The number of those with significant medical or surgical history was 31% (n=31). The anthropometric characteristics of the studied group included weight, height, and also BMI in kg/m2, which was 20.23, 21.06 in male subjects and 19.343, 20.42 in female ones. Regarding DEXA measurements, the bone mineral density was 0.97±0.27 (0.48, 1.96) for males and 0.83±0.21(0.01, 1.60) for females, with a total of 0.88±0.24 (0.01, 1.96). CONCLUSION: Low back pain is highly prevalent in postmenopausal women. DEXA is a widely accepted radiological tool used to detect osteoporotic changes in bones earlier, with a higher accuracy than plain radiographs of skeletal system. It is relatively cheap, needs no special preparation and involves less radiation hazard.

Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO2) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. AIMS AND OBJECTIVES: To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. MATERIALS AND METHODS: The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. RESULTS: In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). CONCLUSIONS: Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree.

Delayed presentation of the traumatic abdominal wall hernia; dilemma in the management - review of literature.

Traumatic abdominal wall hernia is a rare entity, and an uncommon type of abdominal wall hernia as far as the etiology is concerned. It is caused by blunt trauma and disrupts the fascial layers, but does not disrupt the elastic skin. In this study, we report the case of a 60-year-old female, diagnosed with traumatic abdominal wall hernia with delayed presentation. In this case, herniation of the bowels was present through the defect in the left iliac region. She was surgically well-managed. During the follow-up of 1 year, there was no recurrence. In the Western medical literature, only a few cases have been reported, especially with intra-abdominal injuries. Confusion still exists in the management of such a disease as to whether to treat the condition at an early or later stage.

Report of two cases of non-union of clavicle treated with nonsurgical management.

CONTEXT: Fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures. Radiographs and MRI of the shoulder provide helpful investigations for diagnosis and treatment. In the following cases, an anterior-posterior view revealed non-union of the clavicle on the right side, which is atypical in children. CASE REPORT: Non-union of a clavicular fracture is an extremely rare condition, especially in children. We are reporting two cases in this paper; in the first case; an 8-year-old male child visited the hospital with a history of fracture of the right clavicle one year ago. In the second case, a 26-year-old male patient presented with a history of fracture of the right clavicle six years ago. CONCLUSION: Careful attention should be paid when obtaining a detailed history and physical examinations, as traumatic arthritis at either clavicular joint may mimic non-union. The explicable evidence of osseous non-union on radiographs may be minor and may not correlate with the clinical symptoms.