Atypical Femoral Fractures Can Happen Even With Short Duration Bisphosphonate Treatment.

Bisphosphonates remain the mainstay of the pharmacological approach to reduce the risk of fractures. Clinical trials have demonstrated their efficacy in reducing the frequency of osteoporosis-related vertebral and nonvertebral fractures. In the last few years, there have been several reports of increased risk of subtrochanteric and femoral shaft fractures also known as "atypical femoral fractures" (AFF) among patients receiving long-term bisphosphonate treatment. Most of these reports have been on alendronate, the most extensively used bisphosphonate. There is paucity of data to link ibandronate to AFF. We report a 66-year-old female presenting with AFF within three years of starting ibandronate and after receiving a total of 27 doses. Prescribers should be aware that AFF can happen even during the early course of bisphosphonate treatment and not necessarily only after prolonged treatment for several years.

To study the levels of C - reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy.

BACKGROUND: The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC). MATERIALS AND METHODS: This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups. RESULTS: There were no differences in the preoperative serum CRP and TLC concentrations - in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters. CONCLUSION: The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

Adalimumab (Humira) induced acute lung injury.

PATIENT: Male, 78. FINAL DIAGNOSIS: Acute lung injury due to Adalimumab. SYMPTOMS: - MEDICATION: Adalimumab. CLINICAL PROCEDURE: Intubated and put on mechanical ventilation. SPECIALTY: Pulmonology. OBJECTIVE: Unusual or unexpected effect of treatment. BACKGROUND: Adalimumab is a recombinant human monoclonal antibody that blocks the effects of tumor necrosis factor-alpha. Adalimumab related acute lung injury is a rare form of acute respiratory distress syndrome of possible immune etiology that develops immediately after an infusion. CASE REPORT: We describe a 78 year old, male with no previous cardiac comorbidities, who developed acute lung injury (ALI) within one hour of administration of adalimumab. He was successfully treated with mechanical ventilatory support and adjuvant therapy. CONCLUSIONS: TNFα antagonists are a part of a new and revolutionary treatment for severe and difficult-to-treat autoimmune and inflammatory diseases. This report emphasizes that this fatal complication may occur with use of this drug. Clinicians need to be aware of this condition as prompt recognition and supportive management can prevent unwanted morbidity and mortality.

Obesity-associated abdominal elephantiasis.

Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.

Schwannoma of the spinal accessory nerve: a case report.

We are reporting a rare case of a schwannoma which originated from the cervical portion of the spinal accessory nerve, which was located in the left posterior triangle of the neck and did not have any neurological deficit, which was diagnosed by the Magnetic Resonance Imaging (MRI) scan and confirmed histopathologically after surgery.