Background: The markers of bone remodelling, such as serum osteocalcin, may be used to assess osteoporosis and to predict the fracture risk in elderly persons, especially in women. The bone mineral density which reflects the bone mass and strength, also predicts osteoporotic related hip fractures. So, this work highlights the association between the bone turnover and the bone mass and strength. Aim:To assess the association between the biochemical markers of bone remodeling and osteocalcin with the bone mineral density in non osteoporotic and osteoporotic women among post menopausal subjects. Materials and Methods:Sixty postmenopausal women whose ages ranged from 55-65 years included in this study, were further divided into group 1 (thirty non osteoporotic subjects) and group 2 (thirty osteoporotic subjects). For all the subjects, serum osteocalcin was measured by ELISA. BMD was measured by the Dual Energy X-Ray Absorptiometry (DXA) scan.The women with osteoporosis were diagnosed, based on the T-score of the bone mineral density, by the DXA scan. The Student's "t" test was performed between the variables of both the groups and a correlation test was also performed between osteocalcin and BMD by using SPSS.Results: A negative correlation was found between the osteocalcin level and the bone mineral density in post menopausal women. The mean values of both serum osteocalcin and BMD between the osteoporotic and the non osteoporotic subjects were statistically significant. Conclusion:An increased bone turnover coincides with the trabecular deterioration in osteoporotic women of the post menopausal age group. A combination of biochemical markers and BMD may be a better predictor of the fracture risk than when it was assessed by either alone. The biochemical markers of the bone turnover cannot be a substitute for the serial BMD measurement, but they may be useful when they are considered in conjunction with the BMD measurement.KalaiSelvi vS, Prabhu K, Mani raMeSh, vathSala venKateSan InTROduCTIOnAccording to the WHO , osteoporosis is a disease which is characterized by a low bone mass and a microarchitectural deterioration of the bone tissue, which lead to an enhanced bone fragility and a consequent increase in the fracture sites. There are two forms of osteoporosis, based on whether the disease is primary or secondary to other identifiable medical conditions or treatment. Primary osteoporosis can be classified into two types, based on the uncoupling defects which are seen in the remodeling unit. Type 1 (postmenopausal) osteoporosis is caused by an acceleration in the bone turnover as a result of hormonal deprivation. Although the entire remodeling unit is activated by oestrogen deprivation, the bone resorption exceeds the bone formation because of the time constraints on the osteoblastic activity, ultimately resulting in bone loss. In type 2 or senile osteoporosis, the osteoblastic activity for forming new bone is impaired, even though the resorption is either normal or enhanced, resulting in a chronic imbalan...
Robot-assisted laparoscopic radical prostatectomy (RRP) has traditionally been done using transperitoneal (TP) approach. This requires patients to be in the steep Trendelenburg position with antecedent risks of high intraoperative ventilatory pressure, post-operative confusion status, corneal and cerebral edema, deep vein thrombosis (DVT), predisposes risk of intestinal injury and slight delay in bowel recovery. Extraperitoneal (EP-RRP) approach circumvents the above given issues. Between July 2013 and October 2016, 57 patients underwent RRP for adenocarcinoma done by a single surgeon (NR). Salvage prostatectomies were excluded. RRP was performed using techniques TP (n = 23) and EP (n = 34). Patients were selected in a non-randomized fashion. Clinico-pathologic parameters and perioperative outcomes were compared in both groups using nonparametric tests. Patient demographics, clinico-pathological features, length of stay and total operative time were similar in both groups. Dock (Trendelenburgh) time was shorter in EP-RRP compared to TP-RRP [median (1st-3rd quartiles) (p value)] [180 (150-220) min vs. 220 (180-230) min (p = 0.039)]. Other significant differences includes EP-RRP vs. TPRRP, ventilatory pressures (cm of HO) [34 (32-34) vs. 40 (38-40) (p = 0.000)], ETCO2 (mm of Hg) [38 (36-40) vs. 32 (30-34) (p = 0.000)], ambulation (day) [0.00 (0-1) vs. 0.00 (0-2) (p = 0.022)], return of bowel activity (day) [1.0 (1.0-2.0) vs. 2.0 (2.0-2.0) (p = 0.000)] and opening of bowel (day) [2.0 (1.0-2.0) vs. 3.0 (3.0-3.0) (p = 0.000)]. EP-RRP offers similar clinical outcomes to TPRRP but with the advantages of shorter Trendelenburgh time, early recovery of bowel functions with avoidance of bowel injury and intraperitoneal urine leak. Overall, early recovery of patients who had undergone EP-RRP potentiates it to be performed as day care procedure.
Purpose: The method of surgery and its recovery play an important part in a success of any surgery. Implementing a minimal invasive approach with enhanced recovery protocol permits Nephrectomy to be performed as a day-case (DC) procedure. Here we report our initial experience with laparoscopic nephrectomy (LN) as DC surgery with an aim to assess its feasibility and safety. Patients and methods: In this retrospective observational study, nine patients underwent DC LN performed by a single surgeon (NR). LN was performed in the standard way followed by enhanced recovery pathway of care for DC. We collected data regarding demographic information, medical co-morbidities, preoperative outcomes, complications and readmission rates. The data was analysed and evaluated. Results: There were four (44.4%) women and five (55.5%) men with a median age of 35 years (range 17–52 years). Eight (88.9%) patients had benign diseases associated with non-functioning kidneys and one (11.1%) patient had a renal tumour. All patients (100%) were successfully discharged the same day with no major complication (Clavien Dindo Grade > I). Readmission rates were 0%. Conclusion: In our small series, DC LN is feasible and safe with a belief that the results are easily reproducible. Increasing experience in laparoscopic surgery with implementation of enhanced recovery protocol may help to increase the success rate of LN as DC.
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