General Surgery

"Trichofolliculomas are benign hamartomas of the hair follicles. Usually seen around the nose, they present as small skin-coloured papules or nodules. We present a patient who presented with a cutaneous horn on the pinna developing over a trichofolliculoma, something not described in literature in the past. The growth was excised and the diagnosis was established on histopathological examination.
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The Updated 304 page Psychopharmacology “Boot Camp” Back to Basics Study Review: Essentials 2013 is a critical quick reference book to help and aid the Medical student, Pharmacy student, Allied Health professional, Resident, Physician, Pharmacist or Psychiatrist navigate through some of the most common challenges and pitflls in an easy to use format. Psychopharmacology “Boot Camp” Back to Basics Study Review: Essentials 2013 represents a decade of clinical vignettes and research, practical tips, study guide lectures, pre-specialty psychopharmacology preparation sessions for Royal College examinations and so much more. Updated to include sections on bioequivalence, tips and pearls, serotonin syndrome and more to help you help others in your practice. Addresses all classes of medications with their ADME variables, clinical "Psych-Snaps" for each medication including antidepressants, mood stabilizers, antipsychotics, atypical antipsychotics, substance abuse, ADHD, stimulants, sedatives and more"""

Alkaptonuria is a rare cause of backache. A 55 years old gentleman, a retired army personal had been having pain and stiffness in the spine for the last 15 years, accompanied by bluish black discolouration of face and hands. Kyphosis and reduced movement of spine were present. Other joints were spared. Osler spots were visible on the sclera. X-rays revealed calcification of intervertebral discs. Asymptomatic renal stone was identified. There was no cardiac involvement. Symptomatic care was provided.

"Objectives: The aim of the present study was to compare and correlate body composition measurements and bone mineral density in patients with rheumatoid arthritis (RA) and age-matched controls to identify the possible prediction factors for low bone mass, fractures, and body composition changes.
Methods: Ninety-two RA patients and 92 age- and sex-matched healthy controls were included for the study. A health assessment questionnaire (HAQ) score, disease activity score - (DAS 28), forearm bone mineral density (BMD) determined by dual energy x-ray absorptiometry (DXA), estimated heel BMD based on quantitative ultrasound and  body composition parameters were analyzed in  both RA patients and controls.
Results: Body fat mass (BFM) differed significantly between RA patient group (26.37±10.05 (kg)) and controls (30.11±8.64 kg, p<0.05). The Fat free mass (FFM) was also significantly different between RA patients (37.63±9.82 kg) and controls (42.97±6.68 kg, p<0.01). Forearm BMD and estimated heel BMD was significantly higher in controls (0.377±0.04 g/cm2, 0.493±0.08 g/cm2), than in RA patients (0.320±0.13 g/cm2 , 0.452±0.10 g/cm2;  p<0.01 and  p<0.05, respectively). The Fat free mass (FFM), muscle mass (MM), segmental muscle mass (SMM) was significantly correlated with the estimated  heel BMD and forearm BMD.
Conclusions: These findings indicated that the body composition measurements might be useful for predicting bone mineral density (BMD) in RA patients. High RA activity was found to be  associated with reduced function, and altered body composition and BMD. "

Purpose Bile duct injury (BDI) represents the most serious complication of laparoscopic cholecystectomy (LC). The aim of this retrospective single-institution study was to evaluate the real incidence of BDI during laparoscopic and open cholecystectomy (OC) in a tertiary academic center in Athens, Greece. Methods Between January 1991 and December 2001, 3 637 patients underwent cholecystectomy in our department; as LC in 2 079 patients (LC group) and as OC in 1 558 patients (OC group). All the LCs were performed or supervised by five staff surgeons and all the OCs were performed or supervised by another five staff surgeons. Results There were 13 BDIs associated with LC (0.62%) and 6 associated with OC (0.38%) (P = 0.317). There was one death associated with BDI after LC. Only two (15.4%) of the BDIs associated with LC occurred within the proposed learning curve limit of 50 LCs per individual surgeon. Conclusion Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence.

"Osteoporosis is more common in India. The prevention of ‘first’ osteoporotic fracture is better than cure. The central dual energy x-ray absorptiometry (DXA) bone densitometer is not widely available, and is expensive. The aim of this study was to screen south Indian rural population aged ≥50 years, for predicting future osteoporotic fracture risk using a simple online FRAX® Calculator. A total number of 48 rural populations (male:female= 25:23), aged ≥ 50 years, residing at Potheri Village, Kattankulathur, Chennai, India, were studied. The forearm bone mineral density (BMD, g cm-2) of each subject was measured using a peripheral DXA (pDXA) densitometer.Using the value, the femur neck BMD was predicted using the published regression equation with good sensitivity. The 10-year probability of future osteoporotic fracture risk was evaluated using a FRAX calculator. It was found that, both major osteoporotic fracture risk as well as hip fracture risk was 1.8 folds greater in osteoporotic females than in osteoporotic males. Further, when applying threshold value (FRAX Score >3%), it was found that 20% (5/25) and 26.1% (6/23) of the males and females were found to be at greater risk for future osteoporotic hip fracture, and hence a suitable personalized preventive treatment is to be started in order to prevent their future bone mineral loss."