Introduction: The surgical treatment of lipedema usually requires the removal of way higher amounts of fat than are common in aesthetic liposuctions. Often, the limit of 4,000ml, which has been established as the definition of high-volume liposuctions, has to be trespassed. There are only few studies considering safety reasons of this procedure. A high complication rate and especially severe cardiovascular problems are named as the reasons. However, there do not exist reliable sources in literature regarding the frequency and course of cardiovascular reactions of water-jet assisted liposuction (WAL) in lipedema.\n\nMethods: Between 01.01.2012 - 31.03.2018, 1,000 surgeries (water-jet assisted Lipo-Decompressions in lipedema) have been examined with regard to postoperative cardiovascular reactions on 499 patients. Patients with lipedema stage I-III were treated. Lipo-Decompressions follow a standardised treatment protocol. The evaluation of cardiovascular reaction up to 24 hours and 1 week after surgery was carried out following an analogue scale. Additionally, we asked for the patients’ satisfaction with their care at home and whether patients were to undergo the same procedure again. Results were broken down according to the area operated on (lower legs, front of thighs, back of the thighs including buttocks, thighs completely, arms). \n\nResults: Volumes between 800 - 13,500ml per session were removed. Overall, mild to average cardiovascular reactions could be observed. A correlation between the volume removed and a relevant cardiovascular reaction could only be observed for the Lipo-Decompressions where the thighs had been treated in one session. Here, with p < 0.05 a significant difference between a high-volume liposuction > 4,000ml and a low-volume liposuction < 4,000ml could be seen. Nevertheless, on the analogue scale from 1 (no cardiovascular reaction) to 6 (severe cardiovascular reaction), in overall the intensity was only rated medium severe. Over 90% felt well being taken care of at home by their friends or relatives and were to undergo the same surgery under the same circumstances again. The total complication rate was 0.9%.\n\nConclusion: When applying a standardised surgery protocol, Lipo-Decompression in lipedema via water-jet assisted liposuction represents a safe method with only mild to medium cardiovascular reactions, even in high-volume liposuctions over 4,000ml. It can be carried out in every stage of the disease with an overnight stay.

Background: Alcoholism results from the interaction of several factors. In Brazil, the skin color factor has not been properly studied.\nObjective: To examine some demographic aspects and the alcoholism pattern in men and women classified according to skin color.\nMethods: Transversal study of alcoholism in a population of 300 chronic alcoholics admitted in a psychiatric hospital. Patients were 206 males and 94 females, 199 white skin (149 men, 50 women), 63 black skin (32 men, 31 women) and 38 mixed brown skin (25 men, 13 women).\nResults: White females had higher average individual age and lower duration of consumption than the white males. The daily amount of alcohol consumed and duration of consumption were not significantly different between men and women. The male to female ratios differed significantly between the skin colors (white 2.98, brown 1.92, black 1.03) indicating that the prevalence of alcoholism is higher among patients with darker skin colors, especially among the black females when compared to white females. Conclusions: The overall prevalence of alcoholism was higher in the group of black skin color, especially among females where the statistical significance was larger between the group of black women relative to the white women.

INTRODUCTION:Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate.The incidence of fractures in the proximal femoral area has risen with increasing numbers of elderly persons with osteoporosis and traffic accidents in young adults. The aim of surgery is to achieve early mobilization and prompt return to pre-fracture activity level. The treatment of this fracture remains a challenge to the surgeon. Two broad categories of internal fixation devices are commonly used for intertrochanteric femoral fractures: sliding compression hip screws with side plate assemblies and intramedullary fixation devices. AIM OF THE STUDY: To assess the functional outcome of fixation of intertrochanteric fractures with both dynamic hip screw fixation and proximal femoral nailing fixation and follow up outcomes. MATERIALS AND METHOD: Totally 20 unstable Inter-trochanteric hip fractures that were surgically treated at Department of orthopedicsin the year 2018 at Sri Ramachandra Medical College & Research Institute, SRIHER, porur, Chennai were included in the study. Patients were treated with DHS and PFN fixation. All surgeries were done on a traction table and are followed up at regular intervals of 6 weeks, 10 weeks, 4 months, 6 months were included to compare the outcomes.\nRESULTS: We had 6 cases of type-1, 8 cases of type-2, 4 cases of type-3, and 2 cases of type-4 fractures. 3 cases of type-1, 4 cases of type-2, 2 cases of type-3, and 1 case of type-4 fractures cases were fixed with a dynamic hip screw and other 10 cases were fixed with proximal femoral nailing. The functional results are assessed with Harris Hip Score and we observed good or excellent results in 64% of the DHS group and good or excellent results in 80% of PFN group. We observed no statistically significant difference between two groups in view of late & early complications and time to union. The mean follow up period was 13 months (range, 9 -16 months). CONCLUSIONS: After analyzing the functional outcome of all patients by Harris hip score the average score was found to be 83.2. We had 3 excellent results, 14 good results, and 3 fair results.We observed significantly better functional outcome in PFN group for unstable inter-trochanteric fractures. In unstable fractures, we observed the total duration of surgery, blood loss, and image intensifier exposure time to be significantly lower in PFN group. We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

INTRODUCTION: Intertrochanteric (IT) femur fractures comprise approximately half of all hip fractures.The risk factors leading to hip fractures include increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. The incidence of Intertrochanteric fracture is rising because of increasing number of senior citizens with osteoporosis. Both surgical, as well as non-surgical interventions have been studied by various study modalities. AIM OF THE STUDY: To analyze the clinical and functional outcome of unstable intertrochanteric and subtrochanteric fractures treated with Proximal Femoral Nail. MATERIALS AND METHODS: Totally 20 unstable Inter-trochanteric and sub-trochanteric hip fractures that were surgically treated at Department of orthopedics in the year 2017 at Sri Ramachandra Medical College & Research Institute, SRIHER, Pour ,Chennai, were included in the study. 20 Patients with unstable Intertrochanteric and subtrochanteric fractures who met our inclusion criteria were selected. Basic blood investigations were obtained, X-rays of involved hip with thigh taken. Fractures were classified by Seinsheimers, and Boyd and Griffin Classification.Open reduction is done only when not able to achieve closed reduction. Both short and long proximal femur nail were used depending upon the needs. Patients were treated operatively and evaluated with modified Harris Hip Score. Results: In our study, mean age of the patient was 55.18 yrs, 16 cases were of type 2 fractures, 4 cases were type 3 A fracture. As assessed by modified Harris hip score, excellent to fair results were obtained at 12 months follow up in 16 cases, 4 cases had poor results. Two patient s had superficial infection; one had deep infection that was treated with i.v. antibiotics. 6 patients had limb shortening of 2 cms, varus malunion seen in one patient with Z-effect. CONCLUSION: Proximal femur nail has widened the indication of intramedullary nailing for more complex fractures of the proximal femur. By doing closed reduction, it offers minimal soft tissue damage, preserves the fracture hematoma, decreased blood loss and reduces the operating time.

Introduction:Melorheostosis are rare and have only been occasionally reported. We herein report a case of Melorheostosis affecting left femur and tibia which was diagnosed based on clinical and radiological features and managed with bisphosphonates.Case Presentation Report:A 30 years old woman presented with left leg pain with mild swelling and limitation of knee movement. Initially patient presented with pain in left hip, knee and stiffness of left lower limb with difficulty in moving since 4 years. Pain was insidious in onset, progressive in nature, aggravated on daily routine activities, relieved with analgesics. Clinically, the main symptom is local pain aggravated by mobilization of the affected limb. On physical examination, the patient had minimal swelling with tenderness over the affected limb, with increased local temperature and mild hyperpigmentation. All the joints of the affected segments showed decreased range of motion compared with the healthy limb. No neurological deficit was noted. No other deformity was seen. Radiography x-ray of left proximal femur and middle third tibia shows sclerotic lesion with no cortical breach and periosteal reaction (fig.1,2) and MRI of left femur and tibia shows hypointense lesion (fig.3-7).Conclusion :Melorheostosis is an uncommon cause of a common symptom, it is a rare condition. Positive clinical and imaging features helped us to arrive at the diagnosis. Proper work up would help in early diagnosis and management. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients.

Objective: to assess the health status and its relationship with changes in environmental and socio-economic factors in preschool-age children. Methods: A cross-sectional, observational study was conducted in children between 5 - 8 years, attending municipal preschool institutions. Data regarding parents` education, family income, two/single-parent family, the level of the child physical activity, indoor air pollution were collected using a parent survey. Clinical data were collected through the routine examine. Overall 2,097 preschool children were examined from 2001 to 2011. Statistical analysis: Comparison of proportions; Student’s t-test; two-way ANOVA. Results: Over the study period 2001-2011 the proportion of children exposed second-hand smoking fell by 42%; the proportion of families drinking unfiltered tap water reduced by 29%. At the same time, the number of cars in Ekaterinburg over the period under study more than doubled, resulting in increasing outdoor air pollution. The prevalence of the common pathologies rose in 2.2 – 4.6 times over the period of interest. In 2001 a statistically significant relationship was observed between air pollution and the spread of respiratory diseases: an additional risk of 11.4%; relative risk 1.38 (1.02-1.87), P = 0.049. In 2011 no statistically significant association was found between atmospheric air pollution and the prevalence of respiratory diseases because of sharply increasing of air pollution in all areas of the city and the social and family factors influence. Conclusion: Air pollution, insufficient mother education, second-hand smoking, gas stove using, insufficient child physical activity, low income were associated with higher prevalence of the leading pathologies.