Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

Background: The prevalence of both OSA and metabolic syndrome is increasing worldwide, in part linked to the epidemic of obesity. Beyond their epidemiologic relationship, growing evidence suggests that OSA may be causally related to metabolic syndrome. We are only beginning to understand the potential mechanisms underlying the OSA-metabolic syndrome interaction. Objectives were to study the clinical prevalence of obstructive sleep apnoea in metabolic syndrome; and to find risk factors associated with obstructive sleep apnoea (OSA).Methods: 50 patients attending various OPDs of a tertiary care research and referral hospital and found to have metabolic syndrome on the basis of NCEP criteria were selected. These patients were subjected to overnight polysomnography. Parameters such as apnea-hypopnoea index (AHI), respiratory efforts related arousals (RERA), minimum SpO2, pulse rate, blood pressure, and ECG were monitored throughout the study.Results: Central obesity was found in 34 patients, xanthelasmas in 12 patients and xanthomas in 08 patients. Pitting type of pedal oedema was noted in 14 patients. Epworth sleepiness score (ESS) was calculated in all the patients by interviewing them before the polysomnography. Most of the patients have ESS Score more than 11.03 out of 50 patients were found to have AHI<5.20 patients were found to have moderate AHI (AHI 15-30) whereas 22 were found to have severe AHI.Conclusions: Polysomnography provides a valuable tool to access non symptomatic sleep disordered breathing at an early stage in patients with metabolic syndrome.

Bronchopleural fistula (BPF) is a well known complication of several pulmonary conditions posing challenging management problem and is often associated with high morbidity and mortality. Though no consensus exists on a definite closure management algorithm, strategies for closure widely include various methods like tube thoracostomy with suction, open surgical closure, bronchoscopy directed glue, coiling and sealants which now also includes use of occlusion devices. We report a case in which a novel method of delivery and closure of recurrent post-operative broncho-pleuro-cutaneous fistula by a duct occluder device was done transcutaneously which has not been previously described in literature.

Chronic persistent bronchopleural fistulae (BPF) are challenging management problems. The management of BPF includes various surgical and medical procedures and of great value is the use of bronchoscopy and different devices. In high-risk surgical patients, bronchoscopic procedures serve as a temporary bridge until the patient's clinical condition improves, whereas in other patients bronchoscopic procedures may be the only option. We present a case of postoperative chronic BPF closed by a less invasive interventional bronchoscopic procedure using an atrial septal occluder device.

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Chylothorax is one of the presenting features in many disorders including malignancy. Thorough investigation is often required for establishing the etiology of chylothorax. Unfortunately, despite appropriate work-up etiology of pleural effusion cannot be established. We report a case of chylothorax associated with multiple lytic bony lesions, finally diagnosed as a case of Gorham-Stout disease.

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