Phase II trial of piroxantrone in patients with recurrent and metastatic squamous cell carcinoma of the head and neck

Summary Twenty-two patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with piroxantrone 150 mg/m² intravenously every 21 days. There were no objective responses. The 95% upper confidence bound for response is 15%. Primary toxicity was hematologic.     

Risedronate Reduces the Risk of First Vertebral Fracture in Osteoporotic Women

Risedronate treatment reduces the risk of vertebral fracture in women with existing vertebral fractures, but its efficacy in prevention of the first vertebral fracture in women with osteoporosis but without vertebral fractures has not been determined. We examined the risk of first vertebral fracture in postmenopausal women who were enrolled in four placebo-controlled clinical trials of risedronate and who had low lumbar spine bone mineral density (BMD) (mean T-score =–3.3) and no vertebral fractures at baseline. Subjects received risedronate 5 mg (n= 328) or placebo (n= 312) daily for up to 3 years; all subjects were given calcium (1000 mg daily), as well as vitamin D supplementation (up to 500 IU daily) if baseline serum 25-hydroxyvitamin D levels were low. The incidence of first vertebral fracture was 9.4% in the women treated with placebo and 2.6% in those treated with risedronate 5 mg (risk reduction of 75%, 95% confidence interval 37% to 90%; P= 0.002). The number of patients who would need to be treated to prevent one new vertebral fracture is 15. When subjects were stratified by age, similar significant reductions were observed in patients with a mean age of 64 years (risk reduction of 70%, 95% CI 8% to 90%; P= 0.030) and in those with a mean age of 76 years (risk reduction of 80%, 95% CI 7% to 96%; P= 0.024). Risedronate treatment therefore significantly reduces the risk of first vertebral fracture in postmenopausal women with osteoporosis, with a similar magnitude of effect early and late after the menopause. Received: 12 September 2001 / Accepted: 11 December 2001     

Fit and fill analysis of a newly designed femoral stem in cementless total hip arthroplasty for patients with secondary osteoarthritis

The fit and fill of the femoral canal are critical to the success of cementless femoral stems in total hip arthroplasty. It is difficult for conventional stems to provide a good fit and fill for the femora of patients with secondary osteoarthritis. Based on measurements of 100 femora of these patients, we designed two types of Fukui Medical School (FMS) stems with a proximal lateral flare that differed in the medial radius. We compared the fit and fill of the FMS stems with those of four conventional stems, using computer simulation. The mean proximal fit and total fit of the FMS stems were 46% and 53% respectively, a significant improvement compared with the other stems examined. The mean fill of FMS stems was 82% at the lower end of the lesser trochanter and 84% at the upper end of the isthmus, values that were significantly higher than those of the other stems. Since September 1995, we have implanted FMS stems in 15 hips with secondary osteoarthritis. Radiographic evaluations showed that the canal fill of the FMS stems was significantly greater in the proximal femur compared with other stems previously inserted at our department. A summary of this paper was presented at the 9th Symposium on Computer-Assisted Radiology; June 1995, Berlin, and at the 8th International Symposium on Technology in Arthroplasty; September 1995, Puerto Rico.     

The nature of the head and neck cancer

Summary Squamous cell carcinoma of the head and neck is a disease predominantly of males and is due to a variety of known environmental irritants, notably cigarette smoke. Dietary, viral and immunological factors may also be relevant. Head and neck squamous cancers express epidermal growth factor receptors and some show weak levels of oestrogen receptor activity, but a reliable serum marker of tumour burden remains to be identified. The prognosis is found to be less favourable in females, in those with advanced T stage, in association with multiple node involvement, especially where extracapsular spread is present and where the T4/T8 ratio is elevated. Administration of heterologous blood during therapy may also have an adverse effect on prognosis. Interested clinicians must remember that most cases are preventable. Correspondence to: A.G.D. Maran     

肱骨近端移位骨折的手术治疗

目的：总结肱骨近端移位骨折的手术治疗方法和疗效。方法：分析手术治疗肱骨近端骨折28例资料。患者平均年龄24．4岁，平均随访2年6个月；手术均采用三角肌胸大肌间隙入路，钢板固定15例，交叉克氏针固定11例，单纯螺丝钉固定15例；采用Neer分类及评分方法评价手术结果。结果：两部分外科颈骨折优良率为64．7％，无头坏死及不愈合，三部分骨折和四部分骨折切开复位的满意率较低。结论：两部分骨折和三部分骨折可采用切开复位内固定，但尽量避免使用钢板；对四部分骨折，内固定满意率较低且肱骨头坏死率较高。     

The healing of femoral neck fractures in dogs

Summary This study evaluates healing fractures of the femoral neck in dogs by using standard radiography, intraosseous venography, India ink staining and histology.The 45 animals were divided into three groups, one of which was not treated, but in the other two the fracture was fixed with a screw or two Kirschner wires.Our results suggest that, when intraosseous venography was positive, India ink injection was also positive, and the late phase of fracture healing was reached.

---

Résumé Etude de la consolidation des fractures du col fémoral chez le chien à l'aide des radiographies standard, de la phlébographie osseuse, de la coloration par l'encre de Chine et de l'examen anatomopathologique. Les animaux ont été divisés en trois groupes, dans l'un la fracture n'a pas été traitée, dans les deux autres elle a été fixée soit par une vis, soit par deux broches de Kirschner. Les résultats tendent à montrer que lorsque la phlébographie est positive, la coloration par l'encre de Chine l'est également et que la phase ultime de la consolidation est atteinte.

     

锁骨钩钢板内固定配合康复治疗锁骨远端骨折

目的探讨和分析应用锁骨钩钢板内固定配合康复治疗锁骨远端骨折的新方法。方法42例应用锁骨钩钢板配合术后早期康复治疗锁骨远端骨折的患者全部得到了随访,随访时间2～46个月(平均15.6个月),患者年龄36～57岁,平均45.6岁。术后2d患肩按照制定的康复训练方法进行功能训练,最终随访按Lazzcano评价标准〔1〕评价治疗结果。结果42例患者术后X线检查均达到满意复位与固定,局部Lazzcano功能评定关节功能恢复优良率97.6%。结论应用锁骨钩钢板治疗锁骨远端骨折手术操作简单,配合术后完善的康复治疗,可得到非常满意的结果。     

快速有效的治疗落枕新法

落枕是一种冬春季常见病,虽然治疗的方法很多，但往往收不到快速、有效和彻底的效果,本文以个案经验和病例调查为基础，提供一种快速有效的自我治疗方法，并期望能够得到广大患者的进一步验证。     

Results of non-operative treatment following hip fracture compared to surgical intervention

We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically.     

头颈部良性神经源性肿瘤1H MRS的表现特点

目的：探讨头颈部良性神经源性肿瘤在单体素^1H MRS上的表现特点。材料和方法：共收集经单体素。HMRS检查，并经手术病理证实的头颈部神经源性肿瘤14例（神经鞘瘤11例，神经纤维瘤2例，颈动脉体瘤1例）。采用点分析波谱法（PRESS：TE=144ms，14例）和激励回波法（STEAM：TE=30ms，11例）进行。HMRS空间定位，以胆碱和脂质代谢物为标准评价所有肿瘤。波谱图上，胆碱和脂质分别在3．2ppm和0．9—1．4ppm区域识别。结果：采用PRESS后，14例神经源性肿瘤中检测出胆碱代谢物者11例，检出脂质代谢物者6例。胆碱和脂质代谢物同时检出者5例，仅检出胆碱者6例，仅检出脂质者1例，胆碱和脂质均未检出者2例。采用STEAM后，11例肿瘤中检出胆碱代谢物和脂质者分别为3例和8例。结论：头颈部良性神经源性肿瘤的单体素。HMRS表现具有多样性，多数肿瘤以长TEPRESS上胆碱峰的显示为特点，长TEPRESS能较STEAM更好地检出良性神经源性肿瘤内的胆碱代谢物。