Comparison of anesthetic effects of epidural and intravenous administration of buprenorphine during operation

Thirty six patients were received epidural anesthesia with or without buprenorphine (BPN) during upper abdominal surgery. They were divided into three groups of 12 patients as follows; G-I received 20ml of 1% lidocaine epidurally, G-II received 20ml of 1% lidocaine epidurally and 0.6mg BPN intravenously, G-III received 20ml of 1% lidocaine with 0.6mg BPN epidurally. Additional 5ml of 1% lidocaine was given to any patient if systolic blood pressure or heart rate increased 10% compared to control value. Trachea was intubated following anesthetic induction with thiopental. The lungs were ventilated with a mixture of N₂O/O₂ (33%) and pancuronium was used for muscle relaxation. The total required doses of lidocaine in G-II and G-III were decreased 60% compared to control group (G-I) (P 0.05). The mean period of time until the first administration of pentazocine for postoperative pain was 13 ± 10hr (mean ± SD) in G-II and 19 ± 24hr in G-III compared to 5 ± 4hr in G-I (P 0.001). The dose of the administration of pentazocine that was required for pain relief during the first 48 postoperative hr in G-III was 54 ± 10mg (mean ± SD) compared to 150 ± 21mg in G-I (P 0.02) and 106 ± 28mg in G-II (P 0.05). Recovery from anesthesia in G-III was more rapid than that in G-I (P 0.05). The Pa_{CO 2} values in G-II and G-III increased 15% compared to control group at about 4hr and 8hr after administration of BPN, but any clinical treatment was not needed for them. Nonrespiratory side effects, e.g., nausea, vomiting, fatigue and headache, were comparably common in all groups. Mild hematuria associated with acute hypotension occurred in two patients in G-II (17%) immediately after the intravenous injection of 0.6mg of BPN. The results showed that 0.6mg of BPN given epidurally demonstrated better anesthetic and more potent postoperative analgesic effects and lesser side effects than 0.6mg of BPN given intravenously in patients undergoing upper abdominal surgery.(Yonemura E, Fukushima K.: Comparison of anesthetic effects of epidural and intravenous administration of buprenorphine during operation. J Anesth 4: 242–248, 1990)     

Suppression of proliferative cholangitis in a rat model by local delivery of paclitaxel

Background. Proliferative cholangitis (PC) leads to biliary stricture, which is the main cause of hepatolithiasis, recurrent cholangitis, and biliary cirrhosis. The aim of this study was to determine whether local delivery of paclitaxel, which inhibits cell proliferation by overstabilization of microtubules, prevents PC in a rat model.Methods. PC was induced by introducing a fine nylon thread into the bile duct in a rat. Paclitaxel (100µl of 10, 100, and 1000µmol/l) or solvent vehicle was administered into the bile duct for 15min. One week after treatment, histopathologic examination and 5-bromodeoxyuridine (BrdU) labeling of the bile duct were performed.Results. In comparison with the control, the mean thickness of the bile duct was reduced by 29% in the 1000µmol/l paclitaxel-treated group (2.61 ± 0.31µm vs 3.67 ± 0.25µm, P 0.05). The luminal area increased (P 0.0001) and the grade of epithelial–glandular proliferation was decreased (P 0.01) as the dose of paclitaxel increased. Ductal fibrosis and inflammatory cell infiltration were similar in both groups. The BrdU labeling index was significantly lower in the paclitaxel-treated group (P 0.05).Conclusions. Local delivery of paclitaxel suppressed PC in a rat model by the inhibition of epithelial–glandular proliferation and may offer an effective therapeutic option for biliary stricture.     

Changes in erythrocyte membrane fluidity by endotoxin in rats

The effect of endotoxin on fluidity and lipid composition of the erythrocyte membrane was studied in rats following the intraperitoneal administration of endotoxin (30mg·kg^–1 body weight). Erythrocyte membrane fluidity measured with 16-stearic acid spin label (16-SAL) was significantly decreased in the endotoxin-treated rats as compared with control. A decrease of lysophosphatidylcholine in the membrane lipid was evident in the endotoxin-treated rats. The cholesterol to phospholipid molar ratios and other phospholipid fractions did not differ significantly in the two groups.The levels of plasma -glucuronidase activity and lipoperoxide were significantly increased in the endotoxin-treated rats when compared to controls. There were significant correlations between the parameter of 16-SAL in erythrocytes and plasma -glucuronidase activities or lipoperoxide from both endotoxin-treated and control groups, P 0.005 or P 0.02 respectively.In conclusion endotoxin decreased rat erythrocyte membrane fluidity in vivo. Since membrane fluidity is closely related to the vital functions of the membranes, the change described could be related to the abnormality of cell membrane functions in endotoxin shock state.(Kadota Y, Kamada T, Yoshimura N, et al.: changes in erythrocyte membrane fluidity by endotoxin in rats. J Anesth 6: 145–152, 1992)     

68. Keramik-Traizrippen-Prothesen ohne Zement

Zusammenfassung Zur Vermeidung aseptischer Prothesenlockerung infolge Zementbruches wurde die zementfrei implantierbare Tragrippen-Endoprothese mit dem biomechanischen Verankerungsprinzip der Oberflächenvergrößerung und damit Druckreduzierung entwickelt. Darlegung der Technologie, der verwendeten Aluminiumoxydkeramik Biolox und der neuen Metallegierung Endocast. Hinweis auf die tierexperimentelle Prüfung und Operationstechnik sowie 4 1/2 jährige klinische Erfahrung mit Ergebnisstatistik. Eignung insbesondere für jüngere Patienten.     

Elevation of the extracellular glutamate concentration in the hippocampus after total cerebral ischemia related to the deterioration of the recovery in EEG and evoked potentials in dogs

The concentrations of extracellular glutamate (Glu), aspartate (Asp) and glycine (Gly) were measured by microdialysis method in the cortex and hippocampus before, during and after 15min of total cerebral ischemia in dogs. The correlations between the concentrations of amino acids and the changes in EEG and evoked potentials (EP) after ischemia were evaluated. Total cerebral ischemia was achieved by occluding the ascending aorta and the caval veins. The concentrations of Glu in the hippocampus significantly increased from 1.73 ± 0.59 (mean ± SEM) nmol·ml^–1 at pre-ischemia to 5.46 ± 1.34 (P 0.05) during ischemia and 14.37 ± 3.70 (P 0.01) 0–15min after ischemia, and returned to the pre-ischemic level 30min after ischemia. The concentration of hippocampal Glu 0–15min after ischemia had significant negative correlations with the EEG-EP scores (0 = serious deterioration of electrical function and 6 = normal electrical function) 30min, 3hr and 5hr after ischemia (r = –0.69, P 0.05:r = –0.67, P 0.05:r = –0.70, P 0.05, respectively). The increase of the extracellular Glu concentration in the hippocampus immediately after ischemia may aggravate the neurological outcome after total cerebral ischemia.(Ono K, Iwatsuki N, Tajima T, et al.: Elevation of the extracellular glutamate concentration in the hippocampus after total cerebral ischemia related to the deterioration of the recovery in EEG and evoked potentials in dogs. J Anesth 7: 334–340, 1993)     

Standardization of Ischemic Hepatic Failure in Pigs as a Model for Bioartificial Liver Assessment

Purpose. A standard protocol of ischemic liver failure in pigs was examined to establish a system for assessing the efficacy of a bioartificial liver, based on clinical practice. Methods. The portal blood flow was extracorporeally bypassed into the cervical jugular vein, using a centrifugal blood pump. The portal vein and hepatic artery were then ligated. Results. The maintenance protocol was established as follows: (1) the concentration of the inhaled anesthetic was decreased by 0.2% when the systolic blood pressure was 100mmHg; (2) the volume of an infusion containing 5% glucose was increased to 10ml/kg per hour when central venous pressure was 5mmHg; (3) 20ml of 50% glucose was injected intravenously when the blood glucose was 50mg/dl; (4) 2000 units of heparin was injected intravenously when the activated clotting time was 150s; (5) sodium bicarbonate was given when the blood pH was 7.3; (6) tidal volume was increased by 1ml/kg when the pCO₂ was 80mmHg; (7) oxygen was increased by 25% when the pO₂ was 100mmHg. No vasopressors were used in the experiment. Conclusion. Our protocol reduced the operating time and minimized the risk of data deviation that can arise from variations in operating techniques and individual animal conditions. This experimental model is also easy to use as a bridge to transplantation.     

Effect of Nifedipine on the Healing of Left Colonic Anastomoses in Rats

Purpose Ca²⁺ channel blockers inhibit collagenase production and have a vasodilatatory effect. They also restrict the formation of ischemia-reperfusion induced free oxygen radicals. The aim of this study was to assess the effect of nifedipine on the healing of colonic anastomoses in a rat model.Methods Sixty Wistar rats weighing 240–290g were divided into four groups of 15 rats each: a 3rd day control group (group A), a 3rd day treatment group (group B), a 7th day control group (group C), and a 7th day treatment group (group D). The treatment groups were given Nifedipine 3mg/kg per day orally as three divided doses.Results The bursting pressure values of the anastomoses in the treatment groups were significantly higher than those in the control groups (P 0.05). The hydroxyproline content was also significantly higher in the treatment groups than in the control groups (P 0.05). Histologic examination confirmed that nifedipine treatment significantly increased collagen deposition and fibroblast ingrowth compared with controls (P 0.05).Conclusions These results clearly showed that nifedipine enhanced the stability of colonic anastomoses during the first postoperative week.     

Airway occlusion pressure (P0.1) — A useful predictor for the weaning outcome in patients with acute respiratory failure —

Twenty-five patients who required mechanical ventilatory support (MVS) after major surgery or severe burns were studied to determine whether airway occlusion pressure (P_0.1) is a clinically useful indicator to predict the success or failure of the weaning trial. A total of 33 weaning trials were attempted on these patients. Of the 33 trials, 24 were followed by successful weaning and 9 by failure. Although the success group, when compared with the failure group, had a lower respiratory rate (P 0.001), a lower minute ventilation (P 0.001), a higher maximal voluntary ventilation to minute ventilation ratio (P 0.01) and a higher forced vital capacity (P 0.05), no threshold values separated the success from the failure group. The alveolar-arterial P_{O 2} gradient, with an Fi _{O 2} of 1.0, in weaning success and failure showed no statistical difference. In contrast, all patients in the success group had a P_0.1 of less than 3.5cmH₂O and those in the failure group had a P_0.1 of greater than 3.5cmH₂O (P 0.001). We conclude that P_0.1 is a clinically superior indicator for discontinuing MVS in patients with acute respiratory failure.(Okamoto K, Sato T, Morioka T: Airway occlusion pressure (P_0.1)—A useful predictor for the weaning outcome in patients with acute respiratory failure—. J Anesth 4: 95–101, 1990)     

Sustained effects of plasma norepinephrine levels on femoral-radial pressure gradient after cardiopulmonary bypass

In order to determine the influence of the sympathetic nervous system upon the femoral-radial artery pressure gradient after cardiopulmonary bypass (CPB), we examined plasma norepinephrine levels in 34 adult male patients undergoing coronary artery bypass grafting. Cardiovascular parameters, including systolic arterial pressure, mean arterial pressure, cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), hemoglobin (Hb) and peak dP/dt of radial and femoral artery pressures were measured after sternotomy, and immediately after the discontinuation of CPB and 90min after CPB. Plasma norepinephrine levels were measured after sternotomy, after aortic declamping and 90min after CPB.The patients were divided into two groups. Group A consisted of 17 patients whose femoral minus radial systolic pressure difference was 15mmHg or more at 90min after CPB, while Group B consisted of 17 patients with the difference less than 15mmHg. Group A patients had significantly longer time values in the duration of both CPB (Group A 175 ± 10min; Group B 115 ± 12min, P 0.001) and aortic cross clamping (Group A 116 ± 7min, Group B 71 ± 9min, P 0.001).Although there was no significant difference in Hb or PAP of 90min after CPB in Groups A and B, the following values, listed in the order of A to B, were obtained; CI, 2.79 ± 0.10 versus 3.46 ± 0.16l·min^–1·m^–2 (P 0.01); mean radial artery pressure (MRP), 58.7 ± 2.4 versus 65.1 ± 1.8mmHg (P 0.05); peak dP/dt of radial artery pressure, 568 ± 64 versus 1026 ± 61mmHg·sec^–1 (P 0.001); and plasma norepinephrine concentration, 1.81 ± 0.25 versus 0.98 ± 0.10ng·ml^–1 (P 0.01), which were statistically significant.The higher femoral-radial artery pressure gradient after CPB was observed in patients with both a longer CPB time and a higher plasma norepinephrine concentration. These results suggest that a marked constriction of peripheral arteries might have produced a damped transmission of the pressure pulse to the radial artery.(Nakayama R, Goto T, Kukita I, et al.: Sustained effects of plasma norepinephrine levels on femoral-radial pressure gradient after cardiopulmonary bypass. J Anesth 7: 8–15, 1993)     

Positive inotropic and chronotropic effects of pancuronium and vecuronium in the canine blood-pefused papillary muscle and sinoatrial node preparations

The positive inotropic and chronotropic potencies of pancuronium (Pc) and vecuronium (Vc) were compared with developed tension of the isolated papillary muscle (DT) and sinoatrial rate of the sinoatrial node preparation (SAR). Both Pc and Vc caused dose-dependent positive inotropic and chronotropic effects. Pc showed much more potent effect than Vc on DT (0.1, 0.3mg; P 0.05) or SAR (0.03, 0.1, 0.3mg; P 0.05). DT and SAR were increased by Pc and Vc, and the increase in DT was inhibited by propranolol or tetrodotoxin. These results suggest that the cardiac effects of Pc or Vc may be mediated by release of norepinephrine from the synpathetic nerve endings.(Manabe M, Motomura S, Kumazawa T et al.: Positive inotropic and chronotropic effects of pancuronium and vecronium in the canine blood-pefused papillary muscle and sinoatrial node preparations. J Anesth 2: 202–206, 1988)     

Retrospective study of post-anesthetic mild liver disorder associated with inhalation anesthetics,halothane and enflurane

The incidence of post-anesthetic mild liver disorder (PAMLD) was compared between 928 patients administered halothane and 1766 patients administered enflurane. They were selected from 19504 surgical patients administered general anesthesia at Kyushu University Hospital over the past 6 years and 4 months. They had had normal liver function before operation and had no history of blood transfusion. Alanine aminotransferase (ALT) levels exceeding 70IU·l ^–1 within 180 days after operation were found in 226 patients in the halothane group (24.4%), and in 250 patients in the enflurane group (14.2%) (P 0.01). Both maximum ALT levels and duration of ALT elevation were higher and longer in the halothane group (P 0.01). These results suggest that, not only in the development of fulminant hepatitis but also in PAMLD, enflurane is less hepatotoxic than halothane.(Sakaguchi Y, Inaba S, Umeki Y, et al.: Retrospective study of post-anesthetic mild liver disorder associated with inhalation anesthetics, halothane and enflurane. J Anesth 6: 183–191, 1992)     

Insulin-like growth factor-I increases p21 expression and attenuates cisplatin-induced acute renal injury in rats

Background Exogenous insulin-like growth factor-I (IGF-I) promotes recovery from ischemic renal injury, but its effect on cisplatin (CDDP)-induced nephrotoxicity and its mechanisms for the attenuation of renal injury are unknown.Methods We administered recombinant human IGF-I (rhIGF-I, 150µg/day, i.p.) once a day 24h prior to and after CDDP (5mg/kg, i.v.) injection in rats.Results The rhIGF-I treatment significantly decreased serum creatinine (0.92 ± 0.11 vs 1.50 ± 0.15mg/dl; P 0.05), the tubular damage score, and the ratio of apoptotic cells to tubular epithelial cells in the outer stripe of the outer medulla on day 5 (P 0.05). rhIGF-I significantly increased the numbers of p21-positive nuclei (5.15 ± 0.19 vs 3.45 ± 0.42/×400 high-power field (HPF); P 0.05) and proliferating cell nuclear antigen (PCNA)-positive nuclei (28.61 ± 1.89 vs 18.26 ± 2.14/×400 HPF; P 0.05), but decreased the number of cyclin D1-positive cells (3.3 ± 0.3 vs 6.3 ± 1.7/×400 HPF; P 0.05) on day 3. rhIGF-I did not alter 5-bromo-3-deoxyuridine (BrdU) incorporation.Conclusions Our findings suggested that rhIGF-I increased renal p21 and PCNA expression, but reduced cyclin D1 expression in CDDP-treated kidneys. Exogenous rhIGF-I may ameliorate renal damage, in part by stopping the cell cycle at G1/S phase.     

Prostaglandin E1 reduces blood loss during and after resection of lumbar herniated disc

Controlled hypotension was employed during resection of lumbar herniated disc on 10 patients. Prostaglandin E₁ (PG) was used as a hypotensive agent. The systolic blood pressure was lowered less than 100mmHg in the hypotensive group. The average blood loss during surgery was 95 ± 41ml for the hypotensive group compared with 154 ± 81ml for the normotensive group (P 0.05). The blood loss after surgery was also significantly less in the hypotensive group than in the normotensive group (P 0.05). We conclude that PG is an effective hypotensive agent on blood loss during and after surgery.(Kashimoto S, Nakamura T, Yamaguchi T: Prostaglandin E₁ reduces blood loss during and after resection of lumbar herniated disc. J Anesth 6: 294–296, 1992)     

Efficacy of thoracic sympathetic ganglion block and prediction of complications: Clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients

In the 10 years from 1980 to 1989, a total of 234 patients underwent 557 thoracic sympathetic ganglion blocks. The block was performed by the anterior paratracheal approach in 129 cases and by the posterior paravertebral approach in 428 cases. The procedures for using these two approaches are presented here. The efficacy of thoracic sympathetic ganglion blockade was evaluated as follows; marked efficacy was defined by the complete control of sweating in the palms, moderate efficacy was defined by a decrease in palmar sweating which persisted for at least one week, and minor efficacy was defined by a decrease in sweating followed by recurrence of hyperhidrosis within one week with maintenance of palmar warmth. in addition, the results were retrospectively reviewed in relation to the age and sex of the patients, the technique used, the laterality of the block, the disease treated, the doses of local anesthetic and neurolytic agents, and the number of blocks. The posterior approach was significantly more successful than the anterior approach, and the treatment of both T2 and T3 by the posterior approach was significantly more effective than the treatment of either nerve alone by the same approach (P 0.01). The efficacy rate was significantly lower for hyperhidrosis than for the other diseaces (P 0.01). Complete cessation of hyperhidrosis was significantly less common in the over-60 age group (P 0.01). Regarding the dose of neurolytic, the complete cessation of hyperhidrosis was achieved significantly more frequently with doses of 2.5ml or higher than with lower doses (P 0.01) when both T2 and T3 wee treated by the posterior approach. A dose-dependent response if hyperhidrosis was noted at dose levels higher than 2.5ml. Thoracic sympathetic ganglion blockade was only occasionally associatid with complications, and no serious complications were observed. Before injecting the neurolytic agent, a mixture of contrast medium and local anesthetic was injected to determine the three-dimensional distribution of the contrast and to assess the scope of the analgesia produced by the local anesthetic. Significant complications could thus be avoided.(Ohseto K: Efficacy of thoracic sympathetic ganglion block and prediction of complications: Clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients. J Anesth 6: 316–331, 1992)     

Comparison of early postoperative quality of life in minimally invasive versus conventional valve surgery

Purpose.Minimally invasive cardiac surgery (MICS), an approach in which full sternotomy is avoided and the surgical incision is minimal, has been shown to produce less postoperative discomfort and to enable earlier mobilization and discharge than conventional cardiac surgery (CCS). This study was performed to retrospectively evaluate quality of life following MICS in comparison with CCS valve surgery.Methods.Sixty-six patients scheduled for MICS and 50 patients scheduled for CCS for isolated aortic or mitral valve surgery from January 1999 to June 2001 were enrolled in the study. The clinical records for the two groups were compared across intraoperative parameters and those associated with postoperative quality of life.Results.The aortic clamp and cardiopulmonary bypass times in the MICS group were longer than those in the CCS group (144 ± 42 and 224 ± 58min vs 112 ± 21 and 179 ± 27min, P 0.001). Postoperative pain medication (rectal buprenorphine and intramuscular pethidine) was administered to 18 of the 66 MICS patients (27%), as compared with 26 of the 50 CCS patients (52%, P = 0.007). Postoperative delirium was less frequent in the MICS group than the CCS group (26% vs 44%, P = 0.039). Initial postoperative food intake and urine catheter removal were possible earlier in the MICS than in the CCS group. MICS patients had shorter stays in the intensive care unit than CCS patients (37.4 ± 7.3 vs 45.9 ± 8.7h, P 0.001).Conclusion.Although longer aortic clamp and cardiopulmonary bypass times remain a problem in MICS procedures, our results suggest that MICS, as compared with CCS, facilitates earlier recovery of daily activities and provides improved quality of life in the early postoperative period.     

Hemodynamic and oxygen delivery-consumption changes during partial liver resection

The effects of partial liver resection on hemodynamics and the oxygen delivery-consumption relationship were evaluated in ten patients with hepatocellular carcinoma. The cardiac index and oxygen delivery were increased significantly (P 0.05) at 30 minutes after incision, 30min after liver resection and in the recovery room. Oxygen delivery decreased significantly (P 0.05) during liver resection. Oxygen consumption remained low throughout the procedure. We did not discover any flow-dependent change in oxygen consumption. Although our patients persisted a hyperdynamic state throughout surgery, their arterial ketone body ratio remained low. Therefore, it may be necessary to maintain a hyperdynamic state during partial liver resection in order to increase hepatic blood flow.(Iwasaka H, Kitano T, Mizutani A, et al.: Hemodynamic and oxygen delivery-consumption changes during partial liver resection. J Anesth 7: 145–150, 1993)     

116. Neue Anus praeter-Verfahren: Magnetverschluß

Zusammenfassung Seit Mai 1976 wurden 85 Magnetringe bei 81 Patienten implantiert. In 16 Fällen kam es zur Infektion, darunter 5 Spätinfektionen. 24 von 51 befragten Patienten tragen den Magnetdeckel regelmäßig. Größtes Problem ist eine fehlende Dichtigkeit (39 %). Die Ergebnisse ließen sich mit einem Deckel mit beweglichem Mittelstöpsel verbessern. Auf die Frage, ob das Magnetsystem die Colostomiepflege erleichtert, antworteten 37 % der Kranken mit ja, 22 % mit gering und 41 % mit nein. 56 % würden sich erneut einen Magnetring implantieren lassen.     

Antagonizing potencies of saturated and unsaturated long-chain free fatty acids to isoflurane in goldfish

Purpose We have previously reported that myristate, a saturated free fatty acid (FFA) with 14 carbons (C14), antagonizes volatile anesthetics in goldfish. The hydrophobicity and molecular configuration of FFAs may play an important role in the antagonizing effect. To examine their contribution, we investigated the antagonizing potencies of saturated and unsaturated long-chain FFAs in goldfish.Methods Saturated and monounsaturated FFAs of C14–18 were tested. We determined the anesthetic concentration producing a 50% effect (EC₅₀) of isoflurane in the absence or presence of FFA by observing the escape reaction of goldfish against an electrical stimulus.Results All FFAs increased the EC₅₀ of isoflurane dose-dependently compared with reactions in the absence of FFA (P 0.05). For saturated FFAs, the relationship between chain lengths and antagonizing potencies was not linear. C18 was the most effective and C16 was the least effective antagonist (P 0.05). Among unsaturated FFAs, C14 was the most effective antagonist (P 0.05). In a comparison of saturated and unsaturated FFAs, saturated C14 and C18 were more effective antagonists than unsaturated FFAs of the same carbon numbers (P 0.05).Conclusion The hydrophobicity of FFAs increases as the chain length increases. Therefore, our findings suggest that the antagonizing effect of long-chain FFAs in goldfish, in terms of their capacity to perturb the lipid membrane structure, may be determined not solely by their hydrophobicity but also by their molecular configuration.     

pQCT bone strength index may serve as a better predictor than bone mineral density for long bone breaking strength

Bone mineral density (BMD) is commonly used to predict osteoporotic fracture risk without considering the geometry of the bone. However, geometric parameters are also important in determination of bone strength. An index including both material and geometric properties may be therefore more relevant in prediction of fracture risk. We studied the correlation between parameters measured by noninvasive peripheral quantitative computed tomography (pQCT) and bone bending strength of the diaphysis of 45 fresh goat humeri and 27 femora. Multislice pQCT was used for measuring volumetric diaphyseal cortical BMD, total BMD, diaphyseal and cortical cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) and their derived bone strength indices (BSIs), including BSI_CSMI (cortical BMD × CSMI) and BSI_CSA (cortical BMD × cortical CSA). Conventional dual-energy absorptiometry (DXA) was also conducted to measure areal BMD of diaphysis for comparison. Ultimate fracture load was obtained via three-point bending test. Results showed that for femora, fracture load was correlated better with BSI_CSA (r = 0.697, P 0.001) than cortical BMD (r = 0.304, P 0.05) and total BMD (r = 0.387, P 0.05) measured using pQCT and areal BMD (r = 0.612, P 0.001) measured using DXA. For humeri, fracture load was also correlated with BSI_CSA (r = 0.579, P 0.001) but not with other pQCT parameters including cortical BMD and total BMD (r = 0.282 and 0.305, respectively; P 0.05, both). The best correlation was found with areal BMD measured by DXA (r = 0.760, P 0.001). In conclusion, pQCT noninvasive BSI_CSA derived from cortical BMD (material) and its cortical CSA (bone geometry or distribution) may serve as an important noninvasive index for predicting long bone bending strength. The bending strength was also predicted by bone mass (areal BMD) measured by DXA, an integration of bone mineral and geometry. Further clinical studies are needed to validate the predictive value of BSI in long bone osteoporotic fracture.     

The effects of calcitonin on bone resorption in hyperthyroidism: a placebo-controlled clinical study

The effects of intranasal calcitonin on bone metabolism were investigated in patients with hyperthyroidism. Urinary deoxypyridinoline (uDPD) levels were measured as a bone turnover marker and lumbar spine (L2) bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA) in 7 patients who were given only antithyroid drug (group 1), in 10 patients who were given antithyroid drug plus intranasal calcitonin (group 2), and in 10 healthy subjects who were given placebo (group 3) at the beginning and at the end of the study. The study continued until the patients with hyperthyroidism became euthyroidic according to the laboratory values. This period was approximately 3 months in groups 1 and 2. At the beginning of the study, uDPD was 21.5 ± 2.6nM DPD/mM creatinine in group 1, 23.3 ± 3.6nM DPD/mM creatinine in group 2, and 4.3 ± 1.2nM DPD/mM creatinine in group 3. uDPD levels measured in groups 1 and 2 were significantly higher than those in group 3 (P 0.001). Area BMD Z scores of the patients in groups 1 and 2 were significantly lower than the healthy controls (P 0.01, for both). At the end of the study, uDPD was 11.5 ± 1.6nM DPD/mM creatinine in group 1, 5.3 ± 0.6nM DPD/mM creatinine in group 2, and 4.4 ± 1.3nM DPD/mM creatinine in group 3. The levels of uDPD obtained in group 1 were significantly higher than those obtained in groups 2 and 3 (P 0.05, for both). The difference between groups 2 and 3 was not significant. Area BMD Z scores measured at the end of the study were found to be increased in groups 1 and 2 compared to early values, but the values were slightly lower than the normal values. In comparison of early and late uDPD values, the decrease in late period was statistically significant in groups 1 (P 0.05) and 2 (P 0.001). We concluded that bone turnover is high in hyperthyroidism. The treatment of hyperthyroidism decreases the rate of bone turnover, but it is not sufficient to prevent the degradation of bone in hyperthyroidism. The addition of intranasal calcitonin to the treatment of hyperthyroidism prevents the degradation of bone.