Incident vertebral fractures and mortality in older women: a prospective study

Older persons who have prevalent vertebral fractures have an increased risk of mortality. It is not known whether incident vertebral fractures are also associated with an increased risk of mortality. To determine whether older women with incident vertebral fractures have an increased risk of mortality, we conducted a prospective cohort study of 7233 community-dwelling older women aged 65 years or older who were enrolled in the Study of Osteoporotic Fractures. We measured incident vertebral fractures by radiographic morphometry of paired lateral spine X-rays taken an average of 3.7 years apart. We also collected information on baseline prevalent vertebral fractures; calcaneal bone density; anthropometric measures; and demographic, medical history, and lifestyle variables. Overall mortality was assessed and confirmed by receipt of death certificates. Over an average of 3.7 years, 389 (5.4%) women developed at least one incident vertebral fracture. During an additional 8 years of follow-up, 1617 (22%) women died. Women with at least one new fracture had an age-adjusted 32% increased risk of mortality (RH=1.32; 95% CI=1.10–1.58, P=0.003) compared to those without incident vertebral fractures. After adjustment for weight loss, physical frailty markers, and nine other predictors of mortality, there was no longer an independent association between incident vertebral fractures and mortality (RH=1.06; 95% CI=0.88 1.28). Older women with incident vertebral fractures have an increased risk of mortality that may be explained by weight loss and physical frailty.The abstract was presented at the annual meeting of the American Society of Bone and Mineral Research, in Phoenix, Arizona on 12 October 2001.     

Variable sensitivity of lymphoblastoid cells to apoptosis induced by Viscum album Qu FrF, a therapeutic preparation of mistletoe lectin

BACKGROUND: Viscum album (VA) Qu FrF preparation consists of an aqueous extract of Viscum album, the European mistletoe. It has cytotoxic and immunomodulatory properties that support its usefulness in cancer therapy. However, only little information is available on the interaction between mistletoe lectin (ML) and the humoral compartment of the immune system. METHODS: Inhibition of proliferation of cells was performed by incorporation of (3)H-thymidine, and cell viability was assessed by the uptake of propidium iodide. Detection of Bcl-2 and related molecules was performed by SDS-PAGE followed by immunoblotting. RESULTS: We demonstrated that B lymphocyte lines are insensitive to VA Qu FrF-induced apoptosis. We showed, using Fas-sensitive and Fas-resistant cell lines, that VA Qu FrF-induced apoptosis is Fas independent. In both B and T lymphocytes, treatment of the cells with VA Qu FrF was associated with decreased levels of Bcl-2 and Bcl-X. CONCLUSIONS: Our results suggest that B lymphocyte depletion is not involved in the modulation of humoral immunity by ML. These observations should be of value in appropriate designing of cancer therapy using compounds containing mistletoe extracts.     

Lamellar keratoplasty with air or viscoelastic substance injection

PURPOSE: To analyze the results of very deep lamellar keratoplasty using dissection with air and a viscoelastic substance. METHODS: This was a prospective monocentric noncomparative study. Candidates for lamellar keratoplasty were enrolled between November 1998 and July 2000. Deep lamellar dissection was performed following air injection into the cornea to create a white emphysema of the stroma. The dissection was performed to the Descemet membrane. Whenever a large bulla was present in the recipient bed, the dissection of the deepest stromal lamellae was performed by injecting a viscoelastic substance into the bulla. A full-thickness allogenic corneal button was sutured to the recipient bed. RESULTS: Fifteen eyes of 14 patients (mean age, 39.3 years) underwent deep lamellar keratoplasty: keratoconus (11 eyes), atopic keratoconjunctivitis (1 eye), herpes zoster keratitis (1 eye), corneal scar after pterygium surgery (1 eye), and rosacea keratitis (1 eye). Excluded from the analysis of the refractive outcome were patients who underwent intraoperative perforation (n = 3) and the patients with postoperative complications affecting the central visual axis: (n = 2 [hemorrhage in the interface and herpetic simplex keratitis]). The mean preoperative visual acuity was 0.10 (range, 0.05 to 0.3). After a 3.8-month-follow-up, the mean best corrected visual acuity was 0.21 (range, 0.1 to 0.6). The visual results were better in patients with keratoconus (mean best corrected visual acuity: 0.22; range, 0.1 to 0.6). The mean postoperative astigmatism was 4.15 diopters (range, 0 to 8). CONCLUSION: Intrastromal air and viscoelastic substance injection appeared to be very useful for performing a very deep lamellar keratoplasty. The results of the refractive outcome were encouraging. Deep lamellar keratoplasty is an interesting alternative to penetrating keratoplasty, because it cannot induce progressive primary graft failure and allogenic endothelial graft rejection and it obviates the need to perform a lamellar dissection of the donor button.     

Enucleation with on-the-table evisceration. Is it a good technique?

PURPOSE: To evaluate the surgical technique of enucleation followed by an "on-the-table evisceration" and placement of a hydroxyapatite orbital implant wrapped by the patient's own sclera for the treatment of blind phthisis painful eyes. PATIENTS AND METHODS: In this single-center retrospective study, 50 consecutive patients undergoing an operation using the same surgical technique, between April 1993 and November 1999, were studied. Patients underwent enucleation, then the eyeball was eviscerated "on the table". The patient's own cleaned sclera was used to wrap a hydroxyapatite orbital implant, the posterior pole of the sclera was placed at the anterior pole of the implant. Conjunctival breakdown, sphere size, conjunctival discharge, the first signs of sympathetic ophthalmia motility, and cosmetic results were analysed. RESULTS: After an average follow-up of 13.3 months few complications were encountered: 4 cases (8%) of inclusion cyst and 3 cases (6%) of discharge. The implant placed had a diameter of 18 mm, 20 mm, 22 mm in, respectively, 48%, 48%, and 4% of the eyes. The prosthesis motility was good, medium, and poor in, respectively, 33 (78.6%) cases, 8 (19%) cases, and 1 (2.4%) case. The prosthesis tolerance was good, medium, and poor in respectively 86%, 10%, and 4% of the cases. CONCLUSION: The surgical technique of enucleation followed by an "on-the-table" evisceration and autologous sclera wrapping a hydroxyapatite implant is an easy procedure. It allows, on phthisis eyeballs, the placement of a large orbital implant for good cosmesis results, without major complications.     

Interstitial fibrosis following hydrogen sulfide exposure

This case report describes a patient with interstitial fibrosis 4 years after poisoning by hydrogen sulfide. Hydrogen sulfide causes pulmonary edema and is also toxic to the nervous system. Long-term pulmonary sequelae of hydrogen sulfide poisoning has not been reported frequently in the literature.     

Domain-specific cognitive effects of tramiprosate in patients with mild to moderate Alzheimer’s disease: ADAS-cog subscale results from the Alphase study

Objectives  

Tramiprosate (homotaurine, ALZHEMED™) was recently investigated for its efficacy, safety and disease-modification effects in a Phase III clinical study in mild to moderate Alzheimer’s disease (AD) patients (the Alphase study). The primary cognitive endpoint measure of that study was the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog). To characterize potential cognitive benefits of tramiprosate, the present study describes exploratory analyses performed on scores obtained from the specific ADAS-cog subscales in order to determine whether specific domains of cognition may be differentially affected by tramiprosate, which would not have been evident from the measure’s total score.     

Prognostic value of the exercise test after myocardial infarction

A stress test performed in the early stage after myocardial infarction enables to evaluate directly or indirectly three of the main prognosis factors: alteration of ventricular function, presence of ventricular arrhythmias, residual ischemia. This test, performed around the 15th day, after previous anti-angina treatment have been discontinued, is only done in the absence of the classic contra-indications. It permits to detect abnormalities: electrical positivity (with or without pain), disorder of the ventricular rhythm, abnormality of the blood pressure profile, low stress level. The predictive value of these abnormalities has been the subject of many studies. Although all the results are not in agreement, each one of these abnormalities seems to carry an increased risk of cardiac occurrences after myocardial infarction. In addition, an early stress test enables to detect pluritroncular coronary lesions with, however, an average sensitivity. Thallium scintigraphy in conjunction with a stress test improves, however, the performances of this test. The advantage of an early stress test is the rapid screening of high risk patients who should benefit from additional exploratory measures and possibly of myocardial revascularization procedures.