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     

Tessier type VI-VII cleft combination associated with congenital bimaxillary fusion and anophthalmia.

Congenital intermaxillary fusion is a rare anomaly. Combination of the anomaly with any type of facial cleft is extremely rare. Death in a majority of these patients as a result of feeding and aspiration problems in early life may have caused the reports to be limited. In this article a 5-year-old patient, probably the first in the literature having Tessier type VI-VII facial cleft combination associated with bimaxillary fusion and anophthalmia on the right side, is presented. The patient has survived on fluid meal through a very small opening for 5 years. The features of the case are presented, and the time and method of the management of such a rare anomaly are discussed with a review of the literature.     

Physical laws of cholesterol gallstone fragmentation

Efficient fragmentation is the most important prerequisite for successful treatment of gallstones by extracorporeally induced shock waves. No data are available on the amount of energy necessary for stone disintegration and on the threshold energy below which no further fragmentation occurs. We therefore performed an in vitro investigation on human cholesterol gallstones to elucidate physical laws governing shock-wave lithotripsy. First, the focal pressure of the lithotripter was measured to calculate the energy traversing a stone. Second, 96 gallstones from 16 gall bladders were analysed with respect to physicochemical composition, radiological features and ultrasound before fragmentation was performed. Energy for stone disintegration was constant within each stone family but varied between 4.6 J mL^?1 and 36.8 J mL^?1 in different families. This energy correlated linearly with stone volume. None of the radiological and physicochemical factors revealed a clear-cut correlation of the different energies necessary for similar stone disintegration. The threshold energy differed between 0.26 mJ and 1.04 mJ per pulse. In conclusion, stone volume was the best parameter predicting stone fragmentation. However, in cholesterol stones with a similar composition the required energy per volume varies considerably together with the threshold energy. Radiological and ultrasound parameters appear to be of minor importance in explaining these differences.     

A clinical and radiological two‐year follow‐up study of maxillary overdentures on osseointegrated implants

In order to satisfy the need to restore the aesthetics, phonetics and comfort and to facilitate optimal hygiene procedures, 20 edentulous patients were treated with a new concept of overdenture therapy on implants ad modum Brånemark. After 24±3.5 months the patients were re‐examined. They were asked to answer a questionnaire and use a Visual Analogue Scale (VAS) to give their opinion on the prosthetic treatment. The results indicate that an implant‐retained overdenture in the maxilla with this design can satisfy the patients needs in aesthetics, phonetics and comfort and can 1 facilitate oral hygiene measures.     

Early complex treatment of fractures of leg bones and peripheral nerve injuries

A retrospective analysis of results of treatment of 104 patients with fractures of long tubular bones associated with injuries of peripheral nerves has shown complex therapy to be necessary. Main components of this treatment were biogenic stimulators, vitamin B12, spasmolytic and dehydration drugs in combination with electrophoresis with potassium iodide and thermal procedures. Rapid disturbance of conductivity of nerve trunks after trauma should be followed by revision of the given segment of the extremity in order to remove hematoma and make reposition of displaced fragments of the bone, which can provide recovery of the disturbed function of the nerve.     

Cutaneo-fascial flaps in restorative and reconstructive surgery of burns

On the basis of experience with the treatment of more than 1,500 patients with post-burn defects, deformities, and trophic ulcers, the authors distinguished types of affection in which the traditional methods are ineffective. These 133 patients were subjected to plasty with ++cutaneo-fascial grafts; the zones of donor areas from which the grafts are taken are determined. Plasty with ++cutaneo-fascial grafts is indicated in defects of the face, deformity of the neck, total adduction contracture of the arm, defect of the breast, and affections of the hand, leg, and foot. Concrete grafts and the site from which they are taken for restoration of certain regions of the body are suggested. ++Cutaneo-fascial grafts make it possible to restore the shape, function, and the skin of the involved region.