Effect of estrogen replacement plus low-dose alendronate treatment on bone density in surgically postmenopausal women with osteoporosis

This prospective randomized, double-blind, placebo-controlled, clinical trial was performed to evaluate the effectiveness of estrogens plus low-dose alendronate on bone metabolism. A total of 150 surgically postmenopausal women with osteoporosis were randomized in three groups: group A, micronized E2 (2 mg/d) plus standard-dose alendronate (10 mg/d); group B, micronized E2 plus low-dose alendronate (5 mg/d); and group C, micronized E2 plus placebo (one tablet per day). In all women, bone mineral density (BMD) and serum bone metabolism markers were assessed at admission and every 6 months for 2 yr. After 2 yr, BMD significantly increased compared with baseline in all groups. The percentage BMD change was significantly higher in groups A and B than in group C. The differences in BMD detected between groups A and B were not statistically significant. Since the 6-month follow-up and throughout the study, serum osteocalcin and bone alkaline phosphatase levels and urinary deoxypyridinoline and pyrilinks-D excretion were significantly reduced in all groups. Serum bone alkaline phosphatase levels significantly decreased in groups A and B, without difference between them, in comparison with group C. In conclusion, in surgically postmenopausal osteoporotic women treated with estrogen replacement, the addition of alendronate at a low dose of 5 mg daily induces a gain of bone mass not significantly different in comparison with that obtained using a standard dose of 10 mg daily.     

A multidisciplinary approach to the development of a cervical spine clearance protocol: process,rationale, and initial results

Background/Purpose: Assessment of potential spine injuries is inconsistent and controversial. Subsequent morbidity includes prolonged immobilization and missed injuries. To address these issues, a multidisciplinary team was organized to design a cervical spine management/clearance pathway. The process, algorithm, and initial results are described. Methods: Team members consisted of pediatric surgeons, orthopedic surgeons, neurosurgeons, emergency room physicians, and trauma nurse practitioners. Nationwide standards, guidelines, and experiences across disciplines were reviewed, and a consensus pathway evolved for cervical spine clearance in children 8 years and younger. A short-term retrospective review (5 months) was performed to assess initial performance. Time required for clearance, number and type of imaging studies, and number of missed injuries were compared between a group of patients before (n = 71) and after (n = 56) the implementation of the pathway. Results: Strict guidelines for cervical spine immobilization and clearance criteria were defined. After implementation of this pathway, time required for cervical clearance in nonintubated children decreased (before, 12.3 [plusmn] 1.5 v after, 7.5 [plusmn] 0.9 hours; P = .014). A clear trend toward earlier clearance in intubated patients existed (before [n = 6], 40.0 [plusmn] 16.8 v after [n = 6], 19.4 [plusmn] 8.1 hours; P = .10); there need to be larger numbers to determine statistical significance. The 2 study groups were similar in age; mechanism of injury; Glasgow coma scale score; and number of plain x-rays, computed tomography scans, and magnetic resonance imaging studies obtained. Neither group had missed injuries. Conclusions: standards for cervical spine immobilization, assessment, and clearance. Implementation of such guidelines decreased time for cervical spine clearance, and ongoing analysis of sensitivity is encouraging. J Pediatr Surg 38:358-362.     

Increased Diffusion in the Brain of Professional Boxers: A Preclinical Sign of Traumatic Brain Injury?

BACKGROUND AND PURPOSE: Professional boxing is associated with chronic, repetitive head blows that may cause brain injuries. Diffusion-weighted imaging is sensitive to microscopic changes and may be a useful tool to quantify the microstructural integrity of the brain. In this study, we sought to quantify microscopic alterations associated with chronic traumatic brain injury in professional boxers. METHODS: MR and diffusion-weighted imaging were performed in 24 boxers and in 14 age- and sex-matched control subjects with no history of head trauma. Using distribution analysis, the average diffusion constant of the entire brain (BD(av)) and diffusion distribution width (sigma) were calculated for each subject; findings in professional boxers were compared with those of control subjects. In the boxer group, correlations between diffusion changes and boxing history and diffusion changes and MR imaging findings were assessed. RESULTS: The measured diffusion values in the boxer group were significantly higher than those measured in the control group (BD(av), P <.0001; sigma, P <.01). In the boxer group, a robust correlation was found between increased BD(av) and frequency of hospitalization for boxing injuries (r = 0.654, P <.05). The most common MR finding in the boxer group was volume loss inappropriate to age followed by cavum septum pellucidum, subcortical white matter disease, and periventricular white matter disease. CONCLUSION: Boxers had higher diffusion constants than those in control subjects. Our data suggest that microstructural damage of the brain associated with chronic traumatic brain injury may elevate whole-brain diffusion. This global elevation can exist even when routine MR findings are normal.     

Diabetes mellitus and atypical antipsychotics

Schizophrenic patients present a higher risk for the development of hyperglycemic disorder and the use of antipsychotic drugs seems to increase the risk of diabetes mellitus. The present review concerns the relation between atypical antipsychotic drugs and the risk of developing diabetes mellitus. A Medline and Webofscience search was performed by using the terms "Hyperglycemia", "Diabetes Mellitus" and "Antipsychotic Agents", to identify original papers and reviews published between 1997 and september 2002. It is concluded that there is a higher risk of glycemic disorders in the population of patients treated by antipsychotic drugs. Dietetic measures and attention to risk factors should be taken into account during the treatment of psychotic patients.     

Effect of clozapine on serum leptin,insulin levels,and body weight and composition in patients with schizophrenia

OBJECTIVE: Weight gain frequently occurs during treatment with clozapine. However, the pathophysiology of clozapine-induced weight gain remains unclear. The aim of this study was to investigate the influence of clozapine on hormones leptin and insulin in relation to body weight and composition measures to determine their contribution to clozapine-induced weight gain. METHOD: Data are reported on 19 patients with schizophrenia (11 women and 8 men) who completed 10 weeks of treatment with clozapine. Insulin levels, weight measurements, body mass index (BMI), and body composition measurements were evaluated at baseline and at the end of treatment. Leptin levels were assessed at baseline and after 4 and 10 weeks of treatment. Analysis of variance with repeated measures was used to evaluate changes in weight, body composition measures, leptin, and insulin. The Pearson correlations were used to assess the relationships between changes in hormone levels and weight along with body composition measurements. The correlations of change in Positive and Negative Syndrome Scale (PANSS) score with changes in hormone levels, weight gain and body composition measures were evaluated with Pearson correlations. RESULTS: Leptin and insulin levels did not show any significant alterations across time. The use of clozapine was associated with significant increases in BMI (F=19.8, P<.001), lean muscle mass (F=8.2, P=.01), and fat mass (F=15.4, P=.001), while total body fluid percentage (F=4.1, P=.05) significantly decreased. Improvement in PANSS scores was not correlated to change in leptin, insulin, weight, BMI, or body composition measurements. The change in leptin levels was correlated to change in body fat mass. CONCLUSION: The role of leptin in weight gain induced by clozapine might be a regulatory mechanism rather than being etiologic.     

Uses of formal and informal knowledge in the comprehension of instructions for oral rehydration therapy in Kenya

Information for using pre-mixed oral rehydration salt solutions, which have been made widely available in rural Kenya, is normally obtained from what is printed on the packets in English and either read or explained to the purchaser. Consequently, the comprehension can be improved with simple changes in the printed text, particularly those that reinforce appropriate modern or indigenous medical knowledge. However, the knowledge involved in effectively using oral rehydration therapy is not merely an awareness of its benefits, but an understanding of the environmental and biological causes of diarrhoeal diseases and an ability to explain the course of treatment that secondary schooling seems to develop.     

Epidermoid tumour within the collateral sulcus: A rare location and atypical presentation

Epidermoid tumours (ETs) are uncommon benign lesions that may grow by spreading in the subarachnoid space of the basal cisterns and expanding to conform to the shape of specific sulci and fissures. A temporobasal location is very rare, and there have been no reports regarding single sulcus involvement of ETs. We describe the case of an ET located on the basal surface of the temporal lobe, predominantly within the collateral sulcus, which separates the parahippocampal gyrus medially from the fusiform gyrus laterally. We report the case of a 25-year-old woman with complex visual hallucinations. MRI of the brain revealed a right temporobasal mass lesion, hypointense on T(1)-weighted and hyperintense on T(2)-weighted images, with minimal contrast enhancement, on the basal surface of the temporal lobe. Right-sided anterior temporal lobectomy, along with microsurgical removal of the collateral sulcus ET were performed with consequent resection of mesial temporal structures (the region of the hippocampus, parahippocampal gyrus, and amygdala). It is important to consider ETs when treating lesions on the basal temporal lobe, since the inferior surface of the temporal lobe, more specifically the collateral sulcus, may be a convenient space for ETs to localize. Total surgical resection should be the goal in these cases; however, the surgical approach may be tailored to include the resection of mesial temporal lobe structures when seizure is the predominant presenting symptom.     

Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin

The aim of the study was to investigate the role of cTnT for the prediction of long term cardiac dysfunction after epirubicin-containing adjuvant chemotherapy for breast cancer. The study group comprised of 45 patients (all female; mean age 48 ±8 years), treated with epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer. Patients received either 4 cycles of cyclophosphamide plus epirubicin (90 mg/m²) (n=23; stage 2 breast cancer) or 6 cycles of cyclophosphamide plus epirubicin (75 mg/m²) plus fluorouracil (n=18; stage 3 breast cancer). Venous blood samples were drawn, before and 72 hours after, every cycle of chemotherapy for the measurement of cTnT. Cardiac assessment was carried out at baseline and 1 year after chemotherapy by clinical evaluation, electrocardiography, radio-nuclide ventriculography (RNV) and transthoracic echocardiography. All patients remained free of clinical heart failure during the study period. In 26 patients (63%), cTnT was elevated after chemotherapy. Mean left ventricular ejection fraction, assessed by RNV at baseline and one year after chemotherapy, were 61±8% and 56±7% (p<0.0001). The sensitivity and specifity of cTnT for the detection of left ventricular systolic dysfunction at one year were 69% and 39% respectively. Echocardiographic examinations at baseline and one year after chemotherapy revealed a significant decrease in E/A ratio from 1.15±0.3 to 0.9±0.2 in cTnT positive patients, suggesting diastolic dysfunction. In conclusion, elevated serum cTnT levels after epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer, predict future cardiac dysfunction with moderate sensitivity and poor specificity.     

The sympathetic skin response habituation in sedentary subjects and sportsmen

The aim of the present study was to investigate the habituation rates of the sympathetic skin response (SSR) in sedentary subjects and trained sportsmen. A total of 52 voluntary male students (30 sedentary subjects and 22 trained sportsmen) participated in the experiment. SSR was recorded with the contralateral electrical stimulation of the ulnar nerve (of the upper extremities). In order to initiate the SSRs, 16 square-wave consecutive electrical shock stimuli were presented to each subject over the left ulnar nerve. In 52 subjects, 16 stimuli were applied at random time intervals (20-50 s). In sedentary subjects, the mean amplitude of the SSRs decreased from 4.83 +/- 0.36 mV at the first stimulus, to 0.80 +/- 0.12 mV at the 16th stimulus. In trained sportsmen, the mean amplitude of the SSRs decreased from 3.95 +/- 0.51 mV at the first stimulus, to 0.80 +/- 0.17 mV at the 16th stimulus. In the sedentary subjects, at the S1-S9 stimuli, the mean amplitudes of SSRs were higher than those of trained sportsmen. Depending upon these findings we can say that the trained sportsmen showed a more rapid habituation than sedentary subjects. In these processes, changes of amplitude and latency values reflect changes in amount of neuronal activation. Amplitude reflects the amount of neuronal activation, which is concerned with number of neuronal populations. Neuroplasticity, known as the habituation of the brain, is the adaptation of autonomic nervous system, which can be reflected by SSRs.