Intermittent Cyclic Tiludronate in the Treatment of Osteoporosis

The objective of the study was to determine the efficacy and safety of tiludronate in the treatment of postmenopausal osteoporosis. Two placebo-controlled, randomized, double-masked, multicenter, cyclical, intermittent, dose-ranging studies including 1805 women with low vertebral bone mineral density and prevalent vertebral fractures and 488 women with low bone mineral density and no prevalent fracture were conducted. Patients were randomized to either tiludronate 50 mg/day, tiludronate 200 mg/day or placebo, given orally for the first 7 days of each month. A supplement of 500 mg elemental calcium was provided daily from day 8 to the end of the month. Both studies demonstrated no statistically or clinically relevant trends in the incidence of adverse effects accross the three treatment groups. However, tiludronate administered at these two doses in a cyclic intermittent regimen was not effective in reducing the incidence of vertebral fractures or increasing spinal bone mineral density. Thus, tiludronate, administered at these doses in a cyclic intermittent regimen, cannot be considered an appropriate treatment of postmenopausal osteoporosis, notwithstanding a high safety profile. Received: 6 July 2000 / Accepted: 25 September 2000     

Laryngotracheo-Esophageal Cleft in a Neonate with Esophageal Atresia and Tracheo-Esophageal Fistula: Report of a Case

Laryngotracheo-esophageal cleft (LTEC) is a congenital anomaly, rarely found in neonates with esophageal atresia (EA) and tracheo-esophageal fistula (TEF), that poses diagnostic and treatment dilemmas for the attending surgeon. In most cases previously reported, the diagnosis of this association was made either at surgery or at autopsy. We present herein the case of a neonate with EA and distal pouch (type C) TEF who was also found to have a LTEC (Evans type III) at the time of surgery. The salient clinical and radiological features of this association are highlighted to increase awareness of the possibility of this rare association and to help promote its early detection. Received: September 3, 1999 / Accepted: July 25, 2000     

Congenital Bronchoesophageal Fistula with Crohn's Disease in an Adult: Report of a Case

A 65-year-old man was diagnosed to have Crohn's disease in 1989. In 1991, frequent bronchitis developed, and bronchoesophageal fistula was diagnosed by esophagography. On esophagography and aortography, the disease was diagnosed to be Type IV based on Braimbridge's classification accompanied by pulmonary sequestration. A thoracoscope-assisted fistelectomy was performed. This paper reports the findings of a fistelectomy assisted by thoracoscopy for the treatment of a Type IV bronchoesophageal fistula according to Braimbridge's classification accompanied by Crohn's disease.     

Analysis of Various Treatments for Pulmonary Aspergillomas

The objective of this study was to analyze the results of various treatments for pulmonary aspergilloma and to determine the surgical indications. A total of 41 patients with pulmonary aspergilloma hospitalized at the National Minamifukuoka Chest Hospital between 1973 and 1999 were analyzed with regard to their response to treatment and long-term prognosis. Five asymptomatic patients who were untreated demonstrated no change in the clinical status of aspergilloma. Analysis of the short-term response revealed surgery to be the most effective treatment. Systemic and intracavitary injections of antifungal drugs were not definitely effective, although they had a positive effect in some patients. A survival analysis revealed that all eight patients who underwent surgery are still alive. Using the Cox proportional hazard model, it was found that the favorable prognostic factors were the absence of symptoms, the absence of a superimposed bacterial infection, and surgery. There were ten deaths: three from lung cancer and seven related to uncontrollable superimposed bacterial infections, often resulting in hemoptysis. We conclude that patients with asymptomatic pulmonary aspergillomas should be clinically observed for signs of the development of lung cancer, but do not require active treatment. On the other hand, patients who are symptomatic and have uncontrollable superimposed bacterial infection will benefit from surgery. Received: August 24, 2000 / Accepted: March 6, 2001     

Cardiac surgical Database: Overview

Background Majority of the active cardiac surgical centers in India are still collecting the patient related data in a free flow manner. If the same information is collected in a structured manner, it is helpful in improving quality care of the patient, Resident training, Medical audit, and generation of new knowledge. Structured information is essential to computerize the data which will be useful for rapid analysis and for quick comparisons with published data. This type of format is mandatory to merge individual institutional data with National and International cardiac surgical databases. Methods A new format has been designed to collect the patient related information based on diseases and procedures. Compatible software (Dusk Data) distributed to various cardiac surgical centers in India for data entry and analysis. Results Several Cardiac surgical centers are collecting the data in this format. 10 out of 40 cardiac surgical centers are collecting the data in this format. Conclusions This Paper describes customized data collection forms for CABG, Heart Valve diseases, and common Congenital Heart diseases wider participation is urged for a meaningful National Cardiothoracic surgical registry.     

冷冻干燥同种异体肌腱移植修复手部肌腱缺损的疗效观察

目的;探讨用冻干肌腱修复手部肌腱缺损的疗效。方法：1997年10月至2000年6月间,应用冷冻干燥处理的同种肌腱修复手部肌腱缺损25例32指,屈肌腱缺损15例19指,伸肌腱缺损10例13指。移植腱缝合方法均采用改良Kessler法。指屈肌腱缺损者,移植腱的缝合口选择在Ⅱ区外,A2滑车缺损者在移植肌腱的同时重建滑车。术后进行早期功能训练。18例因肌腱粘连作二期粘连松解术。疗效评定采用TAM评定标准。结果：术后随访6－21个月,平均13个月。结果达优者24指,良5指,可3指,优良率为90％。结论：经冷冻干燥处理的同种异体肌腱用于临床可取得满意的疗效。     

圣和散联合放射治疗中晚期食管癌临床观察

目的观察圣和散联合放射治疗中晚期食管癌的远期疗效.方法采用随机对照法,治疗组76例采用圣和散联合放射治疗,对照组73例采用单纯放射治疗,观察治疗前后临床症状、体征、瘤体变化,并检测外周血象、细胞免疫及心、肝、肾功能.随访5年以上.结果近期有效率治疗组为89.47%,对照组为贷.75%,两组比较有显著性差异(P＜0.01).1、3、5年生存率,治疗组依次为77.63%、40.79%和30.26%,明显优于对照组的41.10%、16.44%和9.59%(P＜0.05或P＜0.01).同时发现,圣和散能明显提高T淋巴细胞和NK细胞的活性,无明显心、肝、肾毒性.结论圣和散联合放射治疗能明显提高中晚期食管癌远期生存率,并有良好的免疫调整作用.     

同种带瓣大动脉重建右心室流出道

目的：应用自行采集和冷冻保存的同种带瓣大动脉（VHC）完成先天性心脏病右心室流出道的重建,并观察其疗效及存在的问题。方法：用VHC材料治疗先天性心脏病95例,90例手术根治,5例行VHC右心室流出道与肺动脉连接姑息手术。结果：院内死亡13例,术后随访68例,死亡2例,均为感染,66例长期生存者中25例胸部X线片示VHC有钙化,多淡主动脉材料,仅5例有轻中度压力阶差（35－60mmHg)。结论：VHC可广泛用于治疗复杂先天性心脏病,程序降温,超低温保存和两步化冻是VHC使用质量的保证,VHC的长期通畅比合成管道好,随植入时间延长钙化率增加,肺动脉VHC优于主动脉,有肺动脉高压者宜尽早手术,为了预防VHC植入后感染,应重视,改善其收集和保存的方法。     

小儿先心患者呼气末与动脉血二氧化碳分压的相关性及其影响因素

小儿先天性心脏病通常可分为发绀型与非发绀型.由于不同程度的左向右或右向左分流造成的血流动力学的改变.使呼气末与动脉血二氧化碳分压差[P(a-et)CO2]增大,给临床上通过呼气末二氧化碳分压(PETCO2)推测动脉血二氧化碳分压(PaCO2)带来困难.因此,如何正确地评估和预测PaCO2,避免过多地进行动脉血气分析是十分必要的.此文参考近年来的研究,对可能影响P(a-et)CO2值的各种因素作一综述.     

茎突CT薄层冠状扫描在诊断茎突过长综合征中的价值

目的 探讨“一点一线垂直法”茎突CT薄层冠状扫描在诊断茎突过长中的价值。方法测量72例双侧茎突的长度、方位、形态、厚度、尖端与咽侧壁距离,总结茎突过长病人的临床症状与诊断。 结果 ①41例67侧长度超过3.0cm,符合茎突过长的诊断;②12例12侧茎突虽未超过3.0cm(均在2.5～2.9cm),且茎突方位角>20°、末端与咽侧壁的距离<20mm,并有临床症状的应考虑茎突过长综合征;③按茎突的形态进行分型:锥型(分直锥、弧锥),束状型,分节型,发育不良型。其中分节型与临床症状有密切关系。结论 ①茎突CT薄层冠状扫描能清晰显示茎突的长度、形态、厚度、末端与咽侧壁距离,是诊断茎突过长的一种可靠方法;②“一点一线垂直法”茎突CT薄层冠状扫描无需进行图像重建,可操作性强、简捷易行、便于推广。