Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems.

Two dual energy X-ray absorptiometric (DXA) instruments have recently become commercially available for local bone densitometry: the QDR-1000 (Hologic Inc.) and the DPX (Lunar Radiation Corp.). We report the precision, influence of femoral rotation, correlation and agreement of bone mineral measurements of the proximal femur by these two instruments. In vitro (femur phantom) short-term precision was 1.1%-3.5%, and the long-term precision was 1.2%-3.8%. In vivo (groups of 10 premenopausal and 10 post-menopausal women) short-term precision of duplicate measurements was 1.6%-4.7%, and long-term precision was 1.9%-5.5%. Overall, the precision for Ward's triangle was over 3% and that for the femoral neck and trochanter, 2%-3%. Rotation of a femur phantom produced a statistically significant change in the bone mineral density (BMD) of the femoral neck. Within a clinically relevant range of femoral rotation (20 degrees inward rotation +/- 5 degrees) the coefficient of variation (CV%) increased by a mean factor of 1.1-1.4. Although the correlation (r less than 0.9) between BMD measurements of the proximal femur by the DPX and QDR-1000 in 30 postmenopausal women was high, there was lack of agreement between the two instruments. We found no statistically significant differences between the right and left femur in 30 postmenopausal women. A bilateral femur scan took a mean total time of about 22 min. We conclude that with the introduction of DXA instruments, the precision of bone mineral measurements of the proximal femur has improved. However, for comparability between commercially available DXA instruments, it might be advantageous if units were standardized.     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

Changes in calcanean bone mineral occurring spontaneously and during hormone replacement therapy in early post-menopausal women.

The spontaneous calcanean bone loss occurring in healthy early post-menopausal women and the effect of two hormone replacement therapies (HRT's) were investigated in a longitudinal study. There was no difference between the right and left calcanean BMC or BMD (p > 0.15). The spontaneous bone loss was similar at all the skeletal sites measured, with a mean spontaneous loss in calcanean BMD of 1.6% over one year. Both HRT's significantly (p < 0.01) prevented the bone loss from all skeletal sites irrespective of the weight-bearing or content of trabecular bone, and (for the weight-bearing bones) there was even a gain in calcanean BMC and BMD and spinal BMD (p < 0.01). Bone mineral of the calcaneus and the spine correlated equally to body weight (r approximately 0.4, p < 0.001), whereas bone mineral in the forearm was not correlated to body weight. The correlations between the changes in bone mineral at the sites measured were all significant (r approximately 0.2-0.4).     

N-acetylcysteine modifies the acute effects of isosorbide-5-mononitrate in angina pectoris patients evaluated by exercise testing

Nitrates are well established in the treatment of angina pectoris and the presence of sulfhydryl groups seems to be fundamental to nitrate-induced vasodilatation. The present study was performed to elucidate if large oral doses of N-acetylcysteine (NAC, 2,400 mg X 2), a donor of sulfhydryl groups, given together with a single oral dose of the long-acting nitrate, isosorbide-5-mononitrate (5-ISMN, 60 mg), would modify the nitrate effect evaluated by exercise testing before and after additional sublingual doses of nitroglycerin (NTG). Ten patients with angina pectoris and angiographically proven significant coronary artery disease were included. All patients received a baseline therapy with beta blockers. None of the patients had developed nitrate tolerance at inclusion. NAC/5-ISMN treatment significantly prolonged the total exercise time as compared with placebo/5-ISMN (7.7 +/- 2.1 min vs. 6.8 +/- 1.7 min, p less than 0.05). This increase was of such magnitude that no further effect was obtained after additional NTG doses. This study demonstrated that increased availability of sulfhydryl groups can increase the exercise capacity in angina pectoris patients treated with 5-ISMN without nitrate tolerance.