Role of Zoledronic Acid on Bone Loss by Letrozole / 한국유방암학회지

PURPOSE: The aromatase inhibitors cause bone loss by estrogen depletion. Zoledronic acid (ZA) can prevent bone mineral density (BMD) loss associated with the use of aromatase inhibitors. Accordingly interest has arisen in measuring surrogate markers of bone resorption to monitor the response of treatment of BMD loss in place of a radiologic assessment. This study was designed to determine whether ZA would prevent bone loss that is known to occur with letrozole and identified surrogate markers of bone resorption in an animal model. METHODS: In ovariectomized or sham-operated rat, we administrated ZA and letrozole to 5 different groups including: a sham operation control group (OC), a group in which an ovariectomy was performed followed by saline administration (OS), an ovariectomy with ZA treatment group (OZ), an ovariectomy with letrozole treatment group (OL) and an ovariectomy with ZA and letrozole combined treatment group (OZL). The levels of serum osteocalcin, serum bone alkaline phosphatase (BALP), serum calcium and urine N-telopeptide (NTX) and BMD were estimated and compared at the same periods for each group. The distinct microscopic findings of proximal tibia at week sixteen were also compared. RESULTS: Significantly reduced levels of urine NTX and significantly increased BMD were measured in the OZ group. In the OL group no difference was seen in in BMD in comparison to the OS group. However, a significant increase in BMD was measured in the OZL group. Urine NTX levels were measured and found to be lower in the OL group and significantly lower in the OZL group. Serum osteocalcin levels were similar to each other for each group. Levels of serum calcium and BALP were significantly lower in the OZL group than in the OS group. CONCLUSION: The combination treatment with ZA and letrozole is effective in the inhibition of bone resorption and in the preservation of BMD. Measurement of serum osteocalcin, urine NTX, and BMD, levels are recommended as surrogate markers for determining the response for the treatment of bone loss.

Biliary Atresia with Extrahepatic Biliary Cyst

Biliary atresia (BA) with extrahepatic biliary cysts (EHBC) is a rare disease. It has been generally recognized as type I (correctable with cystic dilatation), which means a good prognosis. From a total of 73 patients with BA who underwent operation from September 1988 to September 2003 at our institute, 7 (9.6 %) cases of type III BA with EHBC (uncorrectable with cystic dilatation) are reviewed. Clinical findings, laboratory data, radiologic findings, treatment methods and outcomes were reviewed. Female was more prevalent (male to female ratio; 2:5). All cases were type III with EHBC according to the intraoperative cholangiography, and underwent Kasai's portoenterostomy. The mean age was 57 days at operation. Three patients(42.9 %) are long term survivors. Further evaluation is needed to determine the correlation between prognostic factors and outcome for.

Metachronous Triple Primary Cancers

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasms in the same individual. According to the development of new diagnostic techniques and the increase in long-term survivals, reports of multiple primary cancer have been gradually increasing among patients treated for initial cancers. Since Theodor Billroth reported the first three cases of multiple primary cancer in 1889, there have been many reports of multiple primary cancer, with an incidence range in Korea of 0.35~1.84%. In Korea, there have been a few reported cases of triple cancer. Herein, three recently experienced cases of metachronous triple primary cancer are reported.

Right Congenital Posterolateral Diaphragmatic Hernia

Congenital right posterolateral diaphragmatic hernia is rare. Moreover, cases of delayed presentation are extremely rare. We experienced two cases of right posterolateral diaphragmatic hernia. One case was a 1 day old male neonate with cyanosis. He was diagnosed as a congenital right posterolateral diaphragmatic hernia by chest X-ray and repaired primarily through trans-abdominal approach. There was a 54 cm defective area at the right posterolateral diaphragm. The right lobe of the liver, gall bladder, small intestine and right colon were herniated though the defect into the thoracic cavity. The patient was supported by mechanical ventilation for 1 month and was discharged without complication on the 41st day. The other case was an 11-month male infant with dyspnea, cough and seizure. He was diagnosed with delayed presentation of congenital right posterolateral diaphragmatic hernia by chest X-ray and repaired primarily through transabdominal approach. Almost all of the small intestine and right colon were herniated through a 54 cm sized posterolateral defect in the right diaphragm. He didn't need postoperative ventilatory support and was discharged without complications on the ninth day.