Role of oral versus IV iron supplementation in the erythropoietic response to rHuEPO: a randomized, placebo-controlled trial.

BACKGROUND: Preoperative treatment with rHuEPO (epoetin alfa: EPREX, Janssen-Cilag; or PROCRIT, Ortho Biotech) in conjunction with iron supplementation increases the erythropoietic response in elective orthopedic surgery patients, but it is not known whether the magnitude of this response is dependent on the route of iron administration. STUDY DESIGN AND METHODS: Non-iron-deficient patients undergoing elective orthopedic surgery (N = 110) with baseline Hb > or =10 to < or =13 g per dL were randomly assigned to receive either epoetin alfa (600 IU/kg) plus IV iron (n = 29) or oral iron (n = 29) or placebo plus IV iron (n = 25) or oral iron (n = 27) in this 14-day study. RBC production, Hb, Hct, reticulocytes, iron status, and adverse events were monitored throughout the study. RESULTS: Epoetin alfa treatment plus either oral or IV iron supplementation significantly increased total RBC production, Hb, Hct, and reticulocytes over the values seen with the respective placebo treatments (p = 0.0001). There were no differences between the epoetin alfa treatment groups. Placebo treatment plus oral or IV iron supplementation was not associated with increases in hematologic values. There were no differences in the incidence of adverse events among the treatment groups. CONCLUSION: There was a comparable erythropoietic response to epoetin alfa, irrespective of the route of iron administration. The route of iron administration, therefore, does not modulate the erythropoietic response to epoetin alfa in patients who are not iron deficient. Safety and convenience benefits may be gained by adopting oral iron supplementation in this patient subset.

Repair of the achilles tendon rupture: a functional comparison of three surgical techniques.

A retrospective comparison of three surgical procedures for the acute treatment of closed ruptures of the Achilles tendon is presented: 1) open repair, 2) a percutaneous technique, and 3) a combined mini-open and percutaneous technique. The authors compared the results of 52 tendon ruptures, including 15 open repairs, 15 percutaneous repairs, and 22 combined repairs, with minimal follow-up of 12 months. The authors evaluated the parameters of strength, performance, use of shoes, time of returning to work, range of ankle motion, calf circumference, pain, ability to perform 20 toe-raises on each side, and MRI findings. In comparison to the uninjured leg, the strength of the involved extremity was 74% in the patients with an open repair, 88% in patients with a percutaneous repair, and 92% in the combined mini-open and percutaneous procedure. The combined mini-open and percutaneous repair gave significantly better results than the other surgical procedures. On MRI, the area of the posterior calf of the injured leg, in comparison to the contralateral uninjured leg was 82% in open repair, 81% in the percutaneous procedure, and 91% in combined mini-open and percutaneous procedure. These differences were found to be statistically significant (p < .01). On the basis of their results, the authors prefer to perform the combined percutaneous and mini-open repair of Kakiuchi for the repair of acute Achilles tendon ruptures.

The surgical correction of metatarsal dysmetria.

The authors report the results of surgical correction in 5 cases of metatarsal dysmetria; lengthening in 3 cases and shortening in 2 cases. Lengthening was achieved by gradual distraction without using grafts. External mini-fixators were used which could be either lengthened by a sliding mechanism for distraction or used in compression in the case of shortening. The maximum lengthening obtained was 32 mm, equal to 90% of the initial length.

[Prevalence, characteristics and clinical correlates of left ventricular hypertrophy in stable hypertension. Echocardiographic study]. / Prevalenza, caratteristiche e corrispettivi clinici dell'ipertrofia ventricolare sinistra nell'ipertensione arteriosa stabile. Studio ecocardiografico.

251 in stable hypertensives were studied with M-Mode and two-dimensional echocardiography, in order to evaluate the prevalence of left ventricular hypertrophy (LVH), its patterns and clinical correlates. 54 subjects (21%) had been treated previously with antihypertensive drugs while the remaining 197 (79%) had not. A normal left ventricle was found in 69 subjects (27.1%; group A); a concentric LVH (h/r greater than or equal to 0.45) was found in 99 (39.4%; group B), while an eccentric LVH (left ventricular myocardial mass index greater than 140 g/m2, h/r less than 0.45) in 83 (43.1%; group C). An asymmetric LVH (septum to posterior wall thickness ratio greater than or equal to 1.3) was found in 33 subjects (3 did not fulfill the criteria for LVH, 21 had a concentric, and 10 an eccentric LVH). Mean age was significantly higher in group B as compared to groups A and C. The body mass index was comparable in all groups. Mean systolic blood pressure was significantly higher in groups B and C as compared to A. The duration and the severity of hypertension did not differ among the three groups. W.H.O. stage III was absent in group A, but no differences were found between group B and C as for W.H.O. stage distribution. We conclude that such factors as BMI, duration and severity of hypertension poorly correlate with the occurrence of LVH and its patterns. The fact that group B hypertensives were older than the others on average is against the hypothesis that eccentric hypertrophy follows the concentric pattern. Whether these two patterns represent separate entities in relation to different hemodynamic profiles deserves further investigation.

Use of ceftazidime in the treatment of osteomyelitis and osteoarthritis.

The authors report the results obtained with the use of ceftazidime, administered by various methods, in 18 cases of orthopedic infections (osteomyelitis, arthritis). The results, which are regarded as good, are stable over time. The antibiotic therapy proves particularly efficacious in those cases subjected to appropriate surgical treatment.

[Profile of a new calcitonin: carbocalcitonin-(Asu1,7) E-CT]. / Profilo di una nuova calcitonina: carbocalcitonina-(Asu1,7) E-CT.

(Asu1,7) E-CT (carbocalcitonin-elcatonin) is the aminoasuberic analogue of eel calcitonin differing from the natural hormone in that an ethylene bridge replaces the disulphide bridge in position 1-7. This modification preserves the conformation of natural calcitonin but enhances the physical, chemical and biological stability of the molecule. This in its turn facilitates maximum purification of the product as well as enhancing its resistance to degradation both in vitro and in vivo. The specific activity of carbocalcitonin is equivalent to 5000 U.MRC/mg and it possesses all the pharmacological and clinical properties of natural calcitonins. It has the same hypocalcemic potency of eel or salmon calcitonin, superior to the human and porcine types. Carbocalcitonin has the typical pharmacological effects of the natural hormone on the kidneys, bone and gastrointestinal tract, the target organs of calcitonins. When injected into the cerebral ventricle of laboratory animals it was found to have an analgesic effect. In clinical terms (Asu1,7) E-CT gave good results when used in the treatment of hypercalcaemia and senile osteoporosis. Carbocalcitonin was also employed in conditions characterised by a high bone metabolism turnover such as Paget's disease, Sudeck's atrophy and immobilisation osteoporosis. Experiments to date have shown carbocalcitonin to be extremely interesting in terms of tolerability with very few side effects being noted. This may well be attributable to the greater stability conferred by the absence of the S-S bridge.

[Clinical experience with human calcitonin]. / Esperienza clinica con calcitonina umana.

The Authors report the results of treatment with synthetic human calcitonin in patients suffering from Paget's disease, osteoporosis, Sudeck's disease, osteolytic metastases and in one case adults Cooley's anaemia. They summarize the characteristic blood chemistry changes due to calcitonin in some cases and report a marked clinical improvement in the majority of the patients.

[Treatment of algodystrophic syndromes with calcitonin]. / Trattamento delle sindromi algodistrofiche con la calcitonina.

A general account of algodystrophic syndromes is followed by the presentation of results obtained with 160 MRC U/day extracted pig or 100 MRC U/day synthetic salmon calcitonin in 95 patients with the most common form (Sudeck's syndrome). Clinical, biohumoral and radiographic data are reported. There was no difference in the response to the two products. Excellent results were noted, first clinically and then radiographically. Some radiographs are presented.

Pig calcitonin in the treatment of localised osteoporosis.

On the basis of positive results obtained in the treatment of Sudeck's atrophy with calcitonin, the authors extended their investigation to other forms of localised osteoporosis. Six patients were examined affected by osteoporosis secondary to immobilisation, three patients with osteoporosis of the lower limbs from paralysis of the sciatic nerve and six patients with migrant osteoporosis. Treatment was as follows: pig calcitonin (Calcitar) in doses of 160 u MRC/daily + calcium gluconate in doses of 3 gr/daily. The duration of treatment averaged forty five days. In osteoporosis from immobilisation and nerve lesions the calcitonin treatment did not influence the condition and there was no change in radiographic appearances nor was there any analgesic action. On the other hand, the results were clearly positive in migrant osteoporosis: in all the patients treated there was complete regression of pain, cutaneous trophic changes, and functional loss. At a later stage, normal radiographic appearances were restored.

Effect of calcitonin on carrageenan foot oedema.

The effect of salmon calcitonin (SCT) on acute inflammation was tested in carrageenan induced foot oedema of the rat. A considerable inhibition of the oedema was obtained with 20 MRC U/kg of SCT. The injection of SCT is followed by decrease of calcemia. A hypothesis of possible inhibition of prostaglandin (PG) synthesis and/or release, caused by decrease of calcemia, is advanced.

[Calcitonin, calcium lactate-gluconate + potassium phosphate, calcium phosphate: changes induced in the biology of the patient with multiple fractures]. / Calcitonina, lattato-gluconato di Ca + fosfato di K, fosfato di Ca: modificazioni indotte sulla biologia del polifratturato

The effects of multiple injuries on the principle aspects of bone physiology are reviewed from the literature. In a clinical trial involving 14 patients with multiple fractures excluding cranial injuries, 5 were given porcine Calcitonin, two calcium gluconate-lactate with added potassium phosphate, and two calcium phosphate. Five patients acted as controls. The parameters under study were modified to varying degrees by the different substances. It was found that Calcitonin had no effect whatsoever on the healing of bone which remained virtually unaltered by the other compounds under trial.