Percutaneous lumbosacral fixation and fusion: anatomic study and two-year experience with a new method.

This anatomic and clinical study describes a transsacral, percutaneous approach for fixation and fusion of the L5-S1 disc. A tunnel is created into the L5-S1 disc from this approach, permitting disc removal, bone grafting, and placement of two nine-millimeter diameter titanium screws into the body of L5. There were no complications referable to screw placement, and eight of nine patients had successful fusion.

Effect of long-term triphasic oral contraceptive use on glucose tolerance and insulin secretion.

This study was designed to compare the effects of two low-dose triphasic oral contraceptives (OCs) on glucose tolerance and insulin secretion. Fifty-seven women were randomized to receive OCs containing ethinyl estradiol and either levonorgestrel or norethindrone. Ten subjects using nonhormonal contraception served as controls. Glucose tolerance and insulin secretion were measured at baseline and at 6 and 12 months after an oral glucose stimulus. Both preparations produced a relative hyperglycemia at 6 and 12 months compared with baseline, but within the norms for glucose tolerance. The insulin response, measured in 48 treated and eight control subjects, also increased over 12 months in both treated groups, but the total insulin area was within the range of the reference laboratory. Such minor changes have not been associated with cardiovascular diseases and support the safety of low-dose triphasic preparations.

Osteoporosis.

Osteoporosis, a condition of decreased bone tissue that increases the likelihood of fracture, places a significant burden on our society in terms of health cost and morbidity. The most common type of osteoporosis is involutional, and two subtypes are recognized: type 1 and type 2. Type 1, or postmenopausal, osteoporosis is most commonly seen in perimenopausal and postmenopausal women from ages 51 to 75. Estrogen deficiency is the most dominant factor in the pathogenesis of this disorder. Type 2, or aging related, osteoporosis is seen in elderly women and men aged 70 or more. Bone loss in this group is related to aging, estrogen deficiency, negative calcium balance, and a variety of environmental and genetic factors. The best approach to the management of osteoporosis is to develop a lifelong strategy that maximizes peak bone mass and minimizes aging-related and postmenopausal bone loss. Estrogen is the only medication approved for the prevention of bone loss that is in general use. Other strategies to prevent bone loss (and maximize peak bone mass) include adequate calcium intake, adequate exercise, and avoidance of excess alcohol, tobacco, and caffeine use.

Lipid and lipoprotein changes in women taking low-dose, triphasic oral contraceptives: a controlled, comparative, 12-month clinical trial.

Effects on lipid/lipoprotein metabolism of two triphasic oral contraceptives, Triphasil (ethinyl estradiol/levonorgestrel) and Ortho-Novum 7/7/7 (ethinyl estradiol/norethindrone) were compared in a 12-month controlled, prospective clinical trial. The data indicate that use of both estrogen-progestin preparations were accompanied by increases in cholesterol, low-density lipoprotein and high-density lipoprotein3 cholesterol, apolipoproteins A1 and B, and triglycerides. Also observed were a decline in high-density lipoprotein cholesterol and greater decreases in high-density lipoprotein2 cholesterol levels; the latter were below the lower limits of laboratory's reference range. All other changes remained within clinically acceptable limits. There were no statistically significant differences between the test preparations, suggesting that the impact on lipid metabolism of the triphasic preparations Triphasil and Ortho-Novum 7/7/7 are similar and, given the dynamic balance between the various fractions, are unlikely to impart an adverse cardiovascular risk.

Effect of exercise on glucose metabolism in postmenopausal women.

A cross-sectional study was conducted to examine the effect of treadmill and muscle resistance training on glucose tolerance and insulin levels in a group of 25 normal-weight, naturally menopausal women. Subjects trained 20 minutes three times per week for at least 6 months to 70% to 85% of maximum heart rate on a treadmill, or to maximum effort for all major muscle groups on Nautilus equipment. A nonexercising age-height-weight--matched group was monitored as a control. All three groups were of above-average fitness for age as measured by aerobic capacity during initial testing. The treadmill group significantly increased its maximal oxygen uptake over the training period. Glucose tolerance and insulin response, measured as areas under the curve after a 75 gm oral glucose load, were improved in both exercise groups compared with controls, with more marked improvement in the treadmill group. The only difference achieving statistical significance was the insulin levels 30 minutes or less after glucose ingestion, representing the first phase of insulin release. Long-term exercise training that increases aerobic power thus maintains normoglycemia with lower insulin values than in otherwise physically fit postmenopausal women.

Serum 25-OHD, vitamin A and vitamin E concentrations in healthy Finnish and Floridian women.

The concentrations of 25-hydroxyvitamin D (25-OHD), vitamin A and vitamin E were measured in serum samples of Finnish and Floridian women; the samples were collected in spring. The Floridians had twice as much 25-OHD in serum as the Finns, but the levels of the two other fat-soluble vitamins were equal. Thus, in Florida there is very little risk for vitamin D deficiency, and vitamin A and E status seems to be unaffected by differences in dietary habits.