Atypical incomplete femoral fractures in asymptomatic patients on long term bisphosphonate therapy.

OBJECTIVES: Progression of an incomplete atypical femoral fracture (IF) to a complete fracture in patients on long term bisphosphonate (BP) therapy can be catastrophic. We aimed to determine the frequency and imaging features of IF in asymptomatic patients on long-term BP therapy and to identify distinguishing clinical and laboratory markers in the subset of patients who develop these fractures. MATERIAL AND METHODS: From August 2009 to March 2011, 220 femoral radiographs in 110 asymptomatic patients (101 women, 9 men, age 47-94) were reviewed by 2 radiologists. All patients were on BP therapy for at least 3 years and had no history of hip/thigh pain or recent trauma. MRI was performed when a fracture was suspected on radiographs. Bone mineral density, serum calcium, 25-hydroxy vitamin D, intact parathyroid hormone, serum c-telopeptide and urine n-telopeptide were obtained in all patients. RESULTS: Two of 110 patients (1.82%, confidence interval of 0.6% to 6.3%) had 3 IFs. Both patients, age 50 and 57, were Caucasian, active and on BP for 8 years. MRI confirmed radiographic findings in both patients. Both women had T-scores in the osteopenic range at 2 sites and osteoporotic range at 1 site. CONCLUSION: The 1.82% frequency of IF in asymptomatic patients on long term BP therapy is higher than that suggested in the literature. Statistical differences between fracture and non-fracture groups were not presented as the patient population was too small to draw any significant conclusions.

An evaluation of Open Airways for Schools: using college students as instructors.

Fifteen years ago, Open Airways for Schools (OAS) was found to be an effective asthma education program for elementary school children when taught by professionals. To determine whether OAS is effective when taught by college students and whether it could withstand potential cohort effects, 54 inner-city fourth and fifth graders were taught OAS. Paired t-tests revealed that OAS improved asthma knowledge, self-efficacy, self-management skills, social support, and perception of well-being (p < 0.05). Fifteen years later OAS continues to improve children's self-management skills. Facilitators with little prior experience who received brief training in asthma knowledge and group leadership skills can effectively teach OAS.

Hepatitis C--role of perinatal transmission.

To evaluate the role of perinatal transmission in the spread of hepatitis C virus (HCV), we screened a cohort of pregnant intravenous drug using (IVDU) women for HCV antibody detection; where seropositive HCV RNA detection by polymerase chain reaction (PCR) was found we followed the infants longitudinally for HCV antibody and HCV RNA. Serum prevalence for HCV for this population was 80% with HCV RNA detected in 50%. Recruitment and follow-up over a 3-year period of a cohort of 83 seropositive women, their 91 newborns and 16 siblings of newborns, showed that there had been a 3% perinatal transmission rate with 1 sibling also infected. These positive cases were defined as transient in 1 case (HCV RNA positive by PCR at 1 month, but seronegative and HCV RNA negative at 10 months of age), 2 unevaluable (HCV RNA positive at 2 months of age, but patients lost to follow-up), and 1 chronic infection in a child at 34 months (positive HCV RNA and seropositive 34-month sibling). Maternal HCV RNA levels for those with infected infants was a mean 40-fold greater than those whose babies were uninfected, although this did not reach statistical significance. Of the remaining infants, the majority (93%) had lost passively acquired maternal antibodies by 9 months of age and all by 12 months. Of 18 women who were HCV seropositive and breast feeding (66% of whom were HCV RNA positive in their sera), none had detectable HCV RNA in breast milk. Hence we conclude that transmission of HCV from mother to infant appears to be of low frequency and positivity appears to correlate with maternal circulating viral load.

The management of severe preeclampsia with intravenous magnesium sulphate, hydralazine and central venous catheterization.

A prospective study of patients with severe preeclampsia managed by magnesium sulphate infusion for eclampsia prophylaxis, hydralazine infusion for vasodilatation and central venous catheterization for fluid monitoring is reported. In this preliminary report of 46 patients, there was no episode of eclampsia following treatment, no maternal death, and hypertension was well controlled in all patients. Of the 51 babies born, there were 7 stillbirths, and 4 neonatal deaths; 6 of the 7 stillbirths were less than 30 weeks' gestation, and 23 of the 46 patients were delivered by Caesarean section.

The choice of sterilization procedure among married couples.

Surgical sterilization is playing a growing role in contraception among married couples. Both vasectomy and tubal ligation can be done as outpatient procedures. Neither procedure has overwhelming advantages over the other. This study sought to determine why one member of a couple, rather than the other, decided to undergo the sterilization procedure. There do not seem to be any significant demographic differences between those couples who choose vasectomy and those who select tubal ligation. Men may undergo vasectomy because they feel it is the easier procedure. A significant number of women also feel that vasectomy is easier, yet for various reasons they are motivated to undergo tubal ligation. In many couples, the choice is made because one partner will not consider becoming sterilized, and this is twice as likely to be the husband. Family physicians can play an important role in assisting couples to choose the best alternative.

PIP: This study sought to determine why 1 member of a couple, rather than the other, decided to undergo sterilization. For a 2 month period, questionnaires were distributed to 86 married patients who attended the Wilmington Medical Center for outpatient vasectomy (29 patients) and laparascopic tubal ligation (57 patients). Vasectomy patients had a median age of 35 years whereas that of tubal ligation was 32 years. Both groups had a median number of 2 children. There were no significant demographic differences between those couples who chose vasectomy and those who selected tubal ligation. Spouses of tubal ligation patients were more likely to have strong feelings against having a sterilization procedure. 42% of tubal ligation patients stated that their husbands had refused to consider having a vasectomy while only 21% of vasectomy patients claimed that their wives had refused tubal ligation. 28% of men having had vasectomies were confident of the reversibility of the procedure. There were no differences between the 2 groups concerning what most influenced individual choices of steriliztion procedure.