The American journal of medicine
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Bisphosphonates are synthetic compounds that are taken up preferentially by the skeleton and suppress osteoclast-mediated bone resorption. There are structural differences among the various bisphosphonates that account for considerable differences in antiresorptive potencies and in activity/toxicity ratios. Bisphosphonates are given to patients with established vertebral osteoporosis, either intermittently or continuously, but controlled, long-term data are only available for intermittent regimens. ⋯ This increase in bone mass is not due to redistribution of calcium in the skeleton, as at sites with predominantly cortical bone, BMD values either do not change or increase with treatment. Bisphosphonates also appear to decrease the frequency of new vertebral fractures in some patients with established osteoporosis, but this effect needs to be verified. Other issues that need to be addressed include the optimal mode and dose of administration and hence the choice of bisphosphonate, the duration of treatment, the changes in bone metabolism following treatment arrest, and finally the efficacy of bisphosphonates in the prevention of hip fractures.
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Since the proceedings of the last Consensus Conference on Osteoporosis were published as a supplement to The American Journal of Medicine in November 1991, there has been a plethora of well-documented studies reported in the literature. This article will address some of the issues concerning the relation between bone mass and nutrition raised in those studies.
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Review Case Reports
Thoracic complications of dental surgical procedures: hazards of the dental drill.
Dental surgical procedures occasionally result in intrathoracic complications that may subsequently be encountered by clinicians. We report four patients with such complications, including pneumomediastinum, fatal descending necrotizing mediastinitis, and Lemierre's syndrome. In each of these patients, the commonly used dental handpiece with exhausted air directed to the working drill point was an important, but unrecognized, predisposition to their intrathoracic complication. ⋯ Clinicians should be aware of the spectrum of these problems and, in particular, of the potential hazards of pressurized nonsterile air blown into open surgical sites by the dental drill.
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Noninvasive monitors are finding increased use in the intensive care unit both as labor-saving tools and as a means to reduce complications associated with invasive techniques. The current technology allows for the replacement of a number of invasive devices with a noninvasive counterpart capable of providing similar information. The potential reduction in morbidity and mortality realized with a greater reliance on noninvasive monitors should result in widespread application of these modalities.