Tiludronate infusion in the treatment of bone spavin: a double blind placebo-controlled trial

REASONS FOR PERFORMING STUDY

Tiludronate regulates bone remodelling through a decrease of the resorptive process and should therefore ameliorate the remodelling processes active in osteoarthritis of the distal tarsal joints ('bone spavin') and alleviate pain associated with abnormal bone lysis.

OBJECTIVE

To confirm the efficacy of tiludronate, administered as a single infusion at a dose of 1 mg/kg bwt, in the treatment of bone spavin in the horse.

METHODS

A double blind placebo controlled trial on 108 clinical cases of bone spavin was undertaken. The lameness score of the lamest limb was assessed following distal tarsal analgesia of the contralateral limb and followed-up using the same procedure throughout the study. Bone spavin in the lamest limb was confirmed by distal tarsal analgesia and radiography. Horses were treated at Day 0 and reassessed 60 days later after controlled exercise. A second nonblinded treatment was given to unresponsive horses and all horses were re-examined at Day 120. Exercise levels were recorded at each examination.

RESULTS

Eighty-seven horses completed the trial as per the protocol. The tiludronate horses were significantly less lame than the placebo horses (P = 0.0318). Horses treated at Day 60 with tiludronate showed further improvement in lameness at Day 120 (P = 0.0096 and P = 0.0034 for horses treated with tiludronate and placebo at Day 0, respectively). The only significant difference in radiographic findings between tiludronate and placebo was for presence of periarticular osteophytes (P = 0.006).

CONCLUSIONS

Tiludronate treatment is proven to be effective in bone spavin in horses in association with a controlled exercise programme.

CLINICAL RELEVANCE

Tiludronate in combination with controlled exercise offers an alternate medical treatment for bone spavin.

Pharmacological effects of tiludronate in horses after long-term immobilization

INTRODUCTION

Tiludronate, a bisphosphonate, has recently been introduced in veterinary medicine to treat orthopedic conditions in the horse. This study was designed to evaluate its effects on biochemical biomarkers of bone metabolism and on bone density and structure in an experimental model of disuse osteoporosis induced by cast application in horses.

METHODS

Two groups of eight horses were immobilized during 8 weeks. The first group (P-group) received a placebo, and the second group (T-group) received tiludronate 1 mg/kg by slow IV infusion. Both treatments were administered twice, 28 days apart. Immobilization consisted of stall rest with the left forelimb packed in a fiberglass cast. It was followed by a 4-week remobilization period and an 8-week standardized training protocol. One biomarker of bone resorption, the C-telopeptides of type I collagen cross-links (CTX-1) and one biomarker of bone formation, the bone isoenzyme of alkaline phosphatase (bone ALP), were assessed. Metacarpus III (MCIII) bone mineral density (BMD) and speed of sound (SOS) were evaluated respectively by dual energy X-ray absorptiometry (DEXA) and quantitative ultrasonography (QUS). Lameness was regularly assessed during the remobilization and training periods. Group- and time-related effects were tested by analysis of variance on repeated measurements.

RESULTS

A rapid, transient and significant decrease in CTX-1 concentration was seen after each treatment in the T-group only. No significant differences between groups were seen in the evolution of bone ALP activity. At the end of the experiment, the loss of MCIII BMD measured by DEXA in the immobilized limb was significantly less in the T-group than in the P-group. The MCIII SOS measured by QUS did not significantly vary within or between groups throughout the study.

DISCUSSION AND CONCLUSIONS

Tiludronate was found to significantly reduce bone resorption during immobilization, as well as to prevent long-term osteopenia in the immobilized limb. Disuse osteopenia did not affect the lateral superficial cortex of MCIII.

Tiludronate as a new therapeutic agent in the treatment of navicular disease: a double-blind placebo-controlled clinical trial

REASONS FOR PERFORMING STUDY

Bisphosphonates, such as tiludronate, are used to normalise bone metabolism via inhibition of bone resorption. Areas of increased bone resorption and formation are typical lesions in a diseased navicular bone.

OBJECTIVES

To determine if bone remodelling changes occurring in navicular disease may be corrected with therapies regulating bone metabolism.

METHODS

We designed a double-blind, placebo-controlled clinical trial to compare 2 doses of tiludronate, 0.5 mg/kg and 1 mg/kg bwt administered via daily i.v. injections over 10 days for the treatment of navicular disease. Seventy-three horses, split into 2 subpopulations of recent and chronic cases, were enrolled to be followed-up over 6 months. Of these, 33 recent and 17 chronic cases meeting the selection criteria were maintained in the final efficacy analyses. Clinical examinations were videorecorded and reviewed blindly by an independent expert.

RESULTS

Horses treated with the higher dose showed optimal improvement of lameness and return to normal level of activity 2-6 months post treatment. The more recent the onset of clinical signs at the time of treatment, the greater the efficacy. The treatment did not modify the response to extension and flexion tests. The lower dose failed to significantly improve the condition.

CONCLUSIONS

Tiludronate efficacy is demonstrated in the treatment of navicular disease at the dose of 1 mg/kg bwt.

POTENTIAL RELEVANCE

Our results support the clinical relevance of bone remodelling changes in the outcome of navicular disease.

[Diagnosis of phenylketonuria in a 35-year-old mother in relation to prenatal diagnosis of intrauterine growth retardation with microcephaly]

BACKGROUND

Some French pregnant women with phenylketonuria (PKU), born before 1978, have not been tested with the Guthrie method during the neonatal period. They have a risk of spontaneous abortion and their infants are often mentally retarded with microcephaly and/or congenital heart anomaly.

CASE REPORT

A woman with a moderate mental retardation became pregnant at the age of 31 years. Her newborn had a severe intrauterine growth retardation with microcephaly and developed mental retardation. This mother became pregnant again 4 years later. Repeated fetal ultrasonography showed progressive growth retardation. Maternal blood phenylalanine concentration was 18 mg/100 mL. Therapeutic abortion at 27 weeks of gestational age showed a fetus with several abnormalities, particularly cardiovascular and cerebral.

CONCLUSION

It is still possible to meet women with unrecognized atypical PKU. Fetus or infant born with unexplained growth retardation and microcephaly requires search for maternal PKU.

[Primary amenorrhea revealing congenital hydrocephalus]

Among the various endocrine manifestations of chronic hydrocephaly, amenorrhea is not exceptional, whereas late puberty and obesity are the most frequent. The hypothalamic gonadotropic function usually returns to normal within the few months following the ventricular shunt.

CASE REPORT

A 16 year-old girl, with a von Recklinghausen's disease, developed amenorrhea 2 years after the onset of puberty. X-rays of her skull showed an enlarged sella turcica and a diagnosis of hydrocephalus due to aqueductal stenosis was finally made. As her head circumference was retrospectively shown at +3 SD as early as the first month of life, the stenosis was certainly congenital, a feature known to occur in 2% of patients with von-Recklinghausen's disease.

CONCLUSION

In symptomatic forms of aqueductal stenosis, the preferred surgical procedure is ventriculocisternostomy under endoscopy. Recovery of intellectual functions is often incomplete. Early diagnosis of hydrocephalus is of paramount importance; ultrasonography through anterior fontanel should be proposed to any infant with head circumference reaching +3 SD.

[Acute anemia induced by rupture of a luteal cyst, aggravated by the ingestion of antivitamin K]

A case of hemoperitoneum secondary to the rupture of an ovarian cyst is reported in a 14 1/2 year-old girl. The severity of the bleeding was explained by anticoagulant therapy given during the previous 3 weeks for laceration of ankle ligaments which necessitated surgery. In this age group, the differential diagnosis with a ruptured ectopic pregnancy had to be considered. The relative prevalence (10%) of complications associated with antivitamin K administration is discussed.

Long-term evaluation of direct repair of traumatic isthmic aortic transection

Direct repair of traumatic aortic isthmic transection eliminates the late complications of prosthetic graft repair. This study evaluates the long-term fate of direct aortic repair to which little attention has been paid. Among 32 patients operated upon from 1965 to 1987, 27 (84%) underwent direct repair. The tear was circumferential in 15 patients and partial in 12. Multiple traumatic lesions were present in 26 patients, including intracranial injury in 19. Partial cardiopulmonary bypass was used in 15 patients and simple aortic cross-clamping in 12. No paraplegia was observed. There were 4 deaths from associated lesions among the 14 patients operated upon for acute traumatic isthmic transection and no deaths in the others. Among the 23 survivors, 4 were lost to follow-up; the other 19 patients have excellent clinical results. Intravenous digital aortic angiography performed in 14 patients at a mean delay of 5 years 3 months showed excellent aortic reconstruction in all cases. Technically more demanding and faster than a graft interposition, direct repair is recommended as the procedure of choice in the surgical treatment of traumatic isthmic transection, particularly in young patients, the group most at risk from this lesion.

Blastogenic response of peripheral blood lymphocytes from multiparous pregnant ewes

The immunocompetence of pregnant multiparous ewes was investigated with respect to the blastogenic response of peripheral blood lymphocytes of (PBL) to three mitogens: PHA, Con A, and PWM. The profile of PBL responses shows 1) progressive suppression at 36 and 66 days of gestation, 2) enhanced response at 97 days of gestation, which approaches the mean values observed at the premating period, and 3) a redecline of the response at 137 days of gestation to depressed values lower than observed at 36 and 66 days of gestation. The results suggest that mitogen-treated lymphocytes were depressed and that the immunodepressive factor(s), which can influence lymphocytes at the systemic level, may be involved in the maintenance of the ovine fetal semiallograft.

A prospective study of current diagnostic procedures for assessment of hepatic metastases in colorectal cancers

In a prospective study of 305 patients with colorectal cancers, we assessed the diagnostic value of ultrasonography and laboratory tests. In each case laparotomy was carried out and the presence of liver metastases was established in 47 patients. The results show that the laboratory tests alone are not sufficiently accurate to detect liver metastases. Additional accuracy can be obtained by the combined use of a single liver imaging test (echography) and selected laboratory tests (C.E.A., gamma GT, Alkaline Phosphatase).

[An unusual cause of near-miss sudden death in infants: intermittent volvulus of the small intestine on the mesenterium commune]

A 1 month-old girl presented with severe asphyxia during sleep. Her weight was the same as at birth. The day before the accident she had cried a great deal and had vomited her feeds. Small bowel volvulus was diagnosed. Surgical cure led to the disappearance of all symptoms with a one year follow-up. Episodes of asphyxia require detailed histories. Alkaline esophageal reflux may reveal an anatomic intestinal obstruction and lead to laryngospasm, identical to the one induced by acid reflux.

Colorectal cancer in patients under 40 years of age

In a review of 1037 patients with colorectal cancers, there were 32 patients below the age of 40 years (3 percent). Rectal bleeding and abdominal pain were the most common presenting symptoms. The average delay between the onset of symptoms and treatment was 6.5 months. An analysis of tumors according to Dukes' staging revealed no significant difference between young and elderly patients. The younger patients had a greater frequency of mucinous and poorly differentiated carcinoma. When compared by clinical staging, however, the young patient did as well or better than his older counterpart. Clinical staging was the most important prognostic factor, irrespective of age. No inherent difference was found in the virulence of the cancer in the young, and five-year survival rates were not significantly different in young and old patients (59 percent vs. 49 percent).

Facilitating low colorectal anastomosis. Preliminary results

Low anterior resection with a stapled anastomosis is the operation of choice for almost all rectal lesions in which the sphincter can be safely preserved. We have reported the results of a new technique using the EEA stapler. This method is easy and safe, it eliminates the use of a low pursestring suture, avoids spillage, and keeps contamination to a minimum. It also allows the joining of bowel segments of disparate sizes. The results of this technique used in 16 patients with colorectal anastomoses are encouraging.

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

Pelvic and perineal recurrences of cancer after rectal amputation are frequent, often isolated, and thus directly responsible for a fatal outcome by local decompression accidents or infection. This study explores the patterns of recurrence after "curative" operation for rectal cancers. One hundred thirteen patients who underwent abdominoperineal resection are reviewed: there were 36 local recurrences, i.e., an incidence of 31.8 percent. About 70 percent of these recurrences occurred within two years after surgical treatment. Low level of tumor in the rectum, local spread into perirectal fat or serosa, lymph node involvement, and histologic grade of malignancy were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

[Abscessed adrenal hematoma with arterial hypertension]

A neonate presented with anemia. Its relationship to bilateral adrenal hematoma was recognized only at one month of age, when hepatomegaly, inflammatory syndrome and hypertension associated with ultrasonographic findings suggested the diagnosis of right adrenal abscess with compression of the renal pedicle. The child underwent surgery at 6 weeks of age. Surgical drainage associated with antibiotic treatment led to recovery without sequelae. The authors consider the steps in the diagnosis of an abscessed hematoma in the presence of adrenal hematoma and the screening which may detect complications.

[Neonatal hypoglycemia due to hyperinsulinism secondary to Langerhans' polyadenomatosis. Recovery after pancreatectomy]

Report of a case of a neonatal hypoglycemia detected at the 11th hour of life, secondary to a Langherans polyadenomatosis in a girl with an hemihypertrophy. Pre- and post-operative tests are reported. In case of neonatal hypoglycemia, the criteria leading to the diagnosis of hyperinsulinism, i.e. the only neonatal hypoglycemia with surgical treatment are reviewed. Except in the case of adenoma, the pancreatectomy should be performed subtotally. The best time for surgery is as soon as the 3rd week, in order to preserve the cerebral development.