[2 cases of vertebral hydatidosis treated by the association of surgery and mebendazole]. / Deux cas d'hydatidose vertébrale traités par association chirurgie et mébendazol.

Two cases of vertebral hydatidosis were diagnosed only at the time of operation. The first one, a lumbar localisation treated as a tuberculosis, by posterior graft and chemotherapy went to a large vertebral destruction with paraplegia. An anterior approach revealed the hydatids. A large excision associated with graft and osteosynthesis gave only a temporary improvement, but the treatment by Mebendazol cured the neurological symptoms. The second case, with a large destruction of L5 and S1, was also treated as a tuberculosis even after a decompressive laminectomy and recognized at a second operation on the sacrum. A left paralysis, incompletely improved by a decompression, appeared as favourably influenced by Mebendazol. Epidemiologic conditions of hydatosis, difficulties of diagnosis of the rare bony localizations, are recalled. The great problem of treatment, especially in the most frequent vertebral lesions, where complete excision is impossible, appears as hopefully improved by Mebendazol.

Calcitonin versus etidronate for the treatment of postmenopausal osteoporosis: a meta-analysis of published clinical trials.

This review examines the evidence on the efficacy of calcitonin and etidronate in the prevention of osteoporosis and osteoporotic fractures. MEDLINE was searched for clinical trials calcitonin or etidronate and reviews of the treatment of postmenopausal osteoporosis. The reference sections of the papers retrieved were again searched for trials on the treatments of interest. Two people independently collected data from the trials that met the inclusion criteria of the study. Weighted means in the change in bone mineral density (BMD) and differences in vertebral fracture rates were computed for calcitonin and etidronate separately. The existence of publication bias was investigated by funnel plots of effect size against sample size. Eighteen clinical trials and calcitonin and six with etidronate were included in the meta-analysis. The pooled change in vertebral BMD at the end of the studies was 1.97 (95% CI 1.77 to 2.17) with calcitonin and 3.20 (95% CI 2.92 to 3.48) with etidronate. Pooled change in proximal femur BMD was 0.32 (95% CI -0.27 to 0.91) with calcitonin and 2.42 (95% CI 2.16 to 2.68) with etidronate. The aggregated number of vertebral fractures prevented by the treatment was 59.2 per 1000 patient-years (95% CI 55.1 to 63.3) for calcitonin and 28.3 (95% CI 26.2 to 30.4) for etidronate. With the available evidence we cannot establish the superiority of either of the two drugs for the treatment of postmenopausal osteoporosis. The clinical trials are particularly lacking in data on hip fracture, the most important consequence of osteoporosis. In this situation consideration of the relative costs of the drugs is prominent.

[Calcitonin in the treatment of osteoporosis: its use in a basic health area]. / Calcitonina para el tratamiento de la osteoporosis: su empleo en una zona básica de salud.

OBJECTIVES: To find the number of patients who receive calcitonin in a health district and to evaluate the quality of their treatments in terms of their completeness and of health promotion measures. DESIGN: A descriptive crossover study with a questionnaire. SETTING: A rural health district in Alicante province. PATIENTS OR OTHER PARTICIPANTS: 116 patients who attended the different clinics in the district and received calcitonin treatment. INTERVENTIONS: A questionnaire on treatment and health promotion advice was given to those patients located. We also checked through the existing clinical documentation. MEASUREMENTS AND MAIN RESULTS: The prevalence of treatment was 2.27 per 100 inhabitants over 45. The standardised ratio of consumption of calcitonin in the District was 0.663 of that in the Health Area and 0.631 of that in the Community of Valencia. Eighty-three of the treatments (78.3%) did not contain sufficient calcium salt and/or vitamin D, according to the criteria of the study. Thirty-one patients (29.2%) did not remember having received any recommendation on health promotion measures. There were no significant differences on account of the origin of, or responsibility for, the treatment. CONCLUSIONS: The prevalence of treatment in the district was less than in the Area and the Community of Valencia. Many of these treatments were incomplete in calcium and vitamin D. Recommendations about life-styles were remembered little. An effort is needed to make correct and integrated treatments.