Invasive Aspergillosis among Haematological Malignancy Patients in Ghana: A Pilot Study on Prevalence and Antifungal Prophylaxis at the National Referral Hospital.

BACKGROUND: Invasive aspergillosis (IA) among haematological malignancy patients is rarely diagnosed or studied in many African countries. Aspergillus galactomannan (GM) enzyme immunoassay (EIA) utilized in aiding diagnosis is not readily accessible in Ghana. Previous studies have evaluated the IMMY sona Aspergillus GM lateral flow assay (LFA) and suggested it as a potential alternative to the GM EIA. OBJECTIVES: We aimed to use the LFA in international (EORTC/ MSGERC) definitions to obtain preliminary data on IA among patients with haematological malignancies in Ghana with a focus on the prevalence and antifungal prophylaxis. METHODS: We conducted a pilot study among patients with haematological malignancies at the Korle-Bu Teaching Hospital, Ghana using the LFA, culture and computed tomography scan to screen for and classify IA cases according to international definitions. RESULTS: A total of 56 adult patients were recruited including acute leukaemia 14 (25.0%), chronic leukaemia 38 (67.9%), and lymphoma 4 (7.1%). Nine (16.1%) patients had a history of severe neutropenic episodes. All patients were on at least one chemotherapy drug. Three (5.4%) patients met the criteria for IA, comprising two probable IA in acute myeloid leukaemia and one possible IA in non-Hodgkin's lymphoma and constitutes one of five (20%) patients with ongoing severe neutropenia. The LFA was diagnostic in two IA patients. The IA cases were among 49 (87.5%) patients who did not receive antifungal prophylaxis. CONCLUSION: Proactive diagnostic approaches to IA and effective antifungal prophylaxis may be significant in the management of haematological malignancy patients with severe neutropenia in Ghana.

CONTEXTE: L'aspergillose invasive (AI) parmi les hémopathies malignes est rarement diagnostiquée ou étudiée dans de nombreux pays africains et le dosage immunoenzymatique (EIA) d'Aspergillus galactomannane (GM) utilisé pour faciliter le diagnostic n'est pas facilement accessible. Le test à flux latéral (TFL) IMMY sona® Aspergillus GM récemment introduit est évalué et suggéré comme alternative au GM EIA. OBJECTIFS: Nous avons cherché à utiliser les définitions TFA et les définitions internationales (EORTC/MSGERC) pour obtenir des données préliminaires sur l'AI dans les hémopathies malignes au Ghana en mettant l'accent sur la prévalence et la prophylaxie antifongique. MÉTHODES: Nous avons mené une étude pilote auprès de patients atteints d'hémopathie maligne à l'hôpital universitaire de Korle-Bu, au Ghana, en utilisant le TFL, la culture et la tomodensitométrie pour dépister et classer les cas d'AI selon les définitions internationales. RESULTATS: Au total, 56 patients adultes ont été recrutés, dont une leucémie aiguë (25 %), une leucémie chronique (67,9 %) et un lymphome (7,1 %), neuf (16,1 %) ayant des antécédents d'épisodes neutropéniques. La plupart des patients (70 %) avaient une maladie évolutive. Trois patients répondaient aux critères d'AI, comprenant deux AI probables et une AI possible, uniquement chez des patients atteints de leucémie aiguë et un sur cinq (20 %) avec une neutropénie en cours. Le TFL était utilisé comme méthode de diagnostique chez deux patients d'AI. Les cas d'AI concernaient tous les 49 (87,5 %) des patients n'ayant pas reçu de prophylaxie antifongique. CONCLUSION: L'AI a probablement une incidence de 5,4 % dans les leucémies, mais de 20 % chez les patients neutropéniques et chez aucun patient recevant une prophylaxie antifongique. Des approches diagnostiques proactives de l'AI et une prophylaxie antifongique efficace peuvent être importantes dans la prise en charge des hémopathies malignes au Ghana. Mots clés: Aspergillose invasive, Hémopathie maligne, Ghana, Aspergillus galactomannan, Neutropénie, Prophylaxie antifongique.

Probing the dynamics of highly excited toluene on the fs timescale.

Investigation of the dynamics of toluene-h8 (C6H5CH3), toluene-d8 (C6D5CD3) and toluene-α,α,α-d3 (C6H5CD3) has been performed utilizing the VUV pump-IR probe technique on the fs timescale. Using the 5th harmonic (∼160 nm) of a Ti:sapphire laser as the pump beam, two superimposed electronic states, the valence S3 and the Rydberg 4p, were excited by one-photon absorption, followed by ionization and dissociation induced by the probe beam (800 nm). Analysis of the transient signal of the parent (P(+)) and fragment ions ([P-H](+) or [P-D](+)) implies the existence of two different relaxation processes: (i) from the Rydberg and (ii) from the S3 valence state. Using a rate equation model, the decay times have been determined and comparison between the different isotopologues has been made. Conclusions on the relaxation path, the relative displacements of the potential energy surfaces and the activation energies needed have been drawn from the decay times. The signals corresponding to the fragment ions present a small in amplitude, but nonetheless, unambiguous periodical modulation, which is attributed to out-of-plane bending oscillation, involving also the methyl group. The dynamics of the H- and D-loss channels has been investigated. Especially for the case of toluene-α,α,α-d3, where both channels are in operation, it was found that the ratio of the abundance of H/D-loss dissociation reactions decreases as the pump-probe delay time increases.

Interaction of toluene with two-color asymmetric laser fields: controlling the directional emission of molecular hydrogen fragments.

The interaction of toluene with strong asymmetric two-color laser irradiation of 40 fs duration is studied by means of Time of flight mass spectrometry. Highly energetic H2(+) and H3(+) fragment ions are produced through an isomerization process taking place within transient multiply charged parent ions. Comparative study of deuterium labeled toluene isotopes enables the discrimination between molecular hydrogen fragments formed exclusively within the CH3- part from those that require hydrogen atom exchange between the former and the phenyl moiety. It is demonstrated that by manipulating the relative phase of the ω/2ω field components the selective ionization of oriented toluene molecules can be used as a tool to control the directional emission of the H2(+), H3(+) species.

Selective ionization/dissociation of oriented N2O molecules by asymmetric fs laser field.

We report on the selective ionization of oriented nitrous oxide (N2O) molecules in gas phase by the use of an intense asymmetric two-color ω/2ω 40 fs laser field. By means of a time-of-flight mass spectrometer the induced N2O mass spectra have been recorded as a function of the relative phase of the two-color laser fields. It is found that the applied method facilitates the distinction of different dissociation channels that result in fragments with the same mass and kinetic energy. Thus, the potential of the employed technique for phase control of the molecular excitation for the case of N2O is explored.

Optical encoding by plasmon-based patterning: hard and inorganic materials become photosensitive.

The photosensitivity of nanocomposite AlN films with embedded silver nanospheres is reported. It stems from localized surface plasmon resonances (LSPR) whose modulation is photoinduced by laser annealing that induces a combined effect of metallic nanoparticle enlargement and dielectric matrix recrystallization; the photoindunced changes of the refractive index of the matrix result in strong spectral shift of LSPR. We demonstrate the utilization of this process for spectrally selective optical encoding into hard, durable, and chemically inert films.

Impact of self-reported environmental mould exposure on COPD outcomes.

BACKGROUND: Indoor and outdoor mould exposure can affect respiratory symptoms, but its contribution to COPD outcomes such as exacerbation rates or antibiotics courses is not well defined. Some patients with COPD develop chronic pulmonary aspergillosis (CPA), but the contribution of environmental exposure is not known. METHODS: We correlated activities or exposures related to mould with COPD outcomes in patients with COPD with or without CPA using a questionnaire. RESULTS: One hundred and forty patients were included and 60 had CPA in addition to COPD. Seventy-six were male and mean age was 66.9 years (range 40-87). Thirty-nine (28%) were active cigarette smokers. On multivariate analysis, occupational contact with agricultural resources (p = 0.017), vacuuming once weekly or more often (p = 0.026) and not asking visitors to remove shoes on home entry (p = 0.035) were significantly more common in participants reporting ≥ 4 office visits for COPD symptoms in the last year. Living within one mile of industrial composting sites (p = 0.013), vacuuming once weekly or more often (p = 0.016) and not asking visitors to remove shoes on home entry (p = 0.028) were significantly more common in participants reporting ≥4 antibiotics courses in the last year. Patients with CPA showed a trend for residence within one mile of farms or agricultural areas (P = 0.088, OR 2, 95% CI 0.9-4.4). CONCLUSION: Activities potentially leading to mould exposure were common in a population with COPD with or without CPA and were associated with adverse COPD outcomes. Environmental mould exposure may play a role in the development of CPA in patients with COPD.

Formation of molecular halide ions from alkyl-halide clusters irradiated by ps and fs laser pulses.

We report on the interaction of alkyl-halide clusters with 35 ps and 20 fs laser pulses at λ = 266, 532, and 1064 nm and 400 and 800 nm, respectively. Particularly, we examine by means of time-of-flight mass spectrometry the intracluster photochemical processes, which give rise to the formation of molecular halogen ions. The efficiency of molecular halogen ion formation is found to depend strongly on the laser wavelength and pulse duration. The ionization/excitation schemes involve in both cases the multiphoton absorption by the clusters and the combined action of the laser and the intracluster electric field. Intracluster energy transfer processes seem to have a significant contribution to the molecular halogen ion formation in the ps domain, while in the fs region, this is probably facilitated by a rescattering process and/or by photon absorption. A physical mechanism for the interpretation of our experimental results is proposed.

Emergency and elective surgery for small bowel Crohn's disease.

Advancements in the medical treatment of Crohn's disease have reduced the need for surgery. The indications for surgery include the failure of medical management, especially the persistence or worsening of symptoms in spite of proper treatment and complications of the disease process. These complications include intestinal obstruction, intestinal perforation with fistula formation or abscess, free perforation, gastrointestinal bleeding, urologic complications, cancer, and perianal disease. In these cases, operative therapy should be directed to the specific indication for surgery, resecting only the segment of bowel involved in the complicating process while preserving as much bowel length as possible in order to prevent short-bowel syndrome. Laparoscopic surgery has been gaining acceptance as an alternative surgical approach for properly selected patients with Crohn's disease. In conclusion, identifying the need for surgery and determining the timing of operation are the cornerstones to successful surgical management of patients with Crohn's disease.

Laparoscopic low anterior resection for early rectal cancer.

INTRODUCTION: Early rectal cancer (ERC) is adenocarcinoma that has invaded into, but not extended beyond, the submucosa. Endoscopic or minimal access surgical procedures, such as laparoscopic resection, have emerged as a useful tool in the surgical treatment of such diseases. The aim of this study is to present and analyze the feasibility, the short- and long-term results of laparoscopic colorectal surgery (LCS) in patients with ERC. PATIENTS AND METHODS: Between 2002 and 4/2011, a total of 164 patients with colorectal cancer underwent laparoscopic surgery (LS). Of these, 7 patients (4.2%) had ERC and underwent laparoscopic anterior resection (LAR). The median follow-up was 41 months. RESULTS: The mean operative time was 2.5 h. None of the laparoscopic procedures was converted to open surgery. Liquids and solid food were started on median postoperative days 1 and 3, respectively. The median length of postoperative stay was 5 days. Postoperative complications occurred in 2 patients (28.5%), including wound infection in one patient (14.2%) and atelectasis in one patient (14.2%). None of the patients required an urgent re-operation. There was no mortality related to LS. CONCLUSIONS: LS for ERC can be used as a strategy sited between endoscopic mucosal resection and open anterior resection with beneficial long- and short-term results. It appears as a technically and oncologically safe procedure when performed by surgeons with sufficient experience in laparoscopic techniques.

Breast cancer metastatic to the rectum: a case report.

INTRODUCTION: Patients with breast cancer may present with systemic recurrence in any organ, primarily the bones, lungs, lymph nodes, liver, pleura, and adrenal glands. We report a case of rectal tumor, metastatic from breast cancer, which represents an unusual location of metastasis. CASE PRESENTATION: A 74-year-old woman, operated for lobular breast cancer 5 years ago, but not compliant with the annual follow-up, presented with severe constipation and pseudodiarrhea. Digital examination and anoscopy revealed a mass at the lower rectum, 2 cm distant from the anal verge. CT and MRI scan of the abdomen confirmed this finding and did not reveal metastatic lesions elsewhere. The patient underwent abdominoperineal resection. RESULTS: The postoperative period was uneventful, and the patient was discharged on the 7th postoperative day. The histopathological findings revealed rectal cancer, metastatic from the known invasive lobular breast cancer. CONCLUSIONS: Rectal metastasis from breast cancer is very rare. The presented case emphasizes the need to keep in mind this possibility and at all times associate the emergency condition with the related history of breast cancer.

Cecal volvulus after twin gestation: laparoscopic approach.

INTRODUCTION: Intestinal obstruction in pregnancy is not common. Colonic volvulus occurs in 24% of such cases. Due to the rare incidence and lack of imaging during pregnancy, correct diagnosis is often delayed. CASE PRESENTATION: We present a case of a 33-year-old female with a twin pregnancy gestation, who presented with acute abdominal pain. Physical examination revealed a gravid uterus and tenderness in the lower abdominal quadrants. Due to intense uterine contractions, the patient was urgently submitted to cesarean delivery, giving birth to two healthy infants. Twelve hours after the cesarean section, right lower quadrant abdominal pain was persistently severe. Nausea, vomiting, diarrhea, and abdominal dilatation were also present. Abdominal X-ray and CT scan showed bowel obstruction, possibly secondary to cecal volvulus. The patient was subjected to explorative laparoscopy, cecal volvulus detorsion, and laparoscopic appendectomy. RESULTS: The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. CONCLUSIONS: Cecal volvulus in pregnancy is a rare, difficult to diagnose, clinical entity. It is associated with high morbidity and mortality, both of mother and fetus, because of delayed diagnosis. A high index of clinical suspicion is required in pregnant or puerperant women with signs and symptoms of bowel obstruction and persistent pain at the right low abdominal quadrant. As long as diagnosis is timely set, laparoscopy is a safe and successful means of surgical treatment.

The ejection of triatomic molecular hydrogen ions H(3) (+) produced by the interaction of benzene molecules with ultrafast laser pulses.

The ejection process of triatomic molecular hydrogen ions produced by the interaction of benzene with ultrafast laser pulses of moderate strong intensity ( approximately 10(14) W/cm(2)) is studied by means of TOF mass spectrometry. The H(3) (+) formation can only take place through the rupture of two C-H bonds and the migration of hydrogen atoms within the molecular structure. The H(3) (+) fragments are released with high kinetic energy (typically 2-8 eV) and at laser intensities >or=10(14) W/cm(2), well above that required for the double ionization of benzene, suggesting that its formation is taking place within multiply charged parent ions. The relative ejection efficiency of H(3) (+) molecular hydrogen ions with respect to the atomic ones is found to be strongly decreasing as a function of the laser intensity and pulse duration (67-25 fs). It is concluded that the H(3) (+) formation is only feasible within parent molecular precursors of relatively low charged states and before significant elongation of their structure takes place, while the higher multiply charged molecular ions preferentially dissociate into H(+) ions. The ejection of H(2) (+) ions is also discussed in comparison to the production of H(3) (+) and H(+) ions. Finally, by recording the mass spectra of two deuterium label isotopes of benzene (1,2-C(6)H(4)D(2), 1,4-C(6)H(4)D(2)) it is verified that the ejection efficiency of some molecular fragments, such as D(2)H(+), DH(+), is dependent on the specific position of hydrogen atoms in the molecular skeleton prior dissociation.

A fatal case of cutaneous zygomycosis in a patient with severe metabolic acidosis.

We present a case of cutaneous zygomycosis in a patient with an ureteroileostomy and severe metabolic acidosis, but without diabetes. The patient died despite multiple aggressive surgical interventions and antifungal therapy with liposomal amphotericin B. Ureteroileostomy-related acidosis can be a predisposing factor for zygomycosis. Metabolic acidosis can have a role in the severity of cutaneous disease.

Horner's Syndrome: An Uncommon Complication of Thyroidectomy and Selective Lateral Neck Dissection.

BACKGROUND: Horner's Syndrome is defined by myosis, enophthalmos, lack of sweating and eyelid ptosis, as well as vascular dilatation of one half of the face, caused by damage of the ipsilateral cervical sympathetic chain. It is known that Horner's syndrome is an unusual complication of thyroidectomy and selective lateral neck dissection. Its exact pathophysiology is not totally explained and its treatment remains conservative. CASE PRESENTATION: A 27-year-old man developed one-sided partial eyelid ptosis, enophthalmos and myosis two hours after a total thyroid gland excision and a selective lateral neck dissection for papillary carcinoma. A clinical diagnosis of Horner's syndrome was formed. He was treated conservatively and presented with an incomplete recovery at a 2-month follow up. CONCLUSIONS: The present case report underlines the adjacent anatomical correlation between the thyroid gland, the celluloadipose tissue and the cervical sympathetic trunk throughout thyroidectomy and selective lateral neck dissection. Every surgeon should be familiar with the potential complications in order to preoperatively counsel patients, as well as avoid them during the surgical procedure.

Ongoing epidemic of blaVIM-1-positive Klebsiella pneumoniae in Athens, Greece: a prospective survey.

OBJECTIVES: To determine the current frequency and study the characteristics of VIM-1-producing Klebsiella pneumoniae isolates from bloodstream infections in Greek hospitals. METHODS: All blood isolates of K. pneumoniae were prospectively collected during 2004-06 in three teaching hospitals located in Athens. MICs of antibiotics were determined by the Etest. Extended-spectrum- (ESBL) and metallo-beta-lactamase (MBL) production was examined by clavulanate- and EDTA-based techniques, respectively. Isolates were typed by PFGE of XbaI-digested genomic DNA. Detection of bla(VIM-1) and mapping of the VIM-1-encoding integrons were performed by PCR and sequencing. Beta-lactamase activities were analysed by IEF and imipenem hydrolysis was assessed by spectrophotometry. VIM-1-encoding plasmids were transferred to Escherichia coli by conjugation and transformation and characterized by Inc/rep typing and RFLP. RESULTS: Sixty-seven (37.6%) of 178 K. pneumoniae blood isolates were bla(VIM-1)-positive (VPKP); 77.8% of these were from ICUs. All VPKP isolates were multidrug-resistant. The MICs of carbapenems for VPKP varied from the susceptible range to high-level resistance overlapping with those of MBL-negative isolates. The EDTA-imipenem synergy methods had reduced sensitivity in detecting VPKP isolates when the MICs were in the susceptible range. ESBL production was common among VPKP isolates (n = 45, 67.2%) as indicated by resistance to aztreonam and confirmed by a clavulanate-based double-disc synergy test. The responsible ESBL was always an SHV-5-type enzyme as indicated by IEF. PFGE identified eight clusters (A-H) of VPKP isolates with related (>80%) patterns, as well as four unique types. Both inter-hospital spread of several clones and genotypic similarities among susceptible, ESBL-positive and VPKP isolates were also observed. Location of bla(VIM-1) and expression of VIM-1 were studied in 12 isolates representing the eight PFGE clusters. In all isolates, bla(VIM-1) was part of a class 1 integron that also carried aacA4, dhfrI, aadA and sulI. In eight isolates (clusters C, D, G and H), the bla(VIM-1) integron was located in transferable IncN plasmids. A cluster F isolate carried a VIM-1-encoding, self-transferable plasmid that was not typeable by Inc/rep typing. VIM-1-encodingreplicons were not identified in three isolates (PFGE clusters A, B and E). VPKP isolates exhibited differences in imipenem-hydrolysing activities which, however, were not correlated with the respective carbapenem MICs. CONCLUSIONS: A multiclonal epidemic of bla(VIM-1)-carrying K. pneumoniae is under way in the majorhospitals in Greece. Microorganisms producing both VIM-1 and SHV-5 constitute the prevalent multidrug-resistant population of K. pneumoniae in this setting.

Chromogranin a levels in diagnosis, treatment and follow-up of 42 patients with non-functioning pancreatic endocrine tumours.

BACKGROUND/AIMS: Non-functioning pancreatic endocrine tumours (NFPET) constitute the largest component (35-50%) of pancreatic endocrine tumours. They are characterized by the absence of symptoms of hormone hypersecretion and frequently have clinical manifestations similar to the more common exocrine pancreatic adenocarcinoma. The present studyaims toevaluate the clinical features, diagnostic approach and, in particular, the significance of serum chromogranin A levels (CgA) in the management and outcome of 42 patients with NFPET (from a series of 121 patients with pancreatic endocrine tumours). METHODS: Twenty-five males and 17 females were included, and the mean age at diagnosis was 52.3 years (range: 26-68 years). The diagnosis for each patient was established by histopathological examination and immunohistochemistry. After the histopathological confirmation of diagnosis and during the follow-up period, patients were evaluated clinically and radiologically (including OctreoScan), whilst fasting gut hormones (including CgA) were also estimated. At diagnosis, all patients were checked for the presence of multiple endocrine neoplasia type I syndrome. The follow-up was complete and ranged from 12 to 86 months (mean: 49 months). RESULTS: Dyspepsia (66.5%) and weight loss (47.6%) were the most common symptoms at diagnosis, while in 21.4% of patients tumour lesions were revealed incidentally. Plasma CgA levels were significantly or moderately elevated in all patients with liver metastases at diagnosis (64.3%). The levels also reflected tumour progression or response to treatment during the follow-up period. OctreoScan showed avid uptake in 77.8% of patients with hepatic metastases. Moreover, in 2 patients OctreoScan revealed unexpected metastatic mesenteric deposits, which had not been found by the other studies. However, it was negative in 6 patients with liver metastases, in whom tumours were proved to be poorly differentiated (high-grade). CONCLUSIONS: (1) NFPET may present with clinical manifestations similar to those of an exocrine pancreatic tumour; (2) plasma CgA levels reflect tumour load, and also seem to correlate with tumour progression or response to treatment; (3) surgeryin patients with localized disease at presentation can be curative, while it can also reduce tumour burden in patients with metastases; (4) long-acting somatostatin analogues provide good quality of life and temporary disease stabilization in patients with low-grade tumours; (5) systemic chemotherapy or chemoembolization seem to be beneficial in high-grade and progressive tumours.

Alignment of ethyl halide molecules (C2H5X, X= I, Br, Cl) induced by strong ps laser irradiation.

The alignment of polyatomic molecules under strong 35 ps laser irradiation is investigated for a broad range of laser intensities (10(13)-10(15) W/cm(2)) using time-of-flight mass spectrometry. The dynamic alignment of the molecules under study (C2H5X, X = I, Br, Cl) is verified in single-pulse experiments by recording the fragments' angular distributions, their dependence on the laser intensity, and also the comparison of the ionic signal of the various fragments recorded for linear and circular polarization. For all cases, the angular distributions of the Coulomb explosion fragments are found to be independent of the laser peak intensity, implying that the molecular alignment is taking place during the rise time of the laser pulses at relatively low intensities (approximately 10(13) W/cm(2)). Moreover, the same result implies that the alignment mechanism is close to the adiabatic limit, albeit the laser pulse duration is much shorter than the characteristic rotational times (1/2B) of the molecules under study. Finally, by comparing the angular distributions of the different molecules, we conclude that the degree of alignment is only weakly dependent on the molecular mass and the moment of inertia under the irradiation conditions applied.

Ultrafast laser pulse chirp effects on laser-generated nanoacoustic strains in Silicon.

Nanoacoustic strains are generated in Silicon by chirped femtosecond laser pulses using thin Titanium films as transducers. We investigate the effect that the generating laser pulse chirp has on the amplitude of the induced strains, manifested as Brillouin oscillations observed in degenerate femtosecond pump-probe transient reflectivity measurements. The strain amplitude is larger when negatively chirped pulses are used, which is attributed to the more efficient conversion of laser pulse light into acoustic strain in the Titanium transducer. Our present studies clearly show that the dependence of the Brillouin amplitude and the lattice strain is a non-monotonous function of the laser chirp parameter. An optimum negative laser pulse chirp is found for which the strain amplitude is maximized. A detailed thermomechanical model satisfactorily supports the experimental findings. In such a way, it is possible to suppress or enhance the induced nanoacoustic strain amplitude, thus all-optically controlling it by at least a factor of two.

Effect of intermittent administration of 200 IU intranasal salmon calcitonin and low doses of 1alpha(OH) vitamin D3 on bone mineral density of the lumbar spine and hip region and biochemical bone markers in women with postmenopausal osteoporosis: a pilot study.

A 1-year prospective, open, randomized, controlled trial was conducted as a pilot study to examine the effect of intermittent administration of 200 IU intranasal salmon calcitonin and 1alpha(OH) vitamin D3 [1alpha(OH)D3] on bone mineral density (BMD) of the lumbar spine and hip as well as on the markers of bone metabolism in women with postmenopausal osteoporosis. A total of 102 randomly recruited women received either 200 IU intranasal salmon calcitonin (Miacalcic nasal 200, Novartis, Basel, Switzerland) daily, 1 month on-1 month off, 0.25 mug 1alpha(OH)D3, and 500 mg elemental calcium continuously (n=57 women) or only 0.25 mug 1alpha(OH)D3 and 500 mg calcium (n=45 women) for a period of 1 year. BMD of the lumbar spine and hip plus biochemical markers reflecting calcium (Ca) metabolism and bone turnover [serum Ca, serum phosphorus, intact parathormone (iPTH), total and bone-specific alkaline phosphatase, osteocalcin levels, 24-h urinary Ca, morning fasting urinary Ca/creatinine, and Pyrilinks-D/creatinine ratio] were measured at the beginning of the study before treatment and after 6 and 12 months of treatment. Baseline characteristics of participants, including age, body mass index, lumbar and hip BMD, and biochemical markers were similar between the two groups. A total of 91 patients completed the study (50 in the salmon calcitonin nasal spray group and 41 in the other group). Lumbar BMD increased significantly in the salmon calcitonin group from baseline (3.0%, p=0.005) and in comparison to the non-calcitonin-treated group (p=0.009). The salmon calcitonin group also had a significant increase in femoral neck BMD compared with baseline values (3.1%, p=0.0005) and in comparison to the non-calcitonin-treated group (p=0.0005) in Ward's triangle BMD (2.9% from baseline values, p=0.009) and in comparison to the non-calcitonin-treated group (p=0.005) in trochanteric BMD (3.4% from baseline values, p=0.007) and in comparison to the non-calcitonin-treated group (P=0.01). Urinary Ca/creatinine and Pyrilinks-D/creatinine levels were significantly decreased from baseline in the salmon calcitonin-treated group (-6.1 and -6.3%, respectively, p=0.001). Bone-specific alkaline phosphatase levels were also significantly decreased from baseline in the salmon calcitonin-treated group (-3.6%, p=0.003). In the same group, a significant decrease in iPTH serum levels compared to baseline values (-2.5%, p=0.005) and in comparison to the non-calcitonin-treated group (p=0.005) was noted. In conclusion, in this pilot study, 1-year intermittent treatment with 200 IU intranasal salmon calcitonin and low doses of 1alpha(OH)D3 produced a significant effect on bone turnover and BMD in postmenopausal women with osteoporosis.