Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol <100 mg/dl in patients with hyperlipidemia and coronary artery disease.

The efficacy, safety, and tolerability of a moderate dose, 3-drug lipid-lowering regimen were evaluated among 29 male patients with hyperlipidemia and coronary artery disease. In an initial 12-month phase, regular niacin, 500 mg qid, lovastatin, 20 mg bid, and colestipol, 10 g/bid, were given with dose adjustment for lipid targets and side effects. This was followed by 2 random sequence crossover phases (8 months each) alternating regular niacin with a polygel controlled-release formulation of niacin for use in this regimen. Lipid, lipoprotein, apoprotein, and clinical chemistry determinations were obtained at baseline, during the initial phase, at the 2 crossover phases, and at 6 weeks after therapy. A final questionnaire queried specific side effects and overall preferences. Low-/high-density lipoprotein (LDL/HDL) changed from means of 215/46 mg/dl at baseline, to 94/59 mg/dl after run-in, to 85/52 mg/dl after 8 months of controlled-release niacin, and to 98/56 mg/dl after 8 months of regular niacin (regular niacin vs controlled-release niacin, p <0.005/<0.05). The target of LDL < or = 100 mg/dl was achieved at 8 months by 83% of these patients with controlled-release niacin and by 52% with regular niacin (p <0.01). Compliance was 95% with controlled-release niacin versus 85% with regular niacin (p <0.001). The controlled-release niacin and regular niacin regimens did not differ in terms of uric acid, glucose, insulin, or asparate aminotransferase levels. Overall, 21% of patients called the 3 drugs "very easy" and 72% "fairly easy" to take. The controlled-release niacin-containing regimen was preferred by 21 patients and the regular niacin by 4. In conclusion, these regimens achieve striking lipid changes among hyperlipidemic patients. Controlled release is the preferred niacin preparation in terms of LDL reduction, compliance, patient preference, and achieving the National Cholesterol Education Program guideline of LDL < or = 100 mg/dl. The 2 niacin preparations did not differ in evidence of toxicity.

[Bone scintigraphy with 99mTc-methylene diphosphonate in parodontopathy (author's transl)]. / Knochenszintigraphie mit 99mTc-Methylen-diphosphonat bei Parodontopathien.

In a total of 20 patients (of these 8 without parodontopathy and 12 with parodontitis marginalis profunda), a quantitative scintigraphy of the jaw bones was carried out after application of 99mTc-methylene diphosphonate with a gamma camera computer system. In 8 patients without parodontopathies, approximately the same metabolic activity in the bone was found in the os occipitale as well as in the mandible and maxilla. The 12 patients with parodontitis marginalis profunda showed in contrast to this an appreciable raised bone metabolism in the region of the affected jaw bone. This finding was in agreement with corresponding alterations in the X-ray of the jaw. The use of bone scintigraphy in marginal parodontopathies thus provides in addition to the radiological finding information on processes of bone transformation and degradation which can be registered quantitatively. Digital analysis enables control of the course of therapie.

Accuracy of standard radiographic views in detecting cervical spine fractures.

Recent studies have challenged the accuracy of standard radiographs for detecting cervical spine injuries. We used thin-section tomography to determine the accuracy of the cross-table lateral view (CTLV) alone, and the three standard emergency department views (CTLV, anteroposterior, and open-mouth) together, for detecting acute cervical spine fractures. Seventy-one patients with blunt cervical spine injuries had thin-section tomography performed for the following indications: fracture, dislocation, or suspicious findings on standard radiographs; or persistent severe pain or neurologic deficit. Tomography detected acute fractures in 44 of the 71 patients. The CTLV had a sensitivity of 82%, specificity of 70%, and accuracy of 77% for detecting patients with fractures. The three standard views had a corresponding sensitivity, specificity, and accuracy of 93%, 71%, and 84%, respectively. Eight patients with fractures had the CTLV interpreted as normal, and three patients with fractures had all three standard views interpreted as normal. The use of thin-section tomography is recommended when there are suspicious radiographic or clinical findings suggesting a severe cervical spine injury.