Bone loss and hematological malignancies in adults: a pilot study.

PURPOSE: Bone loss-osteopenia and osteoporosis-is a recognized consequence of solid tumors in adults, of pediatric hematological malignancies, and of the treatment for these diseases, but little research has been published on the adverse effects of hematological malignancies on the bone in adults. The aim of this study is to identify hematological diseases that are associated with the highest prevalence and severity of osteoporosis. METHODS: We evaluated DXA (dual-energy X-ray absorptiometry) in a cross-section of 181 adult patients with hematological neoplasms, excluding multiple myeloma. All patients were over 18 years of age, signed a local institutional review board (IRB)-approved consent form, and had completed a questionnaire regarding predisposing factors to osteoporosis. This data was supplemented by hospital charts. RESULTS: Bone loss as measured by DXA T scores was found in 65% of patients, of whom 38% had osteopenia and 27% osteoporosis. DXA Z scores under - 2.0 were found in 11.4% of patients, compared to the expected 2.5% of the normal population. The DXA Z scores varied by diagnosis, showing bone loss in 49% of chronic lymphocytic leukemia/small lymphocytic lymphoma, compared to 67% of non-Hodgkin lymphoma and 88% of Hodgkin disease; the scores were not affected by the duration of time from diagnosis to DXA (3.6, 2.0, and 1.6 years, respectively). CONCLUSION: Adult patients with hematological malignancies have significant bone loss compared to a normal age-matched population. The type of diagnosis is more important than the time from diagnosis in predicting risk for bone loss. Recognition of bone loss in these patients may warrant prophylactic measures and lifestyle changes before, during, and after therapy.

Serial casting for reconstruction of a deformed Charcot foot: a case report.

INTRODUCTION: Charcot neuroarthropathy may occur in patients with peripheral neuropathy who do not notice pain while their bones and joints collapse or breakdown under the constant pressure of body weight. This can lead to ulcerations from severe deformity and potentially limb-threatening and life-threatening infections. Current treatments vary from immobilization to extensive reconstructive surgical interventions. METHODS: Serial casting, used to correct many pediatric deformities while bones are often more pliable, was used with a 63-year-old male patient who presented with an active phase of Charcot foot with ulceration. The patient previously underwent foot reconstruction and had all hardware removed prior to serial casting. Due to the potential pliability of the bones, serial casting was attempted to reform the shape and position of the foot in a reverse Ponseti-type serial casting to create a more stable structure with less deformity that could lead to epithelial breakdown. RESULTS: The patient regained full ambulation with a plantargrade foot and no wounds, and was followed without complications for 36 months. CONCLUSION: Serial weekly casting was an effective modality for treatment of this patient's Charcot foot deformity.

Inhaled medicinal cannabis and the immunocompromised patient.

Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.

Traumeel S for pain relief following hallux valgus surgery: a randomized controlled trial.

BACKGROUND: In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain. METHOD: We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery. RESULTS: Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04). CONCLUSIONS: Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov. # NCT00279513.