The cumulative effect of bisphosphonates and statins on stress fractures. Is it a failure of steroid biosynthesis? Case Report

Osteoporosis related fractures pose a significant economic and healthcare problem. There is a growing concern about increased numbers of stress or low energy fractures after bisphosphonates therapy. A 65-year-old woman is presented with a stress fracture of the left femur. From our point of view, this fracture was associated with a long-term statin and bisphosphonate therapy. We did not find a similar presentation in medical literature.

Is migraine a consequence of a loss of neurohormonal and metabolic integrity? A new hypothesis

OBJECTIVE

In 2002 we suggested a new hypothesis of migraine. This hypothesis implies that migraine is a consequence of a loss of neurohormonal and metabolic integrity. The goal of this clinical analysis is to present the evaluation of the effect of a multimodal treatment program in migraine management.

MATERIAL AND METHODS

We evaluated 30 patients ages 16-66 with migraine who were treated with a multimodal treatment program. All patients received a complex program which included: hormonorestorative therapy (HT) with bio-identical hormones; correction of balance between sympathetic and parasympathetic systems and simultaneously calcium/magnesium balance; "resetting" the pineal gland; improvement of intestinal absorption through restoration of normal intestinal flora, and a cleanse from parasitic infestation (if necessary). Serum levels of total cholesterol (TC), pregnenolone, dehydroepiandrosterone sulfate (DHEAS), progesterone, total estrogen, and total testosterone were determined,

RESULTS

All patients responded to this regimen. We do not have patients who still have migraine after they started to use this program. Laboratory finding prior to HT showed the significant deficiency in production of all basic steroid hormones (progesterone and pregnenolone production declined the most). Concurrent symptoms such as fibromyalgia, insomnia, depression, gastrointestinal disorders, and fatigue had disappeared. Total cholesterol completely normalized in 22 (91.7%) patients. No adverse effects or complications related to this program were registered.

CONCLUSIONS

Our findings support the hypothesis that migraine is a consequence of a loss of neurohormonal and metabolic integrity, and that migraine can be managed by a multimodal approach.

Correction of steroidopenia as a new method of hypercholesterolemia treatment

OBJECTIVE

In 2002 we proposed a new hypothesis of the etiology and pathogenesis of hypercholesterolemia. There is paucity of information in the literature regarding the association of steroidopenia and hypercholesterolemia. Our goal is to determine if the treatment of steroidopenia with hormonorestorative therapy (HT) to youthful levels will normalize total cholesterol (TC) levels.

MATERIAL AND METHODS

We retrospectively analyzed 43 hypercholesterolemic patients treated with HT. Laboratory workup included lipid profile, serum pregnenolone, dehydroepiandrosterone sulfate (DHEA-S), progesterone, total estrogen, cortisol, total testosterone, and vitamin D-3 levels at presentation with follow up ranging from 3 to 9 months. HT therapy included a combination of several agents such as pregnenolone, dehydroepiandrosterone (DHEA), triestrogen, progesterone, testosterone, hydrocortisone, and vitamin D-3.

RESULTS

HT lowered mean TC from 228.8 mg/dL to 183.7 mg/dL (19.7%) (p<0.05) in all patients. In 12 men of mean age 58, HT statistically significantly lowered TC from 227.9 mg/dL to 177.1 mg/dL (22.3%) (p<0.05). Apparently it did so mostly by lowering LDL and triglycerides (TRG) while HDL did not appreciably change. In 31women, mean age 57, TC declined from 229.2 mg/dL to 186.3 mg/dL (19%) (p<0.05). HDL, LDL, and TRG are also decreased to a statistically significant degree. These results were associated with statistically significant elevations in pregnenolone, DHEA Sulfate, testosterone, progesterone but not total estrogen, cortisol or vitamin D-3 changes in both men and women.

CONCLUSIONS

We conclude that correction of steroidopenia with the use of hormonorestorative therapy is an effective strategy for normalizing and maintaining cholesterol homeostasis.

Angiosarcoma replacing bone marrow--a case report

BACKGROUND

Clinical syndromes caused by marrow replacement by neoplastic cells are usually proven to arise from cells of hematopoetic or carcinomatous lineage. Diffuse marrow replacement by mesodermal origin sarcoma is rare in adults, and angiosarcoma replacing bone marrow is a very rare neoplasm.

METHODS

A case of bone marrow replacement by angiosarcoma in a 54-year-old African American man is described with a review of pertinent literature. The unique histopathologic features of this phenomenon are also described.

RESULTS

Histopathologic exam of trephine bone marrow biopsy revealed replacement of marrow spaces by a proliferating highly vascular malignant neoplasm with features of high-grade angiosarcoma.

CONCLUSION

Few reports in the literature describe angiosarcomatosis of the bone marrow. It is important to recognize this unusual presentation to avoid confusion with other more common bone marrow replacing entities and to promote recognition that more efficacious treatment is needed.

Hypercholesterolemia treatment: a new hypothesis or just an accident?

A new hypothesis concerning the association of low levels of steroid hormones and hypercholesterolemia is proposed. This study presents data that concurrent restoration to youthful levels of multiple normally found steroid hormones is able to normalize or improve serum total cholesterol (TC). We evaluated 20 patients with hypercholesterolemia who received hormonorestorative therapy (HT) with natural hormones. Hundred percent of patients responded. Mean serum TC was 263.5 mg/dL before and 187.9 mg/dL after treatment. Serum TC dropped below 200 mg/dL in 60.0%. No morbidity or mortality related to HT was observed. In patients characterized by hypercholesterolemia and sub-youthful serum steroidal hormones, our findings support the hypothesis that hypercholesterolemia is a compensatory mechanism for life-cycle related down-regulation of steroid hormones, and that broadband steroid hormone restoration is associated with a substantial drop in serum TC in many patients.

Postoperative beta irradiation for control of pterygium

PURPOSE

The purpose of this retrospective analysis is to assess the effectiveness of postoperative irradiation with a strontium 90 (Sr-90) contact applicator in the prevention of recurrence of resected pterygia.

METHODS AND MATERIALS

Thirty five patients were treated with Sr-90 postoperative radiation therapy performed immediately after surgery. The dose of irradiation was 2500 cGy in five fractions using a standard Sr-90 applicator.

RESULTS

The local control rate was 94.6% in the first year after surgery. Pterygia eventually recurred in 5.8% of the 52 eyes treated. In our study primarily treated patients remained recurrence free, but recurrences developed in three eyes irradiated after multiple previous excisions. No patient developed conjunctival ulceration, damage to cornea, eye pain, cataract or any other serious complications.

CONCLUSIONS

Postoperative irradiation was effective in preventing local recurrence after surgical removal of pterygium. In our experience, acute and late morbidity up to three years is nil. A very satisfactory dose/time/fractionation appears to be of 2500 cGy in 5 fractions starting immediately after surgical excision.