SummaryA 36-month observational study compared the incidence of unaffected side hip fracture in Japanese female osteoporosis patients with a history of hip fracture between 173 patients receiving risedronate and 356 risedronate-untreated controls. New hip fractures were significantly less frequent in the risedronate group, suggesting a preventive effect in high-risk patients.IntroductionThe purpose of this study was to investigate the preventive effect of risedronate on second hip fracture immediately following a first hip fracture in Japanese female osteoporosis patients with unilateral hip fracture.MethodsWe conducted a prospective matched cohort study in 184 patients treated with risedronate and 445 patients not receiving risedronate after discharge from hospital. Both groups were followed-up for 36 months, and the incidence of unaffected side hip fracture and the frequency of adverse events were assessed.ResultsEfficacy could be investigated in 173 patients from the risedronate group and 356 patients from the control group. Hip fracture was detected in 5 and 32 patients, respectively. Kaplan–Meier estimates of the 36-month fracture incidence were 4.3% in the risedronate group and 13.1% in the control group (P = 0.010, log-rank test). The hazard ratios (95% confidence intervals) obtained by univariate and multivariate analysis were 0.310 (0.121–0.796) and 0.218 (0.074–0.639), respectively, indicating a significantly lower incidence of unaffected side hip fracture in the risedronate group. Adverse events occurred in 38 patients (48 events) from the risedronate group and 94 patients (108 events) from the control group, with serious adverse events in 21 patients (26 events) and 78 patients (88 events), respectively.ConclusionsNo significant differences were observed between the two groups. The incidence of unaffected side hip fracture was significantly lower in the risedronate group. Accordingly, risedronate may have a preventive effect on hip fracture in high-risk Japanese female osteoporosis patients for fracture with a history of unilateral hip fracture.
Characteristics of blood-flow velocities were investigated at different sites in two types of coronary artery bypass grafts, sequential saphenous vein grafts (SSVG) and internal mammary artery grafts (IMAG). The latter appear to have the longest life span. The patency rate of the side-to-side anastomosis of the SSVG is better than that of the end-to-side anastomosis. The SSVG was anastomosed to the major diagonal branch by side-to-side anastomosis and to the left anterior descending coronary artery (LAD) by end-to-side anastomosis in 13 patients who had 75-100% and 75-90% stenoses in the LAD and major diagonal branch, respectively. IMAG anastomoses were performed to the LAD in 10 patients with 75-100% stenoses of the artery. The blood-flow velocities were measured by the 20-MHz, eighty-channel ultrasound pulsed Doppler method during surgery. In six patients in the SSVG group, we investigated the configuration of velocity profiles at the region just proximal to the side-to-side anastomosis and at the bridge portion between the side-to-side and end-to-side anastomosis. In the other seven patients, we measured the blood-flow velocity at several centimeters proximal to the side-to-side anastomosis and compared it with that in the IMAG. At the region just proximal to the side-to-side anastomosis, the velocity profile skewed toward the anastomosis side wall in all patients, and the flow velocity near the wall opposite to the side-to-side anastomosis was reversed in five of six patients. In the bridge portion, directional changes in skewing of the velocity profile were recognized, that is, a skewed pattern toward the wall opposite to the anastomosis (four patients) or a symmetric pattern (two patients). The peak diastolic velocity in the region was 25.4 + 5.8 cm/sec, significantly lower than that (46.6 ± 12.3 cm/sec) just proximal to the side-to-side anastomosis. The velocity profile across the IMAG several centimeters proximal to the graft-coronary anastomosis showed a parabolic configuration with a narrow spectrum. The velocity profile in eight of 10 patients was statistically parabolic. In the SSVG, however, only two of seven patients were parabolic at the region several centimeters proximal to the side-to-side anastomosis. The peak diastolic velocity in the IMAG (26.6 + 2.0 cm/sec) was almost the same as that in the SSVG (26.3 ± 5.5 cm/sec), but the estimated graft diameter of the IMAG (2.3 ± 0.2 mm) was significantly smaller than that of the SSVG (3.4 ± 0.5 mm), indicating a relatively high shear rate in the IMAG. These findings may provide insight into the underlying mechanisms of graft viability because the patterns of blood flow seem to be a contributory factor in determining the fate of the graft. (Circulation 1988;78:1210-1217 From the Departments of Thoracic Surgery and Medical oronary bypass grafting is frequently perEngineering, Kawasaki Medical School, Kurashiki, Japan. formed to provide adequate perfusion to an
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