Bomeza study
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This document summarizes several studies on the use of zoledronic acid to treat bone complications from various cancers. It finds that zoledronic acid is more effective than other bisphosphonates in preventing bone issues for prostate cancer, bladder cancer, and multiple myeloma. It also reduces skeletal complications and improves survival rates for lung cancer, kidney cancer, and other solid tumors. Additionally, zoledronic acid more effectively treats hypercalcemia of malignancy compared to pamidronic acid and prevents bone loss associated with breast cancer treatments. A combination study showed zoledronic acid safely prevented bone density loss in premenopausal breast cancer patients receiving tamoxifen or anastrozole.
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![Combi study of zoledronic and
anastrozole
? ¡°The results of this study indicate that zoledronic
acid¡effectively and safely prevents loss of [bone
density] in premenopausal patients treated with
either tamoxifen or anastrozole in combination
with [goserelin],¡± stated the authors. ¡°This is the
first report to demonstrate that the combination
of a bisphosphonate with an AI can effectively
and safely prevent [cancer-treatment induced
bone loss] in premenopausal women with early-
stage breast cancer.¡±](https://image.slidesharecdn.com/bomezastudy-150917153755-lva1-app6892/85/Bomeza-study-12-320.jpg)
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Anatomy of the Larynx
Larynx is a cartilaginous structure located in the **anterior neck** at the level of **C3¨CC6 vertebrae**.
* Also called the **voice box**¡ªresponsible for **phonation**, **airway protection**, and **breathing regulation**.
**Cartilages of the Larynx**
**Unpaired Cartilages:**
1. **Thyroid cartilage**:
* Largest cartilage; forms the **Adam¡¯s apple (laryngeal prominence)**.
* Composed of two laminae that fuse anteriorly.
2. **Cricoid cartilage**:
* Ring-shaped; **only complete ring** around the airway.
* Located below thyroid cartilage; articulates with thyroid & arytenoid cartilages.
3. **Epiglottis**:
* Leaf-shaped elastic cartilage.
* Covers the laryngeal inlet during swallowing.
**Paired Cartilages:**
1. **Arytenoid**:
* Pyramid-shaped; sit on top of cricoid.
* Attach vocal cords and muscles.
2. **Corniculate**:
* Small cartilages sitting atop the arytenoids.
3. **Cuneiform**:
* Embedded in the aryepiglottic folds; provide structural support.
**Intrinsic Muscles of the Larynx**
> Responsible for controlling **vocal cord movement**.
| Muscle | Action | Nerve Supply |
| **Cricothyroid** | Tenses vocal cords | External laryngeal nerve |
| **Thyroarytenoid** | Relaxes vocal cords | Recurrent laryngeal nerve |
| **Posterior cricoarytenoid** | Abducts vocal cords (opens glottis) | Recurrent laryngeal nerve |
| **Lateral cricoarytenoid** | Adducts vocal cords | Recurrent laryngeal nerve |
| **Transverse & oblique arytenoids** | Closes the posterior glottis | Recurrent laryngeal nerve |
| **Vocalis** | Fine-tunes pitch | Recurrent laryngeal nerve | **Nerve Supply*
* **Motor**:
* All intrinsic muscles (except cricothyroid): **Recurrent laryngeal nerve** (branch of vagus nerve).
* Cricothyroid: **External branch of superior laryngeal nerve**.
* **Sensory**:
* Above vocal cords: **Internal branch of superior laryngeal nerve**.
* Below vocal cords: **Recurrent laryngeal nerve**.
**Blood Supply**
* **Superior laryngeal artery** (branch of superior thyroid artery).
* **Inferior laryngeal artery** (branch of inferior thyroid artery).
**Laryngeal Cavity & Folds**
Divided into 3 regions:
1. **Vestibule** ¨C from inlet to vestibular folds (false cords).
2. **Ventricle** ¨C between vestibular and vocal folds.
3. **Infraglottic cavity** ¨C below vocal cords to trachea.
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1. The document provides information on Zoledronic acid 4 mg/100 ml Solution for Infusion, including its uses, posology, method of administration, contraindications and warnings.
2. It is used for prevention of skeletal related events in patients with advanced malignancies involving bone and for treatment of tumour-induced hypercalcaemia.
3. Dosing depends on renal function - normal renal function receives 4 mg every 3-4 weeks, while mild-moderate impairment receives reduced doses. It should be administered by intravenous infusion over at least 15 minutes.C¨¢ncer de Mama
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This document discusses bone health management in breast cancer patients receiving adjuvant therapies. Key points include:
- Studies have shown that zoledronic acid and denosumab can reduce bone mineral density loss and fracture risk in premenopausal and postmenopausal breast cancer patients receiving adjuvant aromatase inhibitors or tamoxifen.
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Anatomy of the Larynx
Larynx is a cartilaginous structure located in the **anterior neck** at the level of **C3¨CC6 vertebrae**.
* Also called the **voice box**¡ªresponsible for **phonation**, **airway protection**, and **breathing regulation**.
**Cartilages of the Larynx**
**Unpaired Cartilages:**
1. **Thyroid cartilage**:
* Largest cartilage; forms the **Adam¡¯s apple (laryngeal prominence)**.
* Composed of two laminae that fuse anteriorly.
2. **Cricoid cartilage**:
* Ring-shaped; **only complete ring** around the airway.
* Located below thyroid cartilage; articulates with thyroid & arytenoid cartilages.
3. **Epiglottis**:
* Leaf-shaped elastic cartilage.
* Covers the laryngeal inlet during swallowing.
**Paired Cartilages:**
1. **Arytenoid**:
* Pyramid-shaped; sit on top of cricoid.
* Attach vocal cords and muscles.
2. **Corniculate**:
* Small cartilages sitting atop the arytenoids.
3. **Cuneiform**:
* Embedded in the aryepiglottic folds; provide structural support.
**Intrinsic Muscles of the Larynx**
> Responsible for controlling **vocal cord movement**.
| Muscle | Action | Nerve Supply |
| **Cricothyroid** | Tenses vocal cords | External laryngeal nerve |
| **Thyroarytenoid** | Relaxes vocal cords | Recurrent laryngeal nerve |
| **Posterior cricoarytenoid** | Abducts vocal cords (opens glottis) | Recurrent laryngeal nerve |
| **Lateral cricoarytenoid** | Adducts vocal cords | Recurrent laryngeal nerve |
| **Transverse & oblique arytenoids** | Closes the posterior glottis | Recurrent laryngeal nerve |
| **Vocalis** | Fine-tunes pitch | Recurrent laryngeal nerve | **Nerve Supply*
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Bomeza study
- 1. Bomeza study
- 2. Zolendronic acid in Prostate cancer ? Zoledronic acid is effective than first and second generation bisphosphonates including etidronate, clodronate and pamidronate in preventing bone complications in patients with bone metastases secondary to prostate cancer ? European UrologyVolume 3, issue 5, pages 1-.62, November 2004
- 3. Zolendronic acid in bladder cancer ? Zoledronic acid decreased the incidence of (skeletal related events) SREs and improved the 1-year survival rate of patients with bone metastases from bladder cancer. ? Int J Clin Oncol.2010 April:1-8. ? Home palliative care, administered zoledronic acid used for bladder cancer with hypercalcemia ? Gan To Kagaku Ryoho. 2010 May;37(5):939-42.
- 4. Zoledronic acid in solid tumors ? Zoledronic acid has been shown to reduce SREs in patients with bone metastases from lung cancer, kidney cancer, and a broad range of other solid tumors. ? Oncologist. 2010 November; 15(11): 1147¨C 1158.
- 5. Zoledronic acid in hypercalcemia of malignancies ? Zoledronic acid is significantly more effective than pamidronic acid administered as a 2-hour infusion in the treatment of severe hypercalcaemia of malignancy, In patients with hypercalcaemia of malignancy, zoledronic acid is expected to become the treatment of choice. ? Drugs, Volume 63, Number 4, 2003 , pp. 417- 437(21)
- 7. Zoledronic acid in breast cancer ? Zoledronic acid is more effective than pamidronate in skeletal complication associated with breast cancer. ? Cancer.Volume 110, Issue 8, pages 1860¨C1867, 15 October 2007. ? Longer persistence with zoledronic acid was associated with lower SRE risk, and zoledronic acid treated patients had longer survival rate. ? zoledronic acid, induces apoptosis of breast cancer cells: evidence for synergy with paclitaxel ? Br J Cancer. 2001 April; 84(8): 1126¨C1134.
- 8. Breast cancer ? zoledronic acid can prevent bone loss associated with adjuvant endocrine therapy. in premenopausal patients ? J Clin Oncol. 2007 Mar 1;25(7):820-8. Epub 2006 Dec 11.
- 9. Multiple myeloma ? Zoledonic acid is more effective than pamidronate in lowering the skeletal related complication in multiple myeloma patinets ? Cancer ? Volume 98, Issue 8, pages 1735¨C1744, 15 October 2003 ?
- 12. Combi study of zoledronic and anastrozole ? ¡°The results of this study indicate that zoledronic acid¡effectively and safely prevents loss of [bone density] in premenopausal patients treated with either tamoxifen or anastrozole in combination with [goserelin],¡± stated the authors. ¡°This is the first report to demonstrate that the combination of a bisphosphonate with an AI can effectively and safely prevent [cancer-treatment induced bone loss] in premenopausal women with early- stage breast cancer.¡±