Alendronate in the treatment of avascular necrosis of the hip SIR, Avascular necrosis (AVN) of the bone results from decreased blood supply to the bone, resulting in bone death. The most common site is the head of the femur. AVN is characterized by persistent, often nagging and disabling pain associated with significant reduction in joint movement and mobility. The condition tends to run a progressively downhill course. Medical and surgical management generally aims to improve the blood supply by vasodilators and antiplatelet drugs or by physically drilling holes and bone grafting to restore the blood supply to the avascular area. Eighty-five per cent of patients with symptomatic AVN progress to endstage disease over a 2-yr period [1]. So far, there is no universally accepted treatment that relieves pain and halts its progression. In this communication we report our early experience with the use of alendronate, a bisphosphonate, in AVN of the hip. All cases of proven AVN seen by us between February and October 2000 were assessed. All grades of AVN were considered eligible. Patients were excluded if they had one or more of the following: inability to be followed up regularly, symptoms of oesophagitis or gastritis, age below 18 yr, lactation, and abnormal renal, liver or bone profile. Besides routine physical examination, parameters specifically studied were range of motion, standing and walking time in minutes, pain on visual analogue scale of 0-10 (0, no pain; 10, maximum possible pain) and disability on a scale of 0-10 (0, no disability; 10, totally handicapped). Baseline investigations included complete blood count, liver, renal and bone profiles, Serum 25 (hydroxy) vit D 3 and magnetic resonance imaging (MRI) of both hips. MRI was staged according to the classification of Mitchell et al. [2]. If both hips were affected, for MRI staging the stage of the maximally affected hip was used for analysis. All patients received alendronate 10 mguday plus a calcium supplement of 1 guday. Oral vitamin D 3 was administered to patients

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Spinal dysraphism is a common congenital anomaly with many associated variants. One of the rarest associated findings is a full grown or rudimentary third limb, collectively called Tripagus. We present two cases of spinal dysraphism with rudimentary third limb arising from the ilium.

We report a case of a 35-year-old multigravida with a chief complaint of 8 days of mild pain in the lower abdomen with history of vaginal hysterectomy 2 years prior. Ultrasonography and MRI showed a gestational sac-like structure with a fetal pole in the pelvis. Urine pregnancy test was positive with increased beta-HCG levels. Diagnosis of ectopic pregnancy was made. Surgical exploration and subsequent histopathology confirmed the sonographic findings.