[Serum thiopental values, spontaneous frontal muscle electromyography activity and compressed EEG amplitudes and frequency values in thiopental infusion anesthesia]

Serum thiopentone (S-Thiop) was estimated every 10 minutes using a new high performance liquid chromatographic method during fentanyl-bolus-complemented (0.01 mg) thiopentone infusion anaesthesia (bolus of 5 mg/kg, infusion dosis 23.7 mg/min) for laryngo-microscopic procedures. Before stopping the infusion after 18/17 min (SD 8/5) (male/female) S-Thiop was (mean (SD) range) 16.0/12.4 (4.6/5.7) 5.9-26.8/5.1-26.6 mg/l; after stop of the infusion 12.8/10.5 (4.5/5.3) 7.6-25.5/4.5-23.4 mg/l. Patients reacted to verbal command after 11.5 (10.3) 11-81 min. There were no clinically relevant correlations between S-Thiop and frontal EMG and compressed 1-channel-EEG (ABM, Datex, Helsinki), nor with data recorded during recovery. Reasons may be: the total depolarisation block caused by succinylcholine; the method of compressing the EEG; subjective influences on the recording of recovery data; sampling in intervals of 10 min instead of at certain points of the anaesthesia course. We still recommend this total i.v.-anaesthesia for the short time endolaryngeal procedures need; before using this method for longer periods additional pharmacokinetic studies should be performed.

Vitamin D and mineral metabolism in intrahepatic cholestasis of pregnancy

Serum concentrations of 25(OH)D, 24,25(OH)2D, 1,25(OH)2D, total protein, calcium, phosphorus, magnesium and alkaline phosphatase were measured in patients with intrahepatic cholestasis of pregnancy and in control subjects at the third trimester of pregnancy and at delivery. 25(OH)D levels of 40.5 +/- 21.5 nmol/l in the patient group were initially significantly (P less than 0.01) higher than the value of 26.3 +/- 9.5 nmol/l in the control group and decreased significantly (P less than 0.01) to 26.0 +/- 16.3 nmol/l at delivery. The levels of active 1,25(OH)2D and inactive 24,25(OH)2D did not alter in either group. Also the concentrations of calcium, phosphorus and magnesium remained unchanged in both groups. No significant differences in fetal vitamin D metabolites were observed between patients and controls, and the other analysed fetal parameters were similar in both groups. Cholestyramine and/or phenobarbital treatment had no influence on vitamin D metabolites. Since levels of 1,25(OH)2D and mineral parameters remained normal and a change in 25(OH)D concentrations was only transient, the clinical role of 25(OH)D variations cannot be substantial.

Serum levels of vitamin D metabolites, calcium, phosphorus, magnesium and alkaline phosphatase in Finnish women throughout pregnancy and in cord serum at delivery

Serum concentrations of 25(OH)D, 24,25(OH)2D, 1,25(OH)2D, total calcium, protein, phosphorus, magnesium and alkaline phosphatase were measured in two groups of Finnish women throughout pregnancy and in cord serum at delivery. The autumn group delivered in August-September and the spring group in February-March. There was strong seasonal variation in the 25(OH)D concentrations in both groups. Maternal values (mean +/- s.d.) at delivery were 44.3 +/- 20.8 nmol/l in autumn and 26.0 +/- 13.0 nmol/l in spring. Fetal concentrations were 28.8 +/- 14.3 and 18.3 +/- 11.3 nmol/l, respectively. In both mothers and infants low 25(OH)D values were measured in winter. In the autumn group 7 out of 21 mothers (33 per cent) and in the spring group 17 out of 36 mothers (47 per cent) had values below 17 nmol/l, which is the lowest winter reference value recorded in our laboratory. No significant seasonal variation was observed in dihydroxylated vitamin D metabolites, although 24,25(OH)2D values were a little higher in summer than in winter. Concentrations of 1,25(OH)2D tended to rise towards delivery. Corrected calcium, magnesium and phosphorus concentrations did not change during pregnancy. Fetal calcium and phosphorus concentrations were significantly (P less than 0.001) higher than maternal ones. The data indicate that many mothers and infants have poor vitamin D status in the latitude of Finland. Our results support the concept that vitamin D supplementation should be considered in Finland for pregnant women at least in winter.

Plasma vitamin C levels are low in premature infants fed human milk

To evaluate the vitamin C nutritional status of premature infants, plasma vitamin C concentrations were measured in 7 neonates born before 32 wk of gestation and in 13 premature infants born at or after 32 wk of gestation. Samples of umbilical venous plasma from 14 full-term infants were analyzed to provide reference values. Oral feedings with pooled, pasteurized milk from human donors were initiated 1-3 days after birth and intake was gradually increased to 200 ml X kg X day during the second week. After 2 wk, the 13 larger infants received approximately half of their daily milk intake from their own mothers. Results showed that plasma concentrations of vitamin C decline rapidly after birth and approach very low levels in preterm infants fed pasteurized, pooled human milk.

Liquid-chromatographic detection of aspartylglycosaminuria

We describe a specific, simple liquid-chromatographic method for detecting the lysosomal storage disease aspartylglycosaminuria. The method is based on identification and quantification of the major storage compound 2-acetamido-1-L-beta-aspartamido-1, 2-dideoxy-beta-D-glucose in the urine of affected individuals. Sample preparation and chromatographic analysis requires 30 min. Within-day variation of the method was less than 4.4%, between-day variation less than 11.7% (n = 10 each).

Liquid-chromatographic detection of aspartylglycosaminuria

We describe a specific, simple liquid-chromatographic method for detecting the lysosomal storage disease aspartylglycosaminuria. The method is based on identification and quantification of the major storage compound 2-acetamido-1-L-beta-aspartamido-1, 2-dideoxy-beta-D-glucose in the urine of affected individuals. Sample preparation and chromatographic analysis requires 30 min. Within-day variation of the method was less than 4.4%, between-day variation less than 11.7% (n = 10 each).

Can the fetus regulate its calcium uptake?

To investigate the role of the fetus in vitamin D metabolism concentrations of vitamin D metabolites, 25(OH)D, 24,25(OH)2D and 1,25(OH)2D, were measured in human umbilical artery and vein. There were no differences between artery and vein in 25(OH)D and 24,25(OH)2D levels. 1,25(OH)2D concentrations were statistically significantly higher in the artery than in the vein. It has been shown in animal experiments that 1,25(OH)2D is an important factor in the maintenance of the placental calcium gradient. We suggest that the fetus actively produces 1,25(OH)2D and hence has the capacity to control its calcium influx.

Osteomalacia in fractures of the proximal femur

The occurrence of osteomalacia was studied in 58 hip fracture patients who were admitted to the University Central Hospital of Kuopio for operative treatment. Findings indicating osteomalacia were frequent in the series. Hypocalcaemia was found in 70 per cent and an increase in serum alkaline phosphatase in 22 per cent of the patients. Urinary calcium excretion was decreased in 45 per cent and urinary hydroxyproline excretion was increased in 70 per cent of the cases. The serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were significantly decreased in the patients compared with the controls. Histomorphometric analysis revealed no difference in the amount of trabecular bone in the patients compared with the controls, but the amount of osteoid and resorption surfaces was increased in the patients. Histological osteomalacia was found in 12 out of 50 patients (24 per cent). In 10 of these 12 cases the diagnosis of osteomalacia was supported by biochemical changes. There was only one patient, a 29-year-old man with glutein enteropathy who had an evident reason for osteomalacia. The most obvious cause of osteomalacia was the lack of vitamin D due to a deficient diet and lack of exposure to sunlight. The conclusion drawn was that osteoporosis was the main cause and osteomalacia was an important aggravating factor in the bone fragility in these hip fracture patients.

The effect of partial gastrectomy on bone mineral metabolism

The occurrence of postgastrectomy bone disease was studied in 42 patients who had been subjected to gastric surgery for duodenal or gastric ulceration 5-7 years earlier. Hypocalcemia, hypophosphatemia, and an increase in serum alkaline phosphatase were infrequent. No difference was observed in S-25OHD between the patients and controls, but S-24,25(OH)2D was higher in the patients. The bone mineral density (BMD) values showed no statistically significant difference between the patients and controls before or after the operation. There was a slight fall in BMD values during the follow-up period, but the decrease was similar in the patients and controls and was not statistically significant. The histomorphometric analysis revealed a greater amount of trabecular bone and osteoid in the patients. The means of the osteoid variables were well within normal limits, but a very slight increase in osteoid volume was observed in 4 of the 35 patients. It is concluded that a partial gastrectomy and vagotomy had not caused significant disturbances in bone mineral metabolism. The vitamin D status of the patients was good owing to the adequate dietary regimens that had been given to the patients.