Calcitonin and bone mass status in congenital hypothyroidism

Calcitonin (CT) deficiency and its possible repercussions on bone mass were studied in a group of 9 adult patients (7 females, 2 males) with congenital hypothyroidism of dysgenetic origin. Using a new extraction method (exCT) which considerably improves the sensitivity and the specificity of the assay for CT-monomer, we measured CT levels before and after a short calcium (Ca) stimulation test (2 mg Ca/kg over 5 minutes) to evaluate C-cell secretory reserve. Mean basal plasma CT concentrations were lower in the hypothyroid women (mean +/- SEM: 0.6 +/- 0.1 pg/ml) than in 30 normal female controls (1.7 +/- 0.2 pg/ml, P less than 0.001). Serum calcium increased similarly in the two groups, but postinfusion CT levels were lower in the hypothyroid women, (1.7 +/- 0.2 pg/ml) than in normal women (16.8 +/- 2.9 pg/ml), P less than 0.001. Hypothyroid women showed a 10% reduction in bone mineral content at the diaphyseal site in the radius, 0.840 +/- 0.037 g/cm, compared with normal age-matched controls, 0.930 +/- 0.020 g/cm, (P less than 0.05). Our study demonstrates the existence of a profound CT-monomer deficiency in adult patients with thyroid agenesis or dysgenesis. Both calcitonin deficiency and thyroid hormone treatment could play a role in the observed bone loss. Attention should therefore be paid to bone metabolism during treatment of congenital hypothyroidism to avoid further bone loss.

Involvement of low-calcium diet in the reduced bone mineral content of idiopathic renal stone formers

The possibility that low-calcium intake in renal stone formers could lead to reduced bone mineral content was investigated in 123 male patients with idiopathic urolithiasis. Radius bone mineral content (BMC) was measured by single photon absorptiometry. Two groups of patients were analyzed: group 1 (n = 63) maintained on a free diet; group 2 (n = 60) maintained on a low-calcium diet (350 mg/day +/- 20 SEM) for 3.9 years +/- 0.6 SEM. The two groups of patients were investigated after a standard reduction of calcium intake for at least 1 week. The urinary excretion of calcium and of hydroxyproline, and the serum alkaline phosphatase activity were higher in both groups than in normal subjects submitted to the same low-calcium diet. Both groups of stone formers showed lowered radius BMC values at 3 cm (distal) and 8 cm (proximal) above the styloid process, but distal BMC was significantly lower in group 2 than in group 1. The results suggest that low-calcium intake could worsen the already decreased BMC of idiopathic renal stone formers.

[Local factors in bone repair]

Besides the systemic hormones (parathyroid hormone, calcitonin...), several local factors act on bone resorption and formation. These factors are released by cells of the bone microenvironment (hematopoietic cells, fibroblasts, endothelial cells...) and also by bone cells, mainly of the osteoblastic lineage. Among the factors which increase locally bone resorption ("osteoclastic activating factors, OAF"), interleukin 1, acting alone or synergistically with tumor necrosis factor, seems to be the most potent. As parathyroid hormone, it does not act directly on osteoclasts, but stimulates cells of the osteoblastic lineage to secrete unknown factors stimulating resorption. Prostaglandins E have been thought to be among these soluble factors secreted by osteoblasts or osteoblast precursors which stimulate bone resorption directly, but it appears now that the direct effect of prostaglandins on the osteoclasts is inhibitory. Several growth factors are secreted by cells of the osteoblastic lineage and by other bone cells. They are stored in the bone matrix, from which they are released and activated during resorption. The most important are IGF-I, IGF-II, and TGF beta. These growth factors stimulate replication of the osteoblast precursors and collagen synthesis by osteoblasts, and could be responsible for the well known coupling between resorption and formation. TGF beta also seems to inhibit replication of osteoclast precursors, and could thus stop the resorption process. It seems now that estrogens and physical stress act on bone at least in part by modulating the equilibrium between these local factors which act on resorption and formation.

Low basal thyrotropin with normal thyroid function in primary hyperparathyroidism

TSH serum levels and thyroid function in 32 patients with primary hyperparathyroidism and hypercalcemia were compared to those of 30 age and sex-matched normal subjects. Serum T3 and T4 concentrations in hyperparathyroidism were not different from normal. However, basal serum TSH concentrations measured with an ultrasensitive immunoradiometric assay were significantly lower than normal (1.09 +/- 0.49 vs 2.06 +/- 0.85 mU/l, p less than 0.001). In hyperparathyroidism, TSH, but not T4 or T3, was negatively correlated with serum calcium, not with iPTH. The increase in TSH (delta TSH) 30 min after the iv injection of TRH was also significantly blunted in patients with primary hyperparathyroidism; delta TSH was highly correlated with basal TSH in hypercalcemic patients. The basal TSH concentration was higher and no longer different from normal (1.70 +/- 1.2 mU/l) 2 to 12 months after removal of the parathyroid adenoma, when serum calcium was normalized, whereas T3 and T4 did not change. A low basal TSH with normal T4 and low T3 was found in 13 patients with hypercalcemia of malignancy. In these patients, TSH increased after treatment of hypercalcemia with 3-amino-l,hydroxypropylidene-1, 1-bisphosphonate, whereas T4 did not change. The results suggest that the set point of pituitary thyroid feedback control could be decreased in chronic hypercalcemia and that hypercalcemia could render the thyroid more sensitive to TSH.

Correction of low circulating levels of 1,25-dihydroxyvitamin D by 25-hydroxyvitamin D during reversal of hypomagnesaemia

The effect of 25-hydroxyvitamin D (25OHD), given orally during the reversal of hypomagnesaemia, was studied in five patients with hypomagnesaemic hypocalcaemia and low serum levels of 25OHD and 1,25-dihydroxyvitamin D (1,25(OH)2D). The results were compared to those obtained in five other patients with similar initial levels of magnesium, calcium, 25OHD and 1,25(OH)2D who did not receive 25OHD. Serum levels of 1,25(OH)2D in the ten hypomagnesaemic patients were lower than in ten control subjects with low serum levels of 25OHD. The reversal of hypomagnesaemia was similar in the two groups of patients and elicited a similar increase of circulating iPTH levels. The expected increase of circulating 25OHD was observed in patients supplemented with 25OHD; their circulating 1,25(OH)2D rose within 48 h to normal levels, contrasting with the delayed and poor increase of 1,25(OH)2D in patients receiving no 25OHD. The evolution of serum calcium was however identical in the two groups. Our results suggest that vitamin D deficiency was a significant factor leading to low circulating levels of 1,25(OH)2D in hypomagnesaemic hypocalcaemic patients. The biological consequences of low serum 1,25(OH)2D in these patients remain unclear, but clearly, normal levels of 1,25(OH)2D are not essential for the correction of hypomagnesaemic hypocalcaemia.

Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: usefulness of 99mTc-pyrophosphate bone scintigraphy

Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. 99mTc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients.

Are tuberculous patients at a great risk from hypercalcemia?

The risk of tuberculous patients to develop hypercalcemia was investigated in 33 patients aged 19 to 80. Twenty-two of the 33 received no vitamin D supplements. Before antituberculous chemotherapy serum calcium corrected for albumin and urinary calcium levels were normal, serum 25-hydroxyvitamin D (25(OH)D) levels were low, but serum 1,25(OH)2D levels, oral calcium load test and intestinal 47Ca absorption were normal. After 17 to 34 days of chemotherapy serum calcium corrected for albumin and 1,25(OH)2D levels were lower without change in serum D-binding protein. In 11 patients 25(OH)D, 50 micrograms/day, was given orally for two months. 25(OH)D given three days before chemotherapy in five patients induced an increase of levels of 1,25(OH)2D which was greater than in 10 control patients with similar serum levels of 25(OH)D. When chemotherapy was added to 25(OH)D, the five patients showed high normal 1,25(OH)2D levels. The last six patients received 25(OH)D together with or after starting chemotherapy. None of the 33 patients developed hypercalcemia, even when supplemented with 25(OH)D for two months. It appears that hypercalcemia is uncommon in tuberculosis.

Penetration of aminoglycosides in uninfected pleural exudates and in pleural empyemas

The concentrations of gentamicin, netilmicin, and amikacin were determined after one single intravenous injection in uninfected pleural fluid after thoracotomy and in purulent pleural empyemas. The mean peak concentrations in the pleural fluid after the injection of gentamicin (1.5 mg/kg), netilmicin (2.0 mg/kg), and amikacin (7.5 mg/kg) were 2.9 +/- 0.3 mg/L, 3.7 +/- 0.8 mg/L, and 11.0 +/- 3.1 mg/L, respectively. The pleural penetration of the drugs was very high (from 80.0 to 99.1 percent). By contrast, gentamicin and netilmicin were not detectable in empyema pus; in this exudate the mean peak level of amikacin was 5.7 +/- 2.2 mg/L, with the penetration of this drug being 31.0 percent. The concentrations of parenterally administered aminoglycosides are substantially lower in empyema pus than in sterile pleural fluid. The possibility of poor pleural penetration of some aminoglycosides, as well as the presence of local conditions in pleural empyema unfavorable to the bioactivity of these drugs, must be kept in mind when treating pleural infections.

Bone loss and bone blood flow in paraplegic rats treated with calcitonin, diphosphonate, and indomethacin

Sham-operated (SO) and paraplegic rats were treated from the day of operation during a period of 4 or 6 weeks with salmon calcitonin 4 IU/kg/day or a diphosphonate (APD) 1mM/kg/day or indomethacin 2.5 mg/kg/day. The consequence of spinal cord section on the femur and tibia is a loss of mineral which affects predominantly trabecular bone (-24 and -13% in calcium content for the tibial metaphysis and the whole bone, respectively, when compared with the SO controls), a twofold increase in bone blood flow as measured by the technique of the microspheres trapping, a moderate decrease of the 72 hour 45Ca accretion rate in the bone shaft, and an increase in the number of metaphyseal osteoclasts in the tibia. In paraplegics, all three drugs inhibit bone loss to some degree, calcitonin and indomethacin being mostly effective on the cortical bone of the shaft, and APD tremendously increasing the trabecular network of the metaphysis. APD is the only drug to exhibit a significant effect on the calcium content of the bones of the SO controls, but some effect is apparent for calcitonin on X-rays and histological preparations. The increase in bone blood flow in paraplegics is unaffected, this point being discussed in view of the hypothesis of the resorptive action of prostaglandins produced by newly formed vessels. 45Ca accretion rate increases in the shaft of calcitonin-treated paraplegics, whereas it decreases in APD-treated controls and paraplegics. The number of osteoclasts decreases in paraplegics treated with calcitonin and indomethacin, and increases in both controls and paraplegics treated with APD.(ABSTRACT TRUNCATED AT 250 WORDS)

[Drug transport through artificial lipoid membranes. 21. Ion pair transport with alkyl salicylic acids]

Using hexylsalicylic acid it was demonstrated that alkylated derivatives of salicylic acid are able to increase partition and transport of ionized basic drugs across lipophilic membranes. The influence of different donor concentrations on the relation of transport was studied by means of pholedrine in combination with hexylsalicylic acid. In order to explain the mechanism of the ion-pair-transport experiments were carried out which show beside the mentioned increase of transport the occurrence of a countertransport of protons and lithium-ions, respectively. The lipophilic counterion hexylsalicylate acts inside of this mechanism as a carrier for the ionized drugs.

Partially reversible osteopenia after surgery for primary hyperparathyroidism

Bone mineral content of the radius in 30 patients with primary hyperparathyroidism was determined by single-photon absorptiometry before and one year after the removal of a parathyroid adenoma. When compared with normal age- and sex-matched subjects, preoperative bone mineral content was decreased by more than 1 SD in 24 patients 3 cm from the styloid apophysis (distal site) and in 23 patients 8 cm from the styloid apophysis (proximal site). The decrease at the distal site, where there is more trabecular bone, was significantly greater than at the proximal site (74% +/- 13% of the normal mean vs 79% +/- 13%). Bone mineral content values were not different in the female and male populations. One year after surgery, the bone mineral content was significantly increased but was still lower than normal at both sites (81% and 84% of the normal mean, respectively). In some patients, seen up to three years after surgery, the bone mineral content remained lower than normal. We conclude that primary hyperparathyroidism causes an osteopenia that affects both cortical and trabecular bone and that is only partially reversible, even in the long term.

Autotransplantation of human teeth. A life-table analysis of prognostic factors

In a retrospective study of a sample of 291 autotransplantations of human teeth carried out by 27 oral surgeons over a period of 25 years, the clinically and radiologically available factors at the time of surgery were analysed with reference to their prognostic relevance. Prognostically relevant factors related to loss of the transplanted teeth were determined by both univariate life-table analysis and multivariate Cox regression analysis. Of the 11 factors analysed in the Cox regression analysis, the following seemed to be prognostically relevant to loss or retention of the graft: developmental stage of the graft, age of the patient, donor tooth type, ectopia of the donor tooth, extraoral storage of the graft, and oral surgeon. In the present material, the prognosis of the grafts did not seem to be significantly influenced by such factors as prophylactic administration of antibiotics and fixation time. Using relevant parameters, it is possible to create a prognosis forecast for the individual patient. A case with a favourable set of parameters is shown.

Distribution of negative charges of rat brain synaptosomes established by means of protamine-ferritin conjugate

The negative electric charges on the synaptosomes from rat cerebral cortex were studied by means of protamine-ferritin conjugate. The synaptic vesicles in some synaptosomes were heavily labelled with the positively charged conjugate. The synaptosomal membranes including presynaptic and postsynaptic membranes were also stained but in a lesser degree. It was established that the major dense line and the intraperiod line of myelin contaminants were labelled, too.