[Endocrine secretions by bronchial tumors]

Frequency of ectopic hormonal secretions by lung carcinomas is evaluated about 10 percent. Clinical and biological manifestations are less frequently registered than circulating hormonal products which can be considered as evolution markers of the disease. The main secretions and their clinical consequences are described: parathyroid hormone (PTH), calcitonin (CT), growth hormone (GH), antidiuretic hormone (ADH), corticotrophin hormone (ACTH) and gonadotrophins (HCG, LH, FSH). Problems raised by detection of these hormone-like acting products are studied and different hypothesis are suggested as explanation of these secretions.

Calcium malabsorption and absence of bone decalcination following intestinal shunt operation for obesity. A comparison of two types of operation

Calcium absorption was studied in 23 patients before and one year after intestinal shunt operation for obesity. It decreased from 23 to 12% (p less than 0.02) after surgery, when the jejunum/ileum ratio was 36cm/12cm [type I], and only from 19 to 16% (p greater than 0.05), when the ratio was 12cm/36cm [type III]. It is suggested that the difference is due to variation in absorptive surface in the distal half of the small intestine and to a minor degree to change in external pancreatic function, bile acid metabolism, and fat digestion. Bone mineral content was lower in 37 obese than in normal subjects and underwent only minor changes (p greater than 0.01) 3 and 12 months after surgery, possible because of postoperative daily calcium and vitamin-D substitution.

[Decrease of intestinal absorption of 47-calcium in chronic alcoholism]

Intestinal 47-calcium absorption has been studied in 34 chronic alcoholics, 17 of whom were cirrhotics (group A) and 17 non-cirrhotics (group B). These patients were compared with 44 normal subjects (group C). In group C, the 47Ca 2 h plasma % of the dose showed a significant negative correlation to the total body weight (p less than 0.001) and a positive correlation with the serum albumin (p less than 0.05). The mean intestinal absorption of 47Ca expressed as 2 h plasma % of the dose multiplied by total body weight was 131 +/- SD 52 in group A and 136 +/- SD 71 in group B. These two means are significantly low (p less than 0.001 and p less than 0.002 respectively) in relation to that found in group C (168 +/- SD 32). These results suggest that intestinal calcium absorption is diminished in chronic alcoholism even in the absence of hepatic cirrhosis.

[Parenteral feeding. Prevention of complications in adults during exclusive mid-term parenteral feeding]

The benefits of parenteral feeding need no longer be emphasised. However, qualitative and quantitative food supplements raise a certain number of difficulties which should be better known. Infection is the most frequent complication. It may be avoided by strict aseptic precautions throughout parenteral feeding. Hypoglycemia is a major risk owing to the possible consequence. Hyperglycemia and its consequence of osmotic polyuria is more frequent and should be controlled to avoid loss of water and salt. Complications due to the use of lipid emulsions are exceptional when soya oil is used. Hypophosphoremia should be corrected by increasing phosphate intake. Hypocalcemia is common; it is often associated with hypoproteinemia and sometime a low calcium intake, vitamin D deficiency or a sudden increase in phosphate intake. Vitamin deficiencies, hypomagnesemia, and oligo-element deficiencies should be correcty by appropriate supplements.

Current status of vitamin D metabolism

In summary one can record that the biochemist has discovered a beautiful metabolic pathway for vitamin D which is probably as yet incomplete. Subsequently the medicinal chemist has provided numerous synthetic analogues. However, delays in the diagnosis and treatment of vitamin D disorders, due to lack of specific assays and inadequate supplies of therapeutic metabolites, still unfortunately exist. It is hoped that these problems will be rectified as soon as more plentiful supplies of the appropriate metabolites are available.

Oral manifestations of secondary hyperparathyroidism related to long-term hemodialysis therapy

Patients on long-term hemodialysis therapy may develop secondary hyperparathyroidism with oral symptoms. As the life expectancy of the dialysis patient increases, the dentist is seeing these manifestations with increasing frequency. A review of the subject is presented along with a case illustrating dramatic roentgenographic changes in a patient who was placed on hemodialysis when the technique was in its infancy.

[Hypercalciuric and hyperparathyroid renal lithiasis]

Idiopathic hypercalciuria was noted in 10% of a series of 1635 subjects with renal lithiasis. Eight-day administration of thiazide diuretics as a test for the discovery of latent hyperparathyroidism in idiopathic hypercalciuria is described. In 6 cases diagnosed in this way, surgery disclosed the presence of a parathyroid adenoma. Resection was followed by persistent hypercalciuria and, in some instances, renal lithiasis activity. The pathogenesis of associations of these frequently observed diseases is examined.

[Changes of calcium-phosphorus metabolism in patients with chronic renal failure on hemodialysis treatment]

Hemodialysis induced changes in calcium (Ca) and phosphorous (P) metabolism are studied in a group of ten (10) patients with chronic renal failure. There was a significant rise in total serum calcium (Ca), that was closely related to changes in serum proteins level, and a very significant decrease in serum phosphorous (P). Calcium levels of 7 to 8 mgs/100 cc in the dialyzer fluid were considered ideale.

Skeletal demineralization and growth retardation in inflammatory bowel disease

Skeletal growth and mineralization in 54 adolescent and adult patients with inflammatory bowel disease have been analyzed comprehensively. Quantitative and qualitative radiologic techniques consisted of conventional roentgenography, photon absorptiometry, and radiographic morphometry. The data are correlated with the type, duration, and severity of disease, and with several modes of therapy. The results indicate the osteopenia and retardation of growth are common in patients with inflammatory bowel disease, particularly in adolescents, in whom the effects of corticosteroids on the skeleton are most deleterious.

[New aspects in the treatment of oxalate lithiasis (author's transl)]

The causes of hypercalciuria and simple diagnostic criteria for the various forms of hypercalciuria are outlined. Indications, effectiveness, limitations, and side effects of cellulose phosphate are described. Emphasis is placed on the biochemical pathogenesis and classification of hyperoxaluria. The problems of measuring and controlling oxalate excretion in patients with hyperoxaluria and calcium oxalate stones are discussed. Succinimide offers a partly successful approach to the reduction of endogenous oxalate synthesis.