Phosphorylation of the Goodpasture antigen by type A protein kinases

Collagen IV is the major component of basement membranes. The human alpha 3 chain of collagen IV contains an antigenic domain called the Goodpasture antigen that is the target for the circulating immunopathogenic antibodies present in patients with Goodpasture syndrome. Characteristically, the gene region encoding the Goodpasture antigen generates multiple alternative products that retain the antigen amino-terminal region with a five-residue motif (KRGDS). The serine therein appears to be the major in vitro cAMP-dependent protein kinase phosphorylation site in the isolated antigen and can be phosphorylated in vitro by two protein kinases of approximately 50 and 41 kDa associated with human kidney plasma membrane, suggesting that it can also be phosphorylated in vivo. Consistent with this, the Goodpasture antigen is isolated from human kidney in phosphorylated and non-phosphorylated forms and only the non-phosphorylated form is susceptible to phosphorylation in vitro. Since this motif is exclusive to the human alpha 3(IV) chain and includes the RGD cell adhesion motif, its phosphorylation might play a role in pathogenesis and influence cell attachment to basement membrane.

A new method to obtain bone biopsies at implant sites peri-operatively: technique and bone structure

This study aims at evaluating an objective method for the description of bone structure in the human mandible. Human bone biopsies were harvested at mandibular implant sites prior to insertion of self-tapping Mark II fixtures. Altogether 15 biopsies were taken from 12 patients. Three patients donated 2 biopsies each, one proximally and one distally taken. Ground sections of about 100 microns thickness were prepared prior to microradiography. These sections were ground to a final thickness of about 10 microns followed by histological staining. Histomorphometrical analyses were performed on the microradiographed plates and on the ground sections. On average there was a bone area of about 54% calculated on the microradiographed plates (the 100-microns sections) versus a mean bone area of 62% light microscopically (the 10-microns sections). Bone lengths were calculated on the 10-microns sections in the central part (mid-line) and on each side of the mid-line, revealing a mean of 58% in the former case and a mean of 61% in the latter case. The amount of bone varied between individuals and in different locations of the same jaw. The postoperative healing period following fixture installation is standardized regardless of bone structure. It may in the future be appropriate to more individualize this healing period based on an objective bone quality score.

The plantar flexor muscle attachments on the tibia. A cadaver study

Thirty-six tibiae from 11 female and 7 male cadavers were dissected. Anatomical and histological examinations of the plantar flexor muscle origins at the posteromedial border of the tibia were performed. Many individual variations in the type and size of muscle origin were observed. Muscle fibers and/or connective tissue in different proportions attached the muscle to the periosteum or directly to the cortical bone. The length of the attachments varied greatly and there was a considerable overlap of the muscles in some individuals. The attachments of the flexor digitorum longus overlapped the tibialis posterior and the flexor digitorum longus muscle was overlapped by the soleus muscle. In two cases the soleus muscle did not attach to the tibia at all. Our findings may shed some light on the question as to why some athletes sustain posteromedial tibial stress fractures and others develop shin splits or other posteromedial injuries from similar precipitating activity.

Characterization and expression of multiple alternatively spliced transcripts of the Goodpasture antigen gene region. Goodpasture antibodies recognize recombinant proteins representing the autoantigen and one of its alternative forms

Collagen IV, the major component of basement membranes, is composed of six distinct alpha chains (alpha 1-alpha 6). Atypically among the collagen IV genes, the exons encoding the carboxyl-terminal region of the human alpha 3(IV) chain undergo alternative splicing. This region has been designated as the Goodpasture antigen because of its reactivity in the kidney and lung with the pathogenic autoantibodies causing Goodpasture syndrome. The data presented in this report demonstrate that, in human kidney, the gene region encompassing the Goodpasture antigen generates at least six alternatively spliced transcripts predicting five distinct proteins that differ in their carboxyl-terminus and retain, except in one case, the exon that harbors the characteristic amino-terminus of the antigen. Goodpasture antibodies specifically recognize recombinant proteins representing the antigen and the alternative form that retains the amino-half of the antigen, suggesting that this moiety could be involved in the in vivo binding of the pathogenic antibodies. Furthermore, the sera of control individuals contain autoantibodies against the antigen that can be differentiated from those causing the syndrome based on their specific reactivities, suggesting that the binding of the pathogenic autoantibodies to a specific determinant likely trigger a distinct and unique cascade of events causing the disease.

Localization of the human soluble epoxide hydrolase gene (EPHX2) to chromosomal region 8p21-p12

Epoxide hydrolases have an important function in organisms in that they catalyze the transformation of potentially toxic or carcinogenic epoxides into the corresponding diols. In this study, the chromosomal localization was determined for the human gene encoding soluble epoxide hydrolase. A polymerase chain reaction fragment corresponding to the C-terminal region of the mouse protein was used to isolate a cosmid clone from a human genomic library. By fluorescence in situ hybridization to metaphase chromosomes, the soluble epoxide hydrolase gene was then localized to chromosomal region 8p21-p12.

Biological activities of a Turkish medicinal plant, Prangos platychlaena

Prangos platychlaena has been used in traditional medicine in eastern Turkey. It stops bleeding and heals the scars when applied externally. When the isolated coumarins were tested against bacterial strains, only a slight activity was obtained.

Long-term follow-up of anterior tibial spine fractures in children

In a long-term follow-up (mean 16 years) of 61 children with anterior tibial spine fractures, subjective knee function (Lysholm score) was excellent or good in 87% of the subjects and fair in 13%. Eleven percent of the children had a lower activity level (Tegner score) than desired. Muscle performance was affected in those subjects with the lowest Lysholm scores. Pathological knee laxity was found in 38% of the subjects, but was not reflected in poor subjective knee function. Age at injury did not influence the outcome. There was no indication that young children can eliminate slackness of the anterior cruciate ligament by further growth. Only in type III fractures was there a correlation between fracture displacement after healing and knee laxity, as well as between knee laxity and Lysholm score. Arthroscopy-guided or open reduction and internal fixation seems to be a worthwhile procedure only in dislocated type III fractures.

Results of rectocele repair. A prospective study

PURPOSE

This study was designed to evaluate the results of rectocele repair and parameters that might be useful in selecting patients for this operation.

METHODS

Twenty-five patients with symptom-giving rectoceles were prospectively evaluated with a standardized questionnaire, physical examination, defecography, colon transit studies, anorectal manometry, and electrophysiology. Patients underwent posterior colporrhaphy and perineorrhaphy. They were followed postoperatively (mean, 1.0 year) with the same questionnaire, physical examination, defecography, anorectal manometry, and electrophysiology.

RESULTS

Constipation had improved postoperatively in 21 of 24 constipated patients (88 percent). At postoperative follow-up 13 patients (52 percent) had no constipation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 percent) had symptoms more than once per week. Four patients with rectocele at preoperative defecography, but not at physical examination, had favorable outcomes following surgery. The majority of patients not using vaginal digitalization preoperatively had improved with respect to constipation. All patients with pathologic transit studies had various degrees of constipation postoperatively. Constipation was not improved in two of five patients with preoperative paradoxic sphincter reaction.

CONCLUSIONS

Rectocele is one cause of constipation that can be treated with good results. Preoperative use of vaginal digitalization is not mandatory for a good postoperative result. Defecography is an important complement to physical examination. Patients with pathologic transit study might have a less favorable outcome of rectocele repair with respect to constipation. More studies about the significance of paradoxic sphincter reaction in these patients are indicated.

Eccentric and concentric knee extensor muscle performance in professional ballet dancers

Ballet dancers are exposed to great eccentric loading of the lower extremities due to a high frequency of repetitive jumps and leaps. The purpose of this study was to evaluate eccentric (ECC) and concentric (CON) knee extensor muscle endurance and strength in professional ballet dancers (six men and 11 women) in relation to moderately active control subjects (17 men and 18 women). A Biodex dynamometer was used for isokinetic torque measurements. The ECC endurance (total work per kilogram) was on average 31% greater in professional ballet dancers compared to control subjects, while the corresponding average difference for CON endurance was 7%. A greater ECC CON total work ratio was observed for ballet dancers (mean ballet, 2.07; mean control, 1.74). The ECC and CON strengths (peak torque per kilogram) were greater in professional ballet dancers compared to controls (27 and 22%). No intraindividual torque difference between left and right limbs was found. Men showed significantly greater strength (peak torque per kilogram) and endurance (total work per kilogram) compared to women, similar in both groups. No differences in the ECC/CON relationship between genders were observed. In essence, our results favor the hypothesis that repetitive loading of the lower extremities in ballet dance leads to a higher standard of ECC knee extensor endurance.

The atypical antipsychotic, remoxipride, blocks phencyclidine-induced disruption of prepulse inhibition in the rat

The effect of various typical (haloperidol) and atypical (clozapine, raclopride, remoxipride) antipsychotics on phencyclidine (PCP)-induced disruption of sensorimotor gating was tested in rats using an acoustic startle paradigm. Clozapine (4-40 mumol/kg), haloperidol (1-5 mumol/kg) and raclopride (1-12 mumol/kg) failed to reverse PCP-induced disruption of prepulse inhibition (PPI) of the acoustic startle response. In contrast, remoxipride (12-60 mumol/kg) caused a dose-dependent block of this effect. PCP-induced disruption of PPI is a widely accepted animal model of a corresponding behavioural deficit observed in schizophrenia although little evidence has been presented that it is in fact sensitive to antipsychotic agents. The present results indicate that remoxipride behaves in a unique way in this model compared to clozapine, haloperidol and raclopride.

Defecography. Results of investigations in 2,816 patients

PURPOSE

This study was designed to analyze the frequency of different findings at defecography in patients with defecation disorders and see in what way the evaluation could be improved.

METHODS

The reports of investigations in 2,816 patients were analyzed.

RESULTS

Twenty-three percent of the investigations were considered normal. Thirty-one percent of the patients had rectal intussusception, 13 percent had rectal prolapse, 27 percent had rectocele, and 19 percent had enterocele. Twenty-one percent of the patients had a combination of two or three of these diagnoses. The combination of rectocele and enterocele was rare. The majority of patients with enterocele had other concomitant findings. Patients with or without abnormal perineal descent had similar frequencies of rectal prolapse, rectal intussusception, and enterocele. Rectocele was more common in patients with abnormal perineal descent.

CONCLUSIONS

Defecography is valuable when investigating patients with defecation disorders. Pathologic findings were found in 77 percent of the patients. A standardized protocol should ensure a complete evaluation of defecography.

HCl-stimulated duodenal HCO3- secretion in conscious rat. Interactions among VIP, nicotinic receptor mechanisms, and prostaglandins

Using an isolated loop of the proximal duodenum of conscious rats, the role of vasoactive intestinal peptide (VIP) in the duodenal HCO3- response to HCl was examined, especially interactions with participating cholinoceptor mechanisms and prostaglandins. A 5-min perfusion with 150 mmol/liter HCl increased luminal VIP during 3 hr, with a peak output during and immediately after the acid challenge. The HCl-stimulated output was unaffected by atropine and hexamethonium, but was augmented by indomethacin from 13.6 (9.5-17.8) to 39 (20-85) fmol/cm/min. The HCO3- secretion in response to graded doses of intravenous VIP (0.00625-6 nmol/kg/30 min) was dose-dependent to maximally 33.5 +/- 10.5 mumol/cm/hr. The HCO3- secretion during a single intravenous infusion of VIP (12 nmol/kg/hr), 13.9 +/- 4.2 mumol/cm/hr, was unchanged by atropine, reduced to 10.0 +/- 3.5 mumol/cm/hr by hexamethonium, and augmented to 18.9 +/- 4.7 mumol/cm/hr by indomethacin. Exogenous VIP did not change the basal luminal output of PGE2; neither did exogenous PGE2 nor indomethacin affect the basal luminal output of VIP. HCl-induced increases in luminal outputs of VIP, substance P, and neurokinin A (the two latter with unknown roles) were differentially affected by atropine, hexamethonium, and indomethacin, indicating that the acid challenge released the peptides through controlled mechanisms. In conclusion, in the duodenal HCO3- response to luminal HCl, VIP may have a stimulatory role, which partially depends on nicotinic, but not on muscarinic cholinoceptor mechanisms, and which is negatively modulated by prostaglandins.

A community-based population study of vertebral fractures in 85-year-old men and women

Radiographic examinations for the presence of vertebral fracture between T4 and L5 were performed in a random sample of 85-year-old women (n = 304) and men (n = 158) who participated in a longitudinal study in Gothenburg. A vertebral fracture was defined as an anterior/posterior (A/P) vertebral height ratio of 0.66 or less. A severe vertebral fracture was defined as a compression of vertebral height of more than 33% both at the anterior and posterior edges compared to the posterior edge of the adjacent vertebral body. Bone mineral density was measured with dual photon absorptiometry in the right calcaneus. The most common site for vertebral fractures was L1 in women and Th12 in men. Bone mineral density in men at the age of 75 showed a significant correlation with vertebral fractures at 85 years of age (p < 0.001). This was not the case for women. Stepwise logistic analysis revealed that women with vertebral fractures at 85 years of age had more significant back pain, shorter stature, and more often a history of another fracture and/or chronic treatment with corticosteroids. In men, muscle strength, marital status and body weight at age 85 were the only factors significantly associated with vertebral fractures.

Characterization of anti-GBM antibodies involved in Goodpasture's syndrome

Goodpasture's syndrome is a life threatening autoimmune kidney disease. The patients have autoantibodies to the glomerular basement membrane, which are specific for the C-terminal domain of type IV collagen (NC1). The major antigen has been localized to the alpha 3 (IV)-chain. We have investigated sera from 44 patients with anti-NC1 antibodies. The quantity of antibodies to four different alpha(IV)-chains of type IV collagen was measured with direct ELISA. We used affinity chromatography to separate the antibodies and their specificities were studied with ELISA. The results show that about 1% of the patients total IgG are anti-NC1 antibodies and that 90% of these antibodies are specific for the alpha 3(IV)-chain. Antibodies to the other alpha(IV)-chains were found in 80% of the patients. Furthermore, affinity purified anti-alpha 3(IV) antibodies from one patient were inhibited by antibodies from the other patients, from 4 to 72%. The antibodies, from 39 of the patients, were inhibited by a monoclonal antibody against the alpha 3(IV)-chain. The results indicate that patients with Goodpasture's syndrome can have antibodies to most of the alpha(IV)-chains, while the majority of anti-NC1 antibodies are restricted to the alpha 3(IV)-chain. Moreover the number of epitopes seems to be limited and the majority of the antibodies from most patients are against one single epitope on the alpha 3(IV)-chain.

Risk factors for bone loss in chronic active hepatitis and primary biliary cirrhosis

BACKGROUND

Data on risk factors for bone loss in chronic active hepatitis (CAH) and primary biliary cirrhosis (PBC) are scanty and/or conflicting.

METHODS

Bone mineral density (BMD) in the distal forearm was measured using single-photon absorptiometry in 39 patients with CAH and 32 patients with PBC. We also attempted to identify risk factors for bone loss by means of a questionnaire and through a wide range of biochemical analyses.

RESULTS

In the CAH patients BMD is inversely related to the duration of steroid treatment and to age at menarche. In the PBC patients there was a strong correlation between BMD and serum gastrin concentrations.

CONCLUSIONS

Bone loss in CAH is to some extent explained by steroid treatment and delayed menarche. Bone loss in PBC may be reduced by increased calcitonin secretion induced by gastrocalcin.

Development of tolerance to 8-OH-DPAT induced blockade of acquisition of a passive avoidance response

We examined the effects of manipulating 5-HT1A receptors on the performance of a passive avoidance task in rats. Firstly, we studied the effect of racemic 8-OH-DPAT and compared it to the pure enantiomers (subcutaneous injection, s.c.). Secondly, we investigated the effect (s.c.) of the selective 5-HT1A receptor antagonist (S)-UH-301 [(S)-5-fluoro-8-hydroxy-2-(dipropylamino)tetralin] both alone and on 8-OH-DPAT-induced disruption of acquisition. Thirdly, we examined whether tolerance occurs to the effects of 8-OH-DPAT on passive avoidance acquisition. Finally, we examined the effects (s.c.) of the selective NMDA receptor antagonist dizocilpine, (+)-MK-801[(5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclohe pten-5, 10-imine], on this tolerance development. Different doses of racemic 8-OH-DPAT were injected 10 min before rats were exposed to the acquisition phase of a step through passive avoidance response. When tested for retention 24 h later, 8-OH-DPAT-pretreated rats failed to exhibit any avoidance. R(+) and S(-)-8-OH-DPAT were also active with the R(+)-isomer being more active than the S(-)-isomer. The 5-HT1A antagonist (S)-UH-301 [(S)-5-fluoro-8-hydroxy-2-(dipropylamino)tetralin] was without effect on avoidance performance but antagonized the effect of 8-OH-DPAT. In a further experiment, rats were pretreated with racemic 8-OH-DPAT (0.3 mg/kg). Twenty four hours later, they received a challenge dose of 8-OH-DPAT and exposed to the acquisition phase of the avoidance response. When tested 24 hr later for retention, 8-OH-DPAT challenged rats failed to show any indication of an avoidance response.(ABSTRACT TRUNCATED AT 250 WORDS)

Enterocele is correctable using the Ripstein rectopexy

PURPOSE

About one-third of the patients with rectal prolapse or rectal intussusception have concurrent enterocele at defecography. The purpose of this study was to evaluate the effect of the Ripstein procedure on the concurrent enterocele and to study the outcome of the procedure with respect to the patients' symptoms.

METHODS

Twenty-two patients with enterocele and either rectal prolapse or rectal intussusception at defecography were treated using the Ripstein procedure. Postoperatively, the patients were evaluated with clinical examination (22 patients) and defecography (16 patients).

RESULTS

None of the patients had recurrence of enterocele, rectal prolapse, or intussusception at postoperative follow-up. Continence was improved in 15 of 16 incontinent patients. Emptying difficulties were unchanged in eight patients, improved in five patients, and had deteriorated in four patients.

CONCLUSIONS

Enterocele is corrected by using the Ripstein rectopexy. Persisting defecation difficulties after the Ripstein procedure are unlikely to be secondary to enterocele. The Ripstein procedure can be an alternative in the treatment of enterocele, as a majority of these patients also have rectal prolapse or rectal intussusception.

Enterocele demonstrated by defaecography is associated with other pelvic floor disorders

Sixty-nine patients with enterocele on defaecography, and 128 patients without enterocele but with other abnormal findings were investigated to identify concomitant colorectal disorders and their relationship with enterocele. Of the 69 patients with enterocele, 38 (55%) had concomitant rectal intususception and 26 (38%) rectal prolapse. Abnormal physiological findings on anorectal manometry and electrophysiology were more common in patients with enterocele. Previous hysterectomy increased the risk of enterocele formation. The study has demonstrated that patients with enterocele should be investigated thoroughly for other lesions before treatment is planned. Further investigation of the role of enterocele in patients with defaecation disorders is required.

Dopamine receptor antagonists block amphetamine and phencyclidine-induced motor stimulation in rats

d-Amphetamine (DEX) and phencyclidine (PCP) increased motor activity in rats as measured in automated activity cages. Analysis of the stimulation indicated that both drugs increased horizontal activity (total activity), locomotion, and peripheral activity. However, DEX increased while PCP decreased the incidence of rearing. The ability of different drugs to antagonise DEX- and PCP-induced increases in total activity (called stimulation) was measured. Dopamine (DA) D1 receptor antagonists (SCH23390, NNC-01-0112) were 7-8 times more potent in blocking DEX than PCP. DA D2 receptor antagonists (raclopride, remoxipride, haloperidol) were only 1-2 times more potent against DEX-induced stimulation. Nonselective DA receptor antagonists were also tested. Chlorpromazine was more potent against DEX than against PCP. Buspirone and sertindole were slightly more potent in blocking PCP than DEX. Ritanserin (5-HT2 receptor antagonist) was inactive against both stimulants. 8-OH-DPAT (5-HT1A receptor agonist) potentiated the stimulant effects of DEX and PCP. Prazosin (alpha 1-adrenergic receptor antagonist) partially blocked both DEX and PCP. Most drugs tested depressed spontaneous motor activity. Remoxipride and sertindole, however, caused very little depression even at doses several times higher than those needed to block DEX or PCP. The data show clear pharmacological differences between DEX- and PCP-induced stimulation.

Magnetic characterization of iron oxides for magnetic resonance imaging

The OMP particle and four additional iron oxide samples were investigated in terms of zero field cooled magnetization (ZFCM) curves and hysteresis loops. The observation of superparamagnetic blocking and the absence of magnetic remanence demonstrated that the samples are superparamagnetic at room temperature. The magnitude of the ZFCM peak temperatures are in qualitative agreement with the iron oxide crystal size. One sample deviated from the remaining four in that it had a significantly lower magnetic moment and an irregular ZFCM curve showing the presence of various less magnetic phases. The similar results obtained with the OMP particles and the individual OMP crystallites without the polymer support show that the superparamagnetic properties of the individual OMP crystallites are retained on the OMP particle. Depending on the application, the ZFCM experiment may be viewed as an alternative or a supplement to Mössbauer spectroscopy in studies of the superparamagnetic blocking of iron oxides.

Bone response to hydroxyapatite-coated and commercially pure titanium implants in the human arthritic knee

Rough and smooth commercially pure (c.p.) titanium implants and hydroxyapatite-coated (HA-C) implants were inserted in arthritic human knees and left in situ in order to compare the response of bone to these three implants. Radiographic examination alone could not determine if bone apposition had occurred. After 3 and 6 months, histomorphometric analyses of undecalcified sections, 10 microns thick, revealed a statistical significance in the amount of bone apposition to rough-surfaced and HA-C implants as compared with smooth uncoated implants. Most of the rough-surfaced c.p. titanium implants and the HA-C implants had achieved bone apposition on the order of 50%. No statistically significant differences in apposition were seen between the rough-surfaced and HA-C implants. The smooth c.p. titanium implants were mostly encapsulated in fibrous tissue.

Space-time clustering in insulin-dependent diabetes mellitus (IDDM) in south-east Sweden

Using the method developed by Knox, space-time clustering was analysed in all 584 cases of insulin-dependent diabetes mellitus (IDDM) diagnosed between 1977-1990 and below the age of 16 from four paediatric departments in south-east Sweden. The catchment areas of these clinics form a contiguous geographical area of 26,445 km2 with a total of 165,784 children aged 0-15 years. The annual incidence for the study period was 25.2 per 100,000 children aged 0-15 years with a statistically significant incidence variation between the years; highest incidence in 1983 (39.2) and lowest in 1977 and 1989 (18.9 and 20.7 respectively). In the analysis, 30 different combinations of critical cutoff values were used to define closeness in space and time of pairs of cases. Statistically significant results were seen for several combinations with the highest significance obtained for the cutoff values of 15 km and 7 months, respectively. This space-time clustering tended to be specially pronounced during the period with the highest incidence of IDDM, 1981-1985. Our results indicate that space-time clustering exists in IDDM. These findings may support the hypothesis that infectious agents (possibly viral) give rise to a portion of IDDM.

A high weight gain early in life is associated with an increased risk of type 1 (insulin-dependent) diabetes mellitus

Growth during the first years of life in relation to type of feeding in infancy was retrospectively studied in an unselected population-based group of 297 children who had been diagnosed with Type 1 (insulin-dependent) diabetes mellitus before the age of 15 years (probands) and 792 individually-matched referent subjects. Reliable data were collected from child welfare clinics. Probands weighed slightly less at birth but their weight gain at 6, 9, 18 and 30 months of age was significantly greater (p < 0.02) than that of referent children. The weight gain of children who had never been breast-fed was more marked than that of breast-fed children; this was found for both probands and referent children. But also among exclusively breast-fed children (> 2 months), probands gained significantly more in weight from birth up to 18 and 30 months of age than exclusively breast-fed referent children. Early weight gain appears to be a risk factor for development of Type 1 diabetes. The lower weight gain in breast-fed compared to non-breast-fed children may explain the protective effect of breast feeding against Type 1 diabetes observed in several studies.

Osteoporosis, metabolic aberrations, and increased risk for vertebral fractures after partial gastrectomy

A case-control study compared 129 men with earlier partial gastrectomy (operation during the period 1952-1961) with 216 men from a community-based population study. All were born 1910-1915 and the mean age was 72 years. Men with a previous partial gastrectomy had vertebral fractures in 19% compared with 4% (P < 0.01) in the control population. Bone mineral density (BMD) in the right calcaneus measured with dual energy photon absorptiometry was 20% lower in men with a Billroth II operation (P < 0.001) and 8% lower with a Billroth I operation (ns). In comparison with the controls, the men subjected to partial gastrectomy had higher serum concentrations of osteocalcin and alkaline phosphatase activity, a lower serum concentration of 25-hydroxyvitamin D (25OHD) and a lower body mass index (BMI). There were no difference in serum concentrations of free calcium, intact parathyroid hormone (PTH), or free thyroxine. The smoking prevalence was significantly higher in men with partial gastrectomy than in controls. Smokers had significantly lower serum concentrations of intact PTH and 25OHD than nonsmokers and also lower BMD and BMI. The relationships between intact PTH on one hand, and ionized calcium (inverse relationship) and osteocalcin (direct relationship) on the other were preserved in smokers, however. Gastroscopy was performed in 78 men with multiple biopsies in the gastric remnant and also in the small intestine. All but two subjects had chronic gastritis. Examination of sternal bone marrow smears showed that 40% of the Billroth-operated men lacked bone marrow reticular iron.(ABSTRACT TRUNCATED AT 250 WORDS)