The "can do, do do" concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms

Background

The “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept.

Methods

Within the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups.

Results

Among persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity.

Conclusion

The findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses.

Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.

Traumatic Elbow Arthrotomy Pediatric Case Report: The Saline Load Test is a Reliable Method of Detection

Introduction

Lacerations and open elbow injuries are common emergency department visits which necessitate an orthopedic surgery evaluation for a traumatic elbow arthrotomy (TEA). A delay in this diagnosis can lead to septic arthritis, requiring more invasive surgical procedures, prolonged antibiotics, and possible long-term sequelae. To date, there is scarce literature on TEA. The purpose of this case report is to better educate the orthopedic community on a reliable method of detection for a TEA, including pediatric patients.

Case Report

Case 1 - Twelve-year-old boy sustained a traumatic dog bite to the right elbow by a large stray dog. Evaluation in the emergency department revealed five 1 centimeter or smaller lacerations over the lateral elbow and another 1 cm laceration to the volar and proximal forearm. A saline load test (SLT) was performed from a posterior approach and was positive after 20cc of normal saline was injected into the joint. An arthroscopic irrigation and debridement were performed as definitive treatment. He was discharged with Augmentin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively revealed no signs of infection.Case 2 - Seven-year-old boy who was in a bicycle accident and sustained a large laceration over the posterior elbow. Evaluation in the emergency department revealed an approximately 15 by 4 cm laceration over the posterior elbow. A SLT was positive after 30cc's was injected from the anterolateral approach. He underwent arthroscopic irrigation and debridement as definitive treatment and was discharged home with Cephalexin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively showed no signs of infection.

Conclusion

Performing a SLT is a reliable method of detection to evaluate for a TEA. Our case report demonstrated confirmation of TEA in two pediatric patients based on positive SLT. We were able to treat these injuries appropriately with early surgical intervention and prophylactic antibiotics. Our early diagnosis and time-sensitive management prevented septic arthritis based on the patient's short-term follow-up examinations.

Effect of Postoperative Oral Antibiotics on Infections and Wound Healing Following Foot and Ankle Surgery

BACKGROUND

There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified.

METHODS

A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery.

RESULTS

The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) (P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health.

CONCLUSION

This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.

Intravenous Infusion of Nitroglycerine Leads to Increased Permeability on Dynamic Contrast-Enhanced MR Imaging in Pig Brains

BACKGROUND AND PURPOSE

It has been suggested that off-label use of transdermal nitroglycerine patches to prevent frostbite may lead to severe acute mountain sickness and ataxia. The aim of this study was to investigate the effect of nitroglycerine on brain vascular permeability by using dynamic contrast-enhanced MR imaging in a swine model.

MATERIALS AND METHODS

Eight Danish Landrace-Yorkshire-Danish Landrace pigs of approximately 20-25 kg were scanned with a dynamic contrast-enhanced MR perfusion protocol with and without nitroglycerine intravenous infusion. Compartmental analysis was performed on the basis of the Tofts model, and voxel-based quantitative values of the volume transfer constants from the vascular to the extracellular space were determined.

RESULTS

The scan with nitroglycerine infusion resulted in significantly higher volume transfer constant values than values derived from the first scan without nitroglycerine infusion. Increased volume transfer constant values were observed in 6 of 8 animals.

CONCLUSIONS

Infusion of nitroglycerine increases the vascular permeability of the swine brain on the basis of the transfer constant estimated from dynamic contrast-enhanced MR imaging.

A simpler, less expensive technique for delayed primary closure of fasciotomies

A variety of techniques have recently been advanced for delayed primary closure of wounds following emergent fasciotomy for compartment syndrome. We introduce a very simple, effective method for gradual reapproximation of margins using daily reapplication of Steri-strips (3M Surgical Products, St. Paul, Minnesota). This method allows final closure of fasciotomy wounds with simple suture in 5-8 days without scar contractures, marginal necrosis, infection, or significant pain. Moreover, because it requires no specialized equipment and can be applied in skilled nursing centers or at home by trained nurses, this technique could reduce the cost of caring for fasciotomy patients.

Skin damage probabilities using fixation materials in high-energy photon beams

INTRODUCTION

Patient fixation, such as thermoplastic masks, carbon-fibre support plates and polystyrene bead vacuum cradles, is used to reproduce patient positioning in radiotherapy. Consequently low-density materials may be introduced in high-energy photon beams. The aim of the this study was to measure the increase in skin dose when low-density materials are present and calculate the radiobiological consequences in terms of probabilities of early and late skin damage.

METHOD

An experimental thin-windowed plane-parallel ion chamber was used. Skin doses were measured using various overlaying low-density fixation materials. A fixed geometry of a 10x10 cm field, a SSD=100 cm and photon energies of 4, 6 and 10 MV on Varian Clinac 2100C accelerators were used for all measurements. Radiobiological consequences of introducing these materials into the high-energy photon beams were evaluated in terms of early and late damage of the skin based on the measured surface doses and the LQ-model.

RESULTS

The experimental ion chamber gave results consistent with other studies. A relationship between skin dose and material thickness in mg/cm(2) was established and used to calculate skin doses in scenarios assuming radiotherapy treatment with opposed fields.

CONCLUSION

Conventional radiotherapy may apply mid-point doses up to 60-66 Gy in daily 2-Gy fractions opposed fields. Using thermoplastic fixation and high-energy photons as low as 4 MV do increase the dose to the skin considerably. However, using thermoplastic materials with thickness less than 100 mg/cm(2) skin doses are comparable with those produced by variation in source to skin distance, field size or blocking trays within clinical treatment set-ups. The use of polystyrene cradles and carbon-fibre materials with thickness less than 100 mg/cm(2) should be avoided at 4 MV at doses above 54-60 Gy.

Pediatric all-terrain vehicle trauma: a 5-year statewide experience

BACKGROUND/PURPOSE

This is a retrospective review of the pediatric all-terrain vehicle trauma victims who presented to the five major trauma centers serving the state of West Virginia during the 5-year period from January 1991 to December 1995. The purpose of this research is to characterize the nature of the injuries and the individuals injured to better appreciate the magnitude of the problem of ATV-related injuries in the pediatric population.

METHODS

This study is a retrospective review of these 218 consecutive pediatric patients from trauma registry data and their medical records.

RESULTS

Two hundred eighteen patients between the ages of 2 years and 16 years presented during the study period. Boys outnumbered girls three to one. The average Injury Severity Score (ISS) was 8.76, the average Glasgow Coma Score (GCS) was 14.4, and the average Trauma Score (TS) was 15.2. The most common injuries were orthopedic followed by head and facial injuries. The majority of the children did not wear helmets, and their injuries resulted in an average hospital length of stay of 4.3 days. Thirty-eight percent of the children required surgery. There were a total of four deaths for a mortality rate of 1.8%. The estimated total hospitalization cost for the 218 patients was $1,918,400.00.

CONCLUSIONS

All-terrain vehicle-related trauma remains an ongoing safety concern facing society today. Every physician who cares for children should address this important issue when talking to children and parents about safety issues and injury prevention.

A consecutive series of patients with laryngeal carcinoma treated by primary irradiation

In Denmark there is an increasing frequency of laryngeal carcinoma, in particular in women and among these especially in supraglottic tumours. The incidence during the past 20 years has risen from about 40 to 60 cases per million per year. A series of 335 consecutive patients treated with primary radiation is presented. In one-third of all patients the tumour was localized in the supraglottic area; in women in more than half and in men in about one-fourth of the cases. The frequency of primary lymph node metastases in the supraglottic and the glottic tumours was 24% and 2% respectively. A multivariate analysis identified sex and tumour size as independent prognostic parameters of local control. Five-year survival corrected for intercurrent deaths was obtained in 59% of all cases, in 56% of supraglottic and in 92% of glottic tumours. A multivariate analysis defined localization, tumour grade and stage as independent prognostic parameters of survival. Salvage surgery was performed in about 32% of the cases, total laryngectomy in 26%, and partial laryngectomy in 6%. The survival rate among all total laryngectomies was 55%. A tracheostomy during or before radiation treatment prior to total laryngectomy had no influence on complication rate, admission time or recurrence rate. The frequency of pharyngo-cutaneous fistulae in the entire series was 11.5%; after routine use of metronidazol, however, only 5.7%. Radical neck dissection was carried out in 7.8% of the cases, by far most in the supraglottic group, only a few in the glottic carcinomas, in three-fourth in connection with a laryngectomy and in one-fourth without local recurrence in the larynx.

Dynamic changes in striatal dopamine D2 and D3 receptor protein and mRNA in response to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) denervation in baboons

Loss of nigrostriatal neurons leads to striatal dopamine deficiency and subsequent development of parkinsonism. The effects of this denervation on D2-like receptors in striatum remain unclear. Most studies have demonstrated increases in striatal dopamine D2-like receptors in response to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-mediated denervation, but others have found either decreases or no change in binding. To clarify the response to denervation, we have investigated the time-dependent changes in dopamine D2, D3, and D4 receptor protein and mRNA levels in unilaterally MPTP-lesioned baboons. MPTP (0.4 mg/kg) was infused into one internal carotid artery, producing a contralateral hemi-parkinsonian syndrome. After MPTP treatment, the animals were maintained for 17-480 d and then euthanized. MPTP decreased ipsilateral dopamine content by >90%, which did not change with time. Ipsilateral D2-like receptor binding in caudate and putamen initially decreased then increased two- to sevenfold over the first 100 d and returned to near baseline levels by 480 d. Relative levels of D2 mRNA were essentially unchanged over this period. D4 mRNA was not detected. In contrast, D3 mRNA increased sixfold by 2 weeks and then decreased. At the peak period of increase in binding sites, all D2-like receptors were in a micromolar affinity agonist-binding state, implying an increase in uncoupled D2 but not D3 receptor protein. Taken together, these data suggest that MPTP-induced changes in D2-like dopamine receptors are complex and include translational or post-translational mechanisms.

Prognostic factors of local control after radiotherapy in T1 glottic and supraglottic carcinoma of the larynx

This study presents a retrospective analysis of a consecutive series of 161 patients treated with curatively intended radiotherapy for T1 supraglottic or glottic carcinoma from 1972 to 1990 at the Department of Oncology, Aalborg County Hospital, Denmark. All patients received radiotherapy given with 4-MV X-rays on lateral opposed fields. Intended dose was 60 Gy in 30 fractions. Multivariate analysis of recorded clinical parameters was applied to identify possible prognostic factors of local control. Tumor size, differentiation grade and sex were identified as significant independent prognostic parameters of local control. Five-year local control was 58% and 78% for supraglottic and glottic tumors, respectively. Applying salvage surgery the ultimate control rates were 82% and 97% for supraglottic and glottic tumors, respectively. Evaluation of treatment response 3-6 weeks following accomplishment of radiotherapy demonstrated that remaining tumor at the time of evaluation was an indicator of failure in local control.

Urinary enzyme excretion as a parameter for detection of acute renal damage mediated by N-(3,5-dichlorophenyl)succinimide (NDPS) in Fischer 344 rats

The kidney has been identified as the specific target organ for in vivo exposure to an agricultural fungicide, N-(3,5-dichlorophenyl)succinimide (NDPS). The goal of this study was to determine if urinary protein and enzyme excretion were sensitive, non-invasive markers for NDPS-induced renal damage. The proximal tubular enzymes that were monitored were the brush-border enzyme alkaline phosphatase (ALP) and the lysosomal enzyme N-acetyl-beta-D-glucosaminidase (NAG). Male Fischer 344 (F344) rats were injected intraperitoneally (i.p.) with 0.2 or 1.0 mmol kg-1 NDPS. Control animals were injected i.p. with sesame oil (2.5 ml kg-1). Urine was collected on ice 0-3, 3-6 and 6-24 h after NDPS or vehicle injection. Urinary protein and urinary NAG excretion levels were elevated (P < 0.05) above the control levels 0-3 h after treatment with 0.2 mmol kg-1 NDPS. Urinary protein and enzyme excretion was comparable between 0.2 mmol kg-1 NDPS-treated and control groups for all other time periods. Administration of a marked nephrotoxicant dose (1.0 mmol kg-1) was associated with elevated levels of urinary protein, NAG and ALP beginning 0-3 h after treatment when compared to the control group or to respective baseline values. It was concluded from these studies that measurement of urinary protein as well as the release of ALP and NAG were sensitive markers of renal damage produced by NDPS.

Estimated treatment responses in metastatic colorectal carcinoma based on longitudinal carcinoembryonic antigen series

Patients presenting with advanced or metastatic colorectal carcinoma were randomized to treatment with either 5-Fluoro-Uracil + leucovorin or 5-Fluoro-Uracil + interferon alpha-2-a. Longitudinal series of Carcino-embryonic-antigen were obtained and analyzed with a dynamic model in seven of 16 patients had CEA levels above 10 ng ml-1. Clinical evaluation based on X-ray, ultrasound and CT-scans showed a partial response to the given treatment in three of the seven patients. The dynamic model consistently estimated the maximal accumulated cell kill (approximately three logs) in the patients experiencing a clinical response. The remaining four patients with CEA levels above 10 ng ml-1 showed some reduction in CEA as a consequence of the treatment cycles, although no clinical response could be established. No response was seen among the remaining nine patients with CEA levels below 10 ng ml-1.

Modelling of serial carcinoembryonic antigen changes in colorectal cancer

Carcinoembryonic antigen (CEA) is a tumour marker mainly used for detection of recurrent colorectal cancer. CEA series in 295 patients, who had a macroscopic radical resection of a primary colorectal cancer were studied. A kinetic model was fitted to CEA series of individual patients. Applying the kinetic model recurrences were identified with a sensitivity of 70-80% and specificity of 80-90%. Simulations were performed in order to find the optimal sampling strategy for CEA during follow-up. Simulations showed that CEA determinations at a few weeks interval between would be optimal for early detection of recurrences.

Gestational trophoblastic tumors: cytostatic treatment response evaluated from hCG modelling

Fifty-eight patients representing with gestational trophoblastic tumors were treated at the department of Gynaecologic Oncology of the Norwegian Radium Hospital during the period from 1977 to 1990. Individual serial measurements of hCG were analyzed applying a mathematical dynamic tumor marker model.

Cisplatinum dose dependent response in germ cell cancer evaluated by tumour marker modelling

This study presents an analysis on longitudinal tumour marker series in twenty-two patients with non-seminomatous germ cell cancers treated with cisplatinum (DDP) based combination chemotherapy. Series of alphafoetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactate dehydrogenase (LDH) were analyzed applying a dynamic mathematical marker model. The model analysis provided quantitated values for growth rate and treatment response in the marker producing cells. The analysis showed that LDH had to be above 2,000 U/l to be a trustworthy tumour marker. HCG producing cells tended to grow faster than AFP producing cells, and were 3-5-fold more sensitive to the chemotherapy given than AFP producing cells. Treatment response versus DDP dose appeared to be bi-phasic, but with no significant change in treatment efficiency within the given range of DDP doses.

Human placental lactogen (hPL) model for the normal pregnancy

This study includes 75 females with normal pregnancies, and presents individual cases of longitudinal series of human placental lactogen (hPL). Samples for hPL levels are taken during the period from gestational week 26 and until labour. A modified Gompertz equation is defined, characterized as growth at a continuously decreasing exponential rate, which finally plateaus in gestational week 36. This modified Gompertz equation adequately fitted individual hPL series. The work describes that a final hPL forecast for the normal pregnancy could be obtained in gestational week 30 using knowledge on maternal height and age, combined with a single hPL sample. The present model was applied in six pathological pregnancies with intrauterine growth retardation, and in all cases measured hPL levels were below the model estimate.

The prognostic value of estrogen and progesterone receptors in female breast cancer. A single center study

In the period from September 1980 to December 1987, our laboratory measured estrogen (ER) and progesterone receptor (PgR) levels in 960 patients with primary breast cancer. At presentation, 918 of these had no distant metastases. ER as well as PgR were considered positive at values above 10 fmol/mg cytosol protein. All the patients included had been operated on at one of two participating hospitals in the country of North Jutland, and all patients had been checked up in a uniform way at one oncological out-patient department. By applying test for interaction, the PgR was found to be dependent on nodal status. Separate multivariate analyses were carried out for node positive and node negative patients. By this method, size of tumor, histologic grading, and age turned out to be independent prognostic factors for the node negative patients. Independent prognostic parameters for the node positive patients were histologic grading, PgR and postoperative x-ray therapy. The results support the theory that PgR is a better predictor of disease-free survival than ER.

Infection of cultured human tracheal epithelial cells by human parainfluenza virus types 2 and 3

Despite growing information of the effects of human respiratory virus infection on airway physiology, little information is available on the mechanisms of pathology and pathophysiology in these infections. The human respiratory pathogens, parainfluenza virus types 2 and 3 (hPIV2, hPIV3, respectively), clinically cause laryngotracheobronchitis (infection of the large proximal airways). In order to examine the pathobiology of these viruses in airway cells of human origin, we exposed primary cultures of human tracheal epithelial cells. Primary cultures of human tracheal epithelial cells were readily infected by these agents: cells exposed to hPIV2 and hPIV3 expressed viral antigens (demonstrated by indirect immunofluorescence assay), produced infectious virus, and demonstrated cytopathic effects (including early syncytium formation). Peak viral titers of 2 x 10(7) plaque-forming units per milliliter were obtained, similar to titers from permissive CV-1 cells. Trypan blue staining and direct cell counts demonstrated no difference in the viability of the control and infected cells until the infected cells began to detach from the culture substrate. However, infected cells release significantly more LDH than control cells by 48 h following infection at a multiplicity of infection of 1 virus/target cell. This system provides a model for studying the effects of infection of the human tracheal epithelium by human respiratory viral pathogens without confounding interactions with other cell and tissue types.

The effect of vasectomy on the production of plasma luteinizing hormone and follicle stimulating hormone in man

A prospective study of plasma luteinizing hormone (LH) and follicle stimulating hormone (FSH) in 51 men before vasectomy and 10 days and 3 months after vasectomy revealed a trend to rise in LH 10 days after vasectomy normalizing after 3 months. The literature concerning alterations in LH and FSH after vasectomy is reviewed and different theories are discussed.

Axillary sampling and the risk of erroneous staging of breast cancer. An analysis of 960 consecutive patients

Axillary nodal status was analysed in 960 consecutive cases of primary invasive breast cancer operated in two Danish hospitals. After stratification according to the number of nodes removed, the rate of node positivity in each subgroup was calculated. We found that the probability of finding at least one metastatic node increased continuously up to about 10 removed nodes. In lymph node negative patients, who did not receive any adjuvant treatment, there was a significant association between the recurrence-free survival and the number of nodes removed, provided that less than 8-10 nodes had been collected. The percentage of node positivity in each subgroup seemed to level off above 10 nodes at about 64%, suggesting that this represents the true rate of node positivity at the time of primary surgery. We conclude that about 10 axillary nodes should be removed in order to minimize the risk of erroneous classification of the axilla.

Drug-resistance patterns assessed from tumor marker analysis

We analyzed the levels of the tumor markers alpha-fetoprotein and human chorionic gonadotropin during the course of treatment in 19 patients with nonseminomatous germ cell tumors. We calculated the fractional tumor kill at each cycle using assumptions of exponential tumor growth and exponential marker decay and assumptions assuring that marker production reflects the size of the clonogenic tumor. The observed pattern of decrease was compared with three theoretical models. The first (Skipper) assumes that sensitive and resistant populations are present at the beginning of treatment. The second (Goldie and Coldman) assumes an initially sensitive population with mutation causing subsequent treatment resistance. Both models, under a wide range of parameter values, predict a much more rapid decrease in fractional tumor kill per treatment cycle than was observed. A model in which there are four clones of differing sensitivity at the start of treatment was able to adequately describe the observed time course of tumor killing.

Effects of the North Carolina Prematurity Prevention Program among public patients delivering at New Hanover Memorial Hospital

Twelve per cent of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per cent of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced.

Posterior vitreous fluorophotometry in diabetic patients with minimal or no retinopathy

Vitreous fluorophotometry (VFP) using the Fluorotron Master was performed in 25 insulin-dependent diabetic patients with either minimal or no retinopathy and 22 controls. At 30 minutes, baseline corrected vitreous fluorescence values 3 mm from the retina were significantly greater in diabetic patients with minimal retinopathy than in either controls or patients with no retinopathy but were similar in patients with no retinopathy and controls. At 1 hour, vitreous fluorescence values and fluorescein permeability indexes were similar in all three groups. The absence of increased posterior vitreous fluorescein leakage in the diabetic patients with no retinopathy suggests that the alteration in permeability of the blood retinal barrier, as assessed by current VFP measures, does not precede the development of clinical diabetic retinopathy. However, the significantly increased 30-minute 3-mm fluorescence values suggest that posterior fluorescein leakage is increased in minimal background diabetic retinopathy.

Familial hypocalciuric hypercalcaemia. II. Intestinal calcium absorption and vitamin D metabolism

We compared intestinal calcium absorption, measured by a single isotope technique, and serum concentrations of vitamin D metabolites in ten patients with familial hypocalciuric hypercalcaemia (FHH) and ten age- and sex-matched healthy controls. Our results showed no significant differences in intestinal calcium absorption or in serum concentrations of vitamin D metabolites. There was a significant correlation between serum concentrations of PTH, measured with one of our assays, and 1,25(OH)2D. We conclude that neither increased intestinal calcium absorption nor altered vitamin D metabolism plays a part in the hypercalcaemia of FHH.

Estimation of 131I-hippuran blood activity from externally registered activity

The application of data-processing methods such as deconvolution or computer-assisted background subtraction to renography requires knowledge of the input to the kidneys. The two most commonly used approximations to the kidney input in 131I-hippuran probe renography are to assume that the kidney input is described either by the time-activity curve recorded over the subclavian region (mode I) or by the time derivative of mode I (mode II). A third approximation to the kidney input using two externally recorded time-activity curves, pre-injection of 131I-albumin and two venous samples has previously been described. This approach has been modified in this work, in which two externally recorded time-activity curves and two capillary samples are used to construct an estimate for the kidney input (mode III). The three modes are compared with a reference, which is constructed from capillary samples drawn during the renography examination. Eleven patients participated in this study, all of whom were referred for routine renography. The results show that only mode III is close to the reference in all cases.

Cerebrospinal fluid levels of amitriptyline, nortriptyline, imipramine and desmethylimipramine. Relationship to plasma levels and treatment outcome

Fifty-five (55) depressed patients were treated with amitriptyline (AMI) or imipramine (IMI). Concentrations of AMI, IMI, and their metabolites, nortriptyline (NT) and desmethylimipramine (DMI), were measured in cerebrospinal fluid (CSF) and plasma at steady state by gas chromatography mass spectrometry (GC/MS). Highly significant correlations between CSF and plasma levels of AMI, NT, IMI, and DMI were found (r greater than 0.75; P less than 0.0001 in all cases). There were no significant sex, diagnostic subgroup, or geographic difference in any of the drug parameters measured. An evaluation of the relationship between CSF levels of drug variables and clinical response showed essentially no significant correlations between these various parameters. The results obtained do not support the concept of a 'therapeutic window' for levels of plasma NT in AMI-treated patients. Furthermore, the highly significant correlations between CSF and plasma compartments in terms of drug and metabolite levels would argue against the need to measure CSF levels of these parameters in clinical practice. Plasma level measurements should be equally informative, and simpler to obtain.

Assessment of ileal function by abdominal counting of the retention of a gamma emitting bile acid analogue

In eight patients without gastrointestinal complaints and 30 patients with various gastrointestinal disorders ileal bile acid conservation was assessed by oral administration of 75Se 23-selena-25-homocholic acid (SeHCAT) followed by abdominal gamma counting (SeHCAT-test). The results of the test correlated fairly well with the clinical features and with the [1-14C]-cholylglycine breath test including faecal 14C measurements (breath test). Of the two bile acid absorption tests the new is perhaps the more sensitive and is the one most easily performed.