P0664CKDSENS, A NOVEL HEALTHCARE PLATFORM FOR CHRONIC KIDNEY DISEASE

Background and Aims

The 10% of the global adult population, more than 730 million people, suffers from some degree of chronic kidney disease (CKD). From that population, a 30% is suffering from an advanced stage of the disease. Approximately 38 million of the European population is affected by an advanced stage renal disease with 1 million of new cases every year. These patients require close monitoring, which increase the burden of the disease. New tools and methods are required to improve the patients’ well-being, the perception and management of their disease, decrease the impact of the complications, as well as to delay of the progression of the disease.

Method

Seven partners have joined in the CKDSens consortium and are contributing to the project with different expertise and technical resources (medical, technological, educational, business and management): CreatSens Health SL, Hospital Clínic de Barcelona – Fundació Privada Clínic per a la Recerca Biomèdica, Genesis Biomed, Eurecat, Universitat de Barcelona, Universidad Politécnica de Madrid, and Madopa. This consortium is a novel and unique technological platform, combining in vitro diagnostic devices and software components, that connects patients with CKD and healthcare professionals to improve the well-being of people and the efficiency of the healthcare system by monitoring relevant biomarkers out of the hospital in a simple and cost- effective connected paper-based sensors. The proposal aims to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies.

Results

The CKDSens consortium is developing a novel technological platform for real-time and low-cost diagnostics for two key biomarkers in renal diseases (creatinine and potassium), which include a new point-of-care device that allows monitoring by remote control these biomarkers. The technology has been patented for both biomarkers, and it has been transferred to CreatSens, a spinoff from Universitat Rovira i Virgili. The product integrates paper-based sensors in a drop of blood analysis, wireless connectivity and a digital platform as data analytics. The aim of the consortium is to validate the use of a new medical device as a product that can fit and truly generate value and business. Through that perspective, the optimization, manufacturing and validation of the tool and the business case will be performed as a first step, while usability, end user interaction and regulatory pathway will be developed in the second step. CKDSens will afford a novel approach to embed healthcare in daily life and routine. This new strategy implies production and commercialization for prevention and diagnose where markets are well known and validated. The aim is to mimic a well-known business model such as glucometer, translating this one into renal diseases. CKDSens has risen funding for this purpose through a grant of the European Institute of Innovation and Technology (EIT Health, ID Project 19579), and it is working to have validated this device at the end of the year. This requires also a clinical validation, which will be performed in a clinical trial in the second half of the year.

Conclusion

CKDSens consortium has been created as a novel technological platform to develop and validate a new medical device for a remote control of patients with CKD, in order to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies. It is expected to have this device designed and validated by the end of the year 2020 and ready for further commercialization.

Marking petroglyphs with calcite and gypsum-based chalks: Interaction with granite under different simulated conditions and the effectiveness and harmfulness of cleaning methods

Marking petroglyphs with chalk is a common practice to enhance them for documentation and reproduction. Although this procedure has started to be less frequently used, there is no knowledge about the interaction between the rock engravings nor about the effectiveness achieved by the common cleaning procedures of such markers considering the chalk extraction and the induced damage to the rock. This study evaluates the interaction between two chalks of different composition (calcite and gypsum) and a granite on which the majority of NW Iberian Peninsula-petroglyphs are carved. Granitic samples marked with these chalks were subjected to artificial rain events and high temperatures (700°C) related to fires. After each aging test, chemical and physical modifications on the rock were analysed by means of stereomicroscopy, x-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy and colour spectrophotometry. Moreover, the evaluation of the effectiveness and harmfulness of several mechanical and chemical cleaning procedures commonly used in the field of cultural heritage conservation was carried out. Both chalks remained at different extent on the surface after the artificial rain events. Water would promote a different penetration-depth of the chalks into the stone, depending on their solubility. High temperatures led to mineral phase transformations of the chalks influencing the interaction with the rock. Regarding cleaning effectiveness, despite a few chalk remains were found in all the cleanings, chemical methods showed higher effectiveness than mechanical procedures even though some of them leave chemical contamination. Benzalkonium chloride can be considered as the cleaner with the best results to extract both types of chalk on granite.

Occupational eye lens doses in interventional cardiology. A multicentric study

New European regulation regarding radiological protection of workers and more specifically the new occupational dose limit for the eye lens recently reduced to 20 mSv yr(-1) may affect interventional cardiologists. This paper presents a set of measurements of occupational doses performed in five interventional cardiology centres and then compared with the new dose limit. The measurement of occupational doses was performed over the apron at chest level using electronic dosemeters recording H p(10). In one of the centres, scatter dose at goggles was also measured with optically stimulated luminescence dosemeters calibrated in terms of H p(0.07). An average H p(10) over the apron of 46 μSv/procedure was measured for cardiologists. Lower doses were noted in other professionals like second cardiologists, nurses or anaesthetists. Procedures for valvular and other structural heart diseases involved the highest occupational doses, averaging over 100 μSv/procedure. Important differences in occupational doses among centres may be indicative of different radiation protection habits. The new occupational dose limit for the eye lens is likely to be exceeded by those among the interventionalists who do not use protection tools (ceiling suspended screen and/or goggles) even with standard workloads.

A national programme for patient and staff dose monitoring in interventional cardiology

A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.

Preeclampsia and Calcium‐ATPase Activity of Plasma Membranes from Human Myometrium and Placental Trophoblast

OBJECTIVE

We determined calcium-activated adenosine triphosphatase (Ca-ATPase) activity and thiobarbituric acid-reactive substances (TBARS) of plasma membranes from myometrium and placental trophoblast of normotensive and preeclamptic pregnant women.

METHODS

Samples of myometrium were obtained by uterine biopsies taken upon delivery by cesarean section from nulliparous normotensive and preeclamptic pregnant women. Placentas were obtained after full term vaginal delivery from either normotensive or preeclamptic women. Plasma membrane fractions were prepared from both myometrium and placenta and assayed for Ca-ATPase activity and TBARS.

MAIN OUTCOME MEASURE(S)

We expected to find a higher level of TBARS and, consequently, a lower activity of Ca-ATPase of the plasma membrane fractions obtained from both myometrium and placenta of preeclamptic women.

RESULTS

The Ca-ATPase activity of myometrium and placental trophoblast from preeclamptic women was about 50% lower than that from normotensive women, while the TBARS were higher.

CONCLUSIONS

A reduced Ca-ATPase activity, caused by an increased level of TBARS, may result in an increase in the cytosolic calcium concentration in the vascular smooth muscle cells of preeclamptic women and thus partially explain the high blood pressure developed by these patients.

A blood plasma inhibitor is responsible for circadian changes in rat renal Na,K-ATPase activity

Rhythmic changes in activity following a circadian schedule have been described for several enzymes. The possibility of circadian changes in Na,K-ATPase activity was studied in homogenates of rat kidney cortex cells. Male Sprague-Dawley rats were kept on a schedule of 12h light (06:00-18:00 h) and 12 h darkness (18:00-06:00 h) for 2 weeks. At the end of the conditioning period, one rat was killed every 2 h, until completion of a 24 h cycle. Outermost kidney cortex slices were prepared, homogenized and assayed for Na,K-ATPase activity. The whole procedure was repeated six times. Na,K-ATPase activity shows an important oscillation (2 cycles/24 h). Peak activities were detected at 09:00 and 21:00 h, whereas the lowest activities were detected at 15:00 and 01:00-03:00 h. The highest activity was 40+/-3 nmoles Pi mg protein(-1)min(-1) (09:00 h), and the lowest was 79+/-3 nmoles Pi mg protein(-1)min(-1) (15:00 h). The amount of the Na+-stimulated phosphorylated intermediate is the same for the 09:00 h and 15:00 h homogenates. Preincubation of 09:00 h kidney cortex homogenates with blood plasma drawn from rats at either 03:00 h or 15:00 h, significantly inhibited their Na,K-ATPase activity. This inhibition was not seen when the preincubation was carried out with either 09:00 h or 21:00 h blood plasma. The striking oscillation (2 cycles/24 h) of the Na,K-ATPase activity of rat kidney cortex cells is ascribed to the presence of an endogenous inhibitor in blood plasma.

Epidemiología de la enfermedad de meniere en cantabria

OBJECTIVES

To know the main epidemiologic characteristics of Meniere's disease in Cantabria.

METHODS

All the patients diagnosed of "definitive" Meniere's disease between 1992 and 2002 in Sierrallana Hospital of Torrelavega (Cantabria, Spain) were reviewed. Incidence, prevalence, presence of bilateral disease, age at diagnosis and gender were recorded.

RESULTS

A total of 75 patients were diagnosed of "definitive" Meniere's" disease" during this time. The incidence was 3/100,000 people/year, the prevalence 75/100,000, male/female ratio was 0.38. Most frequent age at onset was between 40 and 60 years and bilateral cases were 5.3%.

CONCLUSIONS

Meniere's Disease is not uncommon in Cantabria. It is more prevalent among middle aged women. Bilateral cases are rare.

Ca-ATPase of human myometrium plasma membranes

We determined and characterized the Mg2+-dependent, Ca2+-stimulated ATPase (Ca-ATPase) activity in cell plasma membranes from the myometrium of pregnant women, and compared these characteristics to those of the active Ca2+-transport already demonstrated in this tissue. Similarly to the Ca2+-transport system, the Ca2+-ATPase is Mg2+-dependent, stimulated by calmodulin, and inhibited by vanadate. The Km for Ca2+ activation is 0.40 microM, very similar to that found for active calcium transport, i.e. 0.25 microM. Consequently, this Ca2+-ATPase can be responsible for the active calcium transport across the plasma membranes of smooth muscle cells.

[Ambulatory septoplasty]

The AA. admit that the septoplasty under general anaesthesia is a surgical procedure that can be realized ambulatory, without added risks to patient. With viewpoint they have done a retrospective survey of the whole group of septoplasties performed under general anaesthesia at Torrelavega Hospital (Santander) in two years, between April 1995 and August 1997. The total number of cases amounted 56 (49 men and 7 women), lasting the procedure, more or less, one hour; postanaesthesia recovery also about 86 minutes and the hospital permanence about six hours and a half. Readmitted were 14 cases, because vomiting (7), for laryngeal spasm (2), bleeding (1), retention of urine (1) and other because vertigo (1), fever (1) and headache (1).

[Usefulness of the flexible fibroscope with working channel in the treatment of pedunculated polyps of the vocal cords]

INTRODUCTION

Suspension laryngoscopy by general anesthesia is the universally method of performing microlaryngeal surgery for the treatment of vocal cord polyps. Recently a new technique using a flexible endoscope with working channel has been introduced and popularized in Spain for treating these lesions.

MATERIAL AND METHODS

A prospective study was undertaken to asses the efficacy of this technique, something modified, for removal either pedunculated vocal cord polyps or with minute implantation basis.

RESULTS

Twenty-six consecutive patients with pedunculated cord polyps were surgically removed, at the ENT-Department of Sierrallana Hospital (Torrelavega, Cantabria) from January 1995 till September 1996. In 4 patients with strong gang reflexes the procedure could not be finished. Twenty-two patients improved their voice and were satisfied with the result. In 2 other cases, of the group, the voice regain was not complete, but owing to the feelings of the individuals no more surgical procedures were scheduled. No postoperative aftermath were observed. One year later all cases were checked and all proclaimed their well-being.

CONCLUSIONS

We suggest that removal of pedunculated polyps of the vocal cord employing the fibroendoscope with working channel and local anesthetic should be the choix procedure for the lot of patients suffering this pathology, and the microsurgery with general anesthesia must be reserved for failure cases or for those patients using voice professionally.

[Major ambulatory surgery in otorhinolaryngology]

In the last years we have witnessed a great increase of major ambulatory surgery procedures in our specialty. Some of them are very common as adenoidectomies, tonsillectomies and also the insertion of transtympanic tubes. Nevertheless there is no agreement about which of the procedures should be realized through AMS. The aim of this work is to do a review on the most important features involved in AMS entlightening what kind of operations can be included i such programmes.

[Ambulatory laryngeal microsurgery]

OBJECTIVE

The aim of the present study was to determine if laryngeal microsurgery (LMS) under general anesthesia is a safe and convenient procedure when carried out on an outpatient basis in selected patients.

MATERIAL AND METHODS

Seventy-eight adult patients (60 men and 18 women) were scheduled for outpatient LMS under general anesthesia between February 1995 and December 1996.

RESULTS

Their age range was 19 to 77 years (mean 48 years). Forty-four (56.4%) were ASA I, 32 (41%) ASA II, and 2 (2.6%) ASA III. Laryngeal biopsy was performed in 40 cases (51.3%), polypectomy in 30 cases (38.5%), excision of Reinke's edema in 5 cases (6.4%), and cyst excision in 3 cases (3.8%). The mean stay in the Day Hospital was 7 hours (range 2.5-10 h). Seven patients (9%) had immediate postoperative complications. Three patients were admitted overnight. No patient had to be readmitted to the hospital after discharge.

CONCLUSIONS

Outpatient laryngeal microsurgery is an appropriate and safe alternative to inpatient surgery in carefully selected patients, who are kept under strict observation in the immediate postoperative period.

[Biopsy of the temporal artery. Experience with the use of a protocol at an ENT department]

INTRODUCTION

Temporal artery (TA) biopsy is required for the evaluation of several clinical scenarios because of the therapeutic implications of a positive result. We describe the experience of our department, which is the center for this technique in our hospital.

PATIENTS AND METHODS

A retrospective study was made of all TA biopsies performed in the Department of Otolaryngology, Hospital Sierrallana, from January 1995 to April 1997.

RESULTS

Thirty-four biopsies of the TA artery were performed in 33 patients for possible temporal arteritis. Mean age was 76 years (range: 61-87 years). Twelve were male and 21 female. Twenty-two patients (66.6%) had recent onset cephalalgia, 11 (33.3%) polymyalgia rheumatica, 5 (15.1%) mandibular claudication, and 8 (24.2%) ocular symptoms. In 75.8% ESR was elevated. An abnormal TA exam was observed in 9 cases (27.3%), 6 of which had a positive biopsy. Only 1 of the 15 patients without local findings at the physical examination had a positive TA biopsy. No information on the physical exam was recorded for the other 2 patients with a positive biopsy.

CONCLUSIONS

TA biopsy is a relatively easy surgical procedure with a very low rate of complications. An abnormal physical TA examination correlates with a positive histopathological study.

Effects of age, menopause and osteoporosis on free, peptide-bound and total pyridinium crosslink excretion

We evaluated urinary excretion of free pyridinoline (PYD)-deoxypyridinoline (DPD) by an enzymelinked immunosorbent assay (ELISA) method, free and total PYD by high-performance liquid chromatography (HPLC), free DPD by ELISA, chemiluminiscent immunoassay (CLEIA) and HPLC, total DPD by HPLC, and N-telopeptides (NTX) and C-telopeptides (CTX) by ELISA in 234 women distributed into three groups: 43 healthy young women (aged 26.2 +/- 2.5 years), 56 control postmenopausal women (aged 55.9 +/- 4.5 years) and 133 untreated osteoporotic women (aged 55.1 +/- 4.0 years). The control postmenopausal women had increased values of all markers considered, except NTX, compared with healthy young women. The osteoporotic postmenopausal women had significantly increased values compared with control postmenopausal women for free DPD by HPLC and free DPD by ELISA or CLEIA. HPLC, ELISA and CLEIA showed adequate correlation to measure free PYD and DPD. Control postmenopausal women had significantly decreased values of the fraction of free PYD and DPD (48.4% and 32.0%, respectively), as did the osteoporotic postmenopausal women (48.0% and 46.1%), compared with healthy young women (55.3% and 57.0%). We found a significant negative correlation comparing age with fraction of free PYD and DPD, but a positive correlation with total PYD and DPD, considering or not the osteoporotic postmenopausal women. T-score and Z-score values derived from healthy young women and control postmenopausal women for PYD, DPD, NTX and CTX measured by immunoassays were calculated to detect changes in bone turnover, DPD by ELISA or CLEIA showing the highest Z-score. The sensitivity and specificity of the different assays were evaluated using a receiver operating characteristic (ROC) curve. With a specificity of 90% the sensitivity of the markers considered was low (from 33% for DPD by CLEIA to 11% for PYD-DPD by ELISA), but increased considerably with a specificity of 75%. In conclusion, urinary pyridinium crosslink derivatives increase with age and after the menopause, and rise slightly in women with osteoporosis, there being a negative correlation among age and the fraction of free PYD and DPD of the total urinary excretion. Among the resorption markers most often available in clinical laboratories, free DPD by ELISA or CLEIA was the best at discriminating osteoporotic postmenopausal women from aged-matched control postmenopausal women.

[Calcitonin-producing neuroendocrine carcinoma of the larynx: atypical carcinoid tumor]

A 63-year-old woman presented with a metastasizing neuroendocrine carcinoma of the larynx (atypical carcinoid) that was misdiagnosed as laryngeal paraglioma. The calcitonin-producing tumor simulated a medullary thyroid carcinoma.

Degradation profile and identification of the major degradation products of dobupride under several conditions by GC/MS and HPLC-particle beam/MS

The effect of pH, light, temperature and oxygen on the stability of dobupride (1), a novel gastroprokinetic drug, has been studied, storing the sample in the solid state and as a solution in methanol-water. The main forced degradation products have been identified by means of techniques such as GC/MS and HPLC-particle beam/MS, and two major degradation pathways have been characterized. One degradation route involves the loss of chlorine, yielding 4-amino-2-butoxy-N-[1-(1,3-dioxolan-2-ylmethyl)piperid -4-yl]benzamide (4) as the major degradation product. The second pathway results from cleavage of the piperidine-amide bond, producing 4-amino-2-butoxy-5-chlorobenzamide (2) as the major degradation product. Under the studied conditions, except when exposed to direct light in solution, dobupride has been shown to be very stable: after 5 months storage, the benzamide 2 (second pathway) was the only product identified (less than 0.5%). However, when dobupride in solution is exposed to natural or artificial sunlight, degradation is very fast, and after 7 days only 5% of the unchanged product remains. Under these circumstances, the main degradation route is the first one, with compound 4 being the most abundant degradation product, and compound 2 only being detectable in small amounts.

[Intraparotid facial neurilemmoma]

Neurilemmomas or schwannomas are known to arise from the sheath of peripheral nerves. Out of the cranial nerves, the eighth nerve is the most frequently involved. Neurilemmomas arising from the facial nerve are are, and they usually affect the intratemporal portion of the nerve. Its location in the intraparotid portion is very uncommon. The case of a patient having an intraparotid mass is shown. After surgery it was found to be a neurilemmoma of the facial nerve. These tumors manifest as an asymptomatic mass in the parotid gland. Most of the times, diagnosis is made postoperatively. It is necessary to remove all the tumor with the caution to preserve the original nerve.

Persistence of antibodies to hepatitis C virus in a chronic hemodialysis population

In order to evaluate the persistence of antibodies against hepatitis C virus (HCV) in a chronic hemodialysis population, we studied 151 HBsAg-negative patients. Anti-HCV titers were evaluated every 3 months over 1 year, and the serum alanine aminotransferase/serum aspartate aminotransferase ratio monthly from the start of hemodialysis. The anti-HCV titers (ELISA C100-3) remained stable in 127 patients and fluctuated in 24, without an evident correlation with hepatic function. Using our criteria, we found 85 patients with non-A, non-B hepatitis, 57 of them with biochemical criteria of chronic hepatic disease. There was a strong correlation between antibodies to HCV and non-A, non-B hepatitis (chi 2; p < 0.05) which was more marked in those patients with biochemical criteria of chronic hepatic disease (chi 2; p < 0.001). We concluded that the anti-HCV titer is reliable as a long-term marker of hepatitis C virus infection.

[Significance of digestive hemorrhage in patients with chronic renal insufficiency in hemodialysis]

Gastrointestinal Bleeding (GIB) is a complication in patients with Chronic Renal Failure (CRF) on regular hemodialysis (HD). To analyse the importance of GIB we studied, retrospectively, the causes of hospitalization in 301 patients, all on HD in the same Unit in January 1990. The average age was 57.4 +/- 14.2 years (17 to 87), time on HD 58.3 +/- 44.9 months, male = 166, female = 135. Of a total of 169 hospitalizations, the infectious disease were the most frequent cause with 37 admissions (21.9%), followed by gastrointestinal diseases with 34 admissions (21.1%). Of these, 23 (13.6%) were due to GIB (Upper GIB = 19, Lower GIB = 4). The etiologies of Upper GIB were: Peptic Ulcer = 9, erosive Gastritis/Duodenitis = 7. Angiodysplasia = 1, Mallory Weiss = 1 and unknown = 1. The etiologies of Lower GIB were: Angiodysplasia of the colon = 3, Cancer of the colon = 1. Non-steroid anti-inflammatory drugs (NSAID) had a positive correlation (p less than 0.01) with Upper GIB due to erosive Gastritis/Duodenitis. Surgery was necessary in a 8 cases of GIB, 7 of them due to Peptic Ulcer. GIB is an important cause of morbidity in patients with CRF on HD. Peptic Ulcer and erosive Gastritis/Duodenitis were the most frequent causes of GIB in the population studied. Angiodysplasia of the colon was the most important cause of Lower GIB. NSAID appear to be a risk factor for GIB from erosive Gastritis and or Duodenitis.

Prevalence of non-A non-B hepatitis and anti-HCV antibodies in a Portuguese dialysis population

Non-A Non-B hepatitis (NANBH) is nowadays one of the most common causes of hepatic dysfunction in dialysis patients. We reviewed the records of 231 HBsAg-negative patients in our unit and found 119 patients with biochemical criteria of NANBH (51.5%), 88 of them (68.9%) with circulating antibodies against HCV (chi 2 P less than 0.0001). Such high prevalence of NANBH was due to an outbreak of NANBH in the late 70s and early 80s. Time on haemodialysis (HD) was the major risk factor of NANBH in this population, and no other risk factors were identified. Prevalence of anti-HCV was similar to reports from non-uraemic populations. Anti-HCV seems to be a reliable test to confirm NANBH, but not better than using common biochemical criteria of NANBH to manage these patients in dialysis units.

[Effect of moderate salt restriction on the antihypertensive action of nifedipine: a double blind study]

Moderate salt restriction is of debatable efficacy in the treatment of mild or moderate hypertension; however, salt restriction enhances the activity of most antihypertensive drugs. Some observations suggest that the antihypertensive activity of calcium antagonists is not increased or could even decrease with dietary salt restriction. In the present work 15 patients suffering arterial hypertension and normal renal function are studied during four two week periods; a) unrestricted diet and medication, b) unrestricted diet and nifedipine (40 mg/day), c) low salt diet (5 g of salt/day) and nifedipine, and d) the same low salt diet, nifedipine and a salt supplement (6 g/day); salt or placebo were given in a double blind manner. At the end of each period arterial blood pressure was recorded, a urine sample for sodium determination was taken, and a blood sample was drawn for serum renine activity and biochemical parameters; at the end of each period patients' weight was recorded. Blood pressure significantly decreased (systolic: 9.83%, and dyastolic 11.17%) in patients treated with nifedipine, with no differences observed with salt modifications. Urinary sodium reflected correctly dietary salt modifications. Serum renine activity significantly increased during salt restriction. No significant changes were observed in weight or in the biochemical parameters studied. These results seem to suggest that the antihypertensive effect of nifedipine in patents suffering mild to moderate essential hypertension, with no change observed is not altered by the amount of salt in diet, at least within the limits studied (89.7 to 190 mEq/day of Sodium).

Serum ferritin and hemochromatosis alleles in chronic hemodialysis patients

There have been some reports on the risk of developing hemosiderosis in hemodialysis patients when heavily transfused and simultaneously possessing hemochromatosis alleles (HA). We evaluated 99 patients on chronic hemodialysis estimating their serum ferritin (SF) levels, transfusion rate, and prevalence of HLA A3, B7 and B14 alleles, which are considered to be more frequent in idiopathic hemochromatosis. We analyzed the patients as a whole group and also separately as low or high transfusion groups. There was no correlation between the number of HA and the mean SF levels. The presence of HA is not a risk factor for the development of hemosiderosis when excessive transfusions and parenteral iron administration are avoided.

The role of growth hormone in the pathogenesis of postmenopausal osteoporosis

The secretory response of somatotropic hormone (STH) to arginine hydrochloride stimulation (0.5 g/kg) was studied in 13 postmenopausal women. Eight showed evidence of osteoporosis, based on clinical and morphoradiological data and on metacarpal cortical thickness measurement, and five had normal bone mass. In addition, the response to levodopa (500 mg) was determined in four of the osteoporotic patients. Baseline STH concentrations in the osteoporotic subjects did not differ from those in the nonosteoporotic group, but the latter showed a significant increase over the former at 45, 60, 90, and 120 minutes after stimulation. Similar findings were obtained with levodopa stimulation. Without necessarily implying a cause-effect relationship, our data appear to support the hypothesis that the poor secretory response of STH may be to some degree responsible for the osteopenia observed during the climateric.

Metacarpal cortical thickness in uremic patients on regular hemodialysis

Metacarpal cortical thickness was measured in 83 patients with chronic renal failure undergoing periodic hemodialysis. Patients were dialyzed twice weekly, 8--9h per session, with a calcium concentration in dialysate of 6.5 mg/dl. Supplements of calcium, vitamin D (5,000 I.U. a day), steroid anabolic hormones, and aluminium hydroxyde were administered to all patients. They were on a normal protein intake and unrestricted physical activity. The results show that the young males have a reduction in cortical thickness as compared to age-matched controls, and that there is a progressive loss in cortical width as the length of dialysis increases. This bone loss is statistically significant in males during their first 18 months of dialysis.