Bone mineral density of lumbar spine and proximal femur in normal Thai women.

OBJECTIVE: To find the reference data for age-specific normal bone mineral density in a Thai female population. STUDY DESIGN: Cross-sectional, Descriptive study. MATERIAL AND METHOD: 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist. RESULTS: The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively. CONCLUSION: The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.

Neonatal screening for hypothyroidism at a university hospital in Thailand.

Neonatal screening is an essential program for early identification of congenital hypothyroidism. Between July 1991 and May 1998, 37, 262 infants born at Chulalongkorn Hospital were enrolled to the screening program. Blood TSH levels were determined on infants at > or = 48 hours after birth. They were performed in dried blood sample taken by heel prick on filter papers. TSH levels were measured by fluoroimmunoassay from July 1991 to December 1997 and by immunoradiometric assay from January to May 1998. Infants with TSH screening level higher than the cut off level (20 mu/l) were recalled for re-evaluation which consist of complete physical examination and blood test for serum T4 and TSH. Bone age determination and thyroid scan using technetium-pertechnetate were performed if the serum T4 and TSH levels were abnormal. The recall rate was 0.28% and response rate was only 69%. Primary congenital hypothyroidism was diagnosed in 15 infants. Prevalence was 1: 2,484. Among these infants, 8 had ectopic thyroid, 3 had normal glands and 3 were athyrotic. One infant died before the thyroid scan could be performed and did not receive treatment. The median age at initiation of thyroxin therapy was 29 days (range, 20-67 days). The follow up result was satisfactory. This study demonstrated the potential vulnerability of congenital hypothyroid screening program in Thailand. Improvement of parents' education, communication and monitoring should be emphasized for a large screening program.

Bone loss in oophorectomized Thai women.

This prospective analysis was done in 95 postmenopausal women to observe bone loss rate between 59 natural and 36 surgical menopausal women with or without hormonal replacement therapy (HRT). Bone mass measurement was performed at lumbar spines (L1-L4) and hip by dual energy X-ray absorptiometer at 0, 6 and 12 months. The results revealed that in the non-HRT group there was significant faster bone loss rate of lumbar spines (LS) and hip (H) of the surgical group at 12 months (Natural group: LS = -1.11%, H = +2.38%; Surgical group: LS = -4.51%, H = -0.66%, P < 0.05). However, there was no significant difference in bone changes of lumbar spines and hip between natural and surgical group with HRT at 12 months (Natural: LS = +2.0%, H = +4.06%; Surgical: LS = +0.62%, H = +2.28%, P > 0.05). This observation showed that without HRT oophorectomized women had greater magnitude of bone loss than women who entered menopause naturally.

Correlation of bone mineral density among various measurement sites.

Bone mineral density (BMD) of the lumbar spine and hip was studied in 1,047 women visiting the menopause clinic, to assess the correlation of BMD among various measurement sites. Bone mass measurement was performed utilizing dual energy X-ray absorptiometer (DEXA), Hologic QDR 2000. The results revealed a significantly high correlation of BMD of total hip and spine. (r = 0.7021, P < 0.001) Nevertheless, BMD of the spine was mostly correlated with BMD of trochanteric site (r = 0.7235, P < 0.001) and least correlated with BMD of intertrochanteric region. (r = 0.2426, P < 0.001) In conclusion, BMD of spine and hip is highly correlated. However, there was some heterogeneity of correlation in different specific measurement sites.

Bone changes in postmenopausal Thai women with or without hormonal replacement therapy.

Bone mass measurement was performed in 95 healthy postmenopausal women to assess the effect of hormonal replacement therapy (HRT) on bone changes. Women in the study group (51/95) received estrogen with or without progestin. The control group (44/95) did not receive any hormone regimen. The measurement was done at lumbar spines (L1-L4) and hip by dual energy X-ray absorptiometer at 0, 6 and 12 months. The results revealed significantly higher per cent changes of bone density of lumbar spines and hip, at 12 months, in the study group than in the control. (Study: Lumbar Spine +1.76%, Hip +3.57%; Control: Lumbar spines -2.32%, Hip +1.32%, P < 0.05). In conclusion, this study showed the value of hormonal replacement therapy for prevention of postmenopausal bone loss in Thai women.

Intrarenal hemodynamic abnormality in severe form of glomerulonephritis: therapeutic benefit with vasodilators.

Intrarenal hemodynamic and tubular function has been assessed in 16 patients who presented clinically with hypertension, hematuria and severe renal functional impairment. Twelve of these 16 patients had histopathologic classification as DPGN (3 cases), MPGN (3 cases) and FSGS (6 cases). The initial assessment of intrarenal hemodynamics in 11 patients revealed strikingly increased afferent (RA) and efferent arterioles (RE), filtration fraction (FF), intraglomerular capillary hydrostatic pressure (PG), whereas, there was marked reduction in renal plasma flow (RPF), in ultrafiltration coefficient (KFG) and in glomerular filtration rate (GFR). Tubular transporting defect as being reflected by enhanced fractional excretions of solutes was also observed. Both enhanced TXB2 production and diminished PGI2 may be in part responsible for the marked reduction of RPF and elevated intrarenal resistance. In light of the preceding intrarenal hemodynamics alteration, therapeutic intervention with vasodilators consisting of dipyridamole, calcium channel blocker and angiotensin convertase inhibitor has been accomplished with clinical improvement in glomerular and tubular functions following the improvement in intrarenal hemodynamics. Thus, this abnormal intrarenal hemodynamics renders a supportive view of the hemodynamically mediated glomerulo-tubulo-interstitial injury to be central to the pathogenetic mechanism.

Hemodynamic response to high-dose methyl prednisolone and mannitol in severe dengue-shock patients unresponsive to fluid replacement.

Nine children; 4 males and 5 females, aged ranging from 2 1/2 to 13 years presented with signs and symptoms of poor tissue perfusion associated with dengue shock syndrome. All these 9 patients were subjected to the therapeutic trial of high dose methyl prednisolone (MP; 9/9) and mannitol (M; 6/9) after their failure to the saline and plasma replacement. Following the high dose MP and M, a significant increment in the effective circulatory blood volume as reflected by the sustained increment in CVP, widening of PP and declining in PR as well as improvement in clinical tissue perfusion were established in 7 of these nine patients so treated.