[The new clinical picture of primary hyperparathyroidism. Diagnostic circumstances and current symptomatic characteristics. Results of a multicenter study]. / Le nouveau visage clinique de l'hyperparathyroïdie primitive. Circonstances de diagnostic et caractères symptomatiques actuels. Résultats d'une enquête multicentrique.

Primary hyperparathyroidism (PHP) is particularly interesting at this time because of the modifications of its traditional symptoms, which have renewed the conditions of its diagnosis. This is the result of a better knowledge and consequently an increased frequency of the simple forms, mild or clearly atypical, usually expressing the initial stages of the disease which are now better detected. The relative part of the classical manifestations of the disease is therefore reduced as well. In order to verify this fact, the authors have initiated a retrospective study of 535 recent cases of PHP, over 12 years, comparing them with 322 older cases, examined and operated upon between 1954 and 1976 by P.L. Chigot. Analysis of the differences that were noted, was the subject of a statistical evaluation. The first result of this investigation is that PHP remains a disease affecting predominantly women, especially between the ages of 40 and 60 years, and beyond that age to a lesser degree. In comparing the data obtained from analyzing the circumstances of discovery of the disease and its symptoms, the most striking modification consisted in a real drop in the frequency of bony lesions. These modifications are much more rare, only exceptionally presenting their classical characteristic X-ray appearance and they only represent a factor of contingency in the clinical picture of PHP. This is probably the result of a much earlier discovery of the disease. The incidence of renal insufficiency is also remarkably low, probably for the same reason. In return, asthenia and urinary lithiasis are now the major symptoms of PHP.(ABSTRACT TRUNCATED AT 250 WORDS)

Variation of surface density and other parameters in remodeling of trabecular bone in various conditions.

To appreciate the remodeling of the trabecular bone, the static morphometric parameters of surface density (SV(TRAB/BONE] and volumetric fraction (VV(TRAB/BONE] of cancellous bone were measured and compared to remodeling parameters, i.e., the surface extents of active/inactive resorption, active bone formation and nonmineralized bone. Iliac bone biopsies from 28 subjects with spasmophilia, osteoporosis and primary hyperparathyroidism were studied by means of a Nachet-France NS 2000 automatic image analyzer and a Zeiss ocular integrator; the results obtained in each group showed comparable values for the two methods (r = .8 for each group, with P less than .01). The remodeling parameters measured by means of the ocular integrator were compared with the variation measurements of the trabecular surface density, SV(TRAB/BONE). The correlation between the inactive osteoid surface and the coefficient of variation of the mean (CVM of SV(TRAB/BONE] on sections was significant for the three pathologic groups. The average mean values and standard errors of the mean of this latter parameter for the spasmophilia and hyperparathyroidic groups were, respectively, 0.063 +/- 0.008 and 0.092 +/- 0.012. Analysis of the experimental data shows that the simple global measurement of CVM (SV(TRAB/BONE] by means of an automatic image analyzer supplies information on the skeletal state during tissue remodeling.

[Calcium nephrolithiasis and phosphate therapy. Long term study (65 cases) (author's transl)]. / Lithiase rénale calcique et phosphothérapie. Etude à long terme (65 cas).

Protected phosphate therapy was used in 65 cases of recurrent calcium nephrolithiasis. Mean duration treatment was 2 years and 1 month (more than 3 years in 17 cases). Mean lithiasis episodes by year-patients were 1,55 renal colics and 0.34 stone formation before phosphate treatment, versus 0.66 renal colics and 0.10 stone formation (more than 60% reduction), during treatment. There was simultaneously decrease of hypercalciuria (24 cases out of 42), of asthenia (16 cases out of 19), of signs of spasmophilia (12 cases out of 18) and disappearing of bone pains (4 cases out of 6). Side effects were rare. Minor digestive troubles were observed in 11 cases: diarrhea (3 cases) or gastralgias (9 cases). These side-effects necessitated discontinuation of thiazide therapy in only two cases and reduction of doses in 6 other cases. From our data, phosphate therapy appears an efficient drug in recurrent calcium nephrolithiasis. It acts in reducing levels of calciuria and enhancing urinary pyrophosphates excretion, inhibitors of calcium crystallization.

[The treatment of osteoporosis (author's transl)]. / Traitement de l'ostéoporose commune.

Treatment for osteoporosis cannot yet be prescribed in a perfectly rational manner, as the total picture of the pathogenesis of this disease remains uncertain. Furthermore, lack of significant criteria makes it difficult to evaluate the different therapeutic methods proposed, and none of them appears to be entirely satisfactory. By acting methodically, however, one can obtain good relief of pain, quiescent osteoporotic activity over long periods, and bone remineralization. At the present time, preference has to be given to standard medications such as calcium, phosphorus, and anabolic proteins which are nearly always given in association. Calcium inhibits osteolysis by slowing down parathyroid secretion. Phosphorus accelerates calcium fixation in bone and appears to stimulate the formation of osteoblasts. Anabolic compounds protect the bone-forming framework and assist the deposition of mineral salts in the bones. The prescription of vitamin D is of value when there is a deficiency. Among recent medications which have been tried, only calcitonin appears to be of some practical value, by assisting inhibition of certain flare-ups and lytic episodes of the osteoporosis when associated with standard therapy.