[Current options for percutaneous endoscopic access to the digestive tract]. / Huidige mogelijkheden voor percutane endoscopische toegang tot de tractus digestivus.

Four patients, aged 67, 52, 56 and 64 years, respectively, undergoing percutaneous colostomy or jejunostomy are presented to illustrate current options for percutaneous endoscopic access to the digestive tract. The first patient had Parkinson's disease and required percutaneous jejunostomy for continuous post-pyloric administration of medication. The second patient had impaired gastric emptying due to gastric graft-versus-host disease following bone marrow transplantation. He was successfully treated with percutaneous jejunostomy, which was removed 2 years later after full recovery. The third patient had severe constipation due to the use ofmorphinomimetic analgesics. She received percutaneous caecostomy for colonic lavage and desufflation. The fourth patient had combined constipation and sphincteric insufficiency. Although the percutaneous endoscopic colostomy was clinically successful, the catheter had to be removed due to local pain and abscess formation.

Lean mass and physical activity as predictors of bone mineral density in 16-20-year old women.

OBJECTIVE: The aim of the study was to quantify the inter-relationship between bone mineral density and physical activity, muscle strength, and body mass composition in a group of healthy 16-20-year-old women. DESIGN: A cross-sectional study. SETTING: Reykjavik area. SUBJECTS: Two-hundred and fifty-four Icelandic Caucasian women aged 16, 18 and 20 years, randomly selected from the registry of Reykjavik. MAIN OUTCOME MEASURES: Bone mineral content (BMC) and density (BMD) in lumbar spine, hip, distal forearm and total skeleton and lean mass and fat mass were measured with dual energy X-ray absorptiometry (DEXA) and compared with grip strength measured with a dynamometer and physical activity as assessed by a questionnaire. RESULTS: The lean mass had the strongest correlation with BMC and BMD, stronger than weight, height and fat mass, both in univariate analysis (r = 0.41-0.77; P<0.001) and in linear regression analysis. The total skeletal BMD was logarithmically higher by hours of exercise per week (P<0.001)). About 30% of variability in total skeletal BMD in this age group can be predicted by lean mass and physical exercise. CONCLUSIONS: Modifiable factors, such as exercise and adequate muscle seem to be significant predictors of the attainment of peak bone mass in women.

Serum 25-hydroxyvitamin D levels and bone mineral density in 16-20 years-old girls: lack of association.

OBJECTIVE: Hypovitaminosis D has been shown to be associated with low bone mineral density in middle-aged and elderly women. The aim of this study was to evaluate whether such an association might exist in adolescent and young adult girls, approaching peak bone mass. DESIGN: Cross-sectional study carried out in late winter. SETTING: Reykjavik area at latitude 64 degrees N. SUBJECTS: Two-hundred and fifty-nine Icelandic Caucasian girls, aged 16, 18 and 20 years, randomly selected from the registry of Reykjavik. MAIN OUTCOME MEASURES: Bone mineral density in lumbar spine, hip, distal forearm and total skeleton was measured with dual-energy X-ray absorptiometry (DEXA) and compared with 25-hydroxyvitamin D levels [25 (OH)D] in serum, measured by radioimmunoassay. Calcium and vitamin-D intake were also assessed by a questionnaire. RESULTS: 18.5% of the girls were below 25 nmol L-1 in serum 25 (OH)D which has been recognized as the lower normal limit for adults. No significant association was found between 25 (OH)D levels and bone mineral density. CONCLUSIONS: Normal calcium and phosphate concentrations in plasma and normal bone mineral density are maintained in adolescent and young adult girls at lower 25 (OH)D levels than published 'normal' levels for middle-aged and elderly.

[Peak bone mass of Icelandic women and associated factors.].

OBJECTIVE: The aim of this study was to evaluate at which age peak bone mass is reached among Icelandic women. Previous studies on this subject have been conflicting indicating that this might be reached sometime between the age of 16 and 35 years. We have also analyzed associated nutritional and physical factors which might be of use for preventive measures against osteoporosis. MATERIAL AND METHODS: A random sample of 16, 18, 20 and 25 years old women in Reykjavik were invited, altogether 335 women participated. Bone mineral density (BMD) was analyzed by Dual Energy X-ray Absorptiometry (DEXA) in the lumbar spine, hip, forearm and total skeleton. Calcium, protein and vitamin D intake was assessed by a semiquantitative food frequency questionnaire. The level of 25-OH-vitamin D in serum was measured by a radioimmunoassay. Physical activity was assessed by a questionnaire. Multivariate analysis was performed by multiple linear regression. RESULTS: Maximal bone mineral density was reached for total skeleton, hip and forearm at the age of 20 years, BMD for the lumbar spine was 1% higher at the age of 25 than at 20 years but this was not statistically significant. No significant association was found between the calcium intake and BMD except in the subgroup of 18 years old women with calcium intake below 1000 mg/day. 25-OH-vitamin D levels were low (<25 nmol/L) in 15-18.5% of the groups but still no significant relationship was found with the bone mineral density. The strongest correlation was found between total BMD and the lean mass (0.38-0.53, p<0.01) but physical activity was also a significant factor in the age groups 16-20 years. About 25-30% of BMD variability can be attributed to these modifiable factors. CONCLUSION: Peak bone mass seems to be reached at the age of 20 and measures to increase it should therefore be emphasized before that age. Our results indicate that modifiable factors, especially lean mass and physical activity, are of considerable importance in the attainment of peak bone mass in women.

Association of BsmI vitamin-D receptor gene polymorphism with combined bone mass in spine and proximal femur in Icelandic women.

OBJECTIVE: To evaluate whether there is an association between BsmI-vitamin-D receptor (VDR) gene polymorphism and combined bone mass in the spine and proximal femur in a group of adult Icelandic women with high and low bone mineral density (BMD). DESIGN: Comparison of distribution of VDR genotypes (BB, Bb and bb) and allele frequency (B and b) in two groups of women: a group with 'strong bones' with high BMD in both the spine and proximal femur (> 1 standard deviation [SD]) above the age-matched mean (n = 35) and a group with 'weak bones' with BMD > 1.5 SD below the age-matched mean at both sites using dual energy X-ray absorptiometry. SETTING: Iceland, a population with a mean calcium intake > 1000 mg day-1. The calcium intake in the study group was however not evaluated. SUBJECTS: Eighty-three Icelandic women, aged 22-65, free of diseases affecting bone and not taking drugs affecting calcium or bone metabolism, recruited from women undergoing bone densitometry at the Reykjavik Hospital. MAIN OUTCOME MEASURES: Frequency of VDR genotypes and alleles in the two groups. RESULTS: The distribution of VDR genotypes was significantly different in the two groups (P < 0.01); the b allele frequency was 70% in the group with high BMD compared to 48.5% in the group with low BMD. CONCLUSIONS: In this selected group of adult Icelandic women the b allele in the vitamin-D receptor gene seems to be associated with high bone mass in the spine and proximal femur.

Relation between calcium intake, grip strength and bone mineral density in the forearms of girls aged 13 and 15.

OBJECTIVES: To evaluate whether there is an association between calcium intake in adolescent girls and bone mineral density (BMD). Also, the relationships between BMD, various anthropometric factors and grip strength were evaluated. DESIGN: Cross-sectional comparison of BMD, calcium intake and grip strength in 13 and 15 year age groups, randomly selected. SETTING: Ten secondary elementary schools in the Reykjavik area. SUBJECTS: One hundred and ninety-seven Icelandic Caucasian girls aged 13 and 15. One hundred and seventy participated and 162 completed the study. MAIN OUTCOME MEASURES: Single photon absorptiometry was used to measure BMD and bone mineral content (BMC) in both forearms. Consumption of milk and dairy products was assessed using a food frequency questionnaire. Height and weight were measured and grip strength was determined with a hand-held dynamometer. RESULTS: Calcium intake was found to be significantly correlated to BMD in the older group after adjustment for menarcheal age and weight (r = 0.24; P < 0.05). Division into three subgroups yielded a significantly greater coefficient of correlation between calcium intake and BMD in the lowest calcium consumption group (r = 0.44; P < 0.05). No association was found in the younger age group. Significant positive correlations between grip strength and regional bone mineral density accounted for up to 16.8% of the variation in BMD (P < 0.001) and 38.4% of the variation in BMC. CONCLUSIONS: This study is consistent with the hypothesis that a threshold effect of calcium intake on BMD might exist. Above this threshold (1000-1200 mg) no further effect on BMD was seen. The results show a strong association between grip strength, a measure representative of total body strength, and BMD.