Is there any connection between the presence of kidney stones in primary hyperparathyroidism and the location of an underlying adenoma?

The majority of the patients with primary hyperparathyroidism (pHPT) recurrently produce kidney stones, while the rest have other clinical manifestations. The aim of this study was to examine the possibility of an association between the presence of kidney stones and the location of an underlying adenoma. This was a retrospective evaluation of the records of 91 patients (10 males, 81 females, mean age: 61.9 years [20 - 70 yrs]) operated for primary hyperparathyroidism between 1995 and 2000. One patient was excluded due to carcinoma. Kidney stones were found in 55 cases and other clinical symptoms in 35 cases. In 50 of the 55 patients (91 %) with kidney stones, the adenoma was located in the left inferior parathyroid gland (chi2 = 67.5, p < 0.00,001), while in 24 of the 35 patients (69 %) without kidney stones, the adenoma was in the right inferior parathyroid gland (chi2 = 43.9, p < 0.0001). These results suggest that the location of the adenoma may influence the presence of kidney stones in pHPT. It is proposed that the biologic effects of parathyroid hormone could differ depending on which of the four parathyroid glands it was secreted in, or the four glands may produce different biologically active fragments.

[Clinical experience with raloxifene]. / Klinikai tapasztalatok raloxifennel.

Selective receptor modulators (SERMs) are drugs which act via the estrogen receptors and possess tissue specific estrogenic or anti-estrogenic properties. The bone and cardiovascular effects of SERMs are estrogen-like, while they have an effect as estrogen antagonist in the mammary tissues. Raloxifene is the first representative of selective estrogen receptor modulators which does not cause estrogenic effects in the uterus. Based on numerous recently completed controlled clinical trials, the authors characterize the clinical features of raloxifene to assess its therapeutic potency.

DNA content of parathyroid tumors.

BACKGROUND: The significance of DNA ploidy in indicating the benign or malignant character of parathyroid and other endocrin tumors is controversial. MATERIALS AND METHODS: DNA content of paraffin embedded parathyroid samples from 25 patients was measured with flow cytometry. RESULTS: The DNA index (DI) was 1.0 in all nonneoplastic samples as well as in 50% of adenomas (10/20) and in one carcinoma (1/2). The remaining 45% of the adenoma cases (9/20) and the other carcinoma showed doubled DNA content (DI = 1.9-2.0). The increased DI did not correlate with either clinical data (sex, age, tumor size, preoperative serum Ca++ or parathormone, primary or secondary hyperparathyroidism) or morphology. CONCLUSIONS: These results indicate that the DI has no value in deciding the benign or malignant character of a given sample. However, the prognostic value of tetraploidization (the potentially increased risk for malignancy) could not be ruled out.

[Cardiovascular diseases and hormone replacement therapy in females]. / Cardiovascularis megbetegedések és nöi hormon kezelés.

The effects of hormone replacement therapy are summarized from the point of view of ischaemic heart disease and stroke syndrome. The beneficial effects of oestrogen or combined oestrogen-gestagen therapy on different lipid parameters, some factors of the haemostasis are discussed, as well as the possibilities of a direct effect on blood vessels. Hormone replacement therapy in the menopause significantly decreases cardiovascular and stroke morbidity and mortality.

Osteoporosis from the point of view of the clinical endocrinologist.

The physiology of the bone tissue is reviewed from the point of view of a clinical endocrinologist. The effect of the main calcium-regulating hormones and various local factors on the osteoblasts and osteoclasts is discussed. The aim of this review is to summarize the physiological and pathophysiological role of calcitonin, parathormone, vitamin D3, thyroid hormones, glucocorticoids, growth hormone and sex hormones on bone metabolism. The significance of endocrinological dysfunctions in the pathogenesis of osteoporosis, the most wide-spread metabolic bone disease, is emphasized. A theory concerning the pathogenetic role of androgen hormone deficiency in postmenopausal osteoporosis is discussed in detail.

Dehydroepiandrosterone sulphate and bone mineral density.

Several series of data suggest that alterations in adrenal androgen output might be a contributing factor to changes in bone mass. To study the possible relationship between bone density and serum levels of dehydroepiandrosterone sulphate (DHEAS) we investigated 105 women (aged 45-69 years; 76 postmenopausal, 29 perimenopausal). The patients were divided into two groups according to the bone mineral density (BMD) measurement (normal density n = 50, low density n = 55). BMD was measured by dual-energy X-ray absorptiometry of the lumbar spine and femoral neck. Bone mineral content (BMC) of the radius midshaft was measured by single photon absorptiometry. Serum DHEAS level was significantly lower in the 'low density' group than in the 'normal' one (1.91 +/- 1.04 v 4.77 +/- 2.03 mumol/l, p < 0.001). The serum DHEAS level decreased significantly with age in both groups (r = 0.43, p < 0.001 in the 'normal' group; r = 0.35, p < 0.01 in the 'low density' group). Unlike the slopes, the positions of the regression lines differed significantly (difference 2.85 mumol/l, p < 0.001). Correcting for age by multiple linear regression we established a significant positive relationship between DHEAS and BMD of the lumbar spine and femoral neck, and BMC of radius midshaft as well. Since there was no significant difference between the two groups regarding oestrogens, we suggest that DHEAS may have a non-oestrogenic effect on bone. The odds ratio of a subject with a low (< 3.3 mumol/l) serum DHEAS level having low BMD was 40 (confidence interval 13-126).(ABSTRACT TRUNCATED AT 250 WORDS)

Bone mineral content of the third lumbar vertebra during 18 months of prednisolone treatment for giant cell arteritis.

Altogether forty-four patients with giant cell arteritis (GCA) were randomly allocated to either daily morning or alternate-day administration of prednisolone. The BMC of the third lumbar vertebra was determined using dual photon absorptiometry. At least ten measurements were performed in each patient during a period of 18 months. During the course of treatment there was no significant change of the mean BMC in either group compared to the pre-treatment value. The changes of BMC were independent of such potentially explanatory variables as cumulative dose of prednisolone, initial BMC, sex and body weight. Corticosteroid treatment in patients with GCA, in the doses used by us, does not appear to cause excessive bone loss.

Reduced bone mineral content in adult patients with growth hormone deficiency.

Bone mineral content was measured in a follow-up study of adult patients with hypopituitarism and growth hormone deficiency. There were 95 patients (59 males, mean age 54.0 years, range 21-74 years; 36 females, mean age 53.5 years, range 31-73 years). Routine replacement therapy with cortisone acetate and L-thyroxine was given. All males that were gonadal deficient were on proper testosterone therapy, except in four patients who were treated separately. Bone mineral content (g/cm) was measured using dual-photon absorptiometry in the third lumbar vertebra. Bone mineral content in the patients was compared with a control population (N = 413, 25-74 years of age). Bone mineral content was significantly lower in males (N = 55, p < 0.05) compared with controls. In females, bone mineral content was significantly lower both among the subjects with untreated gonadal deficiency (p < 0.001) and among those with treated gonadal deficiency and normal premenopausal gonadal function (p < 0.005) compared with controls. To summarize, patients with hypopituitarism on routine replacement therapy but not growth hormone have a lower bone mineral content than the controls. The reduced bone mineral content might be a result of untreated growth hormone deficiency.

[Retrospective clinicopathological study of juvenile nasopharyngeal angiofibroma in a 20-year case load]. / A juvenilis nasopharyngealis angiofibroma retrospektív klinikopatológiai vizsgálata 20 éves anyagunkban.

From the files of our institution 7 cases originally diagnosed as juvenile nasopharyngeal angiofibroma have been reviewed. Only 3 cases proved to be juvenile nasopharyngeal angiofibroma on revision, in one case inflammatory polyp, in two cases pyogenic granuloma and in one case richly vascular granulation tissue was the correct diagnosis. The clinical and histopathological aspects of the differential diagnosis of juvenile nasopharyngeal angiofibroma are discussed. All patients with true juvenile nasopharyngeal angiofibroma were males. The diagnostic usefulness of the recognition of morphological features suggesting erectile tissue are stressed.

[Zinc excretion in osteoporotic women]. / Cinkürítés osteoporosisos nökben.

Urinary zinc excretion was detected in 24 normal and 25 age matched osteoporotic women. The osteoporotic group was classified in two groups on the basis of bone mineral density (BMD) measurements. Urinary zinc excretion was 327 micrograms/g creat. in healthy subjects and 488 micrograms/g creat. in the "common porotic group". In the "trabecular porotic group" (decreased BMC with DEXA at the lumbar spine alone or together with the femoral neck, but with normal radius BMD) it was 455 micrograms/g creatinine while in the "cortical porotic group" (decreased BMD with SPA at the radius midshaft and/or all the sites measured) the zinc excretion was even higher, 588 micrograms/g creat. The difference between the normal and porotic groups was statistically significant, while within the porotic groups it was not, however the tendency was remarkable. A close significant correlation exists between BMC of radius and urinary zinc excretion. In the osteoporotic group the urinary calcium excretion was significantly higher, than in normal group (220.2 vs 145.2 mg/g creat, p < 0.01). The correlation between the urinary zinc and calcium excretion was not significantly statistically. Elevated urinary zinc excretion is characteristic in both types of involutional osteoporosis in women and therefore seems to be a potential new simple marker of bone resorption.

[Treatment of postmenopausal osteoporosis with low doses of calcitonin and a calcitonin-anabolic combination]. / Postmenopausás osteoporosis kezelése kis adag kalcitoninnal és kalcitonin-anabolikum kombinációval: 3 éves kezelési tapasztalat.

Menopausal osteoporotic women (age: 49-69, mean: 59.5 years) with crush fractures of the spine were treated with low doses of calcitonin (Miacalcic, 350 U/month), or with calcitonin + anabolic steroid (Retabolil, 50 mg/month). Efficacy of the therapy was controlled by single foton absorptiometry of midshaft and distal radius, by X-ray morphometry and by registering new crush fractures of the spine. Calcitonin monotherapy stopped further bone loss for two years, but at the end of the third year both absorptiometric values, as well as the radiomorphometrical index of the lumbar spine decreased significantly. In patients on calcitonin+anabolic steroid the decrease was just significant and only at radius midshaft, while at the other measured sites it was not. Two new crush fractures per 1396 patient-months occurred. Intermittent administration of low-dose calcitonin, especially together with an anabolic steroid seems to be a safe and effective therapy in established osteoporosis.

[Spinal and appendicular osteoporosis in streak gonad syndrome. Photon absorptiometric and roentgen-morphometric studies]. / Axiális és appendikuláris osteoporosis csíkgonád szindrómában foton abszorpciometriás és röntgenmorfometriás vizsgálatok.

Patterns of bone loss in the axial and the appendicular skeleton were studied in 48 women with streak gonad syndrome (age: between 14-38 years, mean: 25.5 years). Bone mineral content was measured in vivo at the lumbar spine and right femoral neck by dual photon absorptiometry and at the midradius and distal radius by single photon absorptiometry. The bone mineral status of 20 patients was evaluated by radiomorphometrical indices of the metacarpals, femorals and lumbar spine, too. Mean bone mineral content and radiomorphometrical indices were significantly lower in patients with streak gonad syndrome than in age-matched normal subjects at all three scanning sites. The patients lost cortical and trabecular bone mineral content at the same rate, suggesting that bone loss in streak gonad syndrome is a generalized phenomenon. In spite of serious bone loss osteoporotic fractures were not observed in the patients, in contrast to patients with pathological post-menopausal osteoporosis having equal degree of bone deficiency. The authors did not find any relationship between the occurrence of osteoporosis and the karyotype of the patients. It is suggested that the osteoporosis in streak gonad syndrome--at least after puberty--is a consequence of gonadal hormone deficiency.

Accuracy, precision, and homogeneity effects in the determination of the bone mineral content with dual photon absorptiometry in the heel bone.

In this work the distribution of bone mineral content (BMC) in the calcaneus has been studied by means of dual photon absorptiometry. The bone mineral content determined according to the described method is corrected for the amount of fat and lean soft tissue in the path of the radiation beam. It is found that the bone mineral content shows a large variation in the calcaneus. There does, however, exists a homogeneous region in the central part of the calcaneus. The in vitro precision of the technique has been determined to be 1.02%, and the in vivo precision has been found to be 2.8%. The correlation coefficient between ashed bone mass and measured BMC value was 0.97.

Three-year calcitonin combination therapy for postmenopausal osteoporosis with crush fractures of the spine.

Forty-five postmenopausal osteoporotic women with at least one osteoporotic vertebral crush fracture were randomized into three treatment groups. Each patient was on calcitonin, 50 U, on alternate days for 2 weeks monthly (350 U/month), and 500 mg/day oral calcium supplementation. In group II, this therapy was supplemented with phosphate (750 mg/day), and in group III, norandrostenolone decanoate (50 mg/month) was added to the calcitonin+calcium therapy. Bone mineral content, by single photon absorptiometry, of the radius midshaft and distal site (3 cm), as well as the lumbar and metacarpal radiomorphometrical indices were estimated seminannually. The therapeutic trial lasted 36 months except in the phosphate supplementation group, where, due to unfavorable results, treatment was discontinued after 24 months. Calcitonin practically prevented further bone loss for 24 months even in this relatively small and intermittent dosage. Phosphate supplementation was without benefit; however, according to the majority of the examined parameters, combination of calcitonin with the anabolic steroid norandrostenolone decanoate extended efficacy up to 36 months. This latter combination seems to be a promising, relatively inexpensive therapeutic regimen in the treatment of established postmenopausal osteoporosis.

[Mean value of bone mineral content in Hungary measured by dual-photon absorptiometry]. / A csontok ásványianyag-tartalmának magyarországi átlagértékei kettös energiájú rntgenfoton absorptiometriával mért adatok alapján.

Bone mineral content and density of the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry in normal volunteers (89 women, 77 men) in different age groups. Peak values in both sexes occurred in the 3rd decade and are about 25% higher in men than those in women. In women the bone loss begins around 40 years at lumbar spine and also at the femoral neck. The rate of bone loss in the 6th decade--according to the menopause--significantly accelerates. The diminution in the 8th decade is higher again. In men the decrease of the lumbar spine density is also significant in connection with the ageing process, but the rate of the bone loss is slower, than in women. The femoral neck density and mineral content values begin to decrease at the 4th decade. The decrease of bone mineral content and density of femoral neck are equivalent in both sexes but some difference exists in the velocity. The data were compared with West-european values. The values of the femoral neck are lower, while those of the lumbar spine in the 5th decade in the female are higher in the Hungarian population. The reason of this difference may be the consequence of the obesity of the Hungarian female population.

Selection and mutation at a diallelic X-linked locus.

Equilibria and convergence of gene frequencies are studied in the case of a diallelic X-linked locus under the influence of selection and mutation. The model used is that of an infinite diploid population with nonoverlapping discrete generations and random mating. It is proved that if the mutation rates and fitnesses are constant and the mutation rates are less than one-third, then global convergence of gene frequencies to equilibria occurs. The phase portraits of the dynamical system describing the change of allelic frequencies from one generation to the next are determined. Convergence of gene frequencies is monotone from a certain generation on if every other generation is skipped. In the case without mutation, our proof of this monotone convergence simplifies G. Palm's original proof.

Selection-mutation at a diallelic autosomal locus in a dioecious population.

The population is assumed to be infinite dioecious with nonoverlapping discrete generations and random mating. It is assumed that the fitnesses and mutation rates are constant, heterozygotes are viable and the mutation rates are less than one-half. It is proved that the allelic frequencies converge to equilibria as the number of generations tends to infinity. The a priori types of phase portraits are determined. The method employed is elementary. The results extend those of [1, 2, 5, 8] to the case of selection-mutation rather than pure selection and those of [7] to the case of an autosomal rather than a sex-linked locus.

Dual-photon absorptiometry for determination of bone mineral content in the calcaneus with correction for fat.

A portable dual-photon absorptiometry system for the determination of the bone mineral content BMC in vivo in the calcaneal bone is described. With knowledge of the total thickness of the heel at the measuring point the BMC can be corrected for fat and lean soft tissue. The system is capable of measuring the BMC in the heel bone with a precision of 1.2% in vitro and 1.8% in vivo at an absorbed dose to the skin of 0.2 mSv.