An unusual case of generalized soft-tissue mineralization in a suckling foal.

An atypical case of severe soft-tissue mineralization in a 3-week-old foal from a herd of Andalusian horses is described. The herd clinical history and the laboratory findings were compatible with a diagnosis of secondary hyperparathyroidism due to a mineral imbalance in the diet (low calcium and high phosphorus intake). Mares showed a marked increase in serum parathyroid hormone (PTH) approximately 10 times normal levels. Serum PTH was marginally elevated in foals. Clinical signs (unthriftiness, painful joints, lameness in one or more limbs, and stiff gait) were more pronounced in foals than in mares. Two foals died and necropsy of one of them revealed extensive soft-tissue mineralization of arterial walls and pulmonary parenchyma. Clinical signs in mares and foals resolved by 4 weeks after diet adjustment.

The influence of anticoagulants on the measurement of total protein concentration in equine peritoneal fluid.

The aim of this study was to evaluate the influence of two commonly used anticoagulants (K3EDTA and lithium heparin) on refractometric and spectrophotometric measurement of total protein (TP) concentration in equine peritoneal fluid samples. The influence of a commercial solution of K3EDTA, a solution of K3EDTA in distilled water and lithium heparin on the refractometric and spectrophotometric (biuret) quantification of TP content in peritoneal fluid samples was assessed. Total protein concentration measured by refractometry was consistently overestimated in samples with commercial K3EDTA. The solution of K3EDTA in distilled water only caused TP overestimation at high K3EDTA concentrations (>5 micromol/ml). By contrast, lithium heparin did not influence the refractometric values of TP. Neither anticoagulant modified TP values when measured by the biuret method. In conclusion, the use of K3EDTA as anticoagulant may result in a significant overestimation of TP values of peritoneal fluid samples measured by refractometry.

Diurnal variations in the plasma concentration of parathyroid hormone in dogs.

The plasma concentrations of parathyroid hormone (PTH), ionised calcium (Ca(2+)), total calcium, albumin and inorganic phosphorus, and the pH were measured in blood samples obtained from nine dogs during a period of 26 hours. The plasma pth levels fluctuated slightly during the day, by about 20 pg/ml, but there was a distinct peak (42.8 [8.8] pg/ml) at 07.00. Plasma Ca(2+) showed a diurnal pattern in which two peaks (increases of 0.03 mmol/l) were observed at 05.00 and 17.00, and the plasma concentration of inorganic phosphorus showed a similar pattern. There were no diurnal changes in total calcium or albumin.

Parathyroid gland function in the uremic rabbit.

Rabbits with renal failure have been reported to be hypercalcemic and to have decreased parathyroid hormone (PTH) concentrations. Thus, it would seem that uremic rabbits are resistant to secondary hyperparathyroidism (HPT). The work reported here was designed to investigate parathyroid gland function in uremic rabbits and the effect of diets with different calcium (Ca) and phosphorus (P) content. The relationship between PTH and ionized calcium (Ca2+), parathyroid gland size and parathyroid cell cycle were studied in three groups of rabbits: Group I, rabbits with normal renal function on a standard diet (Ca = 1.2%, P = 0.6%); Group II, partially nephrectomized rabbits on a standard diet; and Group III, partially nephrectomized rabbits on a low Ca (0.6%)-high P (1.2%) diet. Group I rabbits had baseline Ca2+ = 1.71 +/- 0.05 mmol/l and PTH = 26.9 +/- 3.2 pg/ml. During hypo- and hypercalcemic stimulation PTH reached maximal values (PTHmax) of 94.4 +/- 5.5 pg/ml and minimal concentrations (PTHmin) of 3.2 +/- 0.2 pg/ml. Rabbits from Group II were hypercalcemic (baseline Ca2+ = 2.03 +/- 0.06 mmol/l) and had very low PTH levels (1.7 +/- 0.5 pg/ml); however, they reached a PTHmax that was similar to Group I, 92 +/- 8.7 pg/ml. Group III rabbits were hypocalcemic (baseline Ca2+ = 1.22 +/- 0.08 mmol/l) and had very high basal PTH levels (739 +/- 155 pg/ml). Their PTHmax and PTHmin were 801 +/- 169.4 pg/ml and 102.2 +/- 22.2 pg/ml, respectively. Both parathyroid gland size and parathyroid cell proliferation were increased in Group III. In conclusion, our results show that the Ca and P content of the diet markedly influence PTH secretion in the uremic rabbit and that when placed on a low Ca-high P diet uremic rabbits develop secondary HPT.

Quantitative analysis of acid-base balance in show jumpers before and after exercise.

The acid-base status of venous blood was studied in 17 show jumpers before and after exercise using both a traditional and a quantitative approach. Partial pressure of carbon dioxide (PCO(2)), pH, haemoglobin, and plasma concentrations of sodium (Na(+)), chloride (Cl(-)), potasium (K(+)), ionized calcium (Ca(2+)), total proteins, albumin, lactate and phosphorus were measured in jugular venous blood samples obtained before and immediately after finishing a show jumping competition. Bicarbonate, anion gap and globulin concentration were calculated from the measured parameters. 'Quantitative analysis' of acid-base balance was performed utilising values for three independent variables: PCO(2), strong ion difference [SID = (Na(+)+ K(+)+ Ca(2+)) - (Cl(-)+ Lact)] and total concentration of weak acids [A(T)= Alb (1 paragraph sign23 pH - 6 paragraph sign31) + Pi (0 paragraph sign309 pH - 0 paragraph sign469) 10/30 paragraph sign97]; plasma concentrations of hydrogen ion ([H(+)]) were also calculated from these variables using Stewart's equation. No significant changes in blood pH were detected after the show jumping competition. Exercise resulted in a significant increase in lactate, Na(+), K(+), haemoglobin, total proteins, albumin, globulin and anion gap, and a decrease in bicarbonate, Cl(-)and Ca(2+). PCO(2)decreased after exercise while SID and A(T)increased. A significant correlation between measured and calculated [H(+)] was found both before and after exercise. However, individual [H(+)] values were not accurately predicted from Stewart's equation. In conclusion, even though pH did not change, significant modifications in the acid-base balance of horses have been found after a show jumping competition. In addition, quantitative analysis has been shown to provide an adequate interpretation of acid-base status in show jumpers before and after exercise.

Tissue quantification of CA 125 in epithelial ovarian cancer.

The objectives of this study were the determination of CA 125 in the cytosol of healthy and carcinomatous ovarian tissue by immunoanalysis, analysis of its correlation with the biological characteristics of ovarian carcinoma, determination of serum CA 125 levels, and study of the prognostic value of the marker in cytosol. The levels of the marker depend not only on the tumor's production rate, so its determination in tissue can indicate more accurately if the tumor is a producer of the marker and establish its value for the prognosis of the disease. Determination of CA 125 in tissue was performed by immunoanalysis in 50 ovarian epithelial cancer samples, 13 benign pathology samples and 32 healthy ovary samples. The presurgical serum level of the marker was also obtained. The correlation between the CA 125 level in the cytosol and the different biological characteristics of the ovarian carcinoma, the serum levels of the marker and survival were analyzed. The CA 125 level proved to be higher in malignant tissue (p < 0.0001). There was a significant association between the tissue marker and histological type (high CA 125 was associated with serous and endometrioid tumors) and between the marker and survival. No relation with stage was found. There was a correlation between the CA 125 level in the cytosol and serum both variables being dependent, with a correlation coefficient of 0.44. This good correlation speaks in favor of the usefulness of CA 125 determination in serum in the follow-up of ovarian cancer. Tumors having high tissue expression of CA 125 were found to have a double relative risk of death, independently of tumor stage.

Measurement of parathyroid hormone in horses.

Measurement of parathyroid hormone (PTH) in horses was performed on plasma samples using 2 immunoradiometric assays: a human intact PTH assay and a rat amino-terminal PTH assay. The assays were validated by assessment of their precision, sensitivity and specificity, and also by evaluating PTH changes in the horse in response to variation in blood ionised calcium. Intra- and inter-assay variance, precision and sensitivity were similar for both human and rat assays; however, the rat assay was slightly more precise and sensitive than the human assay. Both assays detected an increase in PTH levels in the horse when blood ionised calcium was decreased and a decline in PTH concentration with hypercalcaemia. Measurement of PTH concentration in samples from healthy horses with the human assay yielded a mean (+/-s.e.) value of 31.3+/-4.1 pg/ml. When using the rat assay, PTH values were 44.1+/-5.3 pg/ml. Plasma samples held for up to 3 months at -20 degrees C did not show a significant change in PTH concentration. In conclusion, the human intact PTH and the rat amino-terminal assays detected equine PTH and can be used for measurement of this hormone in horses. Quantification of equine PTH using these assays will allow more precise diagnosis of a variety of disorders affecting mineral metabolism in horses.

Effects of exercise and EDTA administration on blood ionized calcium and parathyroid hormone in horses.

OBJECTIVE: To determine effects of exercise on blood ionized calcium (Ca2+) and plasma parathyroid hormone (PTH) concentrations in horses and to compare the effects of exercise-induced and EDTA-induced hypocalcemia on PTH secretion. ANIMALS: 17 horses entered in a show jumping competition and 5 horses given EDTA. PROCEDURE: Blood Ca2+ and plasma PTH concentrations were measured before and after exercise in the 17 horses entered in the jumping competition. In the other 5 horses, concentrations were measured during infusion of EDTA IV. RESULTS: Exercise resulted in a significant decrease in blood Ca2+ concentration and a significant increase in plasma PTH concentration, and blood Ca2+ concentration was correlated with plasma PTH concentration. Administration of EDTA resulted in hypocalcemia and an increase in PTH concentration. For the same decrease in Ca2+ concentration, magnitude of the exercise-induced increase in PTH concentration was similar to magnitude of the EDTA-induced increase. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the increase in plasma PTH concentration in horses after exercise is secondary to hypocalcemia and that the increase in PTH concentration seems to be commensurate with the decrease in Ca2+ concentration.

Mineral metabolism in healthy geriatric dogs.

To study mineral metabolism in geriatric dogs, parathyroid hormone, calcitriol, ionised calcium, phosphorus, blood urea nitrogen and creatinine were evaluated in 35 geriatric dogs (> 10 years) and in 20 young adult dogs (2-5 years). Parathyroid hormone levels were within the normal range in both groups, but values (mean +/- SEM) were greater in the old dogs (34.8 +/- 3.6 vs 21.2 +/- 2.3 pg ml(-1), P=0.005). Calcitriol and ionised calcium were similar in the two groups, and the values for both parameters were within the normal reference range. Plasma phosphorus levels were in the normal range in both groups but tended to be greater in the older dogs (P=0.09). While blood urea nitrogen was similar in the two groups, creatinine levels (mean +/- SEM) were higher in the young dogs (82.2 +/- 3.5 vs 101.7 +/- 4.4 micromol litre(-1)). Even when the dogs were matched for weight, plasma creatinine concentration was still greater in the younger dogs. In conclusion, an increase in parathyroid hormone without changes in calcium, phosphorus and calcitriol has been identified in geriatric dogs.

Arterial blood gases and acid-base balance in geriatric dogs.

To compare arterial blood gas pressures and acid-base balance in geriatric and young adult dogs, 23 clinically healthy aged dogs (> 10 years old) and 16 young adult dogs (two to four years old) were studied. Blood gases (PaO2 and PaCO2), pH, Na, K, Ca and Cl were measured in arterial blood samples using selective electrodes. Haemoglobin was quantified with a co-oximeter. Total proteins and phosphorus were measured by spectrophotometry in plasma. The alveolar to arterial PO2 gradient (P(A-a)O2), bicarbonate, anion gap and the base excess of blood were calculated. Quantitative analysis of acid-base balance was carried out by calculating unidentified anions. Old dogs had significantly higher P(A-a)O2 than young dogs (2.5 +/- 0.3 versus 1.4 +/- 0.3 KPa). Although the differences were not significant, aged dogs also had a lower PaO2. No differences were detected in PaCO2, pH, Na, K, Ca, Cl, haemoglobin, phosphorus, bicarbonate and base excess of blood. Plasma proteins were higher in old dogs than in young dogs (7.1 +/- 0.2 versus 6.5 +/- 0.2 g dl-1). Anion gap was increased in aged dogs; however, no changes were found in unidentified anions. In conclusion, an increase in P(A-a)O2 has been identified in a group of geriatric dogs. No major changes have been found in the acid-base balance of aged dogs.

Hysteresis of the PTH-calcium curve during hypocalcemia in the dog: effect of the rate and linearity of calcium decrease and sequential episodes of hypocalcemia.

Several studies have shown the presence of hysteresis of the parathyroid hormone (PTH)-calcium relationship in both normal humans and hemodialysis patients; for hypocalcemia, hysteresis is defined as a lower PTH level for the same serum calcium during the recovery from than the induction of hypocalcemia. However, some have questioned whether hysteresis is only a function of the rate and/or direction of change in calcium, and others have proposed that hysteresis is due to depletion of PTH stores. To address these issues, two groups of dogs were studied. To induce hypocalcemia, sodium EDTA (50 mg/kg) was infused either over 60 (termed slow) or 30 (termed fast) minutes; immediately after the cessation of the ethylenediamine tetracetate (EDTA) infusion, calcium chloride (0.75 mEq/kg) was infused over 60 or 30 minutes, respectively, to correct the hypocalcemia. The EDTA infusion produced a linear decrease in serum calcium by progressively increasing the infusion rate at regular intervals. A second cycle of hypocalcemia and recovery using the same protocol was started immediately after the completion of the first cycle. To determine whether a nonlinear decrease in the serum calcium affected the PTH response to hypocalcemia, a third group of dogs, termed superfast, was studied; in this group, EDTA was infused for 30 minutes at a constant rate of 50 mg/kg. The hysteretic loops of PTH produced by the two sequential slow and fast cycles and the superfast cycle during the induction of and recovery from hypocalcemia were similar. Moreover, the maximal PTH level for the two sequential slow and fast cycles and the superfast cycle was not different even though the rates of calcium decrease varied and the calcium decrease was nonlinear in the superfast cycle. In conclusion, (1) since hysteresis was reproducible and the maximal PTH was not different during two sequential cycles of hypocalcemia, hysteresis is not due to PTH depletion; (2) the PTH-calcium curve is not affected by the rate at which hypocalcemia is induced; and (3) the maximal PTH level is not influenced by either the rate or linearity of the reduction in serum calcium.

Sleep apnea in patients with hemispheric stroke.

Sleep pattern and breathing in humans are altered following cerebrovascular accidents involving the brainstem. Sleep apnea is a well-established complication of stroke involving the brainstem. On the other hand, the effect of cerebral stroke on sleep and breathing has not been well defined. The diffuse cerebral symptoms such as cognitive deficits, depression or fatigue, after hemispheric stroke mimic those present in patients with sleep apnea. To define the breathing pattern in patients with stroke involving cerebral hemispheres without brainstem lesion and without the prior history of sleep-disordered breathing, we studied 10 patients within 1 year of their stroke. The data collected during polysomnography from the stroke patients were compared with a group of subjects matched for age, body mass index, presence of hypertension, and smoking history without stroke. Patients with stroke had an abnormal sleep architecture with significantly lower slow wave sleep and rapid eye movement (REM) sleep when compared with controls. Sleep was fragmented because of the presence of increased respiratory disturbances. Stroke patients had a respiratory disturbance index of 52 +/- 10 events per hour when compared with 3 +/- 1 in controls (p < .05). Majorities of respiratory events were obstructive apneas and were associated with arterial oxygen desaturations and arousals. The pathogenic mechanism of sleep-disordered breathing in patients with hemispheric stroke seems to be related to the physiological effect of sleep on already compromised upper airway muscle control. Patients with stroke and diffuse cerebral symptoms should be investigated for the possibility of sleep-disordered breathing.

Bacterial tracheitis with upper airway obstruction in a patient with the acquired immunodeficiency syndrome.

Bacterial tracheitis after an upper viral respiratory infection is a well-recognized entity in the pediatric literature. Bacterial tracheitis has only recently been reported in adults, and it is a potentially life-threatening illness. We report a case of bacterial tracheitis in a patient with AIDS.

Fructosamine levels in CAPD: its value as glycemic index.

We have studied fructosamine (measured by colorimetric methods) and glycosylated hemoglobin (HbA1c) using a high pressure liquid chromatography (HPLC) in 20 uremic patients managed conservatively (8 diabetics and 12 non-diabetics) and 20 patients treated with continuous ambulatory peritoneal dialysis (CAPD) including 12 diabetics and 8 non-diabetics. Twenty healthy subjects were used as control group. We have correlated the mean blood glucose (MBG) of the preceding days to fructosamine and HbA1c measurements. No differences were detected in mean fructosamine and HbA1c levels in non-diabetics patients in the CAPD or conservatively treated groups compared to controls. In diabetic patients undergoing conservative treatment or CAPD, mean fructosamine and HbA1c values were elevated when compared with control group. Both glycemic indicators were increased in most of the diabetic patients, was higher values in those patients with higher MBG. There was a good correlation in CAPD diabetic patients between fructosamine and HbA1c with MBG of the 21 previous days (r = 0.84, p less than 0.01 and r = 0.74, p less than 0.01 respectively). There was also correlation between fructosamine and HbA1c in CAPD diabetic patients (r = 0.78, p less than 0.01). We conclude that fructosamine does not seem to be influenced by uremia or by CAPD. Fructosamine and also glycosylated hemoglobin, when c-fraction is measured and HPLC method is used, can be utilized as glycemic indexes in CAPD diabetic patients.

Osteopenia in rheumatoid arthritis: a biochemical, hormonal and histomorphometric study.

To determine whether the osteopenia of rheumatoid arthritis (RA) is due to reduction of trabecular bone mass (TBV) and/or cortical width (CW), we evaluated these parameters by bone histomorphometry; we also measured the calciotropic hormones parathormone(PTH) and calcitonin (CT), vitamin D [25(OH)D] and the biological markers of bone remodeling in a group of patients with RA. Study subjects were divided into Group C - premenopausal patients, and Group A - menopausal patients and men of the same ages. These groups were compared to two age-matched control groups, B and D. In both A vs. B and C vs. D, TBV and CW were significantly lower in patients. There were no differences in PTH or CT, but 25(OH)D was significantly reduced, and BGP, OHP/Cr and AP were raised in patients. Patients also exhibited TBV loss in more than 55% and CW loss in more than 98%. These changes suggest that the decline in bone mass, mainly cortical, but also trabecular, is due to increased bone turnover and enhanced resorption and seem to reflect intrinsic alterations of RA.

Spectrophotometric method for differentiation of cardiac and hepatic lactate dehydrogenase activities in dogs.

To differentiate the origin of high total lactate dehydrogenase (LD) activity in canine sera, a spectrophotometric method based on the preferential inhibition of cardiac LD isoenzymes by pyruvate was performed. Comparison with the electrophoretic separation of LD isoenzyme activities and determination of the hydroxybutyrate dehydrogenase-to-LD ratio indicated that the method proposed gave a better discrimination between cardiac and hepatic LD activities than did the other tests.