The usefulness of dual energy X-ray and laser absorptiometry of the calcaneus versus dual energy X-ray absorptiometry of hip and spine in diagnosing manifest osteoporosis.

INTRODUCTION: Osteoporosis is a major health problem. Dual energy X-ray absorptiometry (DXA) of the hip and spine is the worldwide standard in diagnosing osteoporosis. Measurement of bone mineral density (BMD) with dual energy X-ray and laser absorptiometry of the calcaneus (Calscan) might be a good alternative. Advantages of the Calscan are that it is quick, widely available and manageable. In this study we compared BMD expressed in T-scores measured by DXA and Calscan. The aim of this study was to define threshold T-scores on the Calscan that could exclude or predict osteoporosis correctly in comparison with DXA. MATERIALS AND METHODS: Patients > or =50 years attending our emergency department with a fracture were offered osteoporosis screening at our fracture and osteoporosis outpatient clinic (FO-Clinic) and enrolled in this study. BMD was measured at the hip and spine using DXA and at the calcaneus using Calscan. A T-score measured by DXA < or =-2 standard deviations (SD) below the reference population was defined as manifest osteoporosis and was the treatment threshold. RESULTS: During a 10-month study period, 182 patients were screened with both devices. The mean DXA-T-score was -1.63 SD (range -4.9 to 2.1) and Calscan T-score -1.91 SD (range -5.3 to 1.4). There was a significant correlation between both devices (r = 0.47, P < 0.01). Using an upper threshold for the Calscan T-score of -1.3 SD, 47 patients could be classified as non-osteoporotic with 89.3% sensitivity (95% CI 80.0-95.3%). Using a lower threshold for the Calscan T-score of -2.9 SD, 34 patients could be classified by the Calscan as osteoporotic with 90.7% specificity (95% CI 83.5-95.4). The remaining 101 patients could only be correctly classified by DXA-T-scores. CONCLUSION: Although DXA is the established modality worldwide in measuring BMD it is restricted to specialized centres. Peripheral bone densitometers like the Calscan are widely available. When BMD measurements with DXA were compared to Calscan measurements it was possible to correctly classify 81 of 182 patients based on the Calscan T-score. Of these 81 patients 34 could be classified as manifest osteoporotic and 47 as non-osteoporotic. Therefore the Calscan seems to be a promising technique which might be used as a screening device at a FO-Clinic, especially when DXA is not easily available.

Electrocardiographic changes in acute malaria.

In this report of two patients with acute malaria, the electrocardiogram on admission showed changes of repolarisation. In both cases these electrocardiographic changes normalised after anti-parasitic treatment. The first patient recovered completely; however, the second patient developed signs of congestive heart failure compatible with cardiomyopathy. In acute malaria, an electrocardiogram should be considered to detect myocardial involvement.

Effects of naloxone infusion on plasma levels of LH, FSH, and in addition TSH and prolactin in males, before and after oestrogen or anti-oestrogen treatment.

The inhibitory action of endogenous opioids on gonadotrophin release is now well documented. Since LHRH-producing neurons do not possess oestrogen-receptors, it is likely that some other compound mediates the negative feedback action of oestrogens on the gonadotrophin release in the male. To test the hypothesis that endogenous opioids are implicated in this negative feedback action in the human male, the opioid receptor antagonist naloxone (2 mg/h for 4 h) was infused into 7 normogonadotrophic oligozoospermic men before and after 6 weeks of treatment with the oestrogen-receptor antagonist tamoxifen (TAM) (10 mg twice daily) and 6 eugonadal transsexual males before and after 6 weeks of administration of ethinyloestradiol (EE) (10 micrograms three times a day). The effects of naloxone on TSH and prolactin (PRL) release were also studied. Naloxone administration resulted in a significant release of gonadotrophins, but not of TSH and PRL. Administration of oestrogen and anti-oestrogen did not significantly affect the response of gonadotrophins to naloxone infusion and no evidence of consistently antagonistic effects of oestrogen and anti-oestrogen on the naloxone-induced gonadotrophin release was obtained. This shows that endogenous opioids are probably not intermediary in the negative feedback control of oestrogens on gonadotrophin release in the human male. Surprisingly, in contrast to the eugonadal transsexual males, FSH levels in the oligozoospermic men did not respond to naloxone administration. As naloxone is thought to exert its action on gonadotrophin release via a disinhibition of endogenous LHRH release, this finding is unexpected. Exogenous LHRH administration leads to a normal response of FSH in normogonadotrophic oligozoospermic men. No plausible explanation for this finding can presently be offered.

Effects of continuous LHRH infusion on plasma levels of LH and FSH in males, before and after oestrogen or anti-oestrogen treatment.

In order to study the role of oestrogens on gonadotrophin release in the human male, LHRH was administered as an infusion at a constant rate of 0.5 micrograms/minute for 4 hours to 7 normogonadotrophic oligozoospermic men, 6 eugonadal male-to-female transsexuals and 9 eugonadal male volunteers. In agreement with in vitro data a biphasic release pattern of both LH and FSH was observed in eugonadal transsexuals as well as in normogonadotrophic oligozoospermic men. In the latter the release of LH was greater than in eugonadal transsexual males and volunteers, which points to a different functioning of the hypothalamic-pituitary unit in normogonadotrophic oligozoospermic men. On the other hand the FSH response to LHRH stimulation was normal in these men. Three months' treatment with the oestrogen-receptor antagonist tamoxifen (TAM) (10 mg twice daily) in the normogonadotrophic oligozoospermic men stimulated basal LH, FSH and testosterone (T) levels. The fact that gonadotrophin levels rose in spite of increased T levels, suggests a role of endogenous oestrogens in the negative feedback regulation of gonadotrophin release in these men. Upon TAM treatment the first phase, the plateau and the second phase of LH release were augmented, whereas only the plateau and the second phase of FSH release were increased. Six weeks' administration of the oestrogen ethinyloestradiol (EE) (10 micrograms three times a day) in the eugonadal transsexual males suppressed basal T and oestradiol (E2) levels without affecting basal gonadotrophin levels significantly. In EE-treated males the first phase of LH release tended to be lower, whereas the plateau of LH had decreased significantly. The second phase of LH was unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

The anti-oestrogen tamoxifen does not interfere with the dopaminergic control of prolactin and TSH release in normogonadotrophic oligozoospermic man.

This study was designed to investigate the role of endogenous oestrogens in the dopaminergic regulation of prolactin and TSH release in 16 normogonadotrophic oligozoospermic men. Three months' administration of the oestrogen-receptor antagonist tamoxifen (10 mg twice daily), blocking oestrogen-receptors both in the CNS and peripherally, did not affect basal prolactin and TSH levels. Neither was the prolactin or TSH response to stimulation with the anti-dopaminergic agents metoclopramide (10 mg i.v.) (acting both in the CNS and peripherally) and domperidone (10 mg i.v.) (acting peripherally) affected by tamoxifen administration. The response of prolactin and TSH to metoclopramide proved to be no greater than to domperidone. It is concluded that: Endogenous oestrogens, in as far as receptor-mediated, do not affect basal or anti-dopaminergic stimulated release of both prolactin and TSH in normogonadotrophic oligozoospermic men. The anti-dopaminergic activity of metoclopramide in the release of prolactin and TSH is likely for the greater part peripheral.

Effects of short- and long-term administration of tamoxifen on hCG-induced testicular steroidogenesis in man: no evidence for an oestradiol-induced steroidogenic lesion.

hCG-induced testicular desensitization is characterized by inhibition at the level of the C-17,20-lyase enzyme. This defect has been attributed to an early rise in oestradiol (E2) following hCG administration. To test this hypothesis the E2-receptor antagonist, tamoxifen, was employed. From in vitro studies the evidence suggests that tamoxifen depletes the E2-receptor within 24 h. In this in vivo study, short-term (36 h) administration of tamoxifen (to 6 eugonadal men) did not affect basal plasma levels of LH, FSH, 17 alpha-hydroxyprogesterone (17-OHP), testosterone (T) and E2, whereas long-term (3 months) tamoxifen with treatment of 6 normogonadotrophic oligozoospermic men increased LH and T levels, indicating a biological effect of tamoxifen. The response of 17-OHP, T, E2 and the 17-OHP/T ratio to hCG was similar in short-term and long-term tamoxifen-treated men as well as in 6 untreated eugonadal male controls. These results do not suggest a role for endogenous E2 in the hCG-induced testicular steroidogenic block.

A family infected with hepatitis B and with concurrently circulating HBsAg and heterotypic anti-HBs.

A family is described, of whom all members were found to be infected with the adw2 subtype hepatitis B virus. The mother and both the children were positive for anti-HBs (anti-y). The usual explanation for the co-occurrence of HBsAg and anti-HBs ("two infections hypothesis") was clinically highly unlikely. HLA typing was performed to investigate the possibility that genetically determined host dependent factors are involved. However, no relationship between the simultaneous presence of HBsAg and anti-HBs and a particular haplotype was observed.

Gamma heavy chain disease with an unusually benign course.

Gamma heavy chain disease (gamma HCD) has been found in approximately 60 patients (Franklin 1978) since its discovery in 1964 (Franklin et al. 1964). Clinical features include fever and local or generalized lymphadenopathy which may wax and wane. Patients suffer from an undue susceptibility to infection. Hepatosplenomegaly is common. Blood smears often reveal lymphocytosis with atypical lymphocytes and eosinophilia. The pathological diagnosis is lymphoma or reactive hyperplasia. The disease is often rapidly progressive and fatal. In some patients it runs a more prolonged course. The case we present is remarkable in that the patient has now been in remission for 24 months.