Annual injection of vitamin D and fractures of aged bones.

In order to investigate the effect of a supplementation of vitamin D in the prophylaxis of fractures of the bones of aged people, an annual intramuscular injection of ergocalciferol (150,000-300,000 IU) was given to two series of aged subjects: first to 199 (45 male) of 479 subjects (110 male) aged more than 85 years who were living in their own home, and second to 142 (29 male) of 320 (58 male) subjects aged 75-84 and living in a home for aged people. This prospective series was divided into treatment groups according to month of birth. These injections were given annually from September to December in the years 1985-1989, two to five times to each participant. The fracture rates, laboratory values, vitamin D levels, possible side effects, and mortality were followed until October 1990. A total of 56 fractures occurred in the 341 vitamin D recipients (16.4%) and 100 in 458 controls (21.8%) (P = 0.034). The fracture rate was about the same in both outpatient and municipal home series. Fractures of the upper limb were fewer in the vitamin D recipients, 10/341 = 2.9% (P = 0.025), than in the controls, 28/458 = 6.1%, during the follow-up. A similar result was obtained in fractures of ribs, 3/341 = 0.9% and 12/458 = 2.6%, respectively. Fractures of the lower limbs occurred almost as frequently, 31/341 = 9.1%, among the vitamin D recipients as among the controls, 49/458 = 10.7%. The fracture rate was higher in females (22.2%) than in males (9.5%). The fractures were fewer in the vitamin D recipients only in females.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of intravenous feeding on wound healing in starvation: an experimental study on the rabbit.

The effects of modified protein sparing therapy (PSP) and total parenteral nutrition (TPN) on total and wound metabolism were studied for 96 hours after laparotomy and a small gastric excision in 40 rabbits starved for seven days. A further eight starved and eight non-starved animals served as controls for the blood variables. Normal healing up to day 14 was studied in 20 non-starved animals. The difference in deaths and animals in poor condition, 42.1 per cent in PSP and 18.6 per cent in TPN, respectively, was clear but statistically non-significant. PSP led to a lower mean serum albumin concentration than TPN, 25.7 +/- 3.7 (SD) and 28.7 +/- 3.0 (p = 0.02), respectively. The animals receiving PSP excreted significantly more 3-methylhistidine. TPN maintained a positive nitrogen balance, but PSP produced a negative one. The collagen content of the skin scar was lower after PSP (3.1 +/- 0.7 mg) than after TPN (4.5 +/- 1.3 mg) (p less than 0.05), the latter coming close to the level for normal 4-day healing, 4.5 +/- 1.2 mg. Prolyl 4-hydroxylase (PPH) activity showed no difference. No inter-group differences in collagen were found in the stomach. Both regimens totally reversed the starvation-induced decrease in PPH activity in the stomach, but only partially in skin. Thus TPN produced better total and skin wound metabolism after laparotomy and starvation than did PSP. No differences in visceral wound healing were observed.

Serum vitamin D level after an annual intramuscular injection of ergocalciferol.

An annual intramuscular injection of ergocalciferol (150,000 IU) normalized low serum (25(OH)D concentrations in elderly people for 1 year. The treatment had a slight effect on serum 24,25(OH)2D levels but no effect on 1,25(OH)2D levels.

Massive resection of the small bowel.

A report is presented on patients (no. = 43. 64 +/- 9 years, 30 men and 13 women) subjected to a massive small bowel resection (69 +/- 25 cm intestine left). The most usual indication was thromboembolism of the arteria mesenterica superioris, but there were also patients who had had intestinal by-pass, occlusion, trauma, tumor and invagination. The preoperative diagnosis was based on peritonitis, increasing abdominal symptoms, paralytic ileus, shock and fever. Fluid and electrolyte treatment, postoperative intensive care, intestinal decompression, parenteral nutrition and antibiotics were also employed. Postoperatively there was a significant decrease in serum protein (SP) (63 +/- 11 vs. 43 +/- 9 g/l) and blood hemoglobin (150 +/- 10 vs. 106 +/- 8 g/l) concentrations (Hb) and hematocrit (CHCT) (0.44 +/- 0.11 vs. 0.31 +/- 0.10). Also the number of patients with subnormal SP and Hb increased from five to nineteen and from fourteen to thirty-two, respectively. The operative mortality (within 30 days) was 60 percent (26/43). Those who survived were younger (59 +/- 8 vs. 67 +/- 9 years) and had higher SP (87 +/- 12 vs. 47 +/- 11 g/l), blood leukocyte count (22 +/- 6 vs. 14 +/- 5 X 10(9] and lower peroperative blood loss (291 +/- 43 vs. 448 +/- 67) than those who died. During the one to 14 year follow-up time nine (21% of all patients and 59% of those who were discharged) were still alive. Thus the patients subjected to a massive small bowel resection are old, have atherosclerotic cardiovascular diseases and preoperatively have peritonitis or severe abdominal complaints and an impaired nutritional state and fluid balance.

Effect of guar gum added to the diet of patients with duodenal ulcer.

In a randomized, double-blind, controlled clinical study, the effects of 5 g of guar gum, a dietary fiber composed of galactose and mannose, or placebo added to the diet of 20 patients with duodenal ulcer for 1 wk each were examined. Ten patients derived evident benefit and five some help from guar gum, on comparing symptoms during administration of guar gum with those experienced earlier or during the placebo week, whereas four patients found that neither guar gum nor placebo had any effect (p less than 0.001). The beneficial effect was associated with increased feelings of repletion after meals. Patients with fewest symptoms benefited only slightly, or not at all, from guar gum. In one patient, guar gum abolished pain felt earlier and on placebo, but also caused severe gastric retention after meals. This patient had pyloric stenosis. In patients who were intolerant to berries, fruits, sugar, sweet rolls, and pizza these foodstuffs were better tolerated during guar gum administration. The diarrhea which occurs in some patients ingesting guar gum was avoided by giving low initial doses. In three patients unpalatability of guar gum was a minor complaint. It is concluded that guar gum is helpful to many patients with uncomplicated duodenal ulcer, but that it is harmful to those having increased gastric emptying, eg, pyloric stenosis patients, and that guar gum may exert its effects by increasing gastric emptying time.