The patients with hypoparathyroidism were studied carrying out: a) tetanic test (PT) for assessment of the degree of neuromuscular excitability and b) double stimulus test (PBP) for assessment of the efficiency of neuromuscular conduction. In six patients low values of calcium, high values of phosphorus and normal values of magnesium were found. In the remaining patients calcium level was decreased also but the phosphorus level was normal, while that of magnesium was low. In all patients the PT was normal while the PBP showed in the first group reduced efficiency of conduction and in the remaining cases increased neuromuscular conductivility. The possible interpretation of obtained results is discussed.

Adolescent↗

PubMedDate not supplied

Imaging of bone in the diagnostics of renal osteodystrophy in children with chronic renal failure.

BACKGROUND: In the last two decades considerable advances have been made in the development of imaging tests of the skeletal system. This progress in diagnostic techniques, along with the growing availability of the tests, renders it necessary to review and evaluate their suitability for daily clinical practice. The aim of this article is to compare the results of radiological testing of bone with densitometrical, histomorphometric, and biochemical tests in children with chronic renal failure. MATERIAL AND METHODS: The research involved 31 children with renal failure, of whom 10 were being treated conservatively, 17 by continuous ambulatory peritoneal dialysis (CADO), and 4 by hemodialysis (HD). In all these children, radiological examinations of bone were performed in the arms, knees, and hips, along with tests for the serum concentration of parathormone (iPTH), calcium (Ca), and phosphates (P), and for the activity of alkaline phosphatase (AP). Bone density tests by the DXA method and bone biopsies were also performed. On the basis of radiological evaluation, the patients were divided into two groups: Group I, consisting of 14 children with a normal bone structure image, and Group II, consisting of 17 children with bone atrophy. RESULTS: No statistically significant differences were discovered in the mean values of the tested biochemical parameters between the two groups. The mineral density of total body was normal in 9 of the 14 patients in Group I (64%), and in 7 of 17 (41%) from Group II. The mineral density of total lumbar spine gave similar results. Lower bone density results were obtained in Group II than in Group I, though only in the case of the lumbar spine were the differences statistically significant. In Group I, 5 cases were discovered of chronic osteodystrophy without osteomalacia and hyperparathyroidism (NB), 2 cases of adynamic bone disease (ABD), 4 cases of hyperparathyroidism (HP), 2 cases of moderate hyperparathyroidism (MHP), and one mixed form (Mix); in Group II, there were 6 NBs, 2 ABDs, 1 case of osteomalacia (OM), 5 HPs, and 3 mixed. Radiological examinations revealed one male in Group I with features of prior Perthes's disease, one with fibrous cortical defect, and four cases of valgity of the coxa valga. In Group II, there were 3 children with radiological changes typical for osteomalacia, and in 1 case typical radiological signs of hyperparathyroidism. CONCLUSIONS: Given the lack of consistency in the results of the tests here presented, an entire panel of available tests should be performed for the comprehensive evaluation of the status of the skeleton.

Adolescent↗

PubMedDate not supplied

Assessment of changes due to the long-term effect of estrogen and calcium deficiency in the trabecular bone structure in rats.

OBJECTIVE: To assess structural changes, especially structural anisotropy, of rat bone trabecular system 6 months after ovariectomy followed by low-calcium diet. METHOD: The study was carried out on the group of 32 female rats, half of which were ovariectomized at the age of 75 days. The animals were divided into 4 groups: one receiving a normal diet (N), another receiving a low-calcium diet (LCa), ovariectomized rats receiving a normal diet (OVX), and ovariectomized animals receiving a low-calcium diet (OVX+LCa). After 6 months the animals were killed, bone specimens were collected and cut into sections of 6 microm thickness. Digital images of the sections were analyzed using a software package enabling analysis of the transversal and longitudinal trabeculae. RESULTS: Significant changes in trabecular structure due to a low-calcium diet (trabecular bone volume loss of 19%), ovariectomy (53%) and ovariectomy combined with low-calcium diet (71%) were observed. In all the analyzed groups, the percentage loss (as compared with controls) of transversal trabeculae was more significant than the loss of longitudinal trabeculae. In the LCa group, transversal trabecular loss was 39%, longitudinal 25%, in (Ovx): 63% and 54%, respectively, and in OVX + LCa: 77% and 72%. The structural anisotropy coefficient, defined as the ratio of transversal to longitudinal trabecular surface area was 0.64 for (N), 0.50 for LCa, 0.49 for OVX, and 0.54 for OVX+LCa groups. CONCLUSIONS: The effect of ovariectomy and low-calcium diet on trabecular structure can be assessed quantitatively by means of analysis of transversal and longitudinal trabeculae associated with the main direction of strain. The degree of transversal trabecular loss is much higher than the longitudinal trabecular loss; the difference becomes smaller with the progress of bone destruction, being greatest in the LCa group, the smallest in the (OVX+ LCa) group.

Animals↗

PubMedDate not supplied

[Pseudohypoparathyroidism].

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Humans↗

PubMedDate not supplied

[Postoperative hypoparathyroidism: Direct para-operative period].

Surgical hypoparathyroidism is a severe complication of the operations on thyroid gland. Hundred thirty patients aged between 17 and 77 years have been analysed clinically. Group I involved 45 patients with surgical hypoparathyroidism of transient or partial character, group II involved 85 patients with severe irreversible surgical hypoparathyroidism. Hypocalcemia in postoperative period was significantly higher in group II than that in group I (p < 0.02), and negatively correlated with the maximal dose of vitamin D3 necessary to compensate calcemia (r = -0.42). Follow-up results indicate that the age and sex of patients, preoperative diagnosis, radiotherapy, and type of surgery have no effect on the degree of damage to parathyroid glands, tetany development rate, degree of hypocalcemia and hyperphosphatemia. High degree hypocalcemia diagnosed in the early postoperative period suggests irreversible injury to parathyroid glands. Management of patients with postoperative tetany requires a close cooperation of surgeon and endocrinologist.

Adolescent↗

PubMedDate not supplied

[Postoperative hypoparathyroidism: long term observation and therapy].

Hundred thirty patients with surgical hypoparathyroidism were followed up. Group I involved 45 patients with mild and group II--85 patients with severe surgical hypoparathyroidism. A delay in vitamin D3 therapy was X +/- SD = 4.2 +/- 8.1 years. A delay in introducing vitamin D3 therapy correlated with the duration of hypoparathyroidism (r = 0.93; 8.9 +/- 9.6 years). Follow up period lasted for 15 years and was 4.3 +/- 3.8 years out of which the attempts to establish ultimate and effective dose of vitamin D3 lasted 1.8 +/- 2.4 years. Dose of vitamin D3 was adjusted 5 times, on the average. Effective daily dose was 4,200-22,500 IU (9,311 +/- 7,252) in group I, and 30,000-195,000 IU (51,385 +/- 32,978) in group II whereas maximum daily dose was 75,000 and 250,000 IU respectively (p < 0.001). Some patients were given 25-OH-D3 in daily doses of 50-225 micrograms or 25(OH)2-D3 in daily dose of 0.10-0.75 micrograms. Calcium oral doses of 400-1600 mg daily were administered to 115 patients. In case of high hypercalciuria (over 350 mg/24 h) hydrochlorothiazide (43 +/- 17 mg a day) or chlorthalidone (60 +/- 22 mg a day) normalized calciuria. Low phosphate diet and aluminium oxide (4.4 +/- 1.7 g a day) were more frequently used in group II. Period of time necessary to establish an effective dose of vitamin D3 is long in patients with surgical hypoparathyroidism. Several dose adjustments are required. Maximum daily vitamin D3 dose required for normocalcemia is approximately higher by 1/3 in the early period of the treatment than the effective maintenance dose. A decrease in diet phosphate content, inhibition of phosphates absorption in the gut or blocking increased calcium loss with the urine are necessary in some patients, only.

Adult↗