[Clinical reports: pseudohypoparathyroidism, pituitary nanism, and adrenal carcinoma].
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17-Hydroxycorticosteroids↗
Biomedical subjects
B Courvoisier
Publications and source records attributed to B Courvoisier.
[Message from the President, Swiss Society of Internal Medicine].
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History, 20th Century↗
[Treatment of hypercalcemias].
Apart from the search for specific oncological treatments, interesting investigations are currently in progress into methods designed to increase bone resistance against tumoral aggression. Several substances are under study. Here the discussion will chiefly centre on the diphosphonates, their mechanism of action and indication in bone oncology. It has been seen that tumoral hypercalcemias (with or without bone metastases) essentially derive from disturbance of the balance between the huge mineral stores of the bone and the small extracellular space. It has also been learned that osteolysis inhibition is the major step in their treatment, while therapies designed to eliminate the calcium excess through the kidney (saline solutions, furosemide, ethacrinic acid, dialysis) or bind it with chelators (EDTA) can have only transitory effects. Tumoral osteolysis may be inhibited by drugs acting on bone and/or tumoral cells (mithramycin, calcitonin, corticosteroids etc.) or by the diphosphonates. At present the latter are the treatment of choice for tumoral hypercalcemias.
Adrenal Cortex Hormones↗
Parenteral diphosphonates for treating malignant hypercalcemia.
Two diphosphonates, EHDP (disodium etidronate, or ethanehydroxy-diphosphonate) and Cl2MDP (disodium clodronate, or dichloromethylene-diphosphonate) were injected in various doses in six patients with one or multiple episodes of malignant hypercalcemia. All patients responded well to the drugs after a delay period of two to seven days. The tolerance of the drugs was excellent. EHDP, and especially Cl2MDP, are promising agents for treating hypercalcemia and inhibiting bone resorption in malignant disorders.
Aged↗
[Treatment of Paget's disease of bone: diphosphonates or calcitonin?].
During the past 6 years 16 patients suffering from Paget's disease of bone have been treated and regularly followed up in our department. 10 of these patients have received etidronate (ethane-hydroxy-diphosphonate), 4 others have received synthetic human calcitonin and the last 2 have received both treatments, first successively then simultaneously. Under either therapy satisfactory clinical and biological results have been observed (diminution of pain and decreased levels of serum alkaline phosphatase and hydroxyprolinuria). Etidronate has been more efficient in reducing biological parameters, whereas calcitonin has produced a faster symptomatic response. On the basis of these observations the present principles for treatment of Paget's disease are discussed.
Aged↗
[Urinary and serum hydroxyproline in the diagnosis of bone metastases of prostatic cancer].
Of 31 patients with prostatic cancer, 21 have skeletal metastases proven by bone scintigraphy and/or radiology. The sensitivity and specificity of the following measurements are compared: total urinary hydroxyproline, urinary hydroxyproline/creatinine ratio, free serum hydroxyproline, alkaline and prostatic phosphatases and serum calcium. The hydroxyproline/creatinine ratio is the most sensitive measurement for the diagnosis of bone metastasis, while total urinary hydroxyproline excretion per 24 hours is the most specific. Free serum hydroxyproline has no particular significance for this diagnosis. The alkaline and acid phosphatases are elevated but are not specific. Serum calcium decreases when skeletal metastases are present.
Acid Phosphatase↗
[Renal osteodystrophy in patients on maintenance hemodialysis: statistical study of clinical, radiological and biochemical features].
Sixty radiological, clinical and biochemical features were simultaneously recorded in a population of 46 patients on maintenance hemodialysis. Radiological signs of bone reabsorption (hands, acromio-clavicular and sacro-iliac joints) were demonstrated in 65% and were quantified as a radiological index of hyperparathyroidism. The index was correlated with the levels of parathormone and of alkaline phosphatase (p less than 0.01) and with the duration of renal failure (p less than 0.01), and inversely related to bone densitometry (p less than 0.05). Discriminant analysis confirmed the redundant value of parathormone and alkaline phosphatases in predicting bone lesions. Factorial analysis showed the existence of 12 classes of patients statistically close to one another. These results demonstrate the heterogeneity of renal osteodystrophy.
Bone and Bones↗
Inhibition by two diphosphonates of bone lysis in tumor-conditioned media.
In order to test the effect of diphosphonates in inhibiting bone lysis induced by human tumors, neonatal mouse calvaria are cultured in sterile conditions in different media. Osteolysis is estimated by the amount of 45Ca released from bone to medium, the mice being given injections of 45Ca on their day of birth. An increased bone lysis is observed when calvaria are incubated in the same medium conditioned from cultured tumor fragments. This effect is significantly decreased when the mice have been treated with either ethanehydroxydiphosphonate or dichloromethylenediphosphonate. These experiments represent a first step in estimating the potential effects of different drugs on malignant osteolysis.
Animals↗
[Vitamin D intoxication].
Vitamin D intoxication is not so rare as is usually thought. Three cases of vitamin D poisoning are described, in each of which the indication for treating the patients was reasonable but the dosage was not adapted as it should have been. All three patients recovered within a few days. The mechanism of these intoxications is discussed and emphasis is placed on the prevention of such accidents.
Adult↗
[Treatment of hypercalcemia of tumoral origin with two diphosphonates].
Two diphosphonates, EHDP (disodium etidronate, or ethane-hydroxy-diphosphonate) and Cl2MDP (disodium clodronate, or dichloromethylene-diphosphonate) were injected in various doses in 8 patients who had had one or more episodes of malignant hypercalcemia. All patients responded well to the drugs after a time lapse of 2-10 days. Tolerance of the drugs was excellent. EHDP, and especially Cl2MDP, are promising agents for the treatment of hypercalcemia and the inhibition of bone resorption in malignant disorders.
Adult↗
[Use of strontium-89 in the analgesic treatment of bone metastases].
The analgesic properties of 89Sr were investigated in 17 patients with multiple painful bone metastases. 89Sr is a radioisotope, the metabolism of which in the body is comparable to that of calcium. It is a pure beta emitter and its half-life is 51 days. When injected intravenously it is captured by bone, especially at locations where the turnover is increased. Each patient received 1--2 mCi of 89Sr. Bone scans and hematological investigations were performed before, and 2 months after, treatment. No significant changes were found. Shealy's method was used to assess pain, initially twice a week and then at more prolonged intervals. One patient suffering from multiple myeloma showed a spectacular improvement and 6 others responded favourably. Improvement generally occurred within 3--7 days, but was sometimes delayed for up to 3 weeks. Relief lasted for up to several months. Five patients had an increase of pain during the 24 hours immediately after treatment. An average of 28% of the administered radioactive dose was found in the urine collections during the first 48 hours. Although the treatment was not successful in every case, the use of 89Sr as a long acting analgesic in multiple bone metastases should be considered more frequently, especially as there are no side effects.
Aged↗
[Effect of 2 phosphonates on the osteolysis induced by tumor extracts].
An in-vitro model is proposed to test the potential effect of diphosphonates in treatment or preventing bone metastases. This model involves culturing of neonatal mice calvaria in sterile conditions in an appropriate medium and measuring 45Ca release from bone to medium, the mice being injected with 45Ca on the day of birth. Tumour extracts added to the medium usually increase the bone lysis; this effect is significantly decreased when the mice have been treated with either ethane-hydroxy-diphosphonate (EHDP) or dichloromethylene-diphosphonate (Cl2MDP). These experiments represent a first step in a group of experiments with a view to clinical trials in cases of bone metastases.
Animals↗
[is there an osteomalacia component in femur neck fractures?].
In 29 patients with fractures of the femoral neck (group A) and 22 patients operated on for osteoarthritis of the hip (group) B), plasma levels of 25-hydroxycholecalciferol (25-OH-D3) were compared with the results of histological bone tests. A third group of 19 patients at the Geriatric hospital served as a control in this age group for 25-OH-D3 values (group C). The average level of 25-OH-D3 was 9.64 +/- 5.8 micrograms/l in group A and 13.25 +/- 7.6 micrograms/l in group B. This difference is not significant. On the other hand, the difference between groups B and C (9.31 +/- 4.04) is significant (2 p less than 0.05). Evaluation of the histological sections did not reveal evidence of osteomalacia. Generally speaking, the levels of plasma 25-OH-D3 in these patients were low, but without signs of osteomalacia on histological evaluation.
Aged↗
[Bartter's syndrome, chondrocalcinosis and hypomagnesemia].
In two cases of Bartter's syndrome with hypomagnesaemia the authors report radiological findings typical of chondrocalcinosis associated with joint symptoms corresponding to this condition. In Bartter's syndrome there is, in addition to hypokalaemic alkalosis, often concomitant magnesium depletion which has marked repercussions with respect to both physiopathology and symptomatology. In particular, hypomagnesaemia could well be important in the pathogenesis of chondrocalcinosis through two simultaneous mechanisms: by reducing the activity of pyrophosphatases and by facilitating the crystallisation of pyrophosphates. These mechanisms could explain the association of Bartter's syndrome and chondrocalcinosis, which is described here for the first time.
Adult↗
The clinical measurement of urinary total hydroxyproline excretion.
The effect of dietary control on the day-to-day variation in total hydroxyproline excretion has been examined in two studies. In the first, a normal volunteer ate a controlled diet containing varying gelatin supplements for several weeks. In the second, the effect of removing hydroxyproline-containing foods from the diets of 8 volunteers was examined. Both studies confirm that the day-to-day variation in total hydroxyproline excretion falls when the gelatin content of the diet is decreased, whether the results are expressed as total hydroxyproline excretion rate or as the total hydroxyproline: creatinine ratio. This fall in variation takes place within 24 h of dietary control beginning and therefore longer periods of dietary restrictions to achieve optimum precision in the measurement of total hydroxyproline are unnecessary. For some analytical methods, results are better expressed as the ratio total hydroxyproline:creatinine than as the total hydroxyproline excretion rate.
Adult↗
[Effect of the sun on circulating 25-hydroxycalciferol levels in normal subjects in Switzerland].
The principal source of human natural vitamin D is cholecalciferol produced in skin by the action of ultraviolet light. Plasma levels of 25-hydroxyvitamin D (25-OH-D), the hepatic metabolite of cholecalciferol, increased by 39.3% in 20 healthy young Swiss subjects after a 3-week holiday in the sun. Significant increases of circulating 25-OH-D (p smaller than 0.001) were found as much as 2 months later when compared with a group not deliberately exposed to sunshine. A short vacation in the sun therefore appears to be beneficial in replenishing vitamin D body stores.
Adult↗