[Therapeutic sequences calcitonin-EHDP and EHDP-calcitonin in Paget's disease. Histological and biological study].
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Biomedical subjects
Publications and source records attributed to A M Laponche.
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The laboratory investigation of cases of Paget's disease has revealed results of three types :--small increases in the sedimentation rate, in the ceruloplasmin level, in the average corpuscule volume, and in uricaemia. These changes are of little practical value;--a considerable increase in the common stocks and in the turn-over of calcium, a frequently negative assessment with a parathyroid hormone level at the lower limit of normality. The levels of calcaemia and calciuria, little changed on average, may increase slightly after hospitalization. The use of these parameters is valuable but they are sometimes difficult to interpret;--an increase in the levels of alkaline phosphatases and of urinary hydroxyproline, in relation to the extent and the activity of the disease, and also of certain parameters of calcium-45 and of quantitative histology. A statistical study of the spontaneous evolution of hydroxyprolinuria in 50 patients with Paget's disease who were not treated for less than 3 years, allowed the authors to establish in what conditions a change induced by calcitonin or mithramycin is significant.
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The authors study the activity of a soluble salt of silicium on the evolution of the trabecular bone volume (TBV). They note a significant increase in the TBV, both in drinkable and in injectable form, in relation to a control population not receiving osteotrope medication. They moreover note, in a series of patients treated with silicium compared to a control group, a net increase in circulating lymphocytes and immunoglobulins (especially IgG).
The authors report the results of a semi-quantitative histological study of bone carried out in 6 patients with Paget's disease treated with salmon calcitonin (about thirty injections of an average of 50 MRC units) over 8 to 14 weeks. The treatment led to a decrease in the resorption surfaces, in the number and the nucleation of the osteoclasts, and in the level of hydroxyprolinuria. Cessation of treatment led to an increase in these parameters, but starting from the fifth month after the cessation renewed improvement was noted, concerning in particular the hydroxyprolinuria and the nucleation of the osteoclasts and this lasted until the tenth month. The possibility of a prolonged action of calcitonin indicates that discontinuous therapy of Paget's disease should be considered (4 months per year, for example).