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Biomedical subjects

D H Gutteridge

Publications and source records attributed to D H Gutteridge.

At least 55 records · Page 3Linked to original sources
PubMed1989

Ultradistal and cortical forearm bone density in the assessment of postmenopausal bone loss and nonaxial fracture risk.

Forearm bone mineral density (BMD) was measured by single-energy photon absorptiometry in 360 healthy females without known axial fractures, 202 of whom were postmenopausal. The three sites addressed included an ultradistal (U) region containing approximately 60% trabecular bone. The other sites, distal (D) and shaft (S), were progressively more cortical. Reproducibility was 1.7-1.9% CV. The earliest evidence of a significant correlation between BMD and years since menopause was seen in trabecular bone in subjects aged 45-55 years. Fractional decrease in BMD, relative to the premenopausal value, was significantly larger at U than at S for the decades 55-65 years and above. Fractional rates of bone loss at all sites were a maximum in the first postmenopausal decade, the rate at U being 0.035, approximately 1.5 times that at D or S. A total of 33 subjects reported 54 previous minimally traumatic nonaxial (MTNA) fractures. When BMD measurements of the entire study were divided into quintiles, the prevalence of MTNA fracture cases in the lowest quintile was eight times that of each of the upper three quintiles. Prevalence of fracture cases ranked by quintiles of BMD were not different for the three scan sites. Therefore, ultradistal measurements confer no advantages over distal or shaft BMD for discriminating past MTNA fracture cases but do show larger fractional rates of loss during the first postmenopausal decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Tubular maximum for calcium reabsorption: lack of diagnostic usefulness in primary hyperparathyroidism and familial hypocalciuric hypercalcaemia.

The theoretical tubular maximum for calcium reabsorption was calculated and its usefulness assessed in the diagnosis and differential diagnosis of primary hyperparathyroidism and familial hypocalciuric hypercalcaemia. The sensitivity of the test in the diagnosis of primary hyperparathyroidism was only 12%. The theoretical tubular maximum for calcium reabsorption was recalculated after correction of calcium concentration in plasma for albumin concentration and for urinary sodium excretion. Despite these corrections, the sensitivity improved to only 44%. This contrasts with a sensitivity of 80% for the plot of fasting calcium excretion against calcium concentration in plasma in primary hyperparathyroidism. The calculation of theoretical tubular maximum for calcium reabsorption cannot be recommended as a useful test for distinguishing between primary hyperparathyroidism and familial hypocalciuric hypercalcaemia. The simple calculation of fractional excretion of calcium was a better test in distinguishing familial hypocalciuric hypercalcaemia from primary hyperparathyroidism.

Calcium↗
PubMed1987

Fasting calcium excretion and parathyroid hormone together distinguish familial hypocalciuric hypercalcaemia from primary hyperparathyroidism.

Routine estimation of plasma calcium has made the finding of asymptomatic hypercalcaemia a frequent occurrence. A high index of suspicion for familial hypocalciuric hypercalcaemia (FHH) will lead to accurate diagnosis and avoidance of unnecessary parathyroid surgery. Four FHH kindreds with 16 hypercalcaemic members were found in an unselected referral population over 3 years. Differentiation from primary hyperparathyroidism (42 patients in the same period) was facilitated by analysis of fasting blood and urine for renal handling of calcium, phosphate and cyclic AMP. We found that a plot of serum PTH against fasting calcium excretion separated all cases of each disorder. The discriminatory power of these two variables was confirmed by multivariate discriminant function analysis. An elevated plasma chloride was found to be common to both diseases and of no value in differentiation.

Adult↗
PubMed1985

Parathyroid hormone radioimmunoassay: the clinical evaluation of assays using commercially available reagents.

This paper reports on the diagnostic usefulness of two commercial PTH assay kits and four "in-house" assays using commercially available reagents, studying the same samples from normal controls and different patient groups. The ability of such assays to discriminate proven primary hyperparathyroid (1 degree HPT) patients from normals varied significantly but without any apparent correlation with assay components. For all assays, performance declined markedly in 1 degree HPT patient groups with lower serum calcium levels. Patients with PTH secondary to chronic renal disease were well discriminated from normal by all assays. Although immunoassays are useful in many cases of 1 degree HPT, it is difficult to develop C-terminal or mid-region PTH assays that are uniformly diagnostically useful in the clinical situation where they are of greatest potential use i.e. in cases of mildly hypercalcaemic 1 degree HPT.

Antibody Specificity↗
PubMed1985

Estimation of 1,25 dihydroxyvitamin D by cytoreceptor and competitive protein binding assays without high pressure liquid chromatography.

Using two different cultured rat osteosarcoma cell lines (UMR 106 and ROS 17/2.8) we have investigated the recently described cytoreceptor assay for 1,25-dihydroxyvitamin D (1,25-(OH)2D). The assay method is relatively simple and sensitive to 2.4 fmole per tube. Using either cell line, assay of serum samples, whose only preparation consisted of extraction and purification on a disposable diatomaceous earth column, produced variable values for serum 1,25-(OH)2D. Additional purification, using a disposable silicic acid minicolumn to remove other vitamin D metabolites resulted in consistent values and additional HPLC resulted in no further decrease in the values obtained. Our results show that a single two stage non-HPLC column can purify serum samples for assay in the cytoreceptor assay. The method is also applicable to the competitive protein binding assay employing calf thymus cytosol and the correlation between values obtained by both methods is highly significant. It is a sensitive, simple, and accurate method with technical advantages which allow greater sample throughput than other 1,25-(OH)2D assays.

Animals↗
PubMed1984

Osteoporosis associated with pregnancy and lactation: bone biopsy and skeletal features in three patients.

Case reports of three young patients who developed vertebral fractures and skeletal complications during pregnancy and/or lactation are presented. Radiologic features are described. All three had severe disease with three to nine vertebral fractures at presentation postpartum. In two patients, follow-up for 5-7.8 yr (including further pregnancy in each) revealed no further fractures. In general, serum and urine features were normal, the exceptions being a low serum 25-hydroxyvitamin D level (plus intermittent elevation of serum parathyroid hormone) in one, a tendency to low plasma alkaline phosphatase in another, and in the third (the most severely affected patient) a transient rise in urinary hydroxyproline and plasma alkaline phosphatase during a phase of bone loss following her second and third pregnancies. Bone biopsies performed 1 to 6-1/2 yr after parturition showed quantitative bone histologic features and bone formation rates that, as a group, were not significantly different from either normal or postmenopausal osteoporotic subjects. These patients did not have osteomalacia and did not show high turnover osteoporotic features. It is possible that this type of osteoporosis may be somewhat self-limiting, although this hypothesis is subject to great influence by any adaptive lifestyle changes introduced by the patient. The severe fracture history of these patients emphasizes the gravity of their bone disease and stresses the need for further study on the etiology and treatment of this form of osteoporosis.

Adolescent↗
PubMed1984

Autoimmune thyroid disease and giant cell arteritis: a review, case report and epidemiological study.

A 75-year-old man with the simultaneous onset of Graves' disease and giant cell arteritis is described. Although there have been few previous reports of simultaneous onset, literature review and a retrospective study of the records of this hospital suggest that the association of Graves' disease and the polymyalgia rheumatica-giant cell arteritis syndrome is not simple coincidence. The patient's course was complicated by cerebral infarction secondary to either arterial thrombo-embolism or arteritis.

Aged↗
PubMed1982

Calcium balance in osteoporotic patients on long-term oral calcium therapy with and without sex hormones.

1. The effect of a high calcium intake (1 mmol day-1 kg-1) alone or with the concomitant administration of oestradiol and testosterone derivatives was monitored by serial calcium balances in 48 patients with osteoporosis of various types. 2. On high calcium alone there was an increase (P less than 0.001) in both total calcium balance and net calcium absorption as compared with values on a simulated home intake. This effect was sustained for periods up to 10 years (mean 3.5 years) by the addition of the hormones. 3. Discontinuation of the hormones (only) produced a significant decrease in both calcium balance and nett absorption but both were still increased when compared with the initial values under simulated home calcium intake. 4. No significant change in the urinary calcium output was observed under any of the regimens.

Adult↗
PubMed1981

Serum and milk alkaline phosphatase in human lactation.

Serum and milk alkaline phosphatase (AP) values are reported for the first 16 weeks of lactation. Serum levels at all stages are elevates above normal-pregnant controls. Sequential milk AP values are reported for the first time. Heat inactivation and phenylalanine inhibition studies would suggest that serum AP in lactation is composed of bone and liver isoenzymes, but it shows an increase in the rate at which enzymatic activity is lost when frozen, indicating that lactation serum AP is largely a different isoenzyme. Electrophoresis demonstrates several AP "slow" bands of unknown origin in lactation serum.

Alkaline Phosphatase↗
PubMed1981

Changes in the milk composition of nonpuerperal women.

Studies were undertaken to determine the effect of expressing small volumes of breast fluid (less than 3.0 ml) on the progressive changes in concentrations of lactose, proteins, and electrolytes in the mammary secretions of four nonpuerperal women with galactorrhea and two nonpuerperal women who artificially induced lactation by breast hyperstimulation. The changes in the concentration of the milk constituents in the mammary secretion of these women are compared to the levels in colostrum, transitional and mature milk obtained from normal lactationg women. In one woman galactorrhea was associated with hypothyroidism and abnormally elevated blood levels of prolactin and thyroid-stimulating hormone. The breast secretion contained lactose, protein, and alpha-lactalbumin at colostrum-like levels over the entire 53 days of sampling. In two women with galactorrhea and amenorrhea associated with a pituitary tumor and hyperprolactinemia, a colostrum-like secretion was expressed on the first day of sampling but with daily sampling during a period of a month the composition approached that of normal milk. Similar results were obtained in another woman with galactorrhea, which appeared to be induced by a psychotropic drug (haloperidol), when she expressed breast fluid at 2-day intervals over a period of a month. In a second series of samples collected from this woman at intervals of 5 days or more over a period of a month, the concentration of lactose and proteins remained at colostrum levels. The composition of the breast secretion produced by two women who induced lactation artificially by breast hyperstimulation was close to the composition obtained for women during established lactation following normal pregnancy. These findings are discussed in relation to breast function and endocrine disorders.

Adult↗
PubMed1981

Composition of breast fluid of a man with galactorrhea and hyperprolactinaemia.

It has been previously reported that men with and without known disease can produce milk, but no studies to date have demonstrated that their secretion contains milk constituents produced specifically by the breast. The present study shows the presence of lactose, alpha-lactalbumin, and lactoferrin in the breast secretion of a 27-yr-old male who had galactorrhea associated with hyperprolactinaemia. The concentrations of lactose, proteins, and electrolytes in the breast secretion of this man are within the range of colostrum and milk obtained from normal lactating women.

Adult↗