Biomedical subjects
F Kuhlencordt
Publications and source records attributed to F Kuhlencordt.
Case report 422: Malignant primary osteoporosis.
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[Malignant primary osteoporosis. A special form in males in early and middle age].
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[Preoperative localization diagnosis of parathyroid adenomas in 72 cases of primary hyperparathyroidism by selective catheterization of neck veins and parathyroid hormone determination].
In 72 cases of primary hyperparathyroidism, selective venous catheterization was performed preoperatively to localize parathyroid adenomas. Diagnosis of primary hyperparathyroidism was proved by operation in all but 5 cases, in which no adenomas could be found intraoperatively. By venous catheterization of the neck and upper region of the thorax, an average of 10 blood samples per patient were taken. Parathyroid hormone was estimated by radioimmunoassay with high sensitivity against the intact PTH-molecule and carboxy-terminal fragments. Only in 24 out of 72 cases was localization of parathyroid adenomas prognosticated correctly with respect to side and height, while in a total of 38 cases localization on the right or left side only could be determined preoperatively. These unsatisfactory results can be improved only by a much more extensive catheterization technic which would be justified only in patients already operated on before without success. The final evaluation of non-invasive methods, e.g. ultrasonics and computerized tomography, is still under discussion.
[Therapy of primary osteoporosis with sodium fluoride and calcium].
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[Clinical relevance of 25-hydroxyvitamin D estimation in plasma (author's transl)].
Plasma concentrations of 25-hydroxyvitamin D (25-OH-D) were determined in 40 healthy persons and in patients with primary osteoporosis (n = 43), primary hyperparathyroidism (n = 19), intestinal osteopathy (n = 13), and after small intestine bypass operations (n = 8). The control group showed physiologic seasonal variations which must be taken into account in the individual case. Whereas there were no deviations from the normal in patients with osteoporosis, significantly lower values were obtained in the other disease groups. Estimation of 25-OH-D in plasma represents a valuable contribution for the diagnosis of generalized osteopathies and for the differential diagnosis of hypercalcaemia. In addition, the effects of vitamin D treatment may be objectively assessed. Overdosage and intoxication may be recognized in time.
[Treatment of Paget's disease of bone with salmon calcitonin (author's transl)].
Subcutaneous injections for two days of 100 MRC units each of synthetic salmon calcitonin were administered to 40 out of 77 patients with Paget's disease of bone. Chemical pathology (alkaline serum phosphatase, hydroxyprolinuria) showed an initially satisfactory response of all patients to this treatment. Resistance developed in 6 out of 8 patients on long term treatment with recurrence of increased serum alkaline phosphatase, occurring after 4 months at the earliest and 24 months at the latest. Human calcitonin may be an alternative of treatment in these cases of secondary resistance. Treatment with calcitonin is nearly risk-free and represents a definite progress in comparison with earlier forms of treatment.
[Calcium and bone metabolism after jejunal bypass operation for alimentary obesity: model for a intestinally-conditioned disorder (author's transl)].
Jejuno-ileostomy was performed in eight women because of severe alimentary obesity. Their calcium phosphate and bone metabolism was studied an average of 31 months post-operatively. This revealed secondary intestinal hyperparathyroidism due to an artificial malabsorption syndrome. While most of the significant metabolic factors were within normal limits, examination of calcium balance and kinetics indicated a marked disorder of calcium and bone metabolism. Calcium balance averaged-138 mg daily, corresponding to a yearly loss of skeletal mass of 4-5%.
[Diaphyseal dysplasia (Camurati-Engelmann syndrome) with progressive loss of vision: 30-year observations and the effect of prednisolone treatment (author's transl)].
Radiological changes in the skeleton had been present for 30 years in a now 42-year-old man with diaphyseal dysplasia (Camurati-Engelmann syndrome). Because of threatened blindness by bony narrowing of the optic canal prednisolone was administered over several years. Biochemical, calcium-kinetic and ophthalmological studies demonstrated a favourable effect of this treatment.
Pathogenesis of osteoporosis.
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Pathogenesis and natural course of primary osteoporosis.
A new concept of the pathogenesis and natural course of osteoporosis is described, based on histomorphometric evaluation of iliac crest bone biopsies of 108 patients with untreated primary osteoporosis. It is suggested that primary osteoporosis spontaneously runs a three-phase course: during the initial period of negative bone balance, bone mass falls below the normal range; during the second phase bone mass remains consistently below age-related normal values; in the third phase restitution of osteoporosis is introduced by a positive bone balance. It is suggested that only about a quarter of patients with a skeletal mass below the age-related normal range have true primary osteoporosis; the remaining three-quarters may have secondary forms of osteoporosis where the underlying disease responsible for the bone loss had been missed before the osteoporosis was diagnosed.
Bone calcium exchange in primary hyperparathyroidism as measured by 47calcium kinetics.
A 2-compartmental analysis of 47Ca kinetics was carried out in 21 patients with primary hyperparathyroidism (pHPT) and 7 healthy control subjects. The results were compared with serum concentrations of calcium, inorganic phosphorus, alkaline phosphatase, and immunoreactive parathyroid hormone (iPTH). The well known increase in exchangeable calcium was found to be not uniform in its subcompartments and with a marked predominance of the osseous fraction. The most important result was the increase of calcium efflux from osseous into extraosseous exchangeable calcium in agreement with the results of Talmage et al. studying PTH actions on calcium flux rates between blood and bone in rats. The increased calcium efflux in pHPT was the only kinetic parameter correlated with serum iPTH. Neither increased calcium accretion indicating high bone turnover, nor serum calcium concentrations and exchangeable calcium fractions correlated with serum iPTH. These results lead to the following conclusions: radiocalcium kinetics provides valuable parameters of bone calcium turnover (osseous exchangeable calcium, bone-calcium efflux, and calcium accretion). Calcium efflux from exchangeable bone calcium, determined kinetically, might be related to PTH induced calcium transport from bone fluid compartment to extracellular fluids according to the concept of Talmage 1977.
[Paget's osteodystrophia deformans. Occurrence, clinical aspects and complications].
33 monostotic and 27 polyostotic manifestations were found in 60 patients with Paget's disease of bone, 30 of whom were females (mean age 65.7 years) and 30 males (mean age 62.8 years). Pelvis, right tibia, lumbar spine, skull and sacrum were most commonly affected. Alkaline phosphatase activity in serum was raised in 95%, and in 88% hydroxyproline excretion in urine was increased. Due to the variable primary osseous or secondary arthrogenic complaints four groups could be distinguished among the monostotic cases. In polyostotic forms only some of the affected bones caused symptoms, whereas the other locations were only detected radiographically. The indication for calcitonin treatment of Paget's disease can only be made after in-patient investigation and evaluation of skeletal involvement, activity of the disease, complaints and assessment of complications actually present or to be expected according to the pattern of involvement. Under these conditions this form of treatment appeared indicated in 41 of 60 patients.
[Paget's disease--manifestations in the vertebral colum. Computer tomographic investigations (author's transl)].
Computer tomography has been found to be of value in the study of deformities and narrowing of the spinal canal in 52 patients with Paget's disease of vertebral bodies. To a limited extent it can also be used for evaluating the intervertebral foramina. Deformities of the spinal canal were classified into three degrees of severity. The most severe changes were found in the lower thoracic region. The presence of neurological complications is an indication for CT studies.
[Results of long-term treatment of primary osteoporosis with sodium fluoride (author's transl)].
Twenty-three patients with primary osteoporosis were treated with sodium fluoride over 25 months. Mean total dose was 21 g fluoride. Symptoms, body size, biochemical results, radiological changes and skeletal mineral content as well as bone histomorphometry were evaluated in assessing results of treatment. Accordingly, no advance in the disease process was demonstrable in 13 patients, while there was definite improvement in six, but in four there was further progression.
[Bone mineral content during chronic hemodialysis long term observation by 125-i photonabsorptiometry (author's transl)].
40 out of 98 patients on chronic haemodialysis show an obviously lowered bone mineral content of the radius (mean -20.4%), 51 patients attain values in the normal range (mean -1%) and 7 subjects slightly increased values (mean +10.9%). A bone mineral loss of 2.5% could be found after long-term observations of this parameter between 6 to 30 months (mean observation period: 15 months). In general a progressive loss of the bone mineral content may be noticed with an increased duration of haemodialysis. This tendency is more distinct after the 40th year of life because of the simultaneous age-depending physiological decrease of bone mass. Abruptly occurring mineral losses of the skeleton may be due to a high incretion of parathyroid hormone and possibly require subtotal parathyroidectomy.
[The coincidence of Paget's disease and an immunoblastic sarcoma (author's transl)].
Malignant change is to be expected in about 1% of patients with Paget's disease. Usually these are osteosarcomas. Fibrosarcomas, benign and malignant giant cell tumours and chondrosarcomas are less common. The present case concerns the development of an immunoblastic sarcoma in the humerus, which was affected by Paget's disease. Only one other similar case is recorded in the literature. Other myelogenous tumours, such as plasmocytomas, are very rare in association with Paget's disease. Consequently there is no evidence for a causal connection between Paget's disease to these tumours, whereas sarcomas arising from bine tissue may be regarded as a form of malignant degeneration of Paget's disease.