[Inflammatory rheumatic diseases--a survey. Classification, diagnosis and treatment].
Explore the source record for details and available documents.
Arthritis↗
Biomedical subjects
H Rickers
Publications and source records attributed to H Rickers.
The value of clinical assessment for preoperative prediction of liver metastases in suspected gastrointestinal cancer. A prospective, consecutive study.
Surgeons' ability to predict liver metastases preoperatively was studied in 185 operable, nonicteric patients strongly suspected to have gastrointestinal cancer. The prediction was based on a clinical assessment comprising medical history, physical examination and low-cost laboratory tests. A pathoanatomic verification procedure was used. The observed predictive value of a positive test was 0.67 and there was a false-negative ratio of 0.79. At the clinical assessment, presence of metastases was believed to be more common in gastric than in colorectal disease (6/43 vs. 3/142), but the actual incidence of metastases was similar in the two groups. Serum alkaline phosphatase (AP) was a priori believed to be of value in the clinical assessment. But the clinical assessment with inclusion of AP was inferior to AP alone as a predictor of metastases, due to undervaluation of the importance of elevated AP in cases of colorectal disease. The difficulties in standardization of the clinical assessment are underlined.
Adult↗
Serum concentrations of vitamin D metabolites in different degrees of impaired renal function. Estimation of renal and extrarenal secretion rate of 24,25-dihydroxyvitamin D.
The serum levels of 25-hydroxycholecalciferol, 24,25-dihydroxycholecalciferol, and 1,25-dihydroxycholecalciferol were measured simultaneously in three groups of adults with different renal function: normal (n = 24), glomerular filtration rate (GFR) greater than 70 ml/min; moderately decreased (n = 15), GFR 5-35 ml/min, and severely decreased (n = 27), GFR less than 5 ml/min. 25-hydroxycholecalciferol was normal in both patient groups with decreased renal function. 1,25-dihydroxycholecalciferol was halved in the group with moderately decreased renal function (p less than 0.01) and severely decreased (almost undetectable) in the group with severely decreased renal function (p less than 0.01). In contrast, 24,25-dihydroxycholecalciferol was normal in the group with moderately decreased renal function and only halved (p less than 0.05) in the group with severely decreased renal function. These findings suggest extrarenal C-24 hydroxylase activity which may be stimulated by decreasing renal function, thus decreasing renal C-24 hydroxylase activity.
24,25-Dihydroxyvitamin D 3↗
Determination of mono- and dihydroxy-vitamin D metabolites in normal subjects and patients with different calcium metabolic diseases.
Reliable assays to determine the vitamin D metabolites are useful aids in the study of disorders involving vitamin D metabolism, and in the evaluation of the response in patients receiving vitamin D treatment. We report here the establishment in our laboratory of a method capable of measuring 25(OH)D, (including 25(OH)D2 and 25(OH)D3), 1,25(OH)2D and 24,25(OH)2D in a single blood sample. The method involves methanol/dichloromethane extraction and Sephadex LH-20 chromatography. The monhydroxylated fraction was purified on Lipidex 5000 and separated in 25(OH)D2 and 25(OH)D3 on high pressure liquid chromatography (HPLC), followed by ultra violet absorbance (UV) detection. The dihydroxylated fraction was separated by HPLC and quantified by protein-binding assays. The method is precise and accurate. The vitamin D metabolites were measured in different groups of patients and in normal subjects.
24,25-Dihydroxyvitamin D 3↗
Bone mineral loss during centre and home haemodialysis. Influence of vitamin D metabolites and serum parathyroid hormone.
Twenty-seven patients on chronic haemodialysis were investigated for a mean of 4.8 years (3.0-6.5 years). Mean bone mineral content fell constantly and similarly at a rate of three to four per cent per year in both centre (n = 14) and home (n = 13) haemodialysis patients. Mean serum values of 25(OH)D3 (normal), 24,25(OH)2D3 (decreased to half the normal level and 1,25(OH)2D3 (severely decreased and almost non-detectable) were similar in patients with a rapid bone mineral content loss (greater than 10%/3 years) and a slow bone mineral loss (less than 10%/3 years). Mean serum parathyroid hormone was markedly elevated, but significantly higher (about twice the level) in the 'rapid losers' than in the 'slow losers'; whereas the two groups did not differ with regard to mean serum concentrations of calcium, phosphate and alkaline phosphatase.
Adult↗
Mineral loss in cortical and trabecular bone during high-dose prednisone treatment.
To evaluate the effect of prednisone and triple treatment (sodium fluoride, calcium, and vitamin D) on trabecular and cortical bone serial bone mineral content (BMC) measurements were made at a metaphyseal (BMCD) and diaphyseal (BMCP) site on the forearm on 31 consecutive and previously bone-healthy patients scheduled for at least 24 weeks high-dose prednisone treatment. The patients were randomized into two further treatment groups: group I (n = 16) received prednisone plus triple treatment and group II (n = 15) received only prednisone. The two groups were similar with regard to age, sex, prednisone dose, and initial BMC. During 24 weeks treatment, BMCD (partially representing trabecular bone) and BMCP (mainly representing cortical bone) fell significantly and similarly, demonstrating that there is no preventive effect on bone mineral loss on the triple regimen. The BMC fall after 12 weeks was significantly more pronounced for metaphyseal (partially trabecular) than for diaphyseal (cortical) bone, whereas the values did not differ significantly after 24 weeks; this indicates a greater sensitivity to the hormone treatment of trabecular bone. In the entire group, the fall in BMC correlated positively with individual prednisone dose, significant at the diaphyseal site (r = 0.39, P less than 0.05), but not at the metaphyseal site (r = 0.31, P = 0.08). It is concluded that corticosteroid-induced osteopenia is a diffuse bone disease which affects trabecular as well as cortical bone, suggesting that BMC measured on the forearm reflects changes in bone mineral at other locations.
Adult↗
Measurement of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in clinical settings.
A quick and simple method for the selective measurement of 25-hydroxyvitamin D3 (25OHD3) and 25-hydroxyvitamin D2 (25OHD2) is described. It includes a rapid sample preparation technique and a combination of a selective radioimmunoassay for 25OHD3 and a competitive protein-binding assay using vitamin D-binding protein for the determination of total 25OHD, including 25OHD3 and 25OHD2. The method was compared with a procedure which include methanol/methylene chloride extraction and chromatography on Sephadex LH 20, and a procedure which includes HPLC and final quantification by u. v. detection. The methods were applied to three groups of patients in order to obtain information on how far assay procedures could be simplified for use in the clinical settings. It is concluded that the method described is applicable for following patients on vitamin D2 therapy. When groups of patients have to be compared, the mean values of the estimates are comparable, whether a simple method or a laborious method is used. Hence, the selection of assay method should take into account the clinical problem and the cost of the analysis.
25-Hydroxyvitamin D 2↗
Glomerular filtration rate during lithium therapy. A longitudinal study.
In order to investigate the side effect of lithium on renal function the glomerular filtration rate (GFR) was measured before (to) and after a mean of 16.5 months (t1) (range 12-25 months) lithium treatment in 13 consecutive patients aged 32-67 years (mean age 46 years). The patients had a normal renal function before the treatment was started; none of them had previously been treated with lithium. During treatment GFR (ml/min) fell from 101.9 to 98.3 which was not significant. However, standard-GFR (ml/min/1.73 m2) fell from 88.4 to 84.8 (P less than 0.05) mainly due to a significant rise in body weight and estimated surface area during treatment. No significant changes appeared in plasma creatinine. It is concluded that lithium therapy for a mean of 16.5 months does not affect the glomerular filtration rate; but considerably longer observations of GFR during lithium therapy should be done by means of a reliable GFR measurement method.
Adult↗
Impairment of vitamin D metabolism and bone mineral content after intestinal bypass for obesity. A longitudinal study.
Ten obese subjects who had undergone intestinal bypass operation (end-to-side jejunoileostomy) were studied longitudinally with respect to vitamin D and other indices of calcium metabolism. Investigations were carried out before operation (t0) and after 6 months (t1), 12 months (t2), and a mean of 54 months (range, 49-58 months) (t3) postoperatively. Serum 25-hydroxyvitamin D (25OHD) was subnormal at t0 but after operation values declined gradually to an extremely low level at t3, possibly because of a loss through malabsorption. Serum 24,25-dihydroxyvitamin D remained normal at t1 and t2 but fell to about half the normal level at t3, probably owing to lack of its precursor, 25OHD. In contrast, serum 1,25-dihydroxyvitamin D (1,25(OH)2D) remained normal throughout the study, indicating a marked stimulation of kidney 1 alpha-hydroxylase activity. Serum calcium fell rapidly to a constant subnormal level, and it is concluded that the serum calcium malabsorption is due to factors other than impaired 1,25(OH)2D activity. Bone mineral content (BMC) was unchanged between t0 and t2, but thereafter (between t2 and t3) the mean BMC fell rapidly to about 90% of preoperative value, possibly due to a defective bone mineralization in the late postoperative period. The findings indicate a high risk of bone disease developing after intestinal bypass operation. Substitution with calcium and vitamin D should be given to these patients, but the optimal vitamin D metabolite (or combination of metabolites) for such treatment is still unknown.
24,25-Dihydroxyvitamin D 3↗
Vitamin D and bone mineral content after intestinal bypass operation for obesity.
Twenty-three obese subjects who had undergone intestinal bypass operation (end-to-side jejunostomy) were studied with respect to vitamin D and other indices of calcium metabolism. Group 1 (11 patients) was examined before and one year after operation. Group 2 (12 patients, bypass operated two to seven years earlier was investigated twice with an interval of one year. The two groups were comparable. Bone mineral content and alkaline phosphatases were unchanged during the study in both groups. Bone phosphorus/hydroxyproline ratio was high postoperatively indicating a high degree of bone mineralisation. Serum calcium declined rapidly in group 1 to a constant level, which was maintained in group 2. The serum levels of iPTH and 1,25(OH)2D did not change within each group, but combining the two groups demonstrated an increase/decrease in iPTH/1,25(OH)2D over the years. The findings suggest that factors other than 1,25(OH)2D and iPTH are involved in calcium metabolism in such patients. The findings do not justify routine administration to such patients of high potency vitamin D derivatives, f.ex. 1 alpha-OH-D3.
25-Hydroxyvitamin D 2↗
Bone mineral content in patients on prolonged maintenance hemodialysis: a three year follow-up study.
Bone mineral content (BMC) was measured annually over a three year period in 31 consecutive patients on maintenance hemodialysis (HD). No patient had received treatment with vitamin D derivatives, anticonvulsants or corticosteroids, nephrectomy or a renal transplant. Initial median BMC value in per cent of sex and age matched normal mean was significantly decreased to 91.0% (P less than 0.01), indicating bone mineral loss in chronic renal failure prior to HD. During HD a highly significant fall in mean BMC (in per cent of initial value) continued to 95.1%, 92,7% and 90.8% after 1, 2 and 3 years, respectively, with no influence of age, sex or initial BMC value. The interindividual variation in BMC changes, however, was considerable: the BMC loss over 3 years exceeded 10% in 13 (42%) patients ("rapid losers") while 12 (39%) patients had a BMC loss below 5%, or no loss at all. The "rapid loser" group had significantly higher serum levels of parathyroid hormone and alkaline phosphatases and, moreover, developed a lower serum phosphate and calciumXphosphorus product than the other group of patients ("slow losers"). The mean BMC loss over 3 years of HD was pronounced and significant (P less than 0.02) in patients with chronic pyelonephritis (9.8%) and polycystic kidney disease (14.2%), but much smaller, and not significant, in patients with chronic glomerulonephritis (4.8%). It is concluded that a selection of patients with a high degree of bone mineral loss during HD is not possible by means of sex, age, initial BMC, biochemical parameters, or diagnosis (2 patients with chronic glomerulonephritis appeared to be "rapid losers"). For that purpose a high-precision BMC method is mandatory.
Adult↗
Corticosteroid-induced osteopenia and vitamin D metabolism. Effect of vitamin D2, calcium phosphate and sodium fluoride administration.
Thirty-one patients scheduled for long-term (24 weeks) treatment with prednisone in comparatively high doses were randomly allocated to two further treatment groups. Group A received prednisone plus 'triple-treatment' (vitamin D2 45000 iu twice weekly, sodium fluoride 50 mg and calcium phosphate 4.5 g daily), group B received only prednisone. The study was undertaken in order to evaluate the effect of prednisone- and triple-treatment upon bone mineral content (BMC) and vitamin D metabolism. The groups were comparable with regard to age, sex and prednisone dose. BMC fell rapidly and similarly in both groups, demonstrating that the triple-treatment has no preventive effect on corticosteroid induced osteopenia. Serum concentrations of 25OHD2, 25OHD3 and 1,25(OH)2D were unchanged in group B (without triple-treatment), whereas in group A 25OHD2 increased enormously, 25OHD3 was suppressed possibly by substrate competition for hydroxylation in the liver and 1,25(OH)2D was halved. The suppression of 1,25(OH)2D may be an effect of raised 25OHD2 alone, or in combination with corticosteroid excess.
Alkaline Phosphatase↗
The diagnostic value of fasting serum total bile acid concentration in patients with suspected liver disease. A prospective, consecutive study.
To assess the diagnostic value of fasting serum total bile acids (STBA) in liver disease, STBA together with serum bilirubin (BIL), serum alkaline phosphatase (AP), and serum aspartate aminotransferase (ASAT) were measured in 66 consecutive patients who had a liver biopsy. Twenty-four of the patients who had normal liver histology all had normal STBA values (less than 8 mumol/l). In the remaining 42 patients with abnormal liver histology STBA values were elevated in 21, corresponding to a sensitivity of 0.50. The same figures for BIL, AP, and ASAT were 0.52, 0.76, and 0.79, respectively. The predictive values of elevated (PVpos) and normal (PVneg) STBA for disclosing or excluding liver disease, respectively, were not better than the figures for BIL, AP, and ASAT. None of the tests were suited for distinguishing among various liver diseases. It is concluded that STBA had no diagnostic advantage as compared with the commonly used liver function tests BIL, AP, and ASAT.
Adolescent↗
Bone mineral content before and after intestinal bypass operation in obese patients.
With the aim of investigating bone mineral loss after intestinal bypass operation, bone mineral content (BMC) was measured by two-dimensional scanning photon absorptiometry on the distal part of the forearm in 23 consecutive patients who had undergone intestinal bypass operation for obesity. Eleven patients (group 1) were investigated before and 12 months after operation, and 12 (group 2), who had been operated on 2-7 years earlier, were investigated two times at an interval of 12 months. No patient received therapeutic calcium or vitamin D supply. The predominant biochemical findings postoperatively were decreased serum values of calcium, magnesium, albumin, and total protein; there was no change in inorganic phosphate or alkaline phosphatase. Mean BMC was normal in both groups postoperatively as well as in group 1 before operation; there was no significant change in mean BMC during 12 months of observation. However, in BMC measurements on extremely obese subjects, a correction for the excessive fat layer on the forearm was necessary because of different attenuation properties of fat and soft tissues. Neglect of this problem will give a systematic underestimation of BMC, and may lead to false conclusions in cross-sectional as well as longitudinal studies.
Adult↗
Renal function and body composition before and after intestinal bypass operation in obese patients.
The distribution volume of [51Cr]EDTA, as an estimate of the extracellular fluid volume (ECV), glomerular filtration rate (GFR) and urinary excretion rate of endogenous creatinine (uc), as an index of muscle mass, were determined in obese patients before and after intestinal bypass operations. The results were compared to those in non-obese controls with the same age and height. GFR, ECV and uc were all significantly increased to the same extent (about 40%) in thirteen patients examined before operation (overweight 86-159%). Means of the ratio GFR/ECV and standard GFR (i.e. GFR corrected to a body surface area of 1.73 m2) did not differ from those in the controls. In eight patients examined before and 1 year after operation (body weight reduction 23-79 kg), GFR were unchanged and remained normal. ECV was significantly increased by 20% in nineteen patients investigated 1-7 years after operation (mean overweight 42%) whereas the mean of uc did not differ from that in the controls. Using the ratio GFR/ECV as reference for the function of the kidneys, the present study shows that the renal function in otherwise healthy obese subjects is normal throughout the whole range of overweight, and that standard GFR is a reliable parameter to assess the renal function even in patients with extreme obesity. The body weight reduction following intestinal bypass operation is in part due to fall in muscle mass, but the results suggest that a normal relation between body cell mass and body water is not achieved.
Adult↗
The glomerular filtration rate during penicillamine therapy in rheumatoid arthritis.
Twenty-one consecutive patients (14 women and 7 men aged 35-68 years, mean age 50 years) with chronic active RNA for 2-24 years (mean 12.7 years) had a normal glomerular filtration rate (GFR) (mean value 99.8 +/- 14.8% (S.D.) of sex- and age-dependent normal value) before penicillamine treatment. All patients had previously been undergoing gold treatment; no patient had signs of renal disorder, or diabetes. GFR (total 51Cr-EDTA plasma clearance) was measured before and after 3 and 6 months' penicillamine treatment, respectively. Treatment was stopped because of side effects in 4 patients, including one with renal side effects. In the remaining 17 patients there was a mean fall in GFR of 3.8 +/- 12.5 (S.D.) ml/min during 6 months' penicillamine treatment, which was not significant. There was no correlation between individual changes in GFR and penicillamine dose. The individual changes in GFR correlated well to individual changes in plasma creatinine. Repeated determinations of plasma creatinine should be done during penicillamine treatment.
Adult↗
Bone mineral loss during maintenance hemodialysis.
With the aim of investigating bone mineral loss during maintenance hemodialysis (MDH), bone mineral content (BMC) was measured by means of two-dimensional scanning photon absorptiometry in 47 chronic renal failure patients on MDH: 13 females (age range 22-50 years, mean dialysis duration 189 days) and 34 males (age range 23-69 years, mean dialysis duration 449 days). Measurements were carried out in most patients three times at an interval of 6 months. Initial mean BMC values were for both sexes significantly lower than normal, but did not correlate to duration of MHD. The longitudinal measurements demonstrated a highly significant decrease in BMC with time: the mean BMC values after 6 and 12 months, respectively, were for females 95.8 and 93.4% and for males 97.3 and 94.4% of the initial values with no significant differences between sexes. The fall in BMC did not correlate to duration of MHD, initial BMC value, or age. In some of the patients a substantial loss of BMC was observed, and it is suggested that these patients in particular may develop server bone disease. A BMC method with high precision is mandatory for selection of such patients.
Absorption↗
The diagnostic value of plasma urea for assessment of renal function.
Explore the source record for details and available documents.
Adult↗