Biomedical subjects
Publications and source records attributed to J M Xipell.
The application of an electronic digitizer and a computerized program for the quantitative assessment of bone morphology is reported. The method was used to measure bone surfaces and areas in undecalcified sections of iliac crest in 50 control subjects at necropsy.
The response to porcine calcitonin has been assessed in 38 patients with Paget's disease, observed during 44 treatment periods of from three to 42 months. In 36 of the treatment courses significant relief of pain was achieved but the contribution of placebo effect could not be determined. Serum alkaline phosphatase and urinary hydroxyproline levels reached normal in a few patients, but the grouped data indicated a plateau effect above the range of normal. The acute hypocalcaemic response to calcitonin was lost only in those patients whose bone turnover was restored to normal. Quantitative histology on iliac crest bone biopsy samples showed no statisically significant lowering of osteoclast counts. No antibody-based clinical resistance occurred and the incidence of side effects was low. The results indicate that porcine calcitonin is a useful treatment of Paget's disease, and the experience of the study helps in arriving at patient selection and treatment schedules. Treatment is recommended for bone pain and for active disease in the relatively young, using intermittent therapy with course of at least six months duration. Resumption of therapy is based on clinical and biochemical indications.
A case of alveolar lipoproteinosis associated with silicosis is reported. A 58-year-old man had been exposed to silica for seven years and died three years after the onset of symptoms. Light microscopy of biopsy and necropsy material showed small silicotic nodules, silica particles, and alveolar lipoproteinosis, and ultrastructural studies were performed to define changes in alveolar epithelium and macrophages. The case provides a further example of alveolar lipoproteinosis developing as a response of the lung to injury by an external agent.
A case of transitional cell carcinoma in the left kidney 25 years after urinary tract investigations, and squamous cell carcinoma in the right kidney 6 years later is described. Thorotrast was identified in the kidneys and in the reticulo-endothelial system post mortem and was presumably the contrast material used for the original retrograde pyelogram. When retained in the kidneys after retrograde pyelography Thorotrast produces a characteristic radiological and histological appearance and can be identified by the spectrum of radiation which it emits. The authors believe that this report of bilateral renal carcinomas related to Thorotrast is unique.
Nephropathy with proteinuria is an occasional complication of gold therapy for rheumatoid arthritis and is considered to be due to an immune hypersensitivity reaction. Three patients are described in whom the structural changes typical of gold nephropathy were demonstrated by electron microscopy of renal biopsies. There was early membranous glomerular nephropathy with multiple sub-epithelial deposits of immune complexes. In one case these were shown by immunofluorescence to contain IgG and complement. Proximal tubules contained characteristic dense granular intracytoplasmic gold inclusions, best demonstrated by electron microscopy of unstained sections.
A case is reported of a twenty-one year old man who developed severe hypercalcemia late in the diuretic phase of acute reversible renal failure secondary to severe trauma. Hypercalcemia persisted for approximately five months. Serum immunoreactive parathyroid hormone levels were undetectable and sub-total parathyroidectomy had no appreciable effect on the serum calcium. The most likely source of this patient's hypercalcemia was resorption of calcium from metastatic deposits in soft tissue and possibly from bone. Failure to incorporate calcium into bone during the period of immobilization may explain the prolonged hypercalcemia.