Familial benign hypercalcaemia: a possible abnormality in calcium transport by erythrocytes

Abstract. The fundamental biochemical abnormality in familial benign hypercalcaemia (FBH) (familial hypocalciuric hypercalcaemia) is unknown. It seemed possible that, since the kidneys and the parathyroid glands are insensitive to the high extracellular calcium levels, a general disorder of the regulation of the calcium pump on the plasma membrane is present. We obtained evidence suggesting that active calcium efflux by erythrocytes from patients with FBH (85·7 pL 4·5 μmol l^-1 min^-1) is higher ( P < 0·005) than that by erythrocytes from control subjects (78·6 pL 4·1 μmol l^-1 min^-1) or from patients with primary hyperparathyroidism (77·5 pL 5·2 μmol l^-1 min^-1, P < 0·05). Calcium influx into erythrocytes was normal in FBH and in primary hyperparathyroidism.     

Prevalence of migraine in a rural area in South Tanzania: a door-to-door survey

We set out to assess the prevalence during the previous year of migraine in a rural area surrounding the Mnero Diocesan Hospital in Southern-Tanzania. A door-to-door survey from August until December 1999 using a questionnaire based on the criteria of the International Headache Society (IHS), including 1047 households with 3351 persons, was done, consisting of a screening dialogue with a representative family member followed by a face-to-face interview with the affected subject. Of the 3351 participants (female 1876; male 1475; age > 10 years), 23.1% had suffered from headache during the past year; overall prevalence of migraine was 5.0% (female 7.0%; male 2.6%); 1.4% reported migraine without aura (female 1.8%; male 0.9%); and 3.6% reported migraine with aura (female 5.2%, male 1.6%). The peak prevalence was found in female persons in the fourth (11.1%), in male persons in the third decade of life (3.8%). Compared with other African surveys, the prevalence rate of migraine headache in South Tanzania is slightly higher than among Ethiopian and Zimbabwean Africans.     

Etidronate disodium for treating hypercalcaemia of malignancy: a double blind, placebo-controlled study

The efficacy of intravenous etidronate disodium in controlling hypercalcaemia of malignancy was evaluated in a double blind, placebo-controlled study. Twenty patients with known malignant disease and hypercalcaemia were randomly assigned on a 2:1 basis to etidronate 7.5 mg kg-1 body weight or placebo for 3-5 days. All patients received 3000 ml saline and 40 mg furosemide per day. Eighteen patients completed the study. Eleven of twelve in the etidronate group reached normocalcaemia compared to two of six in the placebo group (P = 0.05). The etidronate group showed a greater decrease in serum calcium than the placebo group (P less than 0.02). The renal calcium excretion decreased significantly in the etidronate group, but not in the placebo group. A slight increase in serum creatinine was observed in the etidronate group compared to placebo on the first day of treatment. The difference however disappeared the following days. Intravenous etidronate treatment in combination with rehydration and furosemide constitutes a safe and efficient alternative in the treatment of hypercalcaemia of malignancy, although a first approach always should be rehydration.     

Prevalence of cluster headache in the Republic of Georgia: results of a population-based study and methodological considerations

We present a study of the general-population prevalence of cluster headache in the Republic of Georgia and discuss the advantages and challenges of different methodological approaches. In a community-based survey, specially trained medical residents visited 500 adjacent households in the capital city, Tbilisi, and 300 households in the eastern rural area of Kakheti. They interviewed all ( n  = 1145) biologically unrelated adult occupants using a previously validated questionnaire. The household responses rates were 92% in Tbilisi and 100% in Kakheti. The survey identified 32 persons with possible cluster headache, who were then personally interviewed by one of two headache-experienced neurologists. Cluster headache was confirmed in one subject. The prevalence of cluster headache was therefore estimated to be 87/100 000 (95% confidence interval < 258/100 000). We used a conservative approach, which has an obvious advantage of high-quality data collection, but is very demanding of manpower and time.     

军队干体所老年人轻度认知功能损害的患病率调查

INTRODUCTIONMildcognitiveimpairment（MCI）isconsideredtobeatransitionalstagebetweenagingandAlzheimerdisease（AD），whichisanewfocusinclinicalresearchofAD犤１－８犦．MCIisbelievedtobeahigh－riskconditionforthedevelopmentofADandhasbeenproposedasanosologicalentity犤３－８犦．However，theepidemiologyofMCIisnotwellknowninChina．ThisstudywasdesignedtodeterminetheprevalenceofMCIinanelderlypopulation．MATERIALSANDMETHODSMaterialsAlltheveteranssanatoriumsinShijiazhuangcitywereinves…     

Prevalence of migraine in Japan: a nationwide survey

This study presents the first nationwide survey of migraine in Japan. A representative sample of 4029 subjects aged 15 years or older was selected from the Japanese population according to the quota method. A combination of telephone interview and mailed questionnaire methods was used. Diagnosis of migraine was based on the International Headache Society (IHS) Classification. The overall prevalence of migraine in the past year was 8.4%; 5.8% was migraine without aura and 2.6% was migraine with aura. Significant correlation was found between the prevalence of migraine and such variables as gender, age and district of residence. Doctor attendance rate was very low and 69.4% with migraine had never consulted a physician for headache. Yet, 74.2% complained that migraine headache impaired their daily activity significantly. Only 11.6% were aware that their headache was migraine and 56.9% were using only the over-the-counter drugs. The study revealed a comparably high prevalence of migraine in the general population of Japan compared with other countries. A genetic factor was speculated as the cause of regional difference in migraine prevalence.     

Blood pressure in subjects with hypercalcaemia and primary hyperparathyroidism detected in a health screening programme

Primary hyperparathyroidism was the most likely diagnosis in sixty-eight non-thiazide treated patients with hypercalcaemia detected in a health screening. The group included fifty-five females and thirteen males with a mean +/- SEM age of 55.0 +/- 0.7 years. On a pair basis, these patients were compared with a series of sixty-eight age- and sex-matched normocalcaemic subjects selected from the health screening register. Five subjects in each group were receiving medication for hypertension. Systolic and diastolic blood pressures were significantly higher in the hypercalcaemic subjects in the remaining fifty-eight pairs (P less than 0.001). This difference was unrelated to impaired renal filtration and many other factors associated with hypertension. It is concluded that hypercalcaemia and/or other effects of deranged parathyroid function per se may result in a blood pressure elevation on which need not necessarily attain the level of hypertension.     

Prevalence of cluster headache in a population-based sample in Germany

A population-based sample of 6,000 inhabitants of the city of Essen in Germany was screened using a standard questionnaire for possible cluster headache (CH). Fifty-six percent responded (N = 3336, 50.5% of them women, mean age 44.7 +/- 12.7 years). All suspected cases (N = 182) were interviewed by a neurologist. Four subjects with CH (three men) were identified. The 1-year prevalence of CH was estimated to be 119/100,000 (95% confidence interval 3, 238/100,000).     

Prevalence of frequent headache in a population sample

PURPOSE: Patients with daily or near-daily headaches are commonly seen in neurology practices and in headache subspecialty centers, but there is little information on the prevalence of this condition in the general population. We present the first US-based study describing the prevalence and characteristics of frequent headache in the general population. METHODS: In Baltimore County, Maryland, 13 343 individuals 18 to 65 years of age were selected by random-digit dialing and interviewed by telephone about their headaches. Subjects reporting 180 or more headaches per year were classified as having frequent headache. Three mutually exclusive subtypes of frequent headache were identified: frequent headache with migrainous features, chronic tension-type headache, and unclassified frequent headache. RESULTS: The overall prevalence of frequent headache was 4.1% (5.0% female, 2.8% male; 1.8:1 female to male ratio). Frequent headache was 33% more common in Caucasians (4.4%) than in African Americans (3.3%). In both males and females, prevalence was highest in the lowest educational category. Among frequent headache sufferers, more than half (52% female, 56% male) met criteria for chronic tension-type headache, almost one third (33% female, 25% male) met criteria for frequent headache with migrainous features, and the remainder (15% female, 19% male) were unclassified. Overall, 30% of female and 25% of male frequent headache sufferers met International Headache Society (IHS) criteria for migraine (with or without aura). CONCLUSIONS: Frequent headache is common in the general population and is more prevalent in Caucasians and in those with less than a high school education. Chronic tension-type headache is more common than frequent headache with migrainous features, though the latter is more disabling. Although more common in females than males, the female preponderance of frequent headache is less marked than in migraine. The sex ratio varies by frequent headache subtype.     

Serum gastrin response to acute and chronic hypercalcaemia in man: studies on the value of calcium stimulated serum gastrin levels in the diagnosis of Zollinger-Ellison syndrome

In this study the effect of calcium infusion over 3 h without gastric aspiration on serum gastrin was determined in fifteen normal subjects, ten patients with duodenal ulcer, nine with stomal ulcer, five with total gastrectomy, six with achlorhydria and sixteen with proved or presumed Zollinger-Ellison (ZE) syndrome. Serum gastrin only rose significantly in the patients with ZE-syndrome or achlorhydria. An increase of above or below 50% of basal value seems to be a valuable criterion by which to differentiate between patients with and without ZE-syndrome. Serum gastrin levels in forty-four patients with chronic hypercalcaemia (72+/-24 pg/ml, mean+/-SD) were not significantly different from the levels in 100 normal subjects (66+/-18 pg/ml; P greater than 0.10). However, in one patient with ZE-syndrome and in two patients with achlorhydria serum gastrin values were markedly higher during chronic hypercalcaemia than during normocalcaemia. It is concluded that acute or chronic hypercalcaemia without gastric aspiration does not lead to hypergastrinaemia in the absence of ZE-syndrome or achlorhydria.     

Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs

Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35,805 day in group 1 and 29,109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 +/- 20 versus 32 +/- 19, P < .05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 +/- 20 in group 1, 45 +/- 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.     

Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden

Objective: Elevated calcium concentration is a commonly used measure in screening analyses for primary hyperparathyroidism (pHPT) and cancer. Low bone mineral density (BMD) and osteoporosis are common features of pHPT and strengthen the indication for parathyroidectomy. It is not known whether an elevated calcium concentration could be a marker of low BMD in suspected pHPT patients with a normal parathyroid hormone concentration.

Purpose: To study if low BMD and osteoporosis are more common after ten years in patients with elevated compared with normal calcium concentrations at baseline.

Design: Prospective case control study.

Setting: Primary care, southern Sweden.

Subjects: One hundred twenty-seven patients (28 men) with baseline elevated, and 254 patients (56 men) with baseline normal calcium concentrations, mean age 61 years, were recruited. After ten years, 77% of those still alive (74 with elevated and 154 with normal calcium concentrations at baseline) participated in a dual energy x-ray absorptiometry measurement for BMD assessment and analysis of calcium and parathyroid hormone concentrations.

Main outcome measures: Association between elevated and normal calcium concentration at base-line and BMD at follow-up. Correlation between calcium and parathyroid hormone concentrations and BMD at follow-up.

Results: A larger proportion of the patients with elevated baseline calcium concentrations who participated in the follow-up had osteoporosis (p value?=?0.036), compared with the patients with normal concentrations. In contrast, no correlation was found between calcium or parathyroid hormone concentrations and BMD at follow-up.

Conclusions: In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%), which highlights the importance of examining these patients further using absorptiometry, even when their parathyroid hormone level is normal.

• Key Points

• Osteoporosis is common, difficult to detect and usually untreated. It is not known whether elevated calcium concentrations, irrespective of the PTH level, could be a marker of low bone mineral density.

• No correlation was found between calcium or parathyroid hormone concentrations and bone mineral density at follow-up.

• In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%).

     

Adolescents with fluctuating symptoms of eating disorders: a 1-year prospective study

Title. Adolescents with fluctuating symptoms of eating disorders: a 1-year prospective study. Aim. This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence. Background. In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents. Methods. The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15–17 years. At baseline, in 2003–2004, the SCOFF (‘Sick’, ‘Control’, ‘One’, ‘Fat’ and ‘Food’) questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments. Results. Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms. Conclusion. Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.     

207例银屑病患者代谢综合征的患病率调查

目的研究代谢综合征(MS)在银屑病患者中的患病率。方法 2010年7月~2010年12月在上海市皮肤病医院住院的银屑病患者,通过测量身高、体重、血压、空腹血糖、甘油三酯、高密度脂蛋白等数据,统计MS的患病率及特点。结果住院银屑病患者中MS患病率为36.7%,男性银屑病患者MS的患病率为32.7%,女性银屑病患者MS的患病率为52.4%,女性高于男性(P<0.05)。寻常型与重型银屑病患者的MS患病率无统计学意义(P>0.05)。结论银屑病患者中MS的患病率较高,治疗中应加强银屑病患者健康宣教,以降低糖尿病、心血管疾病的风险,提高生活质量。     

One-year prevalence of migraine in Austria: a nation-wide survey

This study presents the first nation-wide survey of migraine in Austria. A sample of 997 Austrian > or = 15 years old were interviewed personally (face-to-face) in a random sample in the whole country. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Of the Austrian adult population 10.2% were identified to suffer from IHS migraine, 5.6% from migraine without aura, 2.3% from migraine with aura and 2.3% from borderline migraine. Another 8.5% have possible migraine. Other primary headaches were reported in 30.7%. Sex, age, working status and region were found to be the main demographic influencing factors. Further influences were stress, spinal column problems or weather changes. The most used acute medications were over-the-counter drugs, doctor attendance rate was very low. Working people with migraine dropped out of work 14 days per year, which adds up to 6.8 million working days per year. This remains a substantial economic factor. The findings indicate that migraine sufferers in Austria need to be more informed about their illness and what to do against it, especially encouraging doctor visits.     

A follow-up study of professionals' perspectives on the development of family health nursing in Scotland: a questionnaire survey

BACKGROUND: In 1998 the World Health Organisation Europe introduced the Family Health Nurse concept. The envisaged role of this community-based nurse was seen as multi-faceted and included helping individuals, families and communities to cope with illness and improve their health. During 2000-2002 Scotland led enactment of the concept through education and practice, and the first research study evaluating its operation and impact in remote and rural areas was published in 2003. OBJECTIVE: This study's purpose was to follow up health care professionals' perspectives on the development of family health nursing in remote and rural areas of Scotland since 2002. METHODS: The main research method used was questionnaire survey of all the established family health nurses in these areas and all other health and social care professionals with whom they had regular work-related contact. Where novel contexts or practice patterns emerged, further investigation was undertaken through telephone interviews. FINDINGS: Twenty-three family health nurses (88%) and 88 of their colleagues (52%) returned questionnaires. Eight family health nurses were interviewed. The dominant theme within the findings was the gradual, positive development of a role which tended to maintain established community nursing service provision, yet also supplement this with a limited expansion of family health services and public health activities. The flexibility and wide scope of the FHN role in terms of providing generalist community health nursing services was clearly evident. However, capacity to engage with whole families was found to vary widely in practice. CONCLUSIONS: Within remote and rural Scotland family health nursing is gradually consolidating and developing, but its particular aspiration to engage with whole families is often difficult to enact and is not a priority within mainstream UK primary care policy, planning or provision.     

Predictive values of various serum biomarkers in women with suspected preeclampsia: A prospective study

BackgroundPreeclampsia (PE) prediction has been shown to improve the maternal and fetal outcomes in pregnancy. We aimed to evaluate the PE prediction values of a series of serum biomarkers.MethodsThe singleton pregnant women (20–36 gestational weeks) with PE‐related clinical and/or laboratory presentations were recruited and had the blood drawn at their first visits. The following markers were tested with the collected serum samples: soluble fms‐like tyrosine kinase 1 (sFlt‐1), placental growth factor (PlGF), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (tPAI‐C), complement factors C1q, B, H, glycosylated fibronectin (GlyFn), pregnancy‐associated plasma protein‐A2 (PAPP‐A2), blood urea nitrogen (BUN), creatinine (Cre), uric acid (UA), and cystatin C (Cysc).ResultsOf the 196 recruited subjects, 25% (n = 49) developed preeclampsia before delivery, and 75% remained preeclampsia negative (n = 147). The serum levels of sFlt‐1, BUN, Cre, UA, Cysc, and PAPP‐A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia‐positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt‐1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP‐A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP‐A2). The positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%.ConclusionsThe serum markers investigated in current study showed better performance in ruling out than ruling in PE. Absence of pre‐defined latency period between blood draw and the onset of PE limits the clinical utility of these markers.     

Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults

We examined prospectively the risk for major depression (MDD) and panic disorder in persons with prior history of migraine. A random sample of 995 young adults was interviewed in 1989 and reinterviewed in 1990. A history of migraine at baseline increased fourfold the risk for MDD during the follow-up interval. A history of any anxiety disorder exacerbated the risk for MDD in persons with migraine. Persons with a history of migraine were twelve times more likely to become cases of panic disorder than those with no history of migraine. The risk for MDD and/or panic disorder was unrelated to whether or not migraine was active during the year preceding the baseline interview or in remission for more than one year. The findings suggest that migraine, major depression and anxiety disorders might share common predispositions.