Effects of vitamin K2 (menatetrenone) and alendronate on bone mineral density and bone strength in rats fed a low-magnesium diet

In this study, we examined changes in bone parameters and bone strength in rats fed low-Mg diets (experiment 1) and the effects of vitamin K2 (MK-4, experiment 3) and alendronate (ALN, experiment 2) in this model. In experiment 1, 5-week-old male Wistar rats were fed three low-Mg diets (Mg 9, 6, 3 mg/100 g diet) for 4 weeks. Although the cortical bone mineral content (CtBMC) and cortical thickness (CtTh) of the femoral diaphysis in all low-Mg-diet groups were the same as or greater than those in the intact group (Mg: 90 mg/100 g diet), the maximum load and elastic modulus were significantly reduced in the 3-mg-Mg group. In experiment 2, 4-week-old Wistar rats were fed a 6-mg-Mg diet for 8 weeks, and the effect of ALN (2, 20, and 200 microg/kg twice a week) was evaluated. The administration of ALN at 200 microg/kg increased the cortical bone mineral content (CtBMC), CtTh, and maximum load, but had no effect on the elastic modulus, as compared with the low-Mg-control group. In experiment 3, the effect of MK-4 was evaluated under the same conditions as in experiment 2. The administration of MK-4 had no effect on CtBMC, CtTh, or bone components of the femoral diaphysis. However, MK-4 inhibited the decreases in maximum load and elastic modulus due to the low-Mg diet. Since there is no other experimental model in which there is a decrease in bone mechanical properties without a decrease in bone mineral content, the low-Mg diet model is considered to be an excellent model for examining bone quality. Our results from this model suggest that MK-4 and ALN affect bone mechanical properties by different mechanisms.     

Vitamin K<Subscript>2</Subscript> (menaquinone 4) reduces serum undercarboxylated osteocalcin level as early as 2 weeks in elderly women with established osteoporosis

 Twenty elderly osteoporotic women with vertebral fracture(s) were randomly allocated to two groups; women in the MK₄ group received calcium with menaquinone 4 (MK₄) at a dose of 45 mg/day for 2 weeks, and women in the control group received calcium alone for the same period. Serum intact osteocalcin (OC) and undercarboxylated osteocalcin (uc-OC) levels were measured by immunoradiometric assay and enzyme immunoassay, respectively, at baseline and on the 7th and 14th days following the start of the treatment. There were no differences in the baseline data including age, weight, phylloquinone, menaquinone 4, menaquinone 7, OC, and uc-OC levels between the MK₄ group and the control group. Administration of MK₄ significantly raised the MK₄ level from 0.20 ± 0.10 (mean ± SE) pg/ml to 15.09 ± 5.62 pg/ml (P < 0.04), and reduced serum uc-OC levels from 2.80 ± 0.93 ng/ml to 1.76 ± 0.56 ng/ml (P < 0.05) at the end of the study, respectively. No significant changes in these levels were observed in the control group. Serum OC levels were stable during the period in both groups. In this randomized prospective study, the MK₄ group shows a reduction in the serum uc-OC level within 2 weeks without any significant change in OC, suggesting that the uc-OC is changed to carboxylated OC. This early effect of MK₄ on bone metabolism may be estimated by the measurement of serum uc-OC in elderly osteoporotic women with vertebral fractures. Received: January 21, 2002 / Accepted: November 6, 2002 Offprint requests to: T. Miki     

Effect of vitamin K<Subscript>2</Subscript> and growth hormone on the long bones in hypophysectomized young rats: a bone histomorphometry study

The purpose of the present study was to determine whether vitamin K₂ and growth hormone (GH) had an additive effect on the long bones in hypophysectomized young rats. Forty-eight female Sprague–Dawley rats (6 weeks old) were assigned to the following five groups by the stratified weight randomization method: intact controls, hypophysectomy (HX) alone, HX + vitamin K₂ (30 mg/kg, p.o., daily), HX + GH (0.625 mg/kg, s.c., 5 days a week), and HX + vitamin K₂ + GH. The duration of the experiment was 4 weeks. HX resulted in a reduction of the cancellous bone volume/total tissue volume (BV/TV) at the proximal tibial metaphysis, as well as decreasing the total tissue area and cortical area of the tibial diaphysis. These changes resulted from a decrease of the longitudinal growth rate and the bone formation rate (BFR)/TV of cancellous bone, as well as a decrease of the periosteal BFR/bone surface (BS) and an increase of endocortical bone turnover (indicated by the BFR/BS) in cortical bone. Administration of vitamin K₂ to HX rats did not affect the cancellous BV/TV or the cortical area. On the other hand, GH completely prevented the decrease of total tissue area and cortical area in cortical bone, as well as the decrease of marrow area and endocortical circumference, by increasing the periosteal BFR/BS compared with that in intact controls and reversing the increase of endocortical bone turnover (BFR/BS). However, GH only partly improved the reduction of the cancellous BV/TV, despite an increase of the longitudinal growth rate and BFR/TV compared with those of intact controls. When administered with GH, vitamin K₂ counteracted the reduction of endocortical bone turnover (BFR/BS) and circumference caused by GH treatment, resulting in no significant difference of marrow area from that in untreated HX rats. These results suggest that, despite the lack of an obvious effect on bone parameters, vitamin K₂ normalizes the size of the marrow cavity during development of the bone marrow in young HX rats treated with GH.     

The Prognostic Significance of Total Lymph Node Harvest in Patients with T<Subscript>2–4</Subscript>N<Subscript>0</Subscript>M<Subscript>0</Subscript> Colorectal Cancer

In patients with radically resected colorectal carcinoma, lymph node involvement is particularly important for a good prognosis and adjuvant therapy. The number of such lymph node recoveries is still controversial, with recommendations ranging from 6 to 17 nodes. The aim of this study is to determine if a specified minimum number of lymph nodes examined per surgical specimen can have any effect on the prognosis of patients who have undergone curative resection for T_2–4N₀M₀ colorectal carcinoma. Between September 1999 and January 2005, a total of 366 patients who underwent radical resection for T_2–4N₀M₀ colorectal carcinoma were retrospectively analyzed in a single institution. All specimen segments were fixed, with node identification performed by sight and palpation. We excluded 186 patients who received postoperative adjuvant chemotherapy via oral or intravenous transmission to prevent possible chemotherapeutic effects on patients’ prognosis; therefore, a total of 180 patients with T_2–4N₀M₀ colorectal carcinoma were enrolled into this study. After the pathological examination, a mean of 12 lymph nodes (range 0–66) was harvested per tumor specimen. No postoperative relapse was found in this group, where the number of examined lymph nodes was 18 or more. Univariate analysis identified the size of the tumor, depth of invasion, grade of tumor, and number of examined lymph nodes, which were significantly correlated with postoperative relapse (all P < 0.05). Meanwhile, both the depth of tumor invasion and the number of harvested lymph nodes were independent predictors for postoperative relapse (P < 0.05). The 5-year overall survival rate of T_2–4N₀M₀ colorectal carcinoma patients who had 18 or more lymph nodes examined was significantly higher than those who had less than 18 nodes examined (P = 0.015). Nodal harvest in patients undergoing radical resection for colorectal carcinoma was highly significant in the current investigation. Our results suggest that harvesting and examining a minimum of 18 lymph nodes per surgical specimen might be taken into consideration for more reliable staging of lymph node-negative colorectal carcinoma.     

Videodensitometry of osteons in females with femoral neck fractures

Summary The medial femoral cortices of 10 females with femoral neck fractures and 10 age-matched female autopsy cases were studied using computer-assisted videodensitometry. Radiographic mineral density was determined using the calibration method described by Martin et al. [20]. Measurements were made of porosity, osteon and haversian canal dimensions, and of interstitial and osteon mineral density across the cortical wall of the orthopedic calcar region. There were no differences between the fracture and nonfracture groups in the overall mean mineral density of the bone averaged over the microstructure, excluding pore space, or in the interstitial bone mineral density. The porosity in the fracture group was greater than in the autopsy group, especially in the periosteal region, where the porosity was 2.4 times greater and where there were also 27% fewer osteons per unit area than in the autopsy group (P<0.05). Mean osteon mineral density was 2.5% higher in the fracture group (P<0.05) compared with the autopsy group in the endosteal region, and 4% higher in the periosteal region. Osteon and haversian canal areas were also larger in the fracture group, especially in the middle region of the cortical wall (17% and 23%, respectively, P<0.05). Presented at the Annual Meeting of the Orthopaedic Research Society, 17–20 February 1992     

Effects of sciatic neurectomy on the femur in growing rats: Application of peripheral quantitative computed tomography and Fourier transform infrared spectroscopy

The effects of unilateral sciatic neurectomy (USN) on the development of the femur were studied in 15 growing Wistar-derived rats (age, 5 weeks). The rats were divided into four groups: USN-operated group (right femur), USN-nonoperated group (left femur), sham-operated group (right femur), and sham-nonoperated group (left femur). Bone mineral density (BMD), bone mineral content (BMC), bone area, periosteal circumference, and endosteal circumference were measured by peripheral quantitative computed tomography (pQCT) and the mineral/matrix ratio was evaluated by Fourier transform infrared spectroscopy (FTIR). The USN-operated group showed a significant decrease in cortical BMC, bone area, and periosteal circumference compared with the other groups (P < 0.05). The cortical BMD did not vary significantly between the groups. In the cancellous bone, the USN-operated group showed a significant decrease in BMD and BMC at the metaphysis compared with the other groups (P < 0.05). The mineral/matrix ratio of the cortical bone did not differ significantly between the USN-operated and USN-nonoperated groups. These results suggest that in cortical bone, USN inhibits periosteal bone formation but has no significant effect on the mineral/matrix ratio of cortical bone in femurs. In cancellous bone, USN induces bone loss at the metaphysis. Received: Nov. 19, 1998 / Accepted: Feb. 12, 1999     

Influence of Waist Circumference on the Metabolic Risk Associated with Impaired Fasting Glucose: Effect of Weight Loss after Gastric Bypass

Background Impaired fasting glucose (IFG) is a prediabetic state defined as a fasting plasma glucose (FPG) between 100 and 125 mg/dl. However, individuals in this group do not exhibit the same atherogenic risk. Methods The atherogenic profile of subjects with IFG >110 mg/dl (IFG110, n = 96) or <110 mg/dl (IFG100, n = 131) were compared and the potential differential impact of the waist circumference analyzed. In addition, the same clinical variables were measured in 18 morbidly obese patients (8 males, 10 females; BMI 45.3 ± 1.9 kg/m²) before and after weight loss following Roux-en-Y gastric bypass (RYGBP), in order to analyze the influence of the reduction in waist circumference on the improvement of the metabolic risk factors. Results Individuals in the IFG110 group showed decreased HDL-cholesterol levels together with an increased total cholesterol to HDL ratio (TC/HDL), accompanied by elevated homocysteine concentrations and white blood cell (WBC) count, and higher waist circumference (P < 0.05 for all). Significant correlations between waist circumference and HDL-cholesterol (r = −0.200, P < 0.05), TC/HDL (r = 0.190, P < 0.05), WBC count (r = 0.299, P < 0.05), and QUICKI (r = −0.375, P < 0.0001) were observed. An almost 3-fold increase in the prevalence of T2DM in subjects in the IFG110 group as compared to IFG100 was observed. In the group of patients who underwent RYGBP, the reduction in waist circumference was significantly associated with the improvement in insulin sensitivity as evidenced by the QUICKI index (r = −0.582, P < 0.05) and the reduction in TC/HDL (r = 0.595, P < 0.05). Conclusion Waist circumference is related to metabolic risk factors associated with increased levels of IFG. Our data support that individuals with IFG >110 mg/dl and a high waist circumference should undergo an OGTT to exclude the presence of diabetes.     

Plasma Adhesion and Inflammation Markers: Asymmetrical Dimethyl-L-Arginine and Secretory Phospholipase A<Subscript>2</Subscript> Concentrations before and after Laparoscopic Gastric Banding in Morbidly Obese Patients

Background The aim of this study was to examine the relationship between subclinical inflammation and weight loss by laparoscopic adjustable gastric banding (LAGB). Methods Plasma concentrations of intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), sensitive C-Reactive Protein (sCRP), asymmetrical dimethyl-L-arginine (ADMA), Secretory Phospholipase A2 (sPLA2), and metabolic markers, such as homeostatic model assessment – insulin resistance (HOMA-IR) and body mass index (BMI) were determined in morbidly obese patients (n = 18, BMI 48.6 ± 1.7 kg/m²) at baseline and 1 month after operations. Baseline levels in patients were also compared with age-matched controls (n = 20, BMI 21.3 ± 1.8 kg/m²). Plasma ICAM-1,VCAM, sCRP and ADMA, and sPLA₂ concentrations were determined by enzyme-linked immunoassay methods and colorimetric method, respectively. Results Plasma sCRP, ICAM-1, ADMA and sPLA₂ concentrations and HOMA-IR were significantly higher in morbidly obese patients than in controls (for each, P < 0.01). Plasma VCAM-1 concentration was not changed in obese patients. HOMA-IR was significantly correlated with ICAM-1, ADMA and sPLA₂ in the obese group at baseline (for each, P < 0.01). There was a significant correlation between plasma sCRP and plasma glucose,VCAM-1, ICAM-1, ADMA and sPLA₂ concentrations (for each, P < 0.01). 1 month after LAGB, mean body weight loss was 13.2 ± 6.3 kg, and plasma sCRP and ADMA concentrations and HOMA-IR and BMI were significantly decreased (for each, P < 0.01). However, these levels cannot be decreased to the levels of the controls. Conclusion Obesity and insulin resistance appear to be associated with low-grade inflammation and endothelial dysfunction. Insulin resistance and endothelial dysfunction were improved by weight loss after LAGB.     

The role of mast cells in non-ablative laser resurfacing with 1,320 nm neodymium:yttrium–aluminium–garnet laser

The aim of this study was to investigate the role of mast cells in mechanisms of collagen remodelling induced by non-ablative laser treatment. The dorsal skin of Kunming (KM) mice was exposed to 1,320 nm neodymium–yttrium–aluminium garnet (Nd:YAG) laser weekly for four consecutive weeks. Biopsies were taken 1 h after irradiation and 1 day, 7 days, 14 days, 30 days and 60 days after the first treatment. Skin samples were studied for mast cells, fibroblasts, and type I and III collagen, by toluidine blue, haematoxylin–eosin (HE) and immunohistochemical staining, respectively. The total number of mast cells in the skin of experimental group was significantly greater than that in the control at 1 h, 1 day, 21 days and 60 days after the first treatment (P < 0.05, respectively). At any of the time points studied, the number of degranulated mast cells in the experimental group was significantly higher than in the control (P < 0.01, P < 0.01, P < 0.05, P < 0.01, P < 0.05, P < 0.05, respectively).The number of fibroblasts in the experimental group exhibited a significant increase in comparison with those in control skin at days 7, 21, 30 and 60 after irradiation (P < 0.05, P < 0.01, P < 0.01, P < 0.05, respectively). The amount of type I collagen was significantly higher than in the control from day 21 to day 60 (P < 0.05, P < 0.01, P < 0.01, respectively), and type III collagen showed a marked increase between day 7 and day 60, compared with the control (P < 0.01, P < 0.05, P < 0.01, P < 0.01, respectively). There was a significant positive correlation between the number of fibroblasts and granulated mast cells (r = 0.549, P < 0.01). The amount of type I and III collagen also showed significant positive correlations with the number of degranulated mast cells (r = 0.555, P < 0.01 and r = 0.579, P < 0.01, respectively). The results suggested that dermal mast cells might be involved in the inflammatory response, fibroblast proliferation and collagen remodelling induced by non-ablative laser treatment.     

Relief of Dysphagia after Laparoscopic Heller Myotomy Improves Long-Term Quality of Life

Background and Objective  Quality of life (QoL) is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on the QoL along with their direct effect on the diseases they are targeting. The aim of the study was to assess the impact of residual dysphagia on QoL after laparoscopic Heller myotomy for achalasia. Methods  QoL was evaluated using the short-form-36 (SF-36) and postoperative dysphagia was assessed using a dysphagia score. The score (range 0–10) was calculated by combining the frequency of dysphagia (0=never, 1 = < 1 day/wk, 2 = 1 day/wk, 3 = 2–3 days/wk, 4 = 4–6 days/wk, 5=daily) with the severity (0=none, 1=very mild, 2=mild, 3=moderate, 4=moderately severe, 5=severe). Patients were classified in the Nonresponder group when their dysphagia score was in the upper quartile. Results  Questionnaires were mailed to 110 patients. The overall response rate was 91% with 100 patients (54 female) returning the questionnaires. The average follow-up was 3.3 years. There was a significative inverse correlation between dysphagia score and mental component (P = 0.0001) and total SF-36 (P = 0.001) scores. According to their postoperative dysphagia scores, 77 patients were assigned to the Responder Group and 23 patients to the Nonresponder Group. The two groups were similar in terms of age, gender, rate of fundoplication, and length of follow-up. Mental component and total SF-36 scores were significantly (P < 0.05) higher in the Responder group. Successful relief of dysphagia after Heller myotomy was associated with health-related quality of life scores that were 13 higher in Vitality (P < 0.05), 11 points higher in mental health (P < 0.05), and 12 points higher in General Health (P < 0.05). Overall patient satisfaction with surgical outcome was 92%, with only eight patients not satisfied with the surgery. Conclusion  Laparoscopic Heller myotomy offers excellent long-term relief of achalasia-related symptoms, namely dysphagia, and this was projected on a significant improvement in quality of life and patient satisfaction. Presented at the 47th annual meeting at Digestive Disease Week 2006     

Whole-body microwave exposure emitted by cellular phones and testicular function of rats

This study investigated whether there are adverse effects due to microwave exposure emitted by cellular phones in male rats. Eighteen Wistar Albino rats were separated into three groups, a sham group and two experimental groups. The rats were confined in Plexiglas cages and cellular phones were placed 0.5 cm under the cages. In the first experimental group, cellular phones were in standby position for 2 h. In the second experimental group, phones were turned to the speech position three times each for 1 min duration over 2 h. Rats in the first and second experimental groups were exposed to microwaves emitted by phones for 2 h/day for a duration of 1 month. After the last exposure the rats were killed. Brain, eyes, ears, liver, heart, lungs, stomach, kidneys, testes, small and large intestines and skin of the rats were observed histologically. The decrease of epididymal sperm counts in the speech groups were not found to be significant (P > 0.05). Differences in terms of normal and abnormal sperm forms were not observed (P > 0.05). Histological changes were especially observed in the testes of rats of the speech groups. Seminiferous tubular diameter of rat testes in the standby and speech groups was found to be lower than the sham group (P < 0.05). Rectal temperatures of rats in the speech group were found to be higher than the sham and standby groups (P < 0.05). The rectal temperatures of rats before and after exposure were also found to be significantly higher in the speech group (P < 0.05). Specific absorption rate (SAR) was determined as 0.141 W/kg. Received: 27 July 1998 / Accepted: 7 December 1998     

Postoperative Morbidity Following Chemoradiation for Locally Advanced Low Rectal Cancer

Background  Postoperative morbidity remains a significant clinical problem and may alter long-term outcome particularly after neoadjuvant chemoradiation in patients with locally advanced low rectal cancer. The aim of the present study was to identify a potential long-term effect of postoperative morbidity. Methods  Analysis of prospectively collected data of 90 consecutive patients who underwent neoadjuvant chemoradiation and curative mesorectal excision for locally advanced (cT3/4, Nx, M0/1) adenocarcinoma of the mid and lower third of the rectum during a 7-year period (1996–2002). Results  Major postoperative complications occurred in 17.8% and minor complications in 26.6% of patients. Hospital mortality and 30-day mortality was 0%. Infectious complications were seen in 34.5%. The leading causes of infectious complications were anastomotic leakage and perineal wound infection. Postoperative morbidity was statistically significantly associated with gender (P < 0.05), pre-therapeutic haemoglobin level (P < 0.05), ASA score (P < 0.05), hospitalisation (P < 0.001) and clinical long-time course (P < 0.01). Moreover, early postoperative morbidity was proven as an independent prognostic factor concerning disease-free (P < 0.05) and overall survival (P < 0.05). Conclusion  Early postoperative morbidity in patients with preoperative chemoradiation due to locally advanced low rectal cancer is demonstrated as an independent prognosticator. Gender, pre-therapeutic haemoglobin level and ASA score indicate patients at risk for early postoperative complications and may therefore serve as predictive features.     

Thyroid Hormone Supplementation in Sepsis: An Experimental Study

Purpose: The levels of thyroid hormones decrease in septic, critically ill, and major trauma patients who show a bad prognosis. The aim of this study was to investigate the effects of thyroid hormone supplementation on the sepsis criteria and mortality in an experimental sepsis model. Methods: Forty-eight Wistar-Albino rats were divided into four experimental groups. A cecum ligation and puncture was used as a sepsis model. Group I: sham; group II: a cecum ligation and puncture (control); group III: a cecum ligation and puncture +T3 (0.4 μg/100 g body weight/day) intraperitoneally; group IV: a cecum ligation and puncture +T4 (1 500 ng/100 g body weight/day) intramuscularly. The PCO₂, leukocyte count, peritoneal bacterial content, neutropenia, and mortality rates were assessed in all groups. Results: The PCO₂ levels decreased only in the control group (P < 0.05). The leukocyte counts were lower in the therapy groups (P < 0.05). The rate of neutropenia was seen much more in the control group (P < 0.05). The peritoneal bacteria content decreased in the therapy groups (P < 0.05). The mortality rate significantly decreased in the thyroid hormone-treated animals (P < 0.05). Conclusions: Thyroid hormone supplementation in septic rats had a beneficial effect on the sepsis criteria and also resulted in a lower rate of mortality. Received: November 26, 2001 / Accepted: July 2, 2002 Reprint requests to: A. Koyuncu Presented at the 10th Anniversary of Eurosurgery, Istanbul, Turkey, 20–24 June, 2000     

Usefulness of perioperative blood glucose control in patients undergoing off-pump coronary artery bypass grafting

Objective We investigated the usefulness of perioperative blood glucose control in patients undergoing coronary artery bypass grafting (CABG). Methods DM patients were aggressively treated with intensive insulin therapy to achieve a preoperative fasting blood glucose level of 140 mg/dl and a postoperative level of 200 mg/dl. For comparison, patients were divided as follows: (1) DM group vs. non-DM group, and (2) for mean blood glucose level in the intensive care unit (ICU), lower than 200 mg/dl (IL) vs. 200 mg/dl or higher (IH). Results (1) In the DM group, the amount of insulin (U) used during surgery was greater (P < 0.05), and the duration of ICU stay was longer (P < 0.05). The incidence of all complications was higher in the DM group (P < 0.05). (2) Between the IH group (54) and the IL group (82), the proportion of DM patients was higher in the IH group (75% vs. 38%, P < 0.05). In the IH, the duration of ICU stay (P < 0.01) was longer, and the incidence of all complications was higher (P < 0.05). (3) In the DM group, the incidence of complications tended to be higher in the IH group. The incidence of complications was extremely low in the non-DM group. Conclusion Strict perioperative blood glucose control may help to improve the outcomes of CABG.     

Intact Parathyroid Hormone in Egyptian Type 2 Diabetics with Chronic Hemodialysis: Impact of Glycaemic Control

Osteodystrophy is one of the long-term haemodialysis complications. In diabetic end stage renal failure patients, it mainly occurs as an aplastic or low-turnover bone disease due to their low serum intact parathyroid hormone (iPTH) levels. The aim of the present study is to evaluate intact PTH level in in Egyptian type 2 diabetics with chronic hemodialysis and its relation to glycaemic control .patients. 140 Egyptian patients, their mean age was 60.4 ± 10.6 years were evaluated. They were maintained on regular hemodialysis (HD); 3 times/week, and the patients were divided into two groups according to primary kidney disease, diabetic (98 patients) and non-diabetic (42 patients) groups. Diabetic group was furtherly subdivided according to glycated hemoglobin to controlled (32 patients) and non-controlled diabetics (66 patients). Intact parathyroid hormone (iPTH), glycated hemoglobin (HbA1c), serum bone specific alkaline phosphatase, Albumin, Glucose, calcium, phosphorus and magnesium were estimated. Urea reduction ratio (URR) was estimated to evaluate the hemodialysis adequacy. The diabetic group had significantly lower values of iPTH and serum magnesium than non-diabetic group (p < 0.03 and p < 0.001 respectively). The uncontrolled diabetics had significantly lower values of iPTH, serum magnesium and serum albumin (p < 0.002, p < 0.002& p < 0.03 respectively) than the controlled group. The serum HbA1c levels were strongly correlated with the serum iPTH levels (P < 0.003). intact PTH was lower in diabetic hemodialysis patients; also, glycaemic control was associated with higher PTH levels.     

Corrective osteotomy of the malunited distal radius fracture: use of periosteal bed may reduce the extent of postoperative graft resorption

The aim of this study was to compare osteotomy for malunited distal radius fracture with embedment of a corticospongious graft into a periosteal flap of the recipient bone (test) with the standard procedure (control) with respect to graft resorption. A retrospective assessor-blind analysis of consecutive patients (test: n = 19, control: n = 30) was performed. Ulnar tilt, palmar tilt and capitate-ulna distance were assessed from radiographs taken before, two to four days after and over three months after the surgery to determine loss of correction achieved by the surgery and estimate graft resorption during the postoperative period. In both unadjusted and adjusted comparisons, loss of correction of all parameters was lower in the test group (P < 0.05). The odds of “none to mild” resorption were greater in the test group with an adjusted odds ratio of 5.43 (95% confidence interval: 1.32–26.5, P = 0.025). Total graft collapse occurred in five of 30 controls and in none of 19 test patients. Graft embedment into the periosteum may improve its preservation.     

Serum osteoprotegerin, RANKL and fibroblast growth factor-23 in children with chronic kidney disease

Osteoprotegerin (OPG), receptor activator of the nuclear factor κB ligand (RANKL) and fibroblast growth factor-23 (FGF-23) play a central role in renal osteodystrophy. We evaluated OPG/RANKL and FGF-23 levels in 51 children with chronic kidney disease (CKD) [n = 26 stage 3 or 4 (CKD3–4) and n = 25 stage 5 (CKD5)] and 61 controls. Any possible association with intact parathyroid hormone (iPTH) and bone turnover markers was also investigated. The OPG levels were lower in the CKD3–4 group (p < 0.001) and higher in the CKD5 group (p < 0.01) than in the controls, while RANKL levels did not differ. The FGF-23 levels were higher in both patient groups (p < 0.0001), while the levels of phosphate and iPTH were higher only in the CKD5 group (p < 0.0001). There were independent positive correlations between OPG and RANKL (β = 0.297, p < 0.01) and FGF-23 (β = 0.352, p < 0.05) and a negative correlation with the bone resorption marker TRAP5b (β = −0.519, p < 0.001). OPG was positively correlated with iPTH (R = 0.391, p < 0.01). An independent positive correlation between FGF-23 and phosphate (β = 0.368, p < 0.05) or iPTH (β = 0.812, p < 0.0001) was noted. In conclusion, we found that higher OPG levels in patients with CKD stage 5 correlated with the levels of RANKL, FGF-23, iPTH, and TRAP5b. These findings may reflect a compensatory mechanism to the negative balance of bone turnover. High FGF-23 levels in early CKD stages may indicate the need for intervention to manage serum phosphate (Pi) levels.     

Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea

Introduction  The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified. Discussion  We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P > 0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P < 0.05, respectively). The most common cause of perforation was sphincterotomy (n = 8) in the conservative group whereas scope itself (n = 6) in operative group, showing a significant difference between the two groups (P < 0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P < 0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.     

Quantification of osteopontin in the urine of healthy and stone-forming men

Osteopontin (OPN) is one of the most important components in calcium stone matrix, but its role in stone formation is not clear. Since quantitative data regarding the excretion of OPN are necessary to assess its role, we have developed a quantitative enzyme-linked immunosorbent assay (ELISA) for OPN, and measured the urinary OPN concentrations in urolithiasis patients. Forty-seven men with urinary stones composed chiefly of calcium oxalate participated in the study. The controls were 13 normal healthy male volunteers. Urine samples were collected early in the morning and analyzed by a quantitative ELISA employing purified polyclonal antibodies to synthesized OPN aminopolypeptides. The urinary ratio of the concentrations of OPN and creatinine (OPN/Cre) in the urolithiasis patients (0.039 ± 0.029) was significantly lower than that in the control subjects (0.062 ± 0.030) (P<0.05). Single stone formers (n = 26; 0.050 ± 0.020) had significantly higher OPN/Cre ratios compared with recurrent stone formers (n = 21; 0.031 ± 0.021) (P<0.05). The results show that OPN excretion in urolithiasis patients was lowered, presumably because of the incorporation of OPN by kidney stones. Received: 4 September 1998 / Accepted: 1 March 1999