Einzelreferate und Buchbesprechungen

Ohne Zusammenfassung     

Parathyroid hormone has an important role in blood pressure regulation in vitamin D–insufficient individuals

ObjectiveThe aim of the present study was to evaluate whether vitamin D status is related to blood pressure (BP) in adults.MethodsWe evaluated the relationship between vitamin D status, intact parathyroid hormone (iPTH) and BP in 332 adults. Anthropometric measurements, BP, and a fasting blood sample was obtained. Participants were stratified into the following BP categories: 1) normal BP; 2) high BP; 3) normal BP through medication. Vitamin D insufficiency was defined as 25-hydroxvitamin D ≤ 75 nmol/L; high iPTH as > 65 pg/mL. The relationships between vitamin D status, iPTH and BP were adjusted for body mass index, waist circumference, blood lipids, physical activity, and sunscreen use.ResultsNo differences in prevalences of vitamin D insufficiency and high iPTH were observed among BP groups. No significant association was observed between BP and vitamin D status. Positive correlations were observed between iPTH and systolic BP (r = 0.168; P = 0.002) and between iPTH and diastolic BP (r = 0.168; P = 0.002). iPTH remained correlated with BP even with adjustments.ConclusionsThe present study contributes to the understanding of calcemic hormones and BP regulation.     

Vertebral and carotid artery dissection following chiropractic cervical manipulation

A 50-year-old woman presented a sudden left occipital headache and a posterior circulation stroke after cervical manipulation for neck pain. Magnetic resonance imaging documented a left intracranial vertebral artery occlusive dissection associated with an ipsilateral internal carotid artery dissection with vessel stenosis in its prepetrous tract. This is the first reported case showing an associate vertebral and carotid artery dissection following cervical manipulation. Carotid dissection was asymptomatic and, therefore, its incidence may be underestimated. We emphasize that cervical manipulation should be performed only in patients without predisposing factors for artery dissection and after an appropriate diagnosis of neck pain. Received: 25 October 1997 / Accepted: 19 August 1998     

Screening for CLCN5 mutation in renal calcium stone formers patients

Thirty-five patients (23 males and 12 females), age 35 +/- 13 years old, presenting either idiopathic calcium nephrolithiasis, nephrocalcinosis or mild renal failure with idiopathic calcium nephrolithiasis were selected for the analysis of low molecular weight proteinuria and the possible mutations occurrence in the chloride channel gene CLCN5. The urinary ratio of beta2-microglobulin and creatinine (beta2M/Cr) was very high in a transplanted woman with nephrocalcinosis (> 3.23 mg/mmol) and slightly high in five patients (> 0.052 or < 1.0 mg/mmol) with multiple urological manipulations. Other studied patients showed beta2M/Cr ratio at normal range (0.003-0.052 mg/mmol) without gender difference (p > 0.05). Mutation analysis of CLCN5 gene was performed in 26 patients of 35 selected (11 with idiopathic hypercalciuria; 6 men with normal calciuria; 3 with mild renal insufficiency and 6 with nephrocalcinosis) and was normal in all subjects even in those with abnormal molecular weight proteinuria. Conclusion: CLCN5 gene mutation is not a common cause of kidney stone disease or nephrocalcinosis in a group of Brazilian patients studied.     

Lunate resection and vascularized Os pisiform transfer in Kienböck's Disease: an average of 10 years of follow-up study after Saffar's procedure

PURPOSE: To investigate the long-term results of lunate replacement by vascularized bone transfer in advanced Kienb?ck's disease. METHODS: Twenty-one patients were reviewed (mean follow-up period +/- SD, 9.9 +/- 3.5 y) to analyze results after lunate replacement by vascularized pisiform transposition (Saffar's procedure) for Lichtman stages III and IV. RESULTS: Pain was improved in 16 of 21 patients but range of motion did not improve after surgery. Range of motion was reduced to 68% and grip power to 80% of that of the opposite hand. At follow-up evaluation the mean score on the Disabilities of the Arm, Shoulder, and Hand Questionnaire was 22.3 +/- 17.9 and the mean Cooney score was 75.4 +/- 13.2. Radiologically, Lichtman stage persisted in 8, improved in 1, progressed in 8, and could not be evaluated in 3 patients. Two patients had radiologic signs of arthritis before surgery. At follow-up examination osteoarthritis was found in 50% of patients. The majority of degenerative changes were associated with carpal collapse. CONCLUSIONS: The replacement of the lunate by vascularized pisiform transposition maintained preoperative ranges of motion. At follow-up examination both patient satisfaction and wrist function were high. In the long term, however, Saffar's procedure can restore alignment of the carpus only partly and also results in osteoarthritis in half of all patients.     

Heel Ultrasonography in Monitoring Alendronate Therapy: A Four-Year Longitudinal Study

The possibility of using quantitative ultrasound (QUS) in monitoring the response to antiresorptive drugs has yet to be defined. The aim of the present study was to evaluate whether heel ultrasonography, considering its characteristics of long-term precision, is able to monitor osteoporotic patients treated with alendronate. We studied 150 postmenopausal osteoporotic women (age 59.6 ± 5.3 years) treated with alendronate and calcium (n= 74) or with calcium alone (n= 76) for 4 years. At baseline and after 12, 24, 36 and 48 months, we measured bone mineral density (BMD) at the lumbar spine by dual-energy X-ray absorptiometry (DXA, Hologic 4500), and speed of sound (SOS), broadband ultrasound attenuation (BUA) and Stiffness at the calcaneus by Achilles plus. Moreover, the longitudinal precision of QUS parameters was assessed by measuring 10 subjects once a month for 1 year and, on the basis of the coefficients of variation we obtained, we calculated the Least Significant Change between two measurements. In the alendronate-treated patients, at year 1, BMD increased by 4.2%, SOS by 0.4%, BUA by 1.1% and Stiffness by 3.2%; at year 2, BMD increased by 5.0%, SOS by 0.7%, BUA by 1.4% and Stiffness by 5.7%. At year 3, BMD increased by 6.2%, SOS by 0.9%, BUA by 1.8% and Stiffness by 7.6%. At the end of the study period, BMD increased by 7.6%, SOS by 1.2%, BUA by 1.9% and Stiffness by 9.0%. The minimal significant difference between two measurements was 0.8% for SOS, 5.6% for BUA and 5.0% for Stiffness. Among the QUS parameters, Stiffness showed the greatest total treatment effect and a longitudinal sensitivity which was only slightly lower than BMD. The MTI, which represents the period between scans required to show that a ‘true’ change has occurred, was 1.8, 2.7, 11.9 and 2.2 years for BMD, SOS, BUA and Stiffness respectively. Therefore, although the spinal BMD remains the optimal method, QUS at the heel, and in particular Stiffness, seems to be a sensitive tool for monitoring the response to alendronate. Received: 30 August 2001 / Accepted: 29 November 2001     

Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

COVID-19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS-CoV-2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS-CoV-2-RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS-CoV-2 infection were allowed to be considered for urgent-need transplant candidates with active/resolved COVID-19. We present the results of the first 10 LTs with active COVID-19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post-LT. None of the other eight recipients was found to be SARS-CoV-2 positive during follow-up. IgG against SARS-CoV-2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID-19. In addition, testing for SARS-CoV-2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID-19 in informed candidates with SARS-CoV-2 immunity, might contribute to safely increase the donor pool.

     

口内支抗与微型种植体支抗近中移动下颌磨牙效果比较

目的：研究安氏I类错（牙合）患者中,分别采用微型种植体作支抗与口内前牙作支抗近移下颌磨牙进行比较,以评价两种方法的各自特点。方法：将24例成人患者随机分成两组,分别采用两种方法近移下颌磨牙。测量下颌第二磨牙在移动速度和近远中方向、垂直方向的位置变化,以衡量磨牙的位置改变,并通过下颌中切牙的位置变化,评价支抗强弱。结果：种植体作支抗组下颌第二磨牙平均近中移动8.5mm,疗程10.4个月,平均移动速度0.82mm/月,磨牙长轴向近中倾斜2.5°,磨牙垂直向压低0.28mm,下颌中切牙位置无改变。对照组下颌第二磨牙平均近中移动7.8mm,疗程10.2个月,平均移动速度0.76mm/月,磨牙长轴向近中倾斜角度7.5°,磨牙垂直向压低0.06mm,下颌中切牙发生舌向倾斜9.5°。下颌中切牙切端向舌侧移动了3.0mm。结论：两种方法比较,种植体的支抗更强,未见前牙支抗丧失。二者磨牙的移动方式有所区别。