The effect of 1alpha(OH)D3 and 1alpha,25(OH)2D3 on the bone in patients with renal osteodystrophy

Six patients with chronic renal disease and variable degrees of renal osteodystrophy were treated for three weeks with either 1alpha,25-dihydroxyvitamin D3 (1alpha25(OH)D3) or 1alpha,hydroxyvitamin D3 (1alpha(OH)D3) and both the biochemical and osseous responses measured. The most consistent changes seen were an increase in serum calcium concentration to normal, a decrease in immunoreactive parathyroid hormone toward normal, an increase in the extent of the calcification front and a decrease in the extent of fibrous dysplasia in the marrow cavity. Two important parameters which did not change significantly were serum alkaline phosphatase activity and the osteoid volume. These data, in conjunction with that from previous studies, indicate that therapy with 1alpha,25(OH)2D3 or 1alpha(OH)D3 does not heal the osteomalacia of renal osteodystrophy, but that it does suppress the secondary hyperparathyroidism, and ameliorate the osteitis fibrosa seen in patients with chronic renal disease. They raise the likelihood that additional factors, such as metabolites of vitamin D other than 1alpha,25(OH)2D3, play a role in regulating bone formation and/or mineralization.     

Systolic time intervals during long-term beta-blockade with alprenol in ischaemic heart disease

The effect of long-term treatment with alprenolol on left ventricular function was investigated in a controlled double-blind study of 15 patients with ischaemic heart disease (alprenolol 6, placebo 9), by measurement of systolic time intervals (STI). Significant prolongation of QS2I was observed in patients treated with alprenolol (p less than 0.05), while changes in PEPI, LVETI and PEP/LVET were all insignificant. The heart rate x systolic blood pressure product (RPP) was significantly reduced in the alprenolol group (p less than 0.05). The data suggest that long-term treatment with alprenolol did not impair left ventricular function as evaluated by STI, and that myocardial oxygen demand, assessed by RPP, was reduced during the treatment.     

Effects of malnutrition during the reproductive cycle on nutritional status and lactational performance of rat dams

To assess the effects of malnutrition imposed at various stages of the reproductive cycle on maternal nutritional status and lactational performance, rats were fed 50% of the intake of control animals fed adlibitum (C) either before pregnancy (R-B), before and during pregnancy (R-BP), during lactation (R-L) or throughout the experimental period (R-BPL). At day 14 of lactation, maternal plasma albumin and vitamin A, liver iron stores and carcass fat were reduced in the restricted animals (R-L, R-BPL). Vitamin A stores were lowest in the chronically malnourished rats and were not replenished by refeeding during lactation. Milk yield was compromised in the restricted rats; the acutely malnourished rats (R-L) were much more severely affected than those chronically underfed (R-BPL). The restricted animals (R-L, R-BPL) only partially compensated by producing a more nutrient-dense milk. As a result, only total daily output of milk lactose and iron were reduced in the restricted rats. Thus, nutritional insults occurring both before and during lactation influenced lactational performance. The negative effects of chronic malnutrition were largely overcome by refeeding during lactation.     

Prediction of outcome in acute renal failure by discriminant analysis of clinical variables

To define factors of prognostic importance in patients with acute renal failure, we studied 23 clinical variables (including preexisting conditions, the acute clinical setting, and complications) by univariate and multivariate analysis in 148 patients. Ten variables contributed to discrimination in the overall analysis. Using a function derived by stepwise discriminant analysis, death could be predicted with a positive predictive value of 100% and a sensitivity of 58%. The performance of this discriminant score was validated in a subsequent group of 113 patients with a positive predictive value of 100% and a sensitivity of 26%. Thus, a fatal outcome of acute renal failure can be accurately predicted in a considerable proportion of patients by a weighted evaluation of clinical variables. The discriminant score may be useful in comparing the severity of illness among series of patients with acute renal failure.