Inter-relations between the calcium set-points of Parfitt and Brown in primary hyperparathyroidism: a sequential citrate and calcium clamp study

Abstract. The objective of the present study was to compare the calcium set-points of E. M. Brown and A. M. Parfitt obtained by sequential citrate and calcium clamp in patients with primary hyperparathyroidism and healthy controls. Twenty-six patients with primary hyperparathyroidism were investigated and compared to 22 healthy volunteers. All participants were investigated by sequential calcium lowering and raising comprising the following four phases: Phase (1) blood ionized calcium lowering of about 0·20 mmol l^-1; phase (2) steady-state (relative) hypocalcaemia of blood ionized calcium 0·20 mmol l^-1 below baseline; phase (3) blood ionized calcium is raised to about 0·20 mmol l^-1 above baseline; and phase (4) (relative) hypercalcaemia of blood ionized calcium 0·20 mmol l^-1 above baseline. Serum parathyroid hormone (1–84) was measured by an immunoradiometric assay. Blood ionized calcium was measured by a calcium selective electrode. We found the calcium set-points of Parfitt to be 1·42 mmol l^-1 (SD 0·12, n= 52) vs. 1·25 mmol l^-1 (SD 0·04, n= 44) in patients and controls, respectively (P < 0·001). The calcium set-points of Brown were 1·32 mmol l^-1 (SD 0·10, n= 26) vs. 1·13 mmol l^-1 (SD 0·04, n= 22), respectively (P < 0·001). By comparing the calcium set-points of Parfitt and Brown, a strikingly good correlation was observed, in patients (r= 0·91, P < 0·001) and in controls (r= 0·85, P < 0·001). We demonstrate in this paper in vivo that Brown's and Parfitt's calcium set-points are raised in primary hyperparathyroidism and return to normal following parathyroidectomy. The values for Brown's and Parfitt's calcium set-points are significantly different, but strikingly well correlated, supporting the view that Brown and Parfitt describe two different points on the same sigmoidal curve, corresponding to 50% and about 85% inhibition of PTH maximum, respectively. The mathematical form of the sigmoidal curve between blood ionized calcium and parathyroid hormone is very similar in primary hyperparathyroidism and normal humans.     

全国哨点监测性病流行情况初步分析(1993-1996)

目的 　了解我国性病的现况、流行趋势和有关因素 ,作为制订性病防治规划的依据。方法　 我国在 1 993～ 1 996年建立了性病哨点监测系统。该系统在原有性病发病较高的 1 6个城市监测点的基础上进行调整 ,在全国建立了 2 6个性病监测哨点。对哨点加强管理 (如督导和反馈 ) ,收集完整的监测资料 ,并进行专项调查。结果　 4年内哨点监测系统共报告性病 2 0 2 86 6例 ,年平均发病率为 1 41 .46 / 1 0万 ,发病率逐年增长 ,但其速度较过去有所减慢。报告的病例男性多于女性 ,其性别比有逐年下降趋势。 2 0～ 39岁组患者占病例数的 82 .37% ,但儿童性病比过去明显增加。城市哨点发病率最高( 1 81 .86 / 1 0万 )。淋病仍为优势病种 ,但其发病呈逐年下降趋势 ;梅毒增加较快 (包括儿童梅毒 )。此系统已开始有 HIV/ AIDS病例的个别报告。在传染源中 ,暗娼占有相当高的比例。结论　 哨点监测系统由于加强了管理 ,能较准确地描述当地的性病流行情况 ,特别是其流行趋势。     

更新护理观念 促进护理学科发展

随着新的医学模式的确立，护理学科的核心思想已从以疾病为中心的功能护理逐步发展为以病人为中心的整体护理阶段。其内涵：把病与病人，反生物学的病人与社会和心理学的人，把病人与其所处的环境，把病人从入院－出院－康复都作为一个整体，目前，我国护理工作主体仍处于以疾病为中心的护理思考指导下的功能制护理，局限了护理学科的发展，近年来，我国护理界引进了整体护理，并将其思想应用于临床护理工作中，进行了多方位探讨，旨     

THE TREATMENT OF SPINAL CORD INJURY CASES BY MEANS OF SPINAL OMENTUM TRANSPOSITION

Omentum transposition to cervical spinal cord for the treatment of traumatic cervical spinal cord myelopathy.In treating spinal cord injury, the clinic of cervical spinal cord injury has to face the problems of tetraplegia and control of Respiration. The application of various kins of treatment include skull traction, laminectomy, intervebral bone graft fusion and omen turn spinal cord transposition. We have treated 10 cases in the period from June, 1986 to June, 1983. The discussion will focus on the Oinentum transposition to cervical spinal cord and the related problems of cervical spinal cord injury.     

几种杀虫剂对印鼠客蚤的毒力测定

本文报告用罐头瓶药膜法和点滴法对实验室饲养的3日龄未吸血印鼠客蚤为试验对象,测试了溴氰菊酯、滴滴畏、久效磷、磷胺、喹硫磷、倍硫磷半数致死量(LD_(50))和半数致死浓度(LC_(50))。结果以溴氰菊酯和喹硫磷的LC_(50)值较低,磷胺和滴滴畏的数值较高,LD_(50)以溴氰菊酯和倍硫磷毒力较强,磷胺和久效磷次之,雌雄个体差异不明显。     

Sumatriptan nasal spray in the acute treatment of migraine in adolescents and children

About 4-10% of children and adolescents suffer from migraine. In the last few years, several studies have been performed to assess the efficacy and safety of triptans for the acute treatment of migraine in children and adolescents. Only sumatriptan nasal spray has been approved for the treatment of acute migraine with or without aura in adolescents aged 12-17 years in Europe. This review describes the results of the studies with sumatriptan nasal spray that have been performed in children and adolescents, including a study performed in the Netherlands.     

Absence of effects of prolonged simvastatin therapy on nocturnal sleep in a large randomized placebo-controlled study

1It has been suggested that lipophilic HMG CoA reductase inhibitors, like lovastatin and simvastatin, may cause sleep disturbance. 2Six hundred and twenty-one patients at increased risk of coronary heart disease were randomized in a single centre to receive 40 mg daily simvastatin, 20 mg daily simvastatin or matching placebo. To assess the effects of prolonged use of simvastatin on nocturnal sleep quality and duration, a sleep questionnaire was administered to 567 patients (95% of 595 survivors) at an average of 88 weeks (range: 44–129 weeks) after randomization. 3The main outcome measures were sleep-related problems and use of sleep-enhancing medications reported during routine study follow-up visits, and responses to the sleep questionnaire about changes in sleep duration and about various sleep events during the preceding month. 4No differences were observed between the treatment groups in the frequency of sleep-related problems reported, in the proportion of follow-up visits at which such problems were reported, or in the use of sleep-enhancing medications. The numbers who stopped study treatment were similar in the different treatment groups, and no patient stopped principally because of insomnia. In response to the sleep questionnaire, there were no significant differences between the treatment groups in reports of various sleep events during the preceding month, except that slightly fewer patients allocated simvastatin reported waking often. No differences in sleep duration were observed. 5This placebo-controlled trial does not indicate any adverse effects of prolonged treatment with simvastatin on systematically sought measures of sleep disturbance.