Volume 97  ·   Issue 04  ·  1984

The effect of a single massive dose of vitamin D on the calcium, phosphorus and nitrogen balance, and the serum calcium, inorganic phosphate and alkaline phosphatase in seven woman patients with osteomalacia was studied. Vitamin D2 in the form of concentrated vigantol and vitamin D3 in the form of concentrated delsterol (both E. Merck) were administered either orally or intramuscularly, in doses of either 1,000,000 iu (oral) or 600,000 iu (im). Continuous calcium, phosphorus and nitrogen balance observation was made for extended periods varying from 14 to 57 experimental periods of four days each. The result of investigation showed that there was no difference between vitamin D2 and Vitamin D3. Oral administration and intramuscular injection also made no difference. Conversion of a negative or a minimal positive calcium balance to a distinctly increased positive calcium balance usually occurred in 8 to 16, mostly in 8 days, after initiation of vitamin D therapy. A good positive calcium and phosphorus balance was maintained for at least one year in the cases where the observation was extended. Review of our earlier work on the effect of ordinary dose (6,000-12,000 iu daily for a limited period of 16 days) of vitamin D, on the calcium and phosphorus balance in osteomalacia showed similar findings in the appearance of increased positive calcium balance and the achievement of maximal positive calcium balance after initiation of vitamin D therapy. But we did not see the complete course of events of vitamin D treatment. We are however, inclined to estimate that it would probably last several months or longer. Experiments with the minimal dose of vitamin D (diluted vigantol 500 iu or three or six eggs daily for 16 days at least) showed that the therapeutic effect was distinct but self-limited. No effect of vitamin D2 12,000 iu daily for 16 or 32 days could be observed on the calcium and phosphorus balance in 12 young healthy men and women.

Old age poses a challenge, as physiologic regression slowly proceeds. This paper reviews Cao Ting-dong's classical work published in 1773 on the topic. Much of what he wrote is still apropos. He recommended tranquility, optimism, moderation in everything including medication, exercise, prevention of disease, continued learning, enjoyment of friends and one's achievements, common sense and avoidance of irritation and stress, and control of anger. In this way one's rich experience may be brought into full play in a continuing rich life. His main ideas showed us how to make life rich and rewarding for senior citizens and the society at large.

The levels of Factor B (B), properdin (P) and the third complement component (C3) in serial serum samples obtained from 36 hospitalized patients with epidemic hemorrhagic fever (EHF) were measured by single radial immuno-diffusion. These proteins of the alternative activating pathway of C were activated and their circulating levels reduced. Good correlations were observed between the B, P and C3 levels in patient sera. The alternative C pathway was activated in these patients. The number of the positive cases and positive sera was increased with severity of illness, strongly suggesting the correlation of activation of this pathway with the disease condition. In addition, activation of the classical C pathway in the same patients was again observed through determination of activation of the first complement component (CI) by assessing the ratio of the subunit Clr to subunit Cls (the Clr:Cls ratio) according to a method previously described. Some discrepancies were found in activation between the 2 pathways. A variety of biologically active peptides produced during enormous activation of the C system via the alternative and classical pathways may contribute to a number of serious consequences in EHF, including increased vascular permeability, hypotension, shock, hemorrhage and renal damage.

A clinical analysis of 18 infants with necrotizing enterocolitis disclosed that nosocomial staphylococcal infection is an important factor in the development of necrotizing enterocolitis in this unit. Mature infants with clinical necrotizing enterocolitis are usually complicated by other conditions probably due to alteration of the blood flow to the bowel or bowel motility. Two of the 3 full-term infants who had profound intrapartum asphyxia had Hirschsprung's disease. Early recognition, and management of necrotizing enterocolitis in low birth weight infants may bring about favourable outcomes.

There is still no specific method for the early diagnosis of ovarian carcinoma. It has been suggested that serum lactic dehydrogenase (SLDH) levels may help in diagnosing and following up the patients with this disease. Between 1979 and 1981, SLDH levels of 18 patients with malignant ovarian tumors and 9 with benign tumors were examined before and after surgery and chemotherapy. A control group of 62 blood donors and employees, was also examined. The normal mean value for the control group was 157.29±24.94 IU/100 ml. 11 of the 18 patients with malignant ovarian tumors, had elevated SLDH levels before treatment, which decreased when the tumor was resected or after chemotherapy and radiotherapy. In 11 of 15 patients with primary ovarian carcinoma, SLDH levels were high before treatment. Patients with benign tumors had normal levels of SLDH. SLDH determination seems valuable in the diagnosis, treatment and follow-up study as well as differential diagnosis of ovarian carcinoma.

71 cases of hypoparathyroidism are reported. Of these, 36 were idiopathic hypoparathyroidism, 11 pseudohypoparathyroidism and 24 post-thyroidectomy hypoparathyroidism. Tetany (90%), convulsions (50.7%), extrapyramidal symptom (11%) and mental changes (16.9%) including irritability, anxiety, fear, depression, hallucination and confusion were noted.

The frequency of sister chromatid exchanges and chromosomal aberrations of peripheral lymphocytes (i.e., subploid, hyperploid, tetraploid, breakage, fragmentation) were studied in 20 cases of hydatidiform mole, 23 cases of invasive mole, 22 cases of choriocarcinoma, and 20 normal controls. The sister chromatid exchange frequency was 5.74±0.69 per metaphase in normal women, and 6.84±1.56 in hydatidiform mole, 11.49±2.24 in invasive mole, and 11.37±1.90 in choriocarcinoma. The frequency of chromosomal aberrations was highest in choriocarcinoma, and lowest in normal controls, with hydatidiform mole and invasive mole second and third. Statistically significant differences were found in these 2 indices in the 4 groups.

We used a self-designed instrument to evaluate thyroid function. With this instrument the R-p time intervals were measured from the onset of R wave on ECG to the onset of the pulse wave taken from electrodes placed on the forehead. This interval was related to myocardial contractility and could be changed by circulating thyroid hormones. The range of R-p time interval in 50 normal subjects was 121-144 msec (132±5.8). In 47 cases of hyperthyroidism, this time interval was shortened to 98-119 msec (108.5±5.6) and in 18 cases of hypothyroidism, it was prolonged to 144-179 msec (160±8.7). There was an exponential correlation between R-p time intervals and the concentrations of serum T3, T4. This method could be used as a screening test, for estimating the thyroid functional status and as an index to guide medication during the course of treatment of hyper- and hypothyroidism.

In this paper, micro-in-macro gelatin-encapsulated activated charocal (MMAC), a double gelatin-coated activated charcoal, is recommended as an effective adsorbent for clinical hemoperfusion (HP). In vitro studies show that the clearance and adsorption values for a variety of substances are as good as those with uncoated or collodion-coated activated coconut charcoal. Blood compatibility is excellent and particulate release minimal. Clinical conditions for which MMAC HP has been tried include acute drug overdose, poisoning, chronic uremia and schizophrenia. Experience suggests that MMAC HP is effective and safe in the treatment of intoxications. It is also a useful adjunct to hemodialysis in the treatment of uremia. As for schizophrenia, further study is needed. The shortcomings of MMAC are also discussed.