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Background/aims: Continuous renal replacement therapy (CRRT) is a treatment for acute kidney injury (AKI) patients. It has become a controversy about whether patients with liver dysfunction should perform CRRT with regional citrate anticoagulation (RCA)., Methods: This retrospective observational study enrolled 145 AKI patients (275 CRRT sessions) who received CRRT with RCA and had no history of chronic liver disease. Circuit survival time, blood pressure, trans-membrane pressure (TMP), acid-base and electrolyte status were recorded and analyzed. The severity of liver dysfunction was determined by total bilirubin (TBil) and international normalized ratio (INR), while the accumulation degree of citrates was quantified by total/ ionized calcium (tCa/iCa) raito., Results: Our results showed that there was no correlation of tCa/iCa ratio with TBil or INR. And tCa/iCa ratio was not related to the disturbances of pH, lactates, sodium, magnesium, blood pressure or TMP despite that high tCa/iCa ratios might be related to the decrease of circuit survival time. TBil did not correlate with the above indexes, except for lactates levels. INR did not correlate with the above indexes except for lactates levels and blood pressure. In addition, neither was TBil, INR, nor tCa/iCa ratio, related with fatal outcomes (22.76% of the patients)., Conclusion: The present study demonstrated that, with proper monitoring and adjustment of citrates and calcium infusion, applying RCA in CRRT is reasonably safe for AKI patients with acute liver dysfunction, as long as circuit time stays below roughly 50 hours., (© 2018 The Author(s). Published by S. Karger AG, Basel.)

Objective: Upper urinary calculi (UUC) is considered to be a comprehensive disease associated with many risk factors, but the role of physical activity (PA) is undefined. Here, we conducted a cross-sectional study to investigate this relationship in Asian populations., Materials and Methods: Patients diagnosed with UUC were the subjects of study and those who participated in a health examination in local medical center were included as controls. Information was collected through the same standard questionnaire. A metabolic equivalent score (METs) was measured for each kind of activity. OR of UUC in categories of PA were determined by logistic regression., Results: A total of 1,782 controls and 1,517 cases were enrolled. People who took higher PA (5-9.9, 10-19.9, 20-29.9 and >30 METs/wk) weekly were associated with lower risks of UUC than those took lower PA (<4.9 METs/wk) after adjusting for age, ethnicity, body mass index, systolic blood pressure, water intake, history of gout, history of diabetes mellitus, history of supplemental calcium use and history of hypertension (adjusted OR 0.11, 0.32, 0.24, 0.34; 95% CI 0.08-0.15, 0.23-0.43, 0.15-0.40, 0.22-0.53, respectively; p value <0.001)., Conclusions: In our cross-sectional study, PA was associated with UUC., (© 2016 S. Karger AG, Basel.)

Calcium and bone disorders in children and adolescents are treated with a wide variety of drugs. Several of these drugs have been used for many years on the basis of accepted practice, without being subjected to rigorous trials. Bisphosphonates are the mainstay treatment for children with osteoporosis, but newer, more potent compounds such as zoledronate and risedronate have begun to replace the older-generation bisphosphonates. Hypocalcaemia is managed with calcium and vitamin D and its metabolites. In difficult cases that are secondary to hypoparathyroidism, subcutaneous injections or infusions of parathyroid hormone have been used. Multiple daily phosphate supplements and calcitriol are the standard treatment for hypophosphataemic rickets, but trials of an anti-fibroblast growth factor 23 antibody appear promising, and the results are eagerly awaited. Many new medications are undergoing clinical trials and are starting to emerge as viable treatment options for children. Some of these drugs target specific diseases, such as recombinant alkaline phosphatase for hypophosphatasia and a C-type natriuretic peptide analogue for achondroplasia. Other drugs, such as denosumab and odanacatib, have been used successfully in the adult population, and the appropriate use of these drugs in children is now being evaluated., (© 2015 S. Karger AG, Basel.)

Background: Hereditary vitamin D-resistant rickets (HVDRR) is a rare genetic disorder caused by mutations in the vitamin D receptor (VDR) gene, which result in end-organ resistance to 1,25-(OH)2D3. PATIENTs with HVDRR are mostly treated using i.v. calcium therapy with a central catheter. However, central catheter-related complications have been reported., Patient: The patient was a 3-year-old boy presenting with waddling gait and alopecia. He had hypocalcemia [8 mg/dl (2 mmol/l)], hyperparathyroidism (1,232 ng/l), and elevated 1,25-(OH)2D3 levels (>250 pmol/l). DNA sequence analyses of the VDR gene showed a homozygous C-T transition at codon 152, resulting in a non-sense mutation in exon 5., Interventions and Outcomes: The patient was initially treated with calcitriol (80 ng/kg/day) and high-dose oral calcium (150 mg/kg/day) for one year. At the end of the first year, intermittent (5 days per month) i.v. calcium therapy without a central catheter was initiated because of insufficient clinical and radiological improvement. After 2 years of intermittent i.v. calcium therapy, there was a clear improvement based on clinical progress and on X-ray and biochemical findings. No peripheral complications were reported either., Conclusion: HVDRR with a non-sense mutation in the ligand-binding domain and alopecia was successfully treated with intermittent i.v. calcium without a central catheter., (© 2015 S. Karger AG, Basel.)

Bariatric surgery aims at weight reduction of severely obese patients. The Roux-en-Y technique is one of the most common bariatric procedures and is occasionally accompanied by nutrient insufficiencies and metabolic changes. According to the literature, skin architecture and immunity change after bariatric surgery and may lead to inflammation and increased susceptibility to pathogens. Additionally, vitamin and mineral deficiencies frequently develop in these patients and affect the skin's defense mechanisms, possibly contributing to dermatological complications. Knowledge and recognition of skin changes after bariatric surgery make an important asset for the dermatologist and help in the proper treatment of these patients. We report 2 cases of infectious skin lesions where vitamin and trace element deficiencies have possibly contributed to their persistence and resistance to traditional treatments., (© 2014 S. Karger AG, Basel.)

The purpose of this study is to determine whether a calcium (Ca) prerinse used before a 228 µg/g (ppm) fluoride (F) rinse would induce the formation of 'calcium fluoride-like' (CaF2-like) deposits in human dental plaque. Sixty minutes after the use of the Ca prerinse/F rinse, plaque samples were collected from 10 volunteers, homogenized, and split into 2 aliquots. The plaque mass from one aliquot was then extracted with a 'plaque-like' solution that extracted all the CaF2-like deposits. The total F in both aliquots was then determined and compared. The results demonstrated that, as in previous studies, the Ca prerinse induced large increases in plaque fluid and total plaque F. However, unlike previous results without the Ca prerinse, 30% of the plaque F deposits were CaF2 or CaF2-like. Given that maintaining an elevated F concentration in the vicinity of a developing lesion may play an important role in the cariostatic effect of this ion, and the potential advantages of CaF2-like deposits as an F source, these results suggest that a Ca prerinse may increase the cariostatic effect of topical agents.

Caries develops when the equilibrium between de- and remineralization is unbalanced favoring demineralization. De- and remineralization occur depending on the degree of saturation of the interstitial fluids with respect to the tooth mineral. This equilibrium is positively influenced when fluoride, calcium and phosphate ions are added favoring remineralization. In addition, when fluoride is present, it will be incorporated into the newly formed mineral which is then less soluble. Toothpastes may contain fluoride and calcium ions separately or together in various compounds (remineralization systems) and may therefore reduce demineralization and promote remineralization. Formulating all these compounds in one paste may be challenging due to possible premature calcium-fluoride interactions and the low solubility of CaF2. There is a large amount of clinical evidence supporting the potent caries preventive effect of fluoride toothpastes indisputably. The amount of clinical evidence of the effectiveness of the other remineralization systems is far less convincing. Evidence is lacking for head to head comparisons of the various remineralization systems., (Copyright © 2013 S. Karger AG, Basel.)

Background/aims: Patients with chronic kidney disease (CKD) have a high prevalence of periodontal disease that may predispose to tooth loss and inflammation. The goal of this study was to test the hypotheses that a genetic rat model of progressive CKD would exhibit altered oral bone properties and that treatment with either bisphosphonates or calcium could attenuate these adverse changes., Methods: At 25 weeks of age, rats were treated with zoledronate (ZOL), calcium gluconate, or their combination for 5 or 10 weeks. Mandible bone properties were assessed using micro-computed tomography to determine bone volume (BV/TV) and cementum-enamel junction to alveolar crest distance (CEJ-AC)., Results: Untreated CKD animals had significantly lower BV/TV at both 30 (-5%) and 35 (-14%) weeks of age and higher CEJ-AC (+27 and 29%) compared to normal animals. CKD animals had a significantly higher parathyroid hormone (PTH) compared to normal animals, yet similar levels of C-reactive protein (CRP). ZOL treatment normalized BV/TV over the first 5 weeks but this benefit was lost by 10 weeks. Calcium treatment, alone or in combination with ZOL, was effective in normalizing BV/TV at both time points. Neither ZOL nor calcium was able to correct the higher CEJ-AC caused by CKD. Calcium, but not ZOL, significantly reduced serum PTH, while neither treatment affected CRP., Conclusions: (i) This progressive animal model of CKD shows a clear mandibular skeletal phenotype consistent with periodontitis, (ii) the periodontitis is not associated with systemic inflammation as measured by CRP, and (iii) reducing PTH has positive effects on the mandible phenotype., (© 2013 S. Karger AG, Basel.)

Chronic kidney disease (CKD) is characterized by phosphorus retention and, in more advanced stages, by high serum phosphorus (P) levels. During the last decade, it has been elucidated the central role of P in the pathogenesis of CKD mineral bone disorder (CKD-MBD), determining both renal osteodystrophy and cardiovascular disease. Unfortunately, at least one third of patients on chronic dialysis have high serum P levels, with a consequent higher serum PTH levels, commonly associated with vitamin D deficiency, increased vascular calcification and the highest ratios of morbidity and mortality. In patients with CKD stage 5 on dialysis, therapeutic approaches to reduce serum P levels should include restriction of dietary phosphate intake, optimal dialysis treatment, and use of P binders. In this context, the use of P binders appears to be an essential treatment to control P overload in CKD patients. In this review, we analyzed the use of calcium-based and calcium-free P binders in peritoneal dialysis patients., (Copyright © 2012 S. Karger AG, Basel.)

Background: Impetigo herpetiformis (IH) is a rare skin disorder that occurs during pregnancy. It was previously associated with high maternal and fetal mortality and morbidity, but now has a better prognosis., Case Report: We report a case of a pregnant woman with IH who presented with generalized erythematous pustular eruptions in the 32nd week of gestation. The IH progressed rapidly, and gestational hypertension was observed in the 36th week. The lesions did not subside, despite treatment with corticosteroids and phototherapy. She delivered a healthy male baby via cesarean section in the 37th week. One month after her delivery, her skin returned to normal, except for residual pigmentation, with complete recovery 3 months postpartum., Conclusion: An experienced medical team comprising obstetricians, dermatologists, perinatologists and neonatologists is critical to aggressively treat this life-threatening specific dermatosis of pregnancy and to prevent ensuing complications, such as fluid and electrolyte imbalance, secondary infection and placental insufficiency., (Copyright © 2011 S. Karger AG, Basel.)

Introduction: Cardiovascular disease accounts for almost half of all deaths in individuals with chronic kidney disease stage 5 despite advances in both dialysis treatment and cardiology. A combination of lipid-lowering and anti-inflammatory effects along with avoidance of hypercalcemia should be taken into account when choosing phosphorus binders for maintenance hemodialysis (MHD) patients., Methods: We examined the association of sevelamer versus calcium-based phosphorus binders with lipid profile, inflammatory markers including C-reactive protein (CRP), and mineral metabolism in MHD patients who participated in the Nutritional and Inflammatory Evaluation of Dialysis Patients (NIED) study from October 2001 to July 2005., Results: Of the 787 MHD patients in the NIED study, 697 were on either sevelamer, a calcium-based binder, or both and eligible for this study. We compared the groups based on taking sevelamer monotherapy (n = 283) or calcium binder monotherapy (n = 266) for serum phosphate control. There were no differences between the groups on dialysis vintage. There were significant differences in age, serum calcium and phosphorus levels, as well as intact parathyroid hormone levels. Using a logistic regression models, the sevelamer group had a higher odds of serum CRP <10 mg/l [odds ratio (OR): 1.06, 95% CI: 1.02-1.11] and LDL cholesterol <70 mg/dl (OR: 1.33, 95% CI: 1.19-1.47) when compared to the calcium binder group independent of age, vintage, body mass index, statin use or other variables., Conclusion: The improvements in multiple surrogate markers of inflammation and lipids in the NIED study make sevelamer a promising therapy for treatment in MHD patients with high risk of cardiovascular disease and mortality., (2007 S. Karger AG, Basel)

The aim was to study the effect of lesion preparation technique and solution composition on remineralization of artificial lesions in vitro. Lesions were prepared with similar total mineral loss, but different mineral distribution, i.e., low (14.0) or high R (34.8) values. Lesions from both groups were remineralized (10 days, 37 degrees C) in two different solutions, with similar supersaturation with respect to hydroxyapatite (St), but calcium:phosphate ratios representing either hydroxyapatite stoichiometry or plaque fluid (PF). Remineralization was quantified microradiographically, mineral distribution was compared with natural white-spot lesions. Mineral loss and depth decreased significantly, and surface-zone mineral content (Zmax) increased significantly, in all lesions. Overall there was a significant relationship of decreasing remineralization with increasing Zmax, but not within either lesion type. PF was significantly more efficient than St in high-R lesions, with lesions remineralizing almost completely in PF. Remineralization was not significantly different in PF or St for low-R lesions but in high-R lesions, PF was more efficient than St, possibly through differences in relative saturations with respect to different calcium phosphates. Differences in area:solution ratios and baseline Zmax values may also have explained the different response to PF. Low-R lesions were similar to natural white-spot lesions in terms of mineral distribution, whereas high-R were not. Concluding, both lesion and remineralizing solution type had a marked influence on remineralization. It is proposed that use of low-R lesions would be more appropriate where more physiologically relevant mineral distribution is required, whereas high-R lesions would be appropriate for studying inherent remineralizing efficiency., (Copyright 2007 S. Karger AG, Basel.)

The case of an 8-year-old boy with severe bone mass reduction and 4 fractures as a result of an unsupervised diet established to treat cow's milk allergy is presented. Endocrine, genetic and orthopedic pathologies were excluded. While vitamin D intake had always been appropriate, his calcium intake had been inadequate for many years. This clinical report suggests that both vitamin D and calcium supplementation are necessary when a cow's milk protein-free diet is prescribed, even when a hypo- or non-allergenic formula is provided., (Copyright 2007 S. Karger AG, Basel.)

The results of a recent study by Whitford et al. [Caries Res 2002;36:256-265] with subjects whose drinking water was fluoridated led to two major conclusions: (1) Compared to the use of a placebo dentifrice, plaque fluoride concentrations ([F]) throughout much of the day are not significantly increased by the use of an F dentifrice but (2) they are positively related to plaque [Ca] (p = 0.0001). The present double-blind, double-crossover study with 16 subjects used the same protocol and was done to: (1) determine the effects of the use of an F dentifrice on salivary and plaque [F] in a community without water fluoridation and (2) further examine the relationship between plaque [Ca] and [F]. Following the use of an F dentifrice or placebo for one week, whole saliva and plaque were collected 1.0 and 12 h after the last use of the products. The study was repeated to include rinsing with a 20 mmol/l CaCl(2) solution immediately before the use of the dentifrices. The CaCl(2) rinse had only minor effects on salivary [Ca] and [F] and none on the plaque concentrations. Unlike the results found in the fluoridated community, all salivary and plaque [F] associated with the use of the F dentifrice were significantly higher than those associated with the use of the placebo. The results suggest that the cariostatic effectiveness of an F dentifrice should be greater in areas without water fluoridation. As noted previously, plaque [F] were positively related to plaque [Ca] (p = 0.0001)., (Copyright (c) 2005 S. Karger AG, Basel.)

Osteoporosis is a major public health problem. We now have an approach to case finding that involves the measurement of bone mineral density in people at high risk of fractures. The management of the individual includes the identification of risk factors, the choice of optimal therapy and the encouragement of long-term adherence with the planned treatment. The drugs that are available for the prevention of fractures are classed as anticatabolic or anabolic. The efficacy of these agents can be evaluated in the individual by monitoring changes in bone mineral density or bone turnover markers., ((c) 2005 S. Karger AG, Basel.)

Aim: To investigate whether nasal salmon calcitonin (CT; 200 U/day) given in addition to calcium helps to restore the bone mass after parathyroidectomy (PTX) in patients with primary hyperparathyroidism (PHPT)., Methods: Twenty patients with PHPT were enrolled after successful PTX and received 1 g calcium per os daily for 1 year. They were randomly assigned either to nasal CT (CT group) or to no treatment. The bone mass was measured using dual-energy X-ray absorptiometry at multiple sites., Results: Eight patients in each group completed the study. After 12 months, the bone mass increased significantly at whole-body level and at lumbar spine in both groups, increased at hip and epiphyses of tibia or radius in the CT group only, and did not change at diaphyses of tibia and radius in either group., Conclusions: Bone mass increases after PTX for PHPT in patients receiving oral calcium. CT may help to restore the bone mass at sites of the appendicular skeleton, where trabecular bone predominates., (Copyright 2003 S. Karger AG, Basel)

The foremost step in the initial clinical management of hyperkalemia is to decide whether a hyperkalemic patient requires immediate treatment to avoid a life-threatening situation (serum potassium concentration >6.0 mEq/l and EKG changes). When the decision for urgent treatment of hyperkalemia is based on EKG changes, an important caveat for clinicians is that absent or atypical EKG changes do not exclude the necessity for immediate intervention. Once an urgent situation has being handled with intravenous push of a 10% calcium salt, the initiation of short-term measures can be launched by either a single or combined regimen of the three agents that cause a transcellular shift of potassium - insulin with glucose, beta(2)-agonist (albuterol), and NaHCO(3). As the first choice among these available options, we favor an intravenous bolus of 10 units of insulin with 50 ml of 50% glucose alone or in combination with 10-20 mg of albuterol by nebulizer. These can be repeated as required until the institution of hemodialysis. The combination of insulin with glucose and NaHCO(3) as an another option needs further clarification for its additive effects. However, NaHCO(3) has lost its favor because of its poor efficacy as a potassium-lowering agent when used alone. The next step is to remove potassium from the body - diuretics (furosemide), cation exchange resin (kayexelate) with sorbitol, and dialysis (preferably hemodialysis). The final important step for the managements of hyperkalemia is a long-term plan to prevent its recurrence or worsening. In addition to every effort to elucidate underlying causes and pathophysiologic mechanisms for hyperkalemia, an extensive search must be made to uncover overt or sometimes covert medications that may have led to the development of hyperkalemia. Furthermore, one must obtain detailed dietary and medical history of hyperkalemic patients., (Copyright 2002 S. Karger AG, Basel)

Vitamin-D-dependent rickets type 2 results from autosomal recessive mutations of the vitamin D receptor gene. With congenital total body alopecia and onset of rickets during the second half of the first year of life, patients display rapidly progressing rachitic bone changes, hypocalcemia and secondary hyperparathyroidism. This article describes extensive personal experience with about one third of the world's reported cases, their clinical course, the physiological consequences, diagnostic steps, molecular findings and therapeutic approach, as they developed over the course of the last 25 years., (Copyright 2002 S. Karger AG, Basel)

Patients with vitiligo have low catalase levels in their involved and uninvolved epidermis in association with high levels of hydrogen peroxide (H2O2). H2O2 has been confirmed for the first time in vivo using Fourier Transform Raman spectroscopy. A topical substitution with a UVB-activated pseudocatalase can successfully remove epidermal H2O2 in vitiligo. This approach leads to recovery of the oxidative damage in the epidermis and remarkable repigmentation in this disorder.

Single-section techniques are attractive in enamel de- and remineralization investigations because they allow longitudinal studies in which mineral changes can be assessed by microradiography (TMR). Nail varnish (NV) is in general applied to coat the cut thin-section sides. The aims of this study were to investigate: (1) NV penetration depth in cut surfaces of demineralized enamel, (2) the influence of NV on cut surfaces of demineralized enamel on TMR, (3) the influence of NV penetration on a following remineralization. Cut surfaces of thin sections of demineralized enamel were NV coated; the NV was peeled off and the penetration depth assessed by confocal laser scanning microscopy. The NV penetration was 18+/-5 micrometer (mean+/-SD) in demineralized enamel. To evaluate the possible influence of NV on TMR, cut surfaces of thin sections of demineralized enamel were coated (twice) and microradiographed before and after nail varnishing. The NV effect (total effect of penetrated and surface NV) on the main parameters of TMR, Ld and DeltaZ, was less than 5% of the mean values. In the remineralization experiment (remineralization with 1.5 mM Ca2+, 0.9 mM phosphate, pH 7, 1 ppm F for 1 and 2 weeks), lesions in bulk samples, lesions in thin sections with NV-coated cut surfaces and lesions in thin sections in a PMMA (polymethylmethacrylate) holder were compared. (1) The remineralization of bulk samples and of NV-coated thin sections is different in one aspect. The amounts of mineral deposited in the lesions expressed as DeltaZ are comparable after 1 week. But because the NV penetrates part of the lesion outside, there was an Ld difference. The lesion depth difference between bulk lesions and NV-coated lesions in thin sections was statistically significant and was about 19% less in NV-coated lesions after 1 week; after 2 weeks of remineralization there was no difference in Ld between bulk- and NV-coated lesions any more. (2) There was no difference in remineralization efficacy between lesions in bulk samples and lesions in thin sections in the PMMA holder.

The aim of the present study was to develop transverse microradiography (TMR) in order to quantitatively assess the influence of artificial saliva and orange juice on the erosion of bovine enamel. Bovine incisors were sectioned sagittally into two equal halves. Each half was coated with acid-resistant nail varnish except for a rectangular enamel window on the labial surface of the tooth. While both halves of each tooth were immersed in pure orange juice 6 times daily for a period of 5 min at each occasion making a total of 30 min per day, one half was stored in artificial saliva and the other half in deionized distilled water between exposures to orange juice and for the remaining 12 h overnight, for 24 days making a total of 12 h of exposure to orange juice. Sections bearing intact and eroded enamel surfaces were cut from each specimen and ground to 80 microm thickness, and TMR of the sections was made. Mineral loss was quantified from the microradiographs using two-step image analysis. Mineral loss was significantly greater in those specimens cycled in orange juice and de-ionized distilled water. TMR was used successfully to quantify the mineral loss by erosion in vitro, and it is envisaged that it will be useful for specimens used in intra-oral appliances during in situ trials. Artificial saliva saturated with respect to calcium and phosphate salts can possibly remineralize an erosive lesion and may reduce the degree of erosion.

There are several causes of erosion - acidic foods and drinks have been implicated and reducing their erosive potential would seem an important area of research. Calcium-citrate-malate (CCM) appeared to have potentially useful properties as an anti-erosion additive. The study aims were to test the ability of an intra-oral enamel slab system to measure erosion and to compare the erosive potential of a citric acid-based orange juice drink either with or without added CCM and a positive and negative control. Eleven adults wore an upper removable appliance for four periods each of 6 days. Each appliance held two enamel slabs which were inserted into the test drinks for 15 min 4 times a day for 6 days. Loss of enamel was quantified by profiling casts of the enamel slabs taken before and after the test period. Loss of enamal was greatest during exposure to a diet phosphoric acid-based cola drink (p < 0.001) but was similar during exposure to the two citric acid-based orange drinks, with or without CCM, and distilled water. The loss of surface enamel measured from a scanning electron micrograph agreed well with the measurement obtained by profilometry. It can be concluded that (a) the intra-oral enamel slab system was able to discriminate between drinks in their erosive potential, and (b) it was not possible to determine if CCM had any potential for reduction in erosion in an acid beverage as the level of erosion observed for both the critic acid-based orange drinks was not statistically significantly different from that observed with distilled water.

A high-fat and low-fiber diet is regarded as a major risk factor for colon cancer by increasing luminal contents of secondary bile acids. Calcium, on the other hand, has been implicated as a possible preventive agent in colon tumor development. In in vitro studies with human colonic epithelium, incubation with the secondary bile acid deoxycholic acid (DCA) induced hyperproliferation of colonic crypt cells which is regarded as a sign of preneoplastic transformation. In the present study the effects of calcium chloride (CaCl2) on DCA-induced hyperproliferation were tested at different stages of DCA-induced cell injury. Colonic biopsies from 36 patients (no tumors, polyps or IBD) were incubated with CaCl2 (1 and 10 mM) and 5 microM DCA which was added to the incubation medium either together with (experiment A), after (experiment B), or before CaCl2 (experiment C). Coincubation of the biopsies with DCA and 10 mM CaCl2 at the same time (experiment A) resulted in a significant reduction of whole crypt labeling index by 12% (p < 0.05), whereas in the other incubation experiments no significant growth-inhibitory effects could be demonstrated for CaCl2. These findings may best be explained by the formation of calcium-bound bile acid salts which lost most of their toxicity for the colonic cells.

Following the demonstration that rinses with solutions of soluble calcium salts reduced sucrose-induced demineralization, a study was undertaken to determine whether a similar effect could be obtained by the supplementation of a solid food with calcium lactate (CL). Subjects wore palatal appliances containing blocks of bovine enamel that were coated with Streptococcus mutans IB 1600 and ate 5-gram portions of cookies made with defined levels of CL. Determinations were made of changes in iodide penetrability (delta Ip) of the enamel, as well as the pH, calcium and inorganic phosphate of the streptococcal plaque. CL at 3.2% (w/w) reduced delta Ip from 12.9 +/- 1.7 to 6.1 +/- 0.9 units, i.e. by 52.7%. Plaque pH was not affected. Demineralization was reduced progressively with increasing concentrations of added CL, and CL was most effective with increasingly sweet cookies. Plaque contained 32.4 +/- 6.0 and 17.1 +/- 4.2 mM calcium after 1 and 5 min, respectively. Calculations showed that the plaque was saturated with respect to enamel during the first 5-10 minutes after food ingestion, in spite of the progressive drop in plaque pH. In conclusion, the present study demonstrated the reduction of the cariogenic potential of solid food by relatively low concentrations of CL. The effect appeared to be related to the ability of the food to maintain high levels of calcium in the streptococcal plaque during the period of active acidogenesis.

To study the effect of fluoride on bone mineral density (BMD) in patients treated chronically with glucocorticosteroids, 15 subjects (renal grafted, n = 12; skin disease, n = 1; broncho pulmonary disorder, n = 1; Crohn's disease, n = 1) were prospectively studied in a double-blinded manner and randomly allocated either to group 1 (n = 8) receiving 13.2 mg/day fluoride given as disodium monofluorophosphate (MFP) supplemented with calcium (1,000 mg/day) and 25-hydroxyvitamin D (calcifediol) (50 micrograms/day), or to group 2 (n = 7) receiving Cas+ calcifediol alone. An additional group of 14 renal transplant patients treated chronically with glucocorticosteroids but exempt of specific therapeutic intervention for bone disease was set up as historical controls. BMD was measured by dual-energy X-ray absorptiometry (DXA, Hologic QDR 1000) performed at months 0, 6 and 12 for groups 1 and 2 (lumbar spine, total upper femur, diaphysis and epiphysis of distal tibia), or 11-31 months apart with calculation of linear yearly changes for the historical cohort. Lumbar BMD tended to rise in groups 1 and 2, and to fall in group 3, the change reaching statistical significance (p < 0.05) in group 1, thus leading to a significant difference between groups 1 and 3 (p < 0.05). At upper femur, tibial diaphysis and tibial epiphysis, no significant change in BMD occurred in any of the groups. In conclusion, lumbar BMD rises more after a mild dosis of fluoride given as MFP and combined to calcium and calcifediol than on Ca+ calcifediol alone, without changes in BMD at the upper femur or distal tibia.

Objectives: The aims of this prospective study were to explore the changes in platelet angiotensin II (A-II) binding in pregnancy amongst Chinese women at high risk of developing pregnancy-induced hypertension (PIH) and the effects of low-dose aspirin and calcium supplementation on A-II binding., Methods: Platelet A-II binding was assayed in 15 non-pregnant women and in 63 pregnant women determined to be at risk of PIH on the basis of 2nd-trimester mean arterial pressure (MAP). The pregnant patients were randomized into three groups: control, low-dose aspirin, and calcium supplementation. A-II binding was assayed again during the 3rd trimester in half the women and 8 weeks after delivery., Results: A-II binding was negatively correlated with MAP measured in the left lateral position (p < 0.05) but not with MAP measured in the supine position. There were no significant differences between A-II binding in non-pregnant and pregnant women. Neither low-dose aspirin nor calcium supplementation caused significant reductions in A-II binding., Conclusion: The measurement of platelet A-II binding is unlikely to provide significant information regarding the risk of PIH over and above that obtained from measurement of 2nd-trimester MAP.

Dentine consists simplified of mineral and of several organic components. Sodium hypochlorite (NaOCl) is a well-known nonspecific proteolytic agent capable to remove organic material. The aim of this study was to investigate the influence of organic material removal from artificial dentine lesions by means of NaOCl pretreatment on subsequent remineralization with and without fluoride. Human root dentine samples were demineralized in an acidic gel (pH = 5) at 37 degrees C for 2 weeks. After 2 min of pretreatment with a 0.4, 2 or 10% NaOCl solution, the samples were remineralized in a 20 mM HEPES buffer (pH = 7) containing 1.5 mM Ca(2) and 0.9 mM phosphate with or without addition of 10 ppm F(-) as NaF at 37 degrees C for 8 days. Mineral profiles were assessed by means of transversal microradiography after diol treatment to avoid shrinkage caused by drying. In a separate experiments the dentine contraction caused by 10% NaOCl was assessed. The contraction (negligible for sound dentine) was found to be about 12% for the lesions. The remineralization results showed that pretreatment with a 10% NaOCl solution for 2 min, increased lesion remineralization. After NaOCl treatment, the amount of accumulated mineral increased by about 27% without F in the remineralization solution, and by about 4% with 10 ppm in solution. The in vitro results suggest that removal of organic materials from dentine lesions is an interesting approach to enhance remineralization.

Metabolic acidosis has been shown to alter vitamin D metabolism. There is also evidence that calcium may modulate 1,25(OH)2D3 by a parathyroid hormone (PTH)-independent mechanism. To investigate the effect of rapid correction of chronic metabolic acidosis on serum 1,25(OH)2D3 levels by free calcium clamp in chronic renal failure, 20 patients with mild to moderate metabolic acidosis (mean pH 7.31 +/- 0.04) and secondary hyperparathyroidism (mean intact PTH 156.47 +/- 84.20 ng/l) were enrolled in this study. None had yet received any dialysis therapy. Metabolic acidosis was corrected by continuous bicarbonate infusion for 3-4 h until plasma pH was around 7.4, while plasma ionized calcium was held at the preinfusion level by calcium solution infusion during the entire procedure. The plasma pH, bicarbonate, total CO2, sodium, and serum total calcium levels were significantly increased while serum concentrations of alkaline phosphatase and albumin were significantly decreased after bicarbonate infusion. The plasma ionized calcium, potassium, serum magnesium, inorganic phosphorus, and 25(OH)D levels showed no significant change before and after bicarbonate infusion. The serum 1,25(OH)2D3 levels were significantly increased (38.66 +/- 11.77 vs. 47.04 +/- 16.56 pmol/l, p < 0.05) after correction of metabolic acidosis. These results demonstrate that rapid correction of metabolic acidosis raises serum 1,25(OH)2D3 levels in vitamin D-deficient chronic renal failure patients, and may underline the importance of maintaining normal acid-base homeostasis in the presence of secondary hyperparathyroidism in chronic renal failure.

The effect of calcium supplementation on secondary hyperparathyroidism of old age depends on the intestinal absorption of the calcium preparation used. In order to test the bioavailability and clinical usefulness of a new calcium preparation, heated oyster shell-seaweed calcium (HOSS Ca), a randomized, prospective, double-blind comparison of HOSS Ca, calcium carbonate and placebo was carried out in 58 hospitalized women with a mean age of 82. Group A received 900 mg Ca/day Ca as HOSS Ca, group B 900 mg Ca/day as CaCO3 and group C placebo in addition to the basic hospital diet containing approximately 600 mg Ca/day. After 18 months, lumbar spine bone mineral density (BMD) measured by DPX was 106.1 +/- 3.5% (mean +/- SEM) of the pretrial basal value in group A, 99.8 +/- 3.8% in group B and 90.9 +/- 3.4% in group C (A bu not B significantly higher than C). Midradial BMD measured by DPX was 99.3 +/- 1.3% in A, 94.8 +/- 4.0% in B and 85.5 +/- 6.2% in C. The ratio of whole body calcium content between the 12th and 18th month was 96.5 +/- 1.7% in A, 90.1 +/- 2.7% in B and 89.8 +/- 1.3% in C (A but not B significantly smaller than C). Final/baseline ratio of urinary Ca/creatinine was 91.7 +/- 11.1 in A, 111.4 +/- 18.9 in B and 125.2 +/- 12.6 in C.(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty-three patients with the depigmentation disorder vitiligo were successfully treated with a new topical application of pseudocatalase, calcium and short-term UVB light exposure. First repigmentation occurred in the majority of cases after 2-4 months. Complete repigmentation on the face and dorsum of the hands appeared in 90% of the group. In all patients, active depigmentation was arrested. None of them developed new lesions during treatment. No recurrence of the disease was observed during a 2-year follow-up. The rationale for this pilot study originated from a recent understanding of vitiligo at the molecular level. The involved epidermis produces hydrogen peroxide due to defective tetrahydrobiopterin recycling and increased monoamine oxidase A activity, whereupon catalase is inactivated. In addition, calcium homeostasis is perturbed in the affected skin. The substitution for insufficient catalase by a pseudocatalase together with calcium and UVB exposure lead to effective repigmentation.

A 3-week-old infant with liver failure underwent an orthotopic liver transplant. Following a prolonged second surgical procedure in which he received massive amounts of blood products, his serum calcium was 31.3. mg/dl (7.8 mmol/l). This patient represents a case of severe hypercalcemia secondary to intraoperative calcium infusions given in an effort to overcome infusion-related citrate toxicity in a neonate with hepatic dysfunction.

Several approaches may be suggested for prevention or treatment of senile osteoporosis. In elderly patients, an association of calcium and vitamin D supplementation has been shown to reduce nonvertebral fractures up to 40% over an 18-month period. Calcitonin, given parenterally or nasally, may prevent further bone loss and has been reported to significantly decrease vertebral and hip fractures. This hormone also possesses an important analgesic effect. Fluoride salts are the most effective way to significantly increase bone mass, mainly at the trabecular site. The optimal doses and regimens remain to be clearly established. The use of new formulations like sodium monofluorophosphate are likely to facilitate the search of the optimal therapeutic window. Bisphosphonates are potent inhibitors of bone resorption. They have been shown to significantly increase trabecular bone mass without impairment of cortical bone. Their use may be associated with a significant decrease in vertebral fractures, mainly in patients with severe osteoporosis. The new, second and third generation of bisphosphonates (tiludronate, risedronate, alendronate) look extremely promising but their widespread use will only be possible after a confirmation of the absence of a deleterious effect on bone quality (alendronate) and after demonstration of a reduction in vertebral and/or hip fractures following a prolonged use.

Although calcium (Ca) is pivotal for the prevention of osteoporosis, its role in the prevention of other unrelated diseases such as arterial hypertension, cancer of the colon and nephrolithiasis is perplexing. No unitarian hypothesis explaining these unrelated effects of Ca has been postulated. Cytosolic Ca concentration is 10,000-fold lower than in the extracellular space, and this gradient is tightly maintained. Abnormal elevation of cytosolic Ca causes cell damage and death. Parathyroid hormone is a Ca agonist and the suppression of its secretion by Ca could explain the beneficial role of Ca intake in multiple diseases. Thus, parathyroid ablation improves hypertension in rats and cardiomyopathy in hamsters. Since anthropologic data suggests a higher Ca intake, of approximately 1,600 1,600 mg/day, in preneolithic than in modern diets, it is likely that our levels of PTH on genetically predisposed subjects with a loose cellular Ca control may aggravate frequent modern diseases and the process of aging. A higher Ca intake in both sexes should be one of the goals of preventive medicine of our time.

In this study, we evaluated the effect of long-term administration of daily calcium carbonate (2-4 g/day) and intermittent high oral doses of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3, 3-4 micrograms, given twice a week] in conjunction with a 3-mEq/1 calcium concentration in the dialysate for the treatment of severe secondary hyperparathyroidism in 6 hemodialysis patients. All patients had reduced serum levels of 1,25-(OH)2D3, which increased significantly (p < 0.005) reaching the maximum level in the 4th month. Serum total and ionized calcium levels significantly increased also, in relation to those before treatment. No patients developed hypercalcemia. Serum phosphorus did not significantly change during the study. Initial serum intact parathyroid hormone (PTH) (1,241 +/- 233 pg/ml, mean +/- SEM) markedly decreased after starting treatment with 1,25-(OH)2D3, being 542 +/- 174 pg/ml in the 5th month and 477 +/- 174 pg/ml in the 8th month. These changes are statistically significant (p < 0.05 and < 0.007, respectively). Alkaline phosphatase behavior was similar to that of intact PTH. A constant direct correlation between intact PTH and alkaline phosphatase and an inverse significant correlation between intact PTH and 1,25-(OH)2D3 was evidenced by us. We conclude that oral 1,25-(OH)2D3 pulse therapy is very effective in suppressing PTH secretion. The administration of calcium carbonate and the use of dialysate with a reduced calcium concentration would allow to prevent hyperphosphatemia and the administration of high oral doses of 1,25-(OH)2D3 without concomitant hypercalcemia.

The incidence of bone lesions at diagnosis of childhood acute lymphoblastic leukemia (ALL) is relatively high. However, no cases of severe osteoporosis with multiple vertebral collapses secondary to treatment in children with ALL have been reported. We report the case of a 9-year-old-boy with B-ALL, with no bone lesions at the diagnosis that, following the 4th block of aggressive chemotherapy (protocol B-ALL BFM 86), presented severe back pain and functional impairment with diffuse osteoporosis and vertebral collapses. He was treated with calcitonin, vitamin D, calcium, physical therapy and orthopedic corset. Osteoporosis progressed slowly during the following 2 months of chemotherapy and the boy developed dorsal kyphosis. After discontinuing antiblastic treatment progressive clinical improvement was observed, with complete resolution of kyphosis in about 6 months. An almost complete bone recovery was seen on X-ray survey at 26-months follow-up.

Prevention of bone disease associated with impairment of the renal function is desirable. Attempts at such prevention inevitably also embrace prevention of the extraosseous consequences of autonomous hyperparathyroidism, such as the effects of hypercalcaemia, need for parathyroid surgery, and, perhaps, toxic effects of the parathyroid hormone. Strategies for prevention in early, moderate, and end-stage renal failure are reviewed and discussed with particular reference to dietary phosphorus restriction, use of gut phosphorus binders, control of acidosis, calcium supplementation, use of oral and intravenous calcitriol, and use of synthetic analogues of 1,25-dihydroxyvitamin D3. The onset of severe renal osteodystrophy can be delayed. Early attempts at prevention are logical, but we do not know whether these will reduce the need for parathyroid surgery or will make patients feel better or live longer. The costs of prophylaxis--both financial and in terms of incidence and severity of complications--remain to be defined. An individual approach to each patient with renal impairment seems at present appropriate.

We evaluated low-dose calcitriol (0.25 microgram b.i.d.) in combination with 1 g of supplemental calcium therapy as treatment for osteopenic women over 60 years of age (n = 4). Control patients (n = 6) received ergocalciferol (50,000 units twice a week) and 1 g of supplemental calcium. Bone biopsies and CT-determined bone mineral density were done initially and after 1 year of therapy. Bone mineral density increased from 77 +/- 18 to 88 +/- 9 mg/ml (NS) in the calcitriol-treated group and from 87 +/- 13 to 112 +/- 30 mg/ml (NS) in the ergocalciferol-treated group. There was also no significant change in bone volume, as determined by bone biopsy in either group. No compression fractures occurred in either treatment group. After 1 year of therapy, urinary calcium excretion was increased significantly above that observed in age-matched untreated women. Creatinine clearance did not change significantly. Hypercalcemia was rare. In summary, we found calcitriol was not superior to ergocalciferol in preventing progressive bone loss and fractures. Both therapies were associated with significant hypercalciuria.

In 9 (of 17 attempted) experiments (8 aborted due to premature tissue death), transmembrane electrical activity was recorded from canine false tendons superfused with Mg-free Tyrode's solution to simulate hypomagnesemia. Oscillatory after-potentials (OAP) developed similar to those seen after exposure to 2 X 10(-7) M ouabain, a short-lasting (0.5-1 time the duration of an action potential) OAP that often reached threshold superimposed on a long-lasting (3-4 times as long as the short) OAP. Both forms of OAP were shown to be Ca2+-dependent, as both were prevented by 10(-7) M nifedipine, but only the short OAP were abolished by nifedipine once they had appeared, while high (5 mM = 10 times normal) Mg2+ both prevented and terminated short and long OAP in digitoxic preparations. Results suggest that cardiac glycosides may deplete Mg from the myocardium. The mechanism of the therapeutic action of Mg2+ in digitalis intoxication is discussed in light of its involvement in Ca2+ sequestration by the sarcoplasmic reticulum.

The urinary excretion of oxalate, calcium, magnesium and creatinine was investigated in 21 outpatients who underwent jejunoileal bypass operation 6-9 years previously. Furthermore, a urinary stone index expressed as the quotient (calcium X oxalate)/(magnesium X creatinine) (mmol/mol) was calculated. The oxalate excretion exceeded normal ranges in 20 patients (1.20 +/- 0.55 mmol/24 h), and the stone index was found critically high in all. Daily administration of 1,100 mg ionized calcium in 17 of these patients die not change the urinary excretion of oxalate, calcium and magnesium separately, but the stone index was reduced significantly suggesting some preventive effect of calcium on the tendency of stone formation after jejunoileal bypass.

Parathyroidectomy was carried out in 26 patients over a 14-year period. Excellent results were obtained in patients with severe hyperparathyroidism. Vascular calcification, hypercalcaemia and pruritus did not justify surgery unless associated with unequivocal hyperparathyroidism. 13 patients required intravenous calcium infusion for up to 2 weeks to control post-operative hypocalcaemia. Calcium requirements could be predicted from the pre-operative plasma alkaline phosphatase level. Following operation continued treatment with vitamin D was necessary to prevent hypocalcaemia. Hyperparathyroidism recurred in 1 patient after 8 years and 4 patients developed osteomalacia. Since parathyroid hormone may have toxic effects other than those on bone, maintenance of normal levels should be a long-term objective in the treatment of patients with chronic renal failure. Where large parathyroid glands are present, surgical reduction in gland mass is a logical prelude to long-term suppression of parathyroid hormone with vitamin D and phosphate-binding agents.

A 14-year-old boy with focal seizures, syncopal attacks, and progressive intellectual deterioration had intracranial calcifications on a CT scan and hypocalcemia unresponsive to parathyroid hormone. The commonly recognized neurological manifestations of pseudohypoparathyroidism were complicated by signs of Friedreich's ataxia. A marked elevation of serum CPK was unexplained and was unrelated to seizures.

In terms of a short review indications and applications of infusion therapy in gastroenterology (concerning vomiting, fistulas, diarrhea, ileus and peritonitis) are discussed. It is pointed out that in cases of water and electrolyte deficiency a rigid regimen is not reasonable. If possible a balance should be obtained. Parenteral nutrition is applied in obstructions of the upper gastrointestinal tract and in maldigestion and malabsorption.

The concept of massive blood transfusion is defined not by the number of units of blood administered but rather by the relationship of the number of blood units transfused to the normal blood volume of the recipient and the rapidity of administration. The composition of stored blood can lead to different metabolic disturbances, specifically in cases of massive transfusion. The importance of hyperkalemia, hypocalcemia and citrate intoxication as well as disturbances in the acid-base balance and blood coagulation as seen in cases of massive transfusion are analysed and the necessary therapeutical consequences discussed.

We have studied some effects of small doses of 1,25-dihydroxycalciferol (calcitriol) and calcium, either combined or separately, in 45 patients with osteoporosis and malabsorption of calcium. In 24 patients on 0.25 micrograms/d of calcitriol the hourly fractional rate of radiocalcium absorption rose from 0.37 +/- 0.02 to 0.55 +/- 0.04 (p less than 0.001) and in 21 patients on 0.50 micrograms/d it rose from 0.36 +/- 0.02 to 0.69 +/- 0.05 (p less than 0.001). These responses were seen within 5 days and were not increased further at 6 weeks to 3 months. The combined therapy significantly reduced the fasting urinary hydroxyproline/creatine ratio (OHPr/Cr) and plasma alkaline phosphatase activity (ALP) in 6-12 weeks, the smaller dose of calcitriol (0.25 micrograms/d) being as effective as the larger one (0.50 micrograms/d) in this respect. Calcium alone (1 g/d) had no effect and calcitriol alone (0.25 mcg/d) had a lesser effect on both OHPr/Cr and ALP than the combined therapy. The falls in OHPr/Cr and ALP tended to be greatest in the cases with the highest initial levels but constituted only partial suppression of these variables towards the theoretical non-bone components. These results suggest that treatment with calcitriol and calcium suppresses bone resorption in osteoporosis associated with malabsorption of calcium and is more effective than calcium or calcitriol given alone.