Efficacy of intranasal human calcitonin in patients with Paget's disease refractory to salmon calcitonin.

PURPOSE: A cause for the resistance to intranasal salmon calcitonin (sCT) therapy in patients with Paget's disease is the occurrence of neutralizing antibodies to sCT. As a result, a new formulation of intranasal human calcitonin (hCT) was developed, and the efficacy investigated in patients treated earlier with sCT. PATIENTS AND METHODS: Twelve patients with Paget's disease were treated twice daily for 6 months with 1 mg synthetic hCT administered intranasally. Five patients demonstrated low-titer antibodies to sCT, and four of the patients did not respond previously to 1-year therapy with intranasal sCT. The hypocalcemic effect of 3 mg hCT was compared to that of 0.1 mg sCT before and after the intranasal hCT therapy. Serum alkaline phosphatase and the ratio between the urinary excretion of hydroxyproline and creatinine were measured before and during intranasal hCT treatment. RESULTS: The hypocalcemic response to 3 mg intranasal hCT (-6.60 +/- 0.67%, mean +/- standard error) was similar before and at the end of intranasal hCT therapy (-5.92 +/- 0.80%, p greater than 0.1). Intranasal sCT (0.1 mg) lowered serum calcium less effectively (-2.86 +/- 0.76%) than 3 mg intranasal hCT (p less than 0.05). The presence of low-titer antibodies to sCT did not affect the hypocalcemic response to sCT or hCT. As a result of the 6-month intranasal hCT regimen, serum alkaline phosphatase and urinary hydroxyproline/creatinine ratio were reduced to 62 +/- 5% (p less than 0.001) and 80 +/- 7% (p less than 0.05) respectively, of pretreatment levels. In four patients previously resistant to intranasal sCT therapy because of neutralizing antibodies to sCT, serum alkaline phosphatase was similarly lowered by intranasal hCT to 66 +/- 6% of pretreatment levels (p less than 0.05). CONCLUSION: A new formulation of intranasal hCT effectively lowered serum calcium levels, alkaline phosphatase concentrations, and urinary hydroxyproline excretion in patients with Paget's disease, some of whom were previously resistant to intranasal sCT because of neutralizing antibodies.

Locked posterior dislocation of the shoulder.

The posterior dislocation of the shoulder is a rare but clinically and radiologically well-defined entity. Missing its diagnosis can lead to locked dislocations, incorrect treatment, and shoulder dysfunction. The cases in this series will illustrate the typical errors of diagnosis and treatment, and the possible and recommended management strategies.

Discography with manometry and discographic CT: their value in patient selection for percutaneous lumbar nucleotomy.

In minimally invasive spinal surgery and percutaneous disc surgery the exact preoperative structural analysis of the disc herniation becomes a prerequisite in patient selection. Discography including discal manometry and discographic CT (in addition to CT and MRI) are used to review the anatomy of disc herniations prior to surgery. The analysis of the findings of discography in 360 lumbar discs examined from 1988 to 1994 are presented. In 68 discs operated with hemilaminectomy, later intraoperative findings were available for comparison with preoperative discographic findings. The diagnostic accuracy of determining the exact anatomical location of the herniation with discography alone was 75%. The diagnostic accuracy increased to 99.55% with the use of CT discography. The authors conclude that CT discography is an accurate and useful diagnostic aid.

[Physical therapy aspects of treatment following total hip prosthesis]. / Physiotherapeutische Aspekte der Behandlung nach Hüfttotalendoprothesen.

Our physiotherapy program after total hip arthroplasty is presented, and certain modifications in relation to cemented or cementless implantations are discussed. Three different stages must be considered: preoperative instructions of the patient, mobilization of the patient and his joints, water gymnastics to enable the patient to obtain total independence. During the first three months only partial weight should be put on the operated leg. In comparison to the cemented system, the biomechanical properties of the cementless prosthesis permit only a careful and delayed mobilization and charge of the operated leg, as long as a secondary stability of the implant has not been reached. In more complicated cases it is of importance that the whole planning of postoperative physiotherapy should be discussed individually and in detail with the surgeon concerned.

The coexistence of generations and the availability of kin in a rural community at the beginning of the nineteenth century.

"To study the influence of the city on the demographic behavior of rural people, family genealogies extending back to the beginning of the eighteenth century were reconstructed for a community near the city of Geneva [Switzerland].... The article examines kinship relations and kin network in this community at different ages.... The findings reveal a small kinship group surrounding the stable family unit, with generations overlapping sufficiently to assure the transmission of landed property as well as social reproduction without discontinuity and without the need to appeal to collateral kin for help."

[Cause of death in the 17th and 18th centuries in Geneva: nosology and disease spectrum. Perspectives and objectives of a study]. / Les causes de décès aux XVIIe et XVIIIe siècles à Genève: nosologie et pathocénose. Perspectives et objectifs d'une recherche.

For the twenty years of 1740-1759, the authors analyze, for the city of Geneva, the causes of death as officially indicated on the bills of mortality. This study is part of a larger analysis of mortality: over a longer period, the whole gamut of disease--pathocoenosis--will be studied, and some light should be shed by this on the causes of the decline of mortality in the 18th century. The data are analyzed with regard to age, sex and season and interpreted according to ancient as well as modern medical criteria.

SpO2 sensor embedded in a finger ring: design and implementation.

A novel concept of Oxygen Saturation (SpO2) sensor embedded in a finger ring is presented in this paper. Due to the mechanical conception of the probe, the sensor fits any finger topology and assures a constant force applied to the phalanx. Ambient light artifacts are rejected at the analog electronics level. Finally, an innovative distribution of light sources and detectors and a dedicated signal processing procedure resolve the anatomical heterogeneity of different phalanx topologies, compensate low perfusion indexes due to the phalanx anatomy and estimates equivalent pulse oximetry SpO2 indexes. First in-vivo validation results of the novel sensor are discussed at the end of the paper.

[Child mortality in francophone Europe: the state of the matter]. / La mortalité des enfants en Europe francophone: état de la question.

The interest of a comparative approach at a supranational level is to identify and to underscore the trends that sometimes overcome regional characteristics. Therefore among the great variety of parameters likely to influence mortality, the factors acting on levels and the factors acting on trends must be strictly distinguished. What is more striking where comparisons are possible, is the conformity of trends and the fact that evolution is not continuous but moves forward in stages. This is the reason why socio-economic explanations must be excluded. A whole part of Western Europe knew an important decline of infants' mortality at the turn of the XIXth and XXth centuries and probably also of the XVIIIth century. It was such a rapid, simultaneous extensive decline that the interference of very general factors must be acknowledged. Then the question is raised of the effect that a modification in the pathological balance can produce on the chances of infants to survive. The hypothesis considered here is a minor incidence of infectious diseases connected to changing bio-meteorological conditions (a drop in the temperature gap between winter and summer) which would have acted as a transforming mass along with cumulatiave effects because of the interactive synergy between ill-nourishment and infections. The evolution in the XIXth century and the contrasted profiles or mortality according to age confirm the hypothesis of a modification in the nosological context unrelated to the economic conditions.

[Nosology and pathocenosis: contribution to the debate about causes of the decline in mortality]. / Nosologia y patocenosis: contribucion al debate sobre las causas del descenso de la mortalidad.

"This work reminds us [of] the need to approach the study of mortality as a whole and insists upon the many factors having an influence upon its etiology. At the same time it suggests that more attention should be paid to the subjects of morbidity and the synchronical connections between illnesses.... The paper displays some results...based upon the death registries of Geneva [Switzerland] (1685-1844). Using the data for the years 1740-1759, the work studies the deaths and main death causes from the viewpoint of their gradual development [over] time, their periodicity and their distribution by age groups." (SUMMARY IN ENG AND FRE)

[Not Available]. / Malthusianisme et protestantisme: "un modèle démographique weberien".

PIP: Data from Swiss vital records since the 1600s on age at marriage and family size are presented as evidence of contraception and shown to be associated with Prostestant ethics. A treatise by L.J. Muret in 1766 stated that the women in Vaud canton postponed marriage until 28-30 years and had few children, which resulted in low death rates because of better care. In Vaud the birthrate fell from 33.8% in 1700 to 24.8% in 1785. Average age at marriage was estimated as 26 years, 9 months in Montreux. The mother's age at last childbirth averaged 32.9 years for t hose married at 20-24 years and 36.9 for those married at 25-29 in Vully parish, but 38.6-40.5 in Charney parish, a Catholic parish in the same canton. The author sampled records of Geneva from selected years in the 1600s, 4 periods of 3 or 5 years in the 1700s, and a 10% sample of the 1800s, totaling 5000 families. These data were expressed as number of births before 40 years divided by duration of conjugal life, and classified as short, medium, long (31-48 months) and contraceptive or st erile intervals (longer than 4 years). The proportion of families classed as contracepting grew from 20% in 1675 to 32% (date not stated). The author argues that Calvinism reversed the Catholic ethic in favor of fewer but better cared for children and separation of marital sex from procreation and that this new value system preceded and may have facilitated industrialization by affording better control over resources.^ieng

[Not Available]. / Surmortalité féminine et condition de la femme (XVIIe-XIXe siècles). Une vérification empirique.

PIP: Data for the town of Geneva, Switzerland, for the period 1625 to 1975 are used to examine the hypothesis that the exceptionally high death rates of women in certain age groups were related to a general worsening of the condition of women starting in the eighteenth century. Changes in mortality are examined over time by age, sex, and social class. The data suggest that although excess mortality declined for women of childbearing age, it rose for women of working age (10 to 50 years). It is also suggested that medical advances had little effect on maternal mortality from infectious diseases over this period.^ieng

[Emerging diseases and demography dynamics]. / Maladies émergentes et dynamique démographique.

The point of view presented in this work is not that of the epidemiologist interested in the etiology of diseases and their specific effect on mortality rates; but rather the view of the demographer who attempts to establish the influence that diseases have on evolution and population dynamics. It is not until the 19th century that the 'unification microbienne' of the world is reached and one has clinical and statistical data on the major diseases. Consequently, it is not possible to have an exact demographic picture of infectious diseases in their emerging phase. To understand globally this effect one may create a conceptual framework capable of integrating all the aspects of mortality rates: genetic, socio-biological and human. The scheme proposed here allows for a description and at the same time an evaluation of a given historical situation, how a population achieves protection from lethal diseases and what are the factors determining receptivity or resistance to a disease. This approach serves to study the interdependent relations that link all elements involved in a given morbid process.

[Chronic posterior shoulder dislocation]. / Die veraltete hintere Schulterluxation.

The posterior dislocation of the shoulder is frequently unrecognized for many days, months or even years after the initial accident. After the presentation of its clinical and radiological features, as the different ways of its treatment, some cases will illustrate this entity, too frequently missed or wrongly treated.

[Possibilities of shoulder arthroscopy in comparison with magnetic resonance tomography and arthro-computerized tomography]. / Möglichkeiten der Schulterarthroskopie im Vergleich zur Magnetresonanz-Tomographie und Arthro-Computertomographie.

In the last 15 years the methods of examination of the shoulder have intensively expounded. According to a well documented retrospective study we describe the value of the shoulder arthroscopy and its correlation to MRI and arthro-CT findings. MRI represents nowadays the best way of exploring rotator cuff lesions and of investigating an impingement syndrome. Associated with a contrast medium its ability to clear up an anterior or posterior shoulder instability is now superior to the arthro-CT's. The arthroscopy allows the dynamic exploration of the joint and can be used not only as a diagnostic but also as a therapeutic procedure.

Sixty children with congenital hypothyroidism detected by neonatal thyroid: mental development at 1, 4, and 7 years: a longitudinal study.

A prospective study of mental development has been carried out in 60 unselected children with congenital hypothyroidism (C.H.) detected between 1976 and February 1985. Treatment with 1-thyroxin was initiated at the age of 10.4 +/- 2.5 days and supervised by T4 and TSH monitoring in 3-6 monthly intervals. Although clinical signs were mild or missing, skeletal maturation was prenatal in more than half. Developmental testing was carried out at 1, 4 and 7 years by the Brunet-Lezine (n = 60), the non-verbal Snijders-Oomen (n = 40), and the german version of the Wechsler intelligence test (n = 20), respectively. The global DQ/IQ in all but a few children at each age group are within the 3rd and 97th percentile of the DQ/IQ distribution in a control group tested during the same period of time. The mean values of all global and subscores, however, are lower than that one in the control group, differences being highly significant at 1 year. In 21 of our 60 children, associated findings and/or risk factors were present. The DQ/IQ in children without risk factors are identical to that of the control group. There are no significant DQ/IQ differences neither between athyroidism and ectopic thyroid glands, nor between prenatal bone age and normal skeletal maturation at diagnosis. We assume that the favourable results in our children with C.H. may be ascribed to the early onset of thyroid hormone replacement and the strictly controlled compliance.