Increased serum osteocalcin levels in elderly females with vitamin D deficiency.

Serum levels of osteocalcin (OC), a 49 amino acid bone matrix protein, have been found to be a biochemical parameter of bone formation. In order to study bone metabolism in aging subjects we measured serum levels of OC, parathyroid hormone (PTH) and 25 hydroxy-vitamin D (25 OH Vit D) in 36 institutionalized elderly females (age range: 80-93 years) and in 21 premenopausal control subjects. Serum levels of 25 OH Vit D were significantly decreased in the elderly subjects (p less than 0.0001), whereas serum levels of OC and PTH were significantly higher in the elderly subjects than in the controls (p less than 0.0025 and p less than 0.0001, respectively). Serum OC levels correlated significantly with the serum PTH levels (p less than 0.009). Our data demonstrate that in elderly females with vitamin-D deficiency secondary hyperparathyroidism is associated with increased serum OC levels indicating an increased bone formation; these conditions might contribute to the bone disease of geriatric patients.

Double-blind, placebo-controlled, clinical, psychometric and neurophysiological investigations with oxiracetam in the organic brain syndrome of late life.

The therapeutic efficacy and safety of oxiracetam (ISF 2522), a new nootropic cyclic GABA derivative, were investigated in a double-blind, placebo-controlled study in 40 patients with organic brain syndrome in late life. The psychopathology was characterized by memory deficits, intellectual dysfunction, lack of drive, and disturbance of affectivity. Patients were randomly assigned to a 4-week treatment with either 2 X 400 mg oxiracetam capsules t.i.d. or identical placebo capsules in the same dosing schedule. Evaluation of the psychopathology and side effects was carried out at weeks 0, 1 and 4; laboratory tests (hematology, blood chemistry and urinalysis), a battery of psychometric tests and quantitative EEG investigations were done at weeks 0 and 4. In the oxiracetam group a slight but significant improvement in global symptomatology was observed within 1 week, with further improvement after 4 weeks. In the placebo group, an improvement was seen only in the 4th week. Evaluation of the detailed psychopathology by means of the Sandoz clinical assessment geriatric scale (SCAG) showed in the oxiracetam group significant improvements in loss of appetite and vertigo after 1 week and in short-term memory, anxiety, emotional lability, fatigue, loss of appetite and vertigo after 4 weeks. In contrast, not a single item improved significantly during placebo treatment. Although the differences in SCAG scores between the two groups failed to reach statistical significance, the overall trend towards improvement was significantly better in the oxiracetam group. The tolerability of the drug was good.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term treatment with Des-Phe-Insulin]. / Langzeittherapie mit Des-Phe-Insulin.

At a geriatric department 61 insulin-dependent diabetics have been treated with des-phe-insulin (DPI) for periods of up to 6 years since 1976. The use of either pure DPI, amorphous DPI or DPI mixed with varying amounts of crystalline non-modified insulin of the same species allowed flexible longterm therapy, as well as management of metabolic emergencies. Comparison of the doses needed before and after change to and from other insulin preparations showed no difference in efficacy. No side effects of such severity as to necessitate interruption of therapy were observed.

Enzymes of the purine interconversion system in chronic lymphatic leukemia: decreased purine nucleoside phosphorylase and adenosine deaminase activity.

Activities of adenosine deaminase (ADA), adenosine kinase (AK), adenine phosphoribosyltransferase (APRT), hypoxanthine guanine phosphoribosyltransferase (HGPRT), and purine nucleoside phosphorylase (PNP), all enzymes of the purine interconversion system, were determined in lymphocytes of 25 patients with chronic lymphatic leukemia (CLL) and in 23 controls. A statistically significant decrease of PNP activities and a reduction of ADA activities at borderline levels were found in the patients, whereas for the other enzymes assayed no deviation from normal values was observed.

[Monoclonal gammopathy and platelet function (author's transl)]. / Monoklonale Gammopathie und Thrombozytenfunktion.

This study of 20 patients with monoclonal gammopathy (17 patients with multiple myeloma and 3 patients with Waldenström's syndrome) showed a decreased platlet aggregation induced by ADP and collagen, a reduced platlet retention and a prolonged bleeding time in 25% of the cases in comparison with 30 age- and sex-matched healthy controls. Using Wu and Hoak's technique as increased number of reversible platelet aggregates was observed. There was no relationship between the parameters of primary haemostasis and protein analysis. A disturbed mechanism of primary haemostasis is the main factor responsible for the bleeding diathesis in patients with monoclonal gammopathy.

[Monocyte cytotoxicity in Hodgkin's disease]. / Monozytenzytotoxizität bei Morbus Hodgkin.

Monocyte mediated antibody dependent cellular cytotoxicity (ADCC) was determined in 23 patients with Hodgkin's disease and 29 normal healthy controls. ADCC activity of monocytes was found to be significantly increased (p less than 0.01) in patients when compared to the controls. No significant difference was observed in the number of non specific esterase positive-monocytes in both groups of individuals, investigated. Thus increased ADCC activity of monocytes in Hodgkin's disease in this particular ADCC system is due to an increased lytic capacity of monocytes.

[New aspects in the clinical course determination and therapy in multiple myeloma]. / Neue Aspekte über die klinische Verlaufsbeurteilung und Therapie beim multiplen Myelom.

Multiple myeloma can be regarded as model disease for quantification of tumor mass, investigation of tumor cell kinetics and of tumor response to therapy. The quantification of the tumor cell number allows evaluation of prognosis and monitoring of disease as well as of therapy induced responses. Treatment of multiple myeloma is primarily based on the alkylating drugs cyclophosphamide and melphalan. In recent years other cytostatic substances, also effective in the treatment of this disorder have been introduced. However, the sensitivity determination of the individual myeloma stem cells seems to be the only possible method which possibly increases the response rate significantly. In accordance with these considerations we have, in preliminary clinical investigations, observed a good correlation between the in vitro determined cytostatic drug sensitivity and the in vivo response to therapy. Further progress in the treatment of multiple myeloma is to be expected with the introduction of interferon into the therapeutic regimen. Administration of this glycoprotein has resulted in significant reduction of tumor mass in more than half of all patients treated up to this time.

[The problems of informing oncological patients]. / Probleme der Information onkologischer Patienten.

The "phase-model" of Kübler-Ross represents useful auxiliary means, which however prove correct only in a portion of the cases. The information of the diagnosis of a malign disease constitutes one of the most difficult medical problems and requires certain basic conditions. As a rule it cannot be delegated but must be solved within the realm of oncology. In the future it will be necessary to inform the patients concerning their malign disease very much more than is is presently done.

[Ferrokinetic studies in haemoglobin Wien haemolytic anaemia (author's transl)]. / Eisenkinetische Untersuchungen bei der Hämoglobinopathie Wien.

Ferrokinetic studies in two patients with haemolytic anaemia due to haemoglobin Wien revealed increased haemoglobin synthesis and an increase in effective erythropoiesis. Haemolysis is due to an instability of the haemoglobin itself. The spleen does not appear to play any appreciable role in the aetiology of this condition. There was no extramedullary erythropoiesis in our patients.

[Determination of the tumor cell mass and its significance as a parameter for prognosis and therapy in patients with multiple myeloma]. / Die Bestimmung der Tumorzellmasse und ihre Bedeutung als Parameter für Prognose und Therapie bei Patienten mit multiplem Myelom.

In 19 patients with multiple myeloma tumor cell mass was determined. In addition the influence of tumor cell number on certain clinical parameters as well as on survival time has been analysed. In some patients the behaviour of tumor cell number in the course of different therapeutic regimen was studied. A close correlation between tumor cell mass on the one side and certain clinical parameters as well es more objective rationale for planning further therapy regimen can be obtained with the application of this method.

[The question of the diagnostic value of increased erythrocyte enzymes in leukemia]. / Zur Frage der diagnostischen Wertigkeit erhöhter Erythrozytenenzyme bei Leukosen.

The investigated erythrocyte enzymes (LDH, pyruvatkinase, Glukose-6-phosphat-dehydrogenase) are moderately to extremely elevated in most cases of leucemia. There exists no significant correlation to the number of reticulocytes and the erythrocyte half life time.

[Fetal haemoglobin levels in acquired and congenital haematological diseases and malignant tumours in adults (author's transl)]. / Das fetale Hämoglobin bei hämatologischen Erkrankungen und malignen Neoplasien des Erwachsenen

Hb F values were estimated in 336 adults on 525 occasions. A variable elevation appeared not only in patients with a variety of haematological diseases, but also in conjunction with malignant neoplasms, liver disease etc. The highest values were encountered in cases of pernicious anaemia, haemolytic anaemia, panmyelopathy and plasmocytoma. The determination of Hb F in peripheral blood smears by means of this extremely simple elution method (Betke and Kleihauer) represents a useful tool in the diagnosis of haematological disorders in adults, especially the haemoglobinopathies. The possible causes of this biochemical redifferentiation of erythropoiesis are discussed.