Patients' satisfaction with anesthesia in enzymatic debridement from a surgical perspective.

INTRODUCTION: Various clinical studies found that enzymatic debridement (EDNX) is superior to tangential excision after severe burns. The current study evaluates patients' satisfaction with pain management in EDNX with special respect to different anesthesia techniques. METHODS: Between 2015 and 2016, all patients at a department of plastic surgery were asked to complete a German-wide validated pain questionnaire. In a retrospective study design, satisfaction with pain management was compared between the control group (diagnosis from the whole field of plastic surgery except burns) and the EDNX group (burns treated with EDNX only). Analgosedation, general, regional and local anesthesia were chosen for pain management. RESULTS: In the control group 403 patients (153 females, 250 males, medium age 53 years) could be included The EDNX group included 88 patients (20 females, 68 males, medium age 38 years). The mean burn size was 5.3% TBSA. Between 0.5%-10.5% of the surface was treated with EDNX. EDNX patients could be treated under analgosedation and regional anesthesia, by topical anesthesia creme and without any anesthesia. They reported less pain during stress (p = 0.04) and were less frequently affected by motion (p = 0.024) and nausea (<0.001). However, they felt that they need more information about alternative anesthetic treatments (<0.001). CONCLUSION: EDNX can be performed sufficiently either under analgosedation, regional or local anesthesia. Thus, side effects of general anesthesia can be reduced and treatment costs can be decreased. However, it was found that neither after topical anesthetic creme nor after hand block pain treatment was sufficient.

Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm.

INTRODUCTION: Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands. METHODS: We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described. RESULTS: EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28. CONCLUSION: EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation.

Bromelain-based enzymatic debridement and minimal invasive modality (mim) care of deeply burned hands.

The objective was to critically review the data and assess the implications of NexoBrid [NexoBrid-NXB formerly Debrase Gel Dressing-DGD]a in the special field of deep hand burns. Detailed analysis of endpoints in the treatment of hand burn patients was conducted as part of a multi-center, open label, randomized, controlled two-arm study to evaluate the safety and efficacy of NXB enzymatic debridement, comparing it to the current standard of care (SOC). These results were compared to a large cohort of patients treated with NXB in a previous, single arm study. Thirty-one burned hands were treated with NXB and 41 hand burns were in the SOC group. In the NXB group, 4 out of 31 hand burns (12.9%) required some excisional debridement compared to 29 out of the 41 (70.7%) in the SOC group (p<0.0001). Mean percentage of burn wound area excised in the NXB group was 4.4 ± 13.1% compared to 52.0 ± 41.4% in the SOC group (p<0.0001). None of the NXB-treated hands required escharotomy compared to 4 out of the 41 (9.7%) in the SOC group. NXB enzymatic debridement demonstrated a statistically significant reduction in burn wound excision and auto-grafting compared to SOC, and seems to prevent the need for emergency escharotomy. a DGD is produced by MediWound and distributed under the name NexoBrid®.

Le but était de réaliser une révision attentive des données et d'évaluer la place de Nexobrid (Nexobrid-NXB, précédemment Debrase Gel Dressing-DGD) dans l'indication particulière des brûlures profondes de la main. Une analyse détaillée des objectifs dans le traitement des brûlures de la main a été conduite en partie par une étude multicentrique, ouverte, randomisée, contrôlée avec 2 groupes pour évaluer la sécurité et l'efficacité de ce débridement enzymatique par rapport aux soins habituels (Standard of Care ou SOC). Ces résultats ont été comparés à une vaste cohorte de patients traités par NXB dans une étude précédente sur un seul groupe. 31 mains brûlées furent traitées par NXB et 41 dans le groupe SOC. Dans le groupe NXB, 4 sur 31 mains brûlées soit 12,9 % nécessitèrent une excision partielle, alors que 29 sur 41 dans le groupe SOC (70,7 %) (p < 0,0001). La moyenne des zones brûlées excisées dans le groupe NXB était de 4,4 (+ ou - 13,1 %) comparée aux 52,0 (+ ou - 41,4 % du groupe SOC) (p <0,0001). Aucune des mains traitées par NXB ont nécessité une excision totale, comparée à 4 sur 41 du groupe SOC (9,7 % du groupe). Le débridement enzymatique NXB montre une réduction statistiquement significative de l'indication d'excision avec autogreffe par rapport au groupe traité classiquement et semble prévenir la nécessité d'une escarrotomie en urgence.

Phase de-synchronization effects auditory gating in the ventral striatum but not auditory cortex.

The underlying mechanisms and involved brain areas in sensory gating of repetitive auditory stimuli remain unclear. Especially, the influence of the auditory cortex and the role of temporal precision are under debate. Our first objective was to analyze gating dynamics of local field potentials in the primary auditory cortex and the ventral striatum in an animal experiment, particularly, assessing the influence of the cortex. The second aim was to follow the hypothesis that auditory gating results from phase de-synchronization of evoked potentials in response to the second auditory stimulus. Local field potentials were recorded simultaneously in the auditory cortex and ventral striatum of awake Mongolian gerbils (n=15) during stimulation with trains of frequency-modulated tones. Gating was analyzed by amplitude ratios of the auditory potentials evoked by the first two stimuli in a train, as well as by time-frequency analyses and between-area phase coupling. The strength of auditory gating in the striatum was found to exceed that in the primary auditory cortex by more than 50%. While total-signal-power was comparable between areas, energy in the striatum was primarily expressed in the non-phase-locked fraction. At the same time, energy in the auditory cortex remained phase-locked to the stimuli. Furthermore, we also observed a between-area phase unlocking during sound presentations. Phase de-synchronization appears to be the candidate mechanism behind attenuation of responses to identical repetitive stimuli in the ventral striatum. We conclude that a direct inhibitory response suppression by the auditory cortex plays a minor role in this process.

Reliability and cost-effectiveness of complete lymph node dissection under tumescent local anaesthesia vs. general anaesthesia: a retrospective analysis in patients with malignant melanoma AJCC stage III.

BACKGROUND: Complete lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) is currently being debated, as it is a cost-intensive surgical intervention with potentially high morbidity. OBJECTIVE: This clinical study seeks to clarify the effectiveness, reliability and cost-effectiveness of CLND performed under tumescent local anaesthesia (TLA) compared with procedures under general anaesthesia (GA). METHODS: We retrospectively analysed the data from 60 patients with primary malignant melanoma American Joint Committee on Cancer stage III who underwent CLND. RESULTS: Altogether 26 (43.3%) patients underwent CLND under TLA and 34 (56.7%) patients underwent CLND under GA. Fifteen of 43 (34.9%) patients had a complication, such as development of seromas and/or wound infections. The rate of complications was 25.0% (3/12) in the axilla subgroup and 28.6% (4/14) in the groin subgroup of the TLA group. In the GA group, the complication rate was 31.3% (5/16) in the axilla subgroup and 44.4% (8/18) in the groin subgroup. The costs for CLND were significantly less for the CLND in a procedure room performed under TLA (mean €67.26) compared with CLND in an operating room under GA (mean €676.20, P < 0.0001). CONCLUSIONS: In conclusion, this study confirms that TLA is an excellent, safe, effective and cost-efficient alternative to GA for CLND in melanoma patients.

Cardiopulmonary baroreceptors affect reflexive startle eye blink.

Baroafferent signals originating from the 'high pressure' arterial vascular system are known to impact reflexive startle eye blink responding. However, it is not known whether baroafferent feedback of the 'low pressure' cardiopulmonary system loading status exerts a similar effect. Lower Body Negative Pressure (LBNP) at gradients of 0, -10, -20, and -30mm Hg was applied to unload cardiopulmonary baroreceptors. Acoustic startle noise bursts were delivered 230 and 530ms after spontaneous R-waves, when arterial baroreceptors are either loaded or unloaded. Eye blink responses were measured by EMG, and psychomotor reaction time by button pushes to startle stimuli. The new finding of this study was that unloading of cardiopulmonary baroreceptors increases startle eye blink responsiveness. Furthermore, we replicated the effect of relative loading/unloading of arterial baroreceptors on startle eye blink responsiveness. Effects of either arterial or cardiopulmonary baroreceptor manipulations were not present for psychomotor reaction times. These results demonstrate that the loading status of cardiopulmonary baroreceptors has an impact on brainstem-based CNS processes.

[Anti-inflammatory action of a hyaluronic acid-chondroitin sulfate preparation in an in vitro bladder model]. / Antientzündliche Wirkung einer Hyaluronsäure-Chondroitinsulfat-Präparation im In-vitro-Blasenmodell.

PURPOSE: Interstitial cystitis and BPS (bladder pain syndrome) are chronic inflammatory diseases of the bladder. They are as yet imperfectly understood diseases, possibly originating from damage to the glycosaminoglycan layer of the bladder epithelium . Hyaluronic acid-containing preparations are currently utilised for palliation of the symptoms and protection of the bladder epithelium . The aim of the work described here was the evaluation of one of these preparations containing chondroitin sulfate together with hyaluronic acid. MATERIAL AND METHODS: The preparation was evaluated for its anti-inflammatory potential as well as regarding the tolerance by the bladder epithelium. The urothelial cell line T24 was employed as an in vitro model of the human bladder because of its ability to react to adequate stimuli with the release of interleukin 6. To this end the cells were treated with hyaluronic acid and chondroitin sulfate. Subsequently, TNF-alpha was applied to induce inflammation. The severity of inflammation was measured on the basis of the IL-6 released by the cells in comparison to untreated control cultures. RESULTS: A reduction of TNF-alpha-induced IL-6 release after treatment with hyaluronic acid and chondroitin sulfate was observed, indicating the anti-inflammatory action of the preparation. As shown by the large number of living cells after treatment the test preparation did not affect cell viability even in high concentrations. These data suggest a good tolerance of the product by the patients. CONCLUSION: The administration of the preparation in patients suffering from interstitial cystitis or BPS appears promising. In additional, the presented work demonstrates the feasibility of the cell culture model for the screening of new therapeutic approaches.

Continuous measurements of cerebral tissue oxygen pressure during hyperbaric oxygenation--HBO effects on brain edema and necrosis after severe brain trauma in rabbits.

INTRODUCTION: Severe brain injury is one of the most frequent causes of severe disability in the young. In acute management of brain trauma, new approaches based on experimental animal investigations should be sought. METHODS: Twenty male, juvenile Chinchilla-Bastard rabbits received standardized cold-injury-induced-brain-trauma (CIBT). A metal probe (temperature -196 degrees C) was applied epidurally over 10 s. The hyperbaric oxygenation (HBO) group (n=10) underwent 90-min HBO sessions with 100% oxygen at 2.5 atmospheres absolute (1 h, 24+/-2 h, 48+/-2 h after CIBT). Cerebral tissue pO2-measurements were performed 60 min after CIBT, during the three HBO sessions and on day 4. The control group (n=10) underwent no treatment. Animals were sacrificed on day 4, and brains were analyzed histologically. RESULTS: In the HBO group, pO2 measurements showed a significant increase in pO2 between day 1 and day 4, whereas no significant changes were observed in the control group. During the first HBO session, mean pO2 was 169 mm Hg, during the second 305 mm Hg and during the third 420 mm Hg. The mean area of necrosis was 16.2 mm2 in the HBO group, in the control group 19.9 mm2. The areas of brain edema were significantly smaller in the HBO group. Mortality in the HBO group was 0%, in the control group 20%. CONCLUSION: HBO appears to be beneficial as an adjunct treatment of severe head trauma. To find optimal treatment protocols, further clinical studies must be developed.

Caged probes: a novel tool in studying symplasmic transport in plant tissues.

Caged probes offer a novel approach to study plant cell-to-cell communication. Instead of introducing fluorescent molecules into cells by microinjection, their caged counterparts can be preloaded into the tissue by diffusion. Following spatially controlled photoactivation, movement of the uncaged fluorochrome can be followed in time and direction by confocal laser scanning microscopy. In the onion bulb scale epidermis used as a model system, symplasmic transport of the tracer out of a target cell was followed. Transport via the symplasmic pathway was challenged by plasmolysing the tissue. The experiments confirmed the symplasmic nature of tracer transport.

Elimination costs for different wastewater compounds.

The present report presents the system and discusses the results of the cost calculation for the reduction/elimination of different wastewater and sludge compounds. These costs were calculated for different types of processes at 102 wastewater treatment plants of Emschergenossenschaft/Lippeverband and Aggerverband. Comparing enhanced biological phosphorus removal and precipitation, one of the results indicates that in general the costs for elimination of one kilogram of phosphorus are lower in the plants in which only chemical precipitation is used for P reduction. Further results of the cost calculation will be presented with a discussion of their possible influence on planning decisions.

Chronic cutaneous sclerodermoid graft-versus-host disease: evaluation by 20-MHz sonography.

BACKGROUND: Chronic graft-versus-host disease (GVHD) is an immunological disorder frequently occurring as a late consequence of allogeneic bone marrow transplantation. Two variants, cutaneous lichenoid and sclerodermoid, have been described, based on clinical and histopathological examinations. It is, however, difficult to determine non-invasively the degree of cutaneous GVHD in vivo. Ultrasonographic methods have recently provided us with the means for objective and non-invasive monitoring of the dynamics of many chronic skin diseases. AIM, PATIENTS AND METHODS: In five patients with chronic cutaneous sclerodermoid GVHD skin thickness was measured with a 20-MHz B-mode ultrasound scanner (DUB 20S, taberna pro medicum, Lüneburg, Germany) in a clinically well-defined target skin lesion. Additionally cutaneous GVHD was assessed histologically before and after treatment. RESULTS: In all patients before treatment the corium of sclerotic skin was thicker than the corresponding areas of healthy skin. The skin thickness was increased from 45% to 83%. In the subcutaneous tissue proper echo-rich reflexes were prominent, representing the correlate of subcutaneous fibrotic trabeculae. In all patients ultrasonographic evidence of regression was shown (decrease of skin thickness by 18-83%). Moreover, it was demonstrated that quantitative assessment of skin thickness is feasible. CONCLUSIONS: In this paper we describe the detailed sonographic features of cutaneous sclerodermoid GVHD for the first time. As the method is simple and non-invasive, repeated examinations are possible. This provides the basis for monitoring treatment effects and efficient follow-up in these chronically progressive clinical conditions after bone marrow transplantation.

[Liposomal daunorubicine combined with cytarabine in the treatment of relapsed/refractory acute myeloid leukemia in children]. / Effektive Rezidivtherapie der akuten myeloischen Leukämie im Kindesalter mit liposomalem Daunorubicin und Cytarabin.

BACKGROUND: First-line treatment in AML commonly included high cumulative doses of anthracyclines with an increasing risk of cardiotoxicity. Liposomal daunorubicin (L-DNR) is thought to be less cardiotoxic without impairment of efficacy. METHODS: The AML-BFM REZ 97 study included two reinduction blocks with L-DNR (2 x 60 mg/m (2) n = 38, since 2/1999 3 x 60 mg/m (2) n = 31) combined with cytarabine (500 mg/m (2) 4 d). Children who achieved a second blast clearance were allocated to allogeneic stem cell transplantation either from a matched related (MRD) or a matched unrelated donor (MUD). Lack of a donor justified haploidentical SCT in early relapse (1st remission < 1 year) and autologous SCT in late relapse. PATIENTS: Between 1/1997 and 9/2001, 69 children were enrolled in the AML-BFM 97 relapse study. The median duration of first remission was 0.9 years. Forty-one patients had a remission of less than one year, 28 of more than a year. RESULTS: 46 children (67 %) achieved a second remission, defined as clearance of blasts in bone marrow and at least a partial hematological reconstitution. Seventeen of these children are alive (12 of 25 children receiving allogeneic SCT (MFD/MUD); 1 of 8 children after haploidentical SCT; 1 of 4 patients after autologous SCT and 3 of 9 patients treated with chemotherapy only). Further three children without 2nd remission survived after MFD-SCT (n = 2) or chemotherapy (n = 1; follow-up 0.3 to 0.7 years). Duration of first remission remains a significant prognostic factor. The pharmacokinetic investigation showed a high overall AUC of 234.6 mg/l h at a dose of 60 mg/m (2), and a volume of distribution of 1.98 l/m (2), which is much lower in comparison to conventional Daunorubicin. Regarding toxicity, the combination of L-DNR and cytarabine followed by SCT was feasible in experienced centers, however, acute complications like infection or septicemia in aplasia, mucositis and GvHD were common. By contrast, no clinical relevant cardiotoxicity was seen so far, but definitive results in long-term cardiotoxicity await a longer follow-up. In conclusion, L-DNR/cytarabine treatment induced a 2nd remission in most of the children with relapsed or refractory AML. It has to be followed by allogeneic SCT which enables long-term survival.

[Kurt Goldstein's understanding of amnesic aphasia and its underlying disorder - an early model of the pensée opératoire of the French psychosomatic school?]. / Kurt Goldsteins Verständnis der amnestischen Aphasie und der Grundstörung - ein frühes Modell der Pensée opératoire der französischen psychosomatischen Schule?

Kurt Goldstein's understanding of amnesic aphasia in some regards anticipated the model of the pensée opératoire, a concept developed during the 60's and 70's by the French psychoanalytical school of psychosomatics. Goldstein interpreted amnesic aphasia within the framework of a "basic disorder". Closely following the philosopher Ernst Cassirer, Goldstein described amnesic aphasia as an expression of a general alteration following localized or generalised brain damage. Due to various historical events (world war, fascism, the holocaust) as well as developments during the 20(th) century (dominance of the English language in many areas of science), these connections were forgotten or were no longer recognised as such. Without wanting to determine the extent to which the concept of pensée opératoire possesses validity, one can interpret Goldstein's reflections on aphasia as a heretofore unreceived preliminary model of the psychosomatic concept of the French School.

Tuber physiology and properties of starch from tubers of transgenic potato plants with altered plastidic adenylate transporter activity.

We showed recently that antisense plants with decreased activity of the plastidic ATP/ADP-transporter protein exhibit drastically reduced levels of starch and a decreased amylose/amylopectin ratio, whereas sense plants with increased activity of the transporter possessed more starch than wild-type plants and an increased amylose/amylopectin ratio. In this paper we investigate the effect of altered plastidic ATP/ADP-transporter protein expression on primary metabolism and granule morphology in more detail. Tuber tissues from antisense and sense plants exhibited substantially increased respiratory activity compared with the wild type. Tubers from antisense plants contained markedly increased levels of free sugars, UDP-Glc, and hexose phosphates, whereas phosphoenolpyruvate, isocitrate, ATP, ADP, AMP, UTP, UDP, and inorganic pyrophosphate levels were slightly decreased. In contrast, tubers from sense plants revealed a slight increase in adenine and uridine nucleotides and in the levels of inorganic pyrophosphate, whereas no significant changes in the levels of soluble sugars and metabolites were observed. Antisense tubers contained 50% reduced levels of ADP-Glc, whereas sense tubers contained up to 2-fold increased levels of this sole precursor for starch biosynthesis. Microscopic examination of starch grain morphology revealed that the size of starch grains from antisense tubers was substantially smaller (50%) compared with the wild type. The large starch grains from sense tubers appeared of a more angular morphology, which differed to the more ellipsoid shape of wild type grains. The results suggest a close interaction between plastidial adenylate transport and starch biosynthesis, indicating that ADP-Glc pyrophosphorylase is ATP-limited in vivo and that changes in ADP-Glc concentration determine starch yield, as well as granule morphology. Possible factors linking starch synthesis and respiration are discussed.

Macromolecular trafficking indicated by localization and turnover of sucrose transporters in enucleate sieve elements.

The leaf sucrose transporter SUT1 is essential for phloem loading and long-distance transport of assimilates. Both SUT1 messenger RNA (mRNA) and protein were shown to be diurnally regulated and to have high turnover rates. SUT1 protein was detected by immunolocalization in plasma membranes of enucleate sieve elements (SEs) in tobacco, potato, and tomato. Analysis by in situ hybridization showed that SUT1 mRNA localizes mainly to the SE and is preferentially associated with plasmodesmata. Antisense inhibition of SUT1 expression under control of a companion cell (CC)-specific promoter indicated synthesis of SUT1 mRNA in the CC. These results provide evidence for targeting of plant endogenous mRNA and potentially SUT1 protein through phloem plasmodesmata and for sucrose loading at the plasma membrane of SE.

Effects of cafestol and kahweol from coffee grounds on serum lipids and serum liver enzymes in humans.

The diterpenes cafestol and kahweol are present in unfiltered coffee in oil droplets and floating fines. They elevate serum cholesterol and alanine aminotransferase (ALT). We measured fines in coffee brews, and examined diterpene availability from spent grounds in healthy volunteers. Turkish or Scandinavian boiled coffee contained 2-5 g fines/L and French press coffee contained 1.5 g fines/L. An intake of 8 g fine grounds/d for 3 wk increased cholesterol by 0.65 mmol/L (95% CI 0.41-0.89 mmol/L) and ALT by 18 U/L (95% CI 4-32 U/L) relative to control subjects (n = 7/group). In a crossover study (n = 15), mean serum cholesterol was 4.9 mmol/L after consumption of both fine and coarse grounds for 10 d (P = 0.43). Serum ALT activities were 29 U/L on fine and 21 U/L on coarse grounds (P = 0.02). Floating fines could contribute substantially to the hyperlipidemic and ALT-elevating effect of unfiltered coffee. Diterpene measurements in coffee brews should include the contribution of fines.

[Osteocalcin and bone histology in osteoporosis]. / Osteocalcin und Knochenhistologie bei Osteoporose.

The decoupling of bone formation and bone resorption causes an insidious bone loss that is responsible for the negative skeletal balance in the frequent form of low turnover osteoporosis. The reduction of bone formation can hardly be verified by clinical methods. Osteocalcin, a non-collagenous bone protein, has proved to be a useful new indicator of bone formation. To establish its predictable value, plasma levels of osteocalcin were compared to conventional serological data of bone turnover and to histomorphometric parameters of iliac crest trabecular bone. In cases of osteoporosis with normal bone turnover activity (as confirmed by histomorphometry) no differences were observed in any of our laboratory data including osteocalcin. However, there was a significant lower mean serum level of osteocalcin in a group of patients with histomorphometrically proven low turnover osteoporosis in comparison to those with normal bone turnover. Serum levels of osteocalcin below 2.0 ng/ml seem to indicate a low turnover in the individual case of osteoporosis while this is unlikely when serum levels above 6.0 ng/ml are measured (according to our RIA).

Enhancement of spontaneous and lymphokine activated human macrophage cytotoxicity by hyperthermia.

Human macrophages grown on hydrophobic teflon membranes from blood-born monocytes were incubated at hyperthermic temperatures for various time periods and then tested for their ability to inhibit the growth of an allogeneic lymphoma cell line (U 937). Incubation at 40.5 degrees C greatly enhanced macrophage cytotoxicity. This effect of hyperthermia developed slowly with an optimal incubation period of 48 h. In addition, lymphokine activation of macrophages for cytotoxicity appeared to be more effective at elevated temperatures.

[Immunoreactive parathyroid hormone, 25-hydroxycalciferol and bone histology in renal osteodystrophy (author's transl)]. / Immunoreaktives Parathormon, 25-Hydroxycalciferol und Knochenhistologie bei renaler Osteopathie

Immunoreactive parathyroid hormone (iPTH) and 25-hydroxycalciferol (25(OH)D) serum levels were determined in 32 patients with renal osteopathy, they were correlated with the results of bone biopsy and other clinical parameters. iPTH was closely related to bone histology, it did not correspond to serum calcium and alkaline phosphatase, but the correlation to serum phosphate was statistically significant. 25(OH)D levels were not related to the histological findings of osteomalacia or increased bone resorption, while a correlation between the vitamin D metabolite and serum calcium could be observed. Since iPTH and 25(OH)D levels exhibited a significant correlation, an inhibitory effect of 25(OH)D on parathyroid gland function in renal failure was discussed.