[Osteoporosis in anorexia nervosa. New aspects of pathogenesis and therapy]. / Osteoporose bei Anorexia nervosa. Neue Aspekte der Pathogenese und Therapie.

Osteoporosis has been shown to be a relatively common complication of anorexia nervosa (AN). So far the exact mechanisms which are implicated are not fully clarified. Several factors such as malnutrition, reduced body weight, amenorrhea, and hypercortisolaemia seem to be involved. There is a strong relationship with the duration of amenorrhea and--in some studies--with the age of onset. Osteoporosis is for a long time a "silent" disease and the first symptoms such as back pain, loss of height, kyphosis, and fractures are late complications. Therefore, routine screening methods for bone density measurements should be established. The most accurate is the dual energy X-ray absorptiometry (DEXA). Therapeutically the primary aim should be to reach restoration of both normal body weight and regular menses. As AN is a chronic disease clinicians should be aware of the dangers of osteoporosis and start with the treatment and/or prevention of osteoporosis early. However, at this stage it is difficult to provide an evidence-based management plan for osteoporosis in AN. Hormone replacement therapy (HRT) as well as calcium and vitamin D-supplementation are under discussion, however, further controlled investigations are warranted.

Osteopenia in anorexia nervosa: specific mechanisms of bone loss.

Osteopenia is a well recognized medical complication of anorexia nervosa (AN). The mechanism of bone loss is not fully understood and there is uncertainty about its management. New markers of bone turnover have been developed. C-terminal type 1 propeptide (PICP) is a measure of bone formation and urinary pyridinolines such as deoxypyridinoline (DPYRX) and serum carboxyterminal crosslinked telopeptide (ICTP) are markers of bone resorption. The aim of this study was to examine these bone markers in patients with AN. Twenty female patients with AN and 12 healthy controls were included in the study. Bone mineral density (BMD) of AN patients was measured by dual energy X-ray absorptiometry (DEXA). Lumbar bone density was significantly reduced in the AN group compared to standardised values of thirty year old adults (t-score 83.2%, S.D. 12.1). Femoral neck bone density showed an even greater reduction (t-score 79.4%, S.D. 13.5). We found a significant negative correlation between femoral BMD and the duration of the illness. Femoral BMD correlated significantly with minimal body weight (r(16) = 0.504, p = 0.033). The markers of bone resorption were significantly higher in the patients with AN compared to the values of the control group (ICTP t(30) = -2.15, p = 0.04, DPYRX t(25) = -2.26, p = 0.033), whereas the markers of bone formation did not differ significantly between the groups. AN appears to be a low turn over state associated with increased bone resorption without concomitant bone formation. This pattern differs from osteopenia in menopausal women and should, therefore, lead to the development of specific therapeutic strategies in AN associated osteopenia. Hormone replacement therapy as well as calcium and vitamine D-supplementation are so far discussed controversially. Long-term treatment studies are warranted.

Hystero-salpingo scintigraphy: a routine investigation in sterile women?

Based on the spontaneous migration of radioactive tracer from the posterior vaginal fornix to the ovaries and peritoneal cavity, several attempts were made to assess hystero-salpingo scintigraphy (HSS). The low acceptance rate by sterile women of routine investigation of tubal function may be due to a fear of radiation exposure and unpleasant examination procedures. Our protocol for HSS adopts a low dose of radioactive tracer (0.2-0.3 mCi), a defined mode of application (between the external and internal os of the cervical canal) and a short imaging time (60 min). From 1990 to 1992, we investigated 60 fallopian tubes in 32 sterile women by HSS, hystero-salpingography (HSG) and/or chromopertubation during laparoscopy (LPSC). The results of HSG and HSS corresponded in 15 of 49 fallopian tubes, LPSC and HSS in 9 of 24. None of the 32 patients had become pregnant naturally during the average observation period of 17 months. Two patients became pregnant after in-vitro fertilization. HSS, performed according to our protocol, causes less pain and results in a lower dose of radiation than HSG (about 50%). It is well accepted by patients and is easy to perform. As an investigation of tubal function, HSS may serve as an additional examination technique in cases of presumed tubal sterility.

[Tuboscopy--an endoscopic approach to the intratubal lumen]. / Die Tuboskopie--Ein endoskopischer Zugang zum intratubalen Raum.

A linear everting catheter in combination with a 0.5-mm microendoscope enables the visualization of the tubal lumen. In 35 sterility patients, diagnostic tuboscopies were performed. Physiological and pathological results of tubal mucosa are described. Tuboscopy is a main tool in the diagnosis of the tubal factor. First steps are taken to use tuboscopy not only for diagnostic but also for therapeutic reasons. Yet, the role of this technique in cases of tubal pregnancies cannot be evaluated.

[Serum proteins in vaginal and abdominal hysterectomy]. / Serumproteine bei vaginaler und abdomineller Hysterektomie.

Postoperative changes in various acute-phase-proteins (alpha 1-antitrypsin, c-reactive protein), alpha 2-macroglobulin, haptoglobin, transferrin, c3-c4-complement and myoglobin as well as four endocrine parameters (TBG, SHBG, prolactin and cortisol) were studied in forty healthy women divided into two groups. Each group consisted of 20 women who underwent either vaginal or abdominal hysterectomy. Differences between both groups related to both operative methods, seen in determination of 2-acute-phase-proteins, alpha 1-antithrypsin, CRP and the muscle specific myoglobin where established, whereby no statistically significant differences were apparent concerning the other parameters and hormones.

[Plasma thiocyanate determination: a simple method for quantifying the smoking habits of pregnant patients--a preliminary study]. / Plasma-Thiozyanatbestimmung: eine einfache Methode zur Quantifizierung der Rauchgewohnheiten Schwangerer--eine Vorstudie.

Plasma thiocyanate (SCN) was measured by means of a simple colorimetric method [8] in 328 persons (175 males, 153 females, aged 5-68 years) as part of an ongoing prospective trial on the influence of SCN defined maternal smoking on fetal development. The interassay coefficient of variation for synthetic K thiocyanate solutions was 3.1% (n = 25%); the intrassay coefficient of variation was 1.2% (n = 15). Mean SCN levels were significantly lower in 226 nonsmokers (SCN 41.4 +/- 18.5 mumol/l) than 102 smokers (SCN 81.4 +/- 28.7 mumol/l; p less than 0.01). Of all the variables tested, a direct influence on SCN was found only in the case of diabetes mellitus and haemolytic blood samples (p less than 0.01), whereas age, sex, chronic diseases and nutrition had no effect on SCN. Mean maternal post partum SCN levels (n = 48) were significantly lower in non-smokers (30.2 +/- 11.2) than in smokers (59.3 +/- 23.1). There was a linear relationship between maternal venous plasma and fetal umbilical cord plasma SCN values (r = 0.88; p less than 0.01). Pregnant women had lower SCN levels than non-pregnant women. We conclude that SCN is an easy means of measuring and a reproducible parameter for quantifying smoking behaviour in pregnancy and in the general population.

[Endocrinology of mastopathy and small breast cancer]. / Endokrinologie der Mastopathie und des kleinen Mammakarzinoms.

The role of hormones in the cancerogenesis of breast cancer is still discussed. It is not clear at the moment if sexual hormones are primarily or secondarily in wall in cancerogenesis. Beside the discussion it is clear that estrogen, progesterone, androgens, prolactin and thyroxin have influences on the physiology and pathophysiology of the breast tissue. Furthermore the isoforms of these hormones and also the sexual hormone, binding-protein could be of interest. At last also the receptor evaluation becomes of interest in the etiology and therapy of breast cancer.