Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis.

INTRODUCTION: Osteoporosis is seen in some 12-50 % patients with liver cirrhosis. Detrimental effects of alcohol are exerted directly on the bone cells and indirectly on hormones. Vitamin D is involved in osteoblast differentiation, bone matrix synthesis and bone mineralization, as well as in its decomposition. Vitamin D deficiency has been reported in about 2/3 patients with liver cirrhosis. OBJECTIVE: Determination of vitamin D status, bone metabolic activity and bone mass in patients with alcoholic liver cirrhosis (ALC). METHODS: Thirty male patients with ALC were investigated in the period October 2011- March 2012. Total vitamin D, parathormone, osteocalcin and CrossLaps were determined by the ECLIA method (electrochemiluminiscence immunoassay) using Elecsys 2010 analyzer. Bone mineral density was measured by means of dual-energy x-ray absorptiometry (DXA) using the Lunar Prodigy. Result analysis was performed using descriptive statistics and hypothesis testing, as well as nonparametric one-way analysis of variance, Kruskal-Wallis test, Mann-Whitney U-test, Pearson correlation coefficient. RESULTS: Deficiency in vitamin D (< 50 nmol/l) was noted in 66.66 % patients, with highest prevalence in Child-Pugh C class patients (chi-square = 5.878, p < 0.05). Osteocalcin levels were below the lower limit of normal in 86.7 % patients. CrossLaps was increased in only 20 % patients, but a significant increase was noted in Child-Pugh C class patients. Osteoporosis was diagnosed in 20 % of patients, with no correlation with disease severity and vitamin D status. CONCLUSIONS: Vitamin D deficiency is present in patients with ALC. Decrease in bone formation and bone mass is most probably multicausal (Tab. 2, Fig. 1, Ref. 30).

Hydrophilic gels containing chlorophyllin-loaded liposomes: development and stability evaluation.

The aim of this study was to develop and characterize hydrophilic gels containing chlorophyllin(CHL)-loaded liposomes as well as to evaluate their stability. Two different CHL-loaded liposome dispersions using non-hydrogenated and hydrogenated soybean lecithin were prepared, characterized for their particle size, polydispersity index and trapping efficiency and incorporated in Carbopol 940 NF hydrogel. The gels obtained were analyzed for flow properties, pH values and CHL content. The control liposome-free gel was obtained by incorporating the CHL solution in the hydrogel. The stability of the gels was evaluated in terms of rheological properties, pH values and CHL content during 6 months' storage at 20 +/- 2 degrees C. Suitable gel formulations for topical use were obtained revealing shear-thinning plastic flow behaviour without significant thixotropy during the whole period of examination. High yield values of the samples during the whole period indicated a long-term stability of the gel formulations. The gel formulations expressed a mild acid value acceptable for topical preparations. After 6 months' storage the CHL content was highest in the gel containing non-hydrogenated lecithin liposomes, followed by the gel containing hydrogenated lecithin liposomes and liposome-free gel, indicating that the encapsulation of CHL in liposomes led to a greater stability of CHL.

[Hyperinsulinemia as a key factor in the development of many metabolic disorders]. / Hiperinsulinemija kao kljucni faktor u nastanku brojnih metabolickih poremecaja.

Insulin resistance and consequent hyperinsulinemia present a frequent disorder and according to some investigations it is present in a quarter of whole population. Leaving aside numerous genetic syndromes caused by pronounced insulin resistance, this paper surveys the influence of specific arrangement of fat tissue in the development of this disorder, its role in insulin-independent form of diabetes, development of lipidic and lipoproteinic disorders, in the essential arterial hypertension, and finally, in the appearance of accelerated and premature atherosclerosis. Further intensive investigations of this problem will probably result in achieving a definite explanation of the importance of hyperinsulinemia as a marker of cardiovascular risk.

[Use of radionuclide quantitative analysis in routine diagnosis of metabolic bone diseases]. / Primena radioizotopskih kvantitativnih analiza u rutinskoj dijagnostici metabolickih bolesti kosti.

Global and regional quantity indexes of metabolic bone activities are determined on the basis of given scintigraphic dose for skeleton examination. The calculation of all analyzed indexes was carried out in all cases of the control group and patients with established disturbance of bone tissue metabolism. When choosing the method used in the routine work, apart from diagnostic value of analysis numerous criteria have been respected. The analyzed global quantity indexes of metabolic bone activity adapted to conditions of routine work have similar diagnostic value, while the best regional index relating bone soft tissue is the one concerned with the upper leg. As the examined quantity indexes enable more reliable interpretation of the scintigraphic findings, in everyday work the scintigraphic examination should be filled in by determination of corrected retention of activity in the whole body and calculation of radiosotope analysis significantly depend one the kidney function and urine elimination.

Renal osteodystrophy--pathophysiological aspects.

The aim of this study was to evaluate status of bone metabolism in patients on chronic maintenance dialysis, to elucidate dominant mechanisms in the genesis of renal osteodistrophy (ROD) with simultaneous measuring of biochemical regulators and parameters of bone metabolism and scintigraphic study of metabolic activity of the skeleton. We found that disturbance of skeletal homeostasis existed in all patients, dominant hyperparathyroid bone disease was found in most of them, mixed uremic osteodistrophy (hyperparathyroidism and vitamin D deficiency) was observed in less percent, i.e. only in 6% renal bone disease with low turnover due to osteomalacia or adynamic bone disease was present. Simultaneous determinations of most relevant factors of bone metabolism and scintiscan discover changes in skeletal homeostasis, and can prevent severe disturbances and treat adequately those ones which already exist.

Hip scintigraphy in the diagnosis and evaluation of morbus Perthes.

During this research the role and significance of hip scintigraphy in diagnosis and evaluation of Perthes disease were examined. Three phase scan was applied in 35 patients clinically suspected of Perthes' disease. There were no false positive findings in 20 patients who did not suffer from Perthes' disease and all 15 who suffered from disease were scintigraphically positive. Our investigation confirmed clearly that late scintigraphy conducted with pinhole colimator can be used as a reliable method for diagnosis and evaluation of Perthes' disease.

Usage of quantitative static scintigraphy of the thyroid gland in defining the therapeutical dose of radioiodine.

In a group of 21 patients sent by endocrinologist for antihyperthyreosis therapy with radioactive iodine, we calculated and compared the weight of the thyroid gland by quantitative static scintigraphy, using two computed parameters--according to surface and volume of the gland. Statistically we came to the conclusion that weight of the thyroid gland calculated on the basis of surface gives significantly higher values than calculation by the use of volume. The calculation of weight of the thyroid gland using the surface of scan image is recommended, while quantitative static scintigraphy increases the standardisation of the procedure very much.

[The importance of intact parathyroid hormone determination in the evaluation of parathyroid gland function]. / Znacaj odredivanja intaktnog paratireoidnog hormona u proceni funkcije paratireoidnih zlezda.

The study investigates the importance of determining the intact parathormone in the evaluation of parathyroid gland function in different conditions of change in their function and the alteration of parathormone metabolism: primary and secondary hyperparathyroidism, hypoparathyroidism and hyperthyroidism. The role and place of intact parathormone determination in routine diagnostic schemes of calcium homeostasis disorders was reviewed by the simultaneous determination of the indicators of calcium and bone metabolism and other calcium homeostasis hormone regulators, as well as the C- and N-terminal parathormone fragments and by establishing their mutual links with the values of the intact parathormone.

[Quantitative static scintigraphy of the thyroid gland]. / Mogucnosti kvantitativne staticke stintigrafije stitaste zlezde.

The paper describes a static scintigram computer processed by the Siemens-Euromeni method which gives rather accurate parameters concerning the overall functional thyroid tissue mass, as well as functions of a certain thyroid gland node. It facilitates the calculation of the dimensions of the right-angled field which borders the thyroid gland (cm), radioactivity uptake (% of a given dose) in the whole gland, left and right lobe, the ratio between the left and right lobe uptake, the surface (cm2) of the whole gland and of the left and right lobe, the ratio between the left and right lobe surfaces, the number of impulses (imp) registered in the whole gland and in the left and right lobe, the volume (cm3) of the whole gland and of the left and right lobe, the ratio between the left and right lobe volume, as well as the surface and radioactivity uptake (% of a given dose and % of the total uptake) in the marked nodes. An additional calculation could offer an uptake ratio per surface unit between the node and paranodal tissue which, by the use of suppression tests offers a very accurate assessment of the function and compensation of each node. The method represents a significant contribution to an accurate assessment of the functional mass as well as to the assessment of nodal changes of the thyroid gland.

[Significance of highly sensitive (immunoradiometry assay) TSH in the evaluation of hypothalamo-hypophyseal-thyroid axis function]. / Znacaj visokoosetljivog (IRMA) TSH u proceni funkcije hipotalamo-hipofizno-tireoidne osovine.

A diagnostic value of immunoradiometric TSH assay in the evaluation of the function of hypothalamo-hypophyseal-thyroid axis was investigated in this paper. Normal values of basal TSH and TSH response during TRH test were determined by the use of ROC analysis. It was found out that there was a highly significant correlation between basal TSH and the responses during TRH test and that the diagnostic value of basal TSH in the evaluation of function of thyroid axis was almost identical to the diagnostic value of responses during TRH test. This finding pointed to the fact that basal TSH determination could replace the application of TRH test in diagnostic of thyroid axis disturbances. Comparing diagnostic value of basal TSH with other tests which served for the confirmation of thyroid axis disturbances, this test proved to be dominant, the most specific and the most sensitive in respect to other applied tests and could be regarded as the first step in diagnostic scheme of thyroid disturbances.

[Radioimmunologic determination of growth factors. I. Determination of somatomedin C]. / Radioimunolosko odredivanje faktora rasta. I. Odredivanje somatomedina C.

The authors' first experience in the determination of plasma somatomedin C concentration by the radioimmunologic method without extraction was put forward. The method itself was checked up through the routine indicators and the range of normal limits was established by the determination of this concentration in the plasma of 15 healthy persons. Values of plasma and serum determination greatly differentiated. By the determination of somatomedin C concentration and growth hormone during the insulin test in 8 persons it was shown that somatomedin C concentration did not change by the abrupt and short changes in growth hormone concentration. A good correlation was made by the comparison of sometomedin C and growth hormone basal concentration in 16 samples whereby the regulatory role of growth hormone in somatomedin C excretion was confirmed. In conclusion, radioimmunologic determination of sometomedin C in diagnostics and the therapy of growth disturbance was emphasized.