Abstract. The bone mineral content (BMC) of 35 patients with primary hyperparathyroidism (PHPT) was measured at the mid radius (95% cortical bone) by photon absorptiometry of a 241Am source. The majority of the patients had an overt disease of moderate to severe degree. Average serum calcium of the group was 12.3 mg/100 ml (range 10.6 to 18.0 mg/100 ml). The percentage of normality of the BMC was (Av ± 1 sd) 75.1 ± 13.0% for the whole group. The average increment of BMC in 14 patients 9 to 26 months after parathyroidectomy was 9.9%, with a wide dispersion. However a highly significant negative correlation (r: 0.83; P < 0.01) was found between the initial bone mass and the percentage increment per month after surgery. No further gain was observed 2 years after parathyroidectomy except in one patient with an extremely severe bone loss. In spite of the gain obtained after surgery the bone mass remained markedly diminished in most patients showing that the cortical bone loss caused by PHPT is mainly irreversible.

Since osteoporotic fractures are mainly related to the diminution of the bone mineral density (BMD), the effect of pamidronate (3-amino-1-hydroxy-propylidene) 1,1-bisphosphonate on the BMD of the spine, proximal femur and radius shaft was evaluated in an initial cohort of 35 postmenopausal women with at least one vertebral fracture due to involutional osteoporosis. Pamidronate was given continuously during 18 months in a daily oral dose of 4.8 to 6.0 mg/kg supplemented with calcium (1 g/day). BMD--measured by dual photon absorptiometry--increased after one year 5.3 +/- 1.0% (P less than 0.001) in lumbar spine and 5.3 +/- 1.5% (P less than 0.001) over trochanter. However no significant changes were observed in the BMD of the femoral neck, Ward's triangle or in the cortical bone of the radius shaft measured by single photon absorptiometry. Pamidronate also decreased significantly urinary hydroxyproline-creatinine excretion after 6 months and thereafter maintained a plateau. After 18 months of treatment the diminution was 42.6 +/- 4.9% (P less than 0.001). The differing effects of pamidronate on the BMD of lumbar spine and proximal femur might be ascribed to dissimilarities between the proportions of trabecular and cortical bone in these. These results suggest that pamidronate may be prescribed to prevent fractures in cases of involutional osteoporosis with a significant decrease of BMD in lumbar spine and/or trochanter.

The bone mineral density (BMD) of the radius and spine was determined by photo absorptiometry in a large number of controls (radius: n = 111; spine: n = 85; age range: 50-79 years) and osteoporotic women (radius: n = 98; spine n = 140; age range: 50-79 years) with at least one "atraumatic" vertebral compression fracture. Compared to age-matched controls, the BMD of the osteoporotic women showed the following diminutions: sixth decade: radius: -9.1%; spine: -25%; femur: -33%; seventh decade: radius: -16%; spine: -19%; femur: -23%; eighth decade: radius: -21%; spine: -20%; femur: -24%. The BMD was significantly diminished at all sites in all decades but in contrast to the radius, the difference from controls was bigger in the spine and femur in the sixth decade than in the seventh and eighth decade. In the osteoporotic women there was a significant correlation between radius BMD and age (r = -0.56; P less than 0.01) but not between spine or femoral BMD and age. The femoral neck BMD was also determined in a subset group of female controls (n = 68), patients with crush fractures of the spine without a fracture of the hip (n = 46), and in patients with fractures of the proximal femur (n = 21). There was no difference among these groups in mean age (64 +/- 7, range: 50-79 years). Patients with hip fracture and spine fracture showed bone diminution in all three regions that was significantly below controls (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

1-hydroxypropylidene-1,1-bisphosphonate (APD) in the treatment of patients with Paget's bone disease. Medicina (B Aires) (in press). Van Breukelen FJM, Bijvoet OL, Van Oosterom AT. Inhibition of osteolytic bone lesions by (3-amino-i-hydroxypropylidene)-1,1-bis

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A case of amniotic fluid embolism during the delivery of a twin pregnancy is reported. After immediate resuscitation with artificial ventilation the mother and the neonates survived the acute episode. As a result of hyperfibrinolysis with premature separation of the placenta a dramatic postpartum haemorrhage occurred, which could be controlled by Fritsch' manoeuvre. Meanwhile it was possible to restore the coagulation disorder with fresh whole blood, fibrinogen and an antifibrinolytic agent (Aprotinin).