Using the intra-arterial 133xenon (133Xe) method, the cerebrovascular response to acute Paco2 reduction was studied in 26 unconscious, brain-injured patients subjected to controlled ventilation. The CO2 reactivity was calculated as delta in CBF/delta Paco2. The perfusion pressure was defined as the difference between mean arterial pressure and mean intraventricular pressure. Although the CO2 reactivities did not differ significantly from that in awake, normocapnic subjects, it was low in the acute phase of injury, especially in those patients with severe outcome in whom the brain-stem reflexes were often affected. An increase of the CO2 reactivity with time was observed, indicating normal response after 1-2 weeks. Chronic hypocapnia in six unconscious patients resulted in sustained CSF pH adaptation. The question whether a delay in CSF pH adapation exerts an influence on the CO2 reactivity, and the influence of cerebral lactacidosis on the CO2 response are discussed.
Seventy-seven calcium balance and 47Ca turnover studies were performed in normal volunteers (n = 15) and in patients with osteoporosis (n = 12), primary hyperparathyroidism (n = 8), osteogenesis imperfecta (n = 5), medullary carcinoma of the thyroid (n = 4), thyrotoxicosis (n = 2) and intestinal bypass for obesity (n = 11). After intravenous injection of 20 microCi of 47Ca two retention curves of 47Ca were obtained: R1(t) directly measured on a whole-body counter and R2(t) calculated from the cumulated daily excretions of 47Ca in urine and faeces. The data were fitted to a modification of the continuously expanding exchangeable calcium pool model. Dermal calcium loss was estimated from the serum 47Ca specific radioactivity curve and the constantly increasing difference between the two retention curves. The median dermal calcium loss in 77 studies was 1.50 mmol 24 h-1 1.73 m-2 (range 0.13-4.60). The dermal calcium loss might be overestimated by redistribution of tracer or by eventual insufficient collection of urine and faeces. The possible influences of these errors have been evaluated. Patients with primary hyperparathyroidism had a greater (P less than 0.02) dermal calcium loss (2.64 mmol; range 0.80-4.50) than a control group (1.38 mmol; range 1.25-2.34).
Clinical findings of four female members from one family with familial hemiplegic migraine are briefly summarized. Cerebral blood flow (CBF) studies using the xenon 133 inhalation method were carried out during and between hemiplegic attacks in two of the family members. CBF was significantly lower over the affected hemisphere during attacks, while equal flow on both sides was seen in headache free periods. The findings indicate that cerebral perfusion is altered, but not necessarily decreased during attacks of familial hemiplegic migraine.
A group of 85 females aged 48-77 years with postmenopausal crush fracture osteoporosis were investigated using a 7 day combined calcium balance and calcium tracer kinetic turnover study to assess the influence of dietary calcium and net absorbed calcium on bone metabolism. During the study, patients were on their habitual diet, as determined by a prestudy registration. Dietary calcium was measured after double serving of all the meals. All urine and feces were collected and analyzed for calcium content. Bone mineralization rate and bone resorption rate were determined by applying the continuously expanding calcium pool model to the tracer kinetic data. Urine calcium excretion and net absorbed calcium were correlated (r = 0.64, p less than 0.0001) with the following equation: urinary excreted calcium (mmol/day) = 2.4 + 0.4 X net absorbed calcium (mmol/day). Dermal calcium loss was not correlated with net absorbed calcium or urinary calcium. The net amount of absorbed calcium necessary to balance urinary and dermal losses was calculated to be 4.2 mmol calcium per day. The daily calcium intake necessary for obtaining a net absorbed calcium in excess of the urinary and dermal calcium losses and thereby ensure skeletal integrity was estimated to be 34.2 mmol calcium per day compared to an average intake of 27.9 +/- 7.6 (mean +/- SD) mmol/day. Net absorbed calcium correlated negatively to bone resorption rate (r = -0.31, p less than 0.005) and positively to bone mineralization rate (r = 0.29, p less than 0.01) and to calcium balance (r = 0.66, p less than 0.0001). Dietary calcium intake and calcium balance correlated positively (r = 0.38, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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