Serum bone Gla-protein (BGP) is produced by osteoblasts in a vitamin K-dependent process. It is well known that serum BGP levels increase after oral administration of active vitamin D3 in postmenopausal women and patients with chronic renal failure before dialysis. These findings indicate that active vitamin D3 increases the BGP production by osteoblasts. In the present study, a daily oral dose of 2μg of 1α(OH)D3 was administered to 10 elderly males (age, 75.0±10.9 years) and 8 young males (age, 29.0±3.2 years) to compare the changes in serum BGP levels between the two groups. None of the subjects had severe renal or hepatic dysfunction or abnormalities in calcium (Ca) metabolism. Serum BGP and 1, 25(OH)2D levels in both groups were measured befrore the initial administration, at 24h and at 1, 2 and 3 weeks after the start of administration. Serum parathyroid hormone (m-PTH), alkaline phosphatase (ALP), Ca and phosphorus levels were also measured in the elderly group. Serum BGP levels before the initial administration were 4.63±1.8ng/ml in the elderly group and 4.33±0.92ng/ml in the young group, with no significant difference between the two groups. In both group serum 1, 25(OH)2D levels were slightly increased at 24h after administration. In the elderly group serum BGP levels increased significantly to 11.5±3.0ng/ml, an increase of approximately 250%, 1 week after the initial administration and the increase was maintanied for up to 3 weeks after the administration commenced. However, no changes in serum BGP levels were noted in the young group. In the elderly group serum m-PTH levels were 544±257pg/ml, almost the upper normal limit, before, and decreased slightly after, the administration of 1α(OH)D3. Serum ALP levels also decreased slightly after the administration and serum Ca levels were slightly increased, however, the changes were within normal limits. We conclude that osteoblastic function is activated after short-term administration of active vitamin D3 in vitamin D deficient elderly subjects.
Pulmonary rehabilitation has been reported to be effective in patients with chronic obstructive pulmonary disease (COPD). To investigate the effect of a moderate period of pulmonary rehabilitation combined with inspiratory muscle training (IMT) in elderly patients with COPD, we instituted pulmonary rehabilitation for 60 weeks in five elderly patients (age: 65.4±3.7 SE years). IMT was performed for 15min twice daily using a pressure threshold device. The inspiratory threshold was set at 15% of the maximal inspiratory pressure (PImax) of each individual. Maximal peak flow significantly increased from 3.0±0.6 (L/s) at baseline to 4.1±0.7 (L/s) after 12 weks (p<0.02) and was maintained at that level for 60 weeks. PImax increased significantly from 49.9±6.4cmH2O at baseline to 67.3±3.0cmH2O after 12 weeks (p<0.05) and to 72.8±3.5cmH2O (p<0.02) after 60 weeks of rehabilitation. The 10-minute walking distance increased from 666.6±55.0 to 764.0±49.9m (p<0.05) after 12 weeks and was maintained at the same level. We conclude that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD between for 12 weeks after commencement, but occurs that no significant increase on lung function or 10-minute walking distance from 12 to 60 weeks. Respiratory muscle strength may fuether increase after 60 weeks.
In order to study the effect of calcium supplementation on bone resorption, a randomized controlled crossover study was carried out on eight healthy 18-19 year old female volunteers using either AAACa heated oyster shell with vacuum-heated seaweed or milk. Regimen A consisted of an oral dose of 200mg calcium in the form of AAACa, B 200ml milk after breakfast and supper and at bedtime, and C control with no calcium supplement. Early morning fasting blood and urine sampling was carried out after 7 days of calcium supplementation. Serum calcium was higher in groups A and B than in C, and serum intact parathyroid hormone (PTH) was significantly lower in group A than in groups B and C, according to a paired t-test. Uninary excretion of crosslinked collagen degradation product, pyridinoline and deoxypyridinoline showed a similar decrease in groups A and B but not in C. The more effective suppression of PTH by AAACa than by milk may be due to its higher bioavailability and the absence of phosphate stimulating PTH secretion.
A report is presented of five aged patients with hemorrhagic colon ulcer, which was strongly suspected to be a side effect of non steroidal anti-inflamatory drugs (NSAID). All patients were suffering from orthopedic diseases and NSAIDs were administered for pain: Zaltoprofen for one patient and slow-releasing diclofenac for the other four. Four patients had being treated underlying diabetes mellitus and three of them were being treated with sulfonylurea. Appetite loss was the earliest symptom, 1-2 weeks after administration of NSAID began. Diarrhea occurred 1-2 weeks after appetite loss, and finally hemorhagic stool developed 1-2 weeks after that. Acute gastric mucosal lesion, hemorrhagic colon ulcer and colitis were diganosed in all patients by emergency gastro-duodenocolonoscopy. NSAID and oral diet were ceased, and intravenous hyperalimentation was instituted when the patients revealed severe anemia due to bleeding. All patients could take an oral diet after a few weeks. In conclusion hemorrhagic colon ulcer must be prevented in patients treated with NSAID especially those who are aged and have a history of diabetes mellitus.
A 73-year-old woman suffering from hypertension and asthma had chest radiography, which showed the shadow of a lump on the inner side of the right lung apex. From a chest CT scan, it was diagnosed as an upper mediastinal tumor (circular in shape with a diameter of 19×23mm) adjacent to the right rib and showing a low-absorption range. Histopathology confirmed the diagnosis as an Antoni B-type melanotic schwannoma. On suspicion of secondary hypertension, the amount of urinary catecholamine was measured before surgery and this revealed high levels of total catecholamine (184.4μg/day), dopamine (1134.6μg/day) and noradrenaline (169.7μg/day). A normal value of 14.7μg/day of adrenalin was obtained. These measurements were conducted again after surgery, and normal values of 127.8μg/day of total catecholamine, 388.6μg/day of dopamine, 117.9μg/ day of noradrenalin and 9.9μg/day of adrenalin were obtained. In view of these findings, the tumor was thought to be a neurogenic tumor of the sympathetic nervous system and capable of generating melanin. Incidentally, after removal of the tumor, the patient's hypertension became less severe and there was improvement in her asthma attacks.