A. Michael Spiekerman

Testosterone deficiency as a risk factor for hip fractures in men: a case-control study.

The objective of this study was to determine whether decreased gonadal function is a risk factor for hip fracture in elderly men. The study was a matched case-control study performed at an in-hospital orthopedic service at a semi-rural and academic tertiary care center. The patients were seventeen men who presented with hip fractures after simple falls over a 10-month period, 11 men with a history of hip fractures in the preceding 25 months, and 28 randomly selected age-, race-, and living status-matched control subjects (mean age 73 years). Serum pooled total testosterone (9.2 ± 5.5 nmol/ L vs. 12.8 ± 5.4 nmol/L; p < 0.02) and free testosterone (37.9 ± 18.8 pmol/L vs. 48.4 ± 20.6 pmol/L; p < 0.03) were significantly lower in hip fracture vs. control patients. Testosterone deficiency was found in 20 (71%) hip fracture men vs. 9 (32%) of the controls (p = 0.003; odds ratio 5.3). Analysis of testosterone values within the stratum of absence of any chronic disorder revealed similar results. Serum 25-hydroxyvitamin D levels were significantly lower in the hip fracture group than in control men (p < 0.001). The conclusion is that gonadal deficiency appears to be an important and heretofore understudied risk factor for hip fractures in men. Prevention of hip fractures in men may involve early recognition and treatment of testosterone deficiency

Prostate-Specific Antigen Levels From Completely Sectioned, Clinically Benign, Whole Prostates

Clinically benign whole, untrimmed prostates and pelvic lymph nodes were obtained from 105 patients at autopsy. All 105 patients had premortem serum from which prostate‐specific antigen (PSA) levels were obtained. Sixty‐eight did not have carcinoma of the prostate (CAP), 28 had CAP less than 1 ml and 9 had CAP larger than 1 ml. Eleven untrimmed prostates weighed 80 g or more and eight had elevated PSA levels (more than 4.0 ng/ml): five of eight without CAP, two of two with CAP less than 1 ml, and one of one with CAP larger than 1 ml. Ninety‐four whole untrimmed prostates weighed less than 80 g and 20 had elevated PSA levels: ten of 60 without CAP, two of 26 with CAP less than 1 ml, and eight of eight with CAP larger than 1 ml. This study suggests that PSA levels from patients with untrimmed prostates weighing 80 g or more (equivalent to a 60‐g trimmed prostate) are usually elevated regardless whether CAP is present. However, CAP less than 1 ml, in untrimmed prostates less than 80 g, usually does not elevate PSA levels whereas CAP larger than 1 ml usually does (P less than 0.0001). The likelihood that elevated PSA levels, from patients with untrimmed prostates less than 80 g, are due to CAP larger than 1 ml increases as the PSA level increases.

Immunoglobulin characterization of human pancreatic fluid

Human pancreatic fluid obtained from 2 subjects, each with a traumatic pancreatic fistula, contained detectable levels of IgG, IgA, IgM, IgD, and IgE. Although the mean IgG/IgA ratio for 10 random specimens was 1.63, the relative concentration was estimated to be less than unity when extreme values were eliminated. The molecular weight of IgA in pancreatic fluid was found to be comparable to that of the IgA molecule in serum. The absence of secretory component in pancreatic IgA provides further evidence that pancreatic IgA and serum IgA are similar. Serial determinations of the immunoglobulins stored at 4° C showed a progressive decrease of all immunoglobulins, the order of stability being IgG≈IgA>IgM≈IgD. The demonstrated proteolytic activity in the specimens could account for the immunoglobulin decay and for the variable detection of IgM and IgD in pancreatic-fluid specimens.