M. Carrozzo

Effect of oestrogen replacement on bone metabolism and cytokines in surgical menopause

SummaryThe effect of oestrogen replacement on bone metabolism and serum cytokine levels (IL1, IL6) was investigated in surgical menopause. The study included 40 female subjects; 10 healthy premenopausal women underwent total hysterectomy without oophorectomy. Thirty healthy premenopausal women underwent total hysterectomy with bilateral oophorectomy. They were randomly divided into 3 groups of 10 subjects. The first group received natural estradiol (0,05 mg/day) for 6 months; the second group received natural estradiol (0,05 mg/day) and medroxyprogesteron acetate (10 mg/day) for 6 months, the third group received no therapy.Calcium-phosphorus metabolism, inflammatory indices, serum IL1 and IL6 levels were tested before and 6 months after surgery in all patients.A significant increase in serum alkaline phosphatase, urinary cross-links, serum PTH and IL1-IL6 was observed in the untreated women with total hysterectomy and oophorectomy.No significant variation in any of the parameters considered was observed in patients treated with oestrogen, in those treated with oestrogens and medroxyprogesteron nor in patients without oophorectomy. These results in human “in vivo” confirm that ovarian steroids play an important role in regulating the production of IL1 and IL6 which could regulate bone resorption.

Pachydermoperiostosis: Dermatological, neurological and radiological observations

SummaryA case of pachydermoperiostosis is described. Interesting features were the presence of carpal and tarsal tunnel syndromes, chronic leg ulcerations and large calcification of the Achilles tendon. Neurological alterations were explained by the stenosis of the tunnels secondary to the periosteal apposition. Chronic leg ulcerations were probably due to neurological and circulatory alterations.

Post biliopancreatic bypass arthritis. Dermatitis syndrome

SummaryA case of arthritis dermatitis syndrome observed after a biliopancreatic bypass for morbid obesity is described. The syndrome had begun 10 days after surgery and involved the knees, ankles, elbows and wrists and erythema nodosum on the legs. After 15 days treatment with sulfasalazine and steroid the symptoms disappeared. The immunologic aetiology of the disease was postulated and the observation of the syndrome, for the first time, after a biliopancreatic bypass suggested that the manifestation of the disease is independent of the kind of the surgical procedures used for the treatment of the morbid obesity.

Mixed sclerosing bone dystrophy with features resembling osteopoikilosis and osteopathia striata

SummaryA 64-year old man, presenting pain in his back and left sciatalgia, was found to have a mixed sclerosing bone dystrophy with features resembling osteopoikilosis and osteopathia striata. Oval and round densities were found in the humeral heads, elbows, wrists, hands, pelvis, knees, feet. Striata densities were in the diaphyses of metacarpal and metatarsal bones. Bone scan was negative. Standard biochemical examinations of the blood and urine were negative. According to our investigations no evidence of osteopoikilosis other sclerosing bone dystrophies were found in the family of our patient. These data were discussed.

The importance of vitamin C for hydroxylation of vitamin D3 to 1,25(OH)2D3 in man

SummaryThe effects of vitamin C on 1,25(OH)2D3 synthesis in humans were evaluated; the study included 20 females. They were divided into 2 groups. The first of the 10 subjects (age range 55–71) received ascorbic acid at a dose of 150 mg/die i.v. for 10 days; the second 10 subjects (age range 55–69) received a placebo i.v. for 10 days. In a later study (after a 30-day washout) the same two groups were tested for the second time with ascorbic acid at a dose of 1,000 mg/die i.v. for 10 days and placebo i.v. for 10 days. Serum calcium and phosphorus, serum Ca++, serum proteins, blood and urinary pH, serum 25(OH)D3 and 1,25(OH)2D3, serum PTH, urinary hydroxyprolin were tested before and after the treatments. In the first study a significant increase in serum 1,25(OH)2D3 was observed after ascorbic acid while no significant variation was observed for the other parameters. In the second study, a significant increase in serum Ca++ and a significant decrease in serum 1,25(OH)2D3 were observed after ascorbic acid while no significant variation was observed for the other parameters. The authors conclude that ascorbic acid promotes 1,25(OH)2D3 synthesis at a paraphysiologic dose (150 mg/die) in humans but this synthesis is inhibited at higher doses (1,000 mg/die). The latter effect by Ca++ or by an effect of ascorbate on 1 alpha-hydroxylase enzyme could be mediated.

Chronic leg ulcerations resembling vasculitis in two siblings with prolidase deficiency.

SummaryTwo cases of prolidase deficiency in two siblings are presented. The patients complained of the typical clinical symptoms of the disease, including chronic leg ulcerations resembling vasculitis. They were mentally retarded, had typical facial characteristics, splenomegaly, and haematologic anomalies. Biochemical and morphological investigations confirmed the diagnosis. In these cases, alterations of the peripheral nervous system and decreased IgA levels were demonstrated for the first time.

MONONUCLEAR CELLS ARE NOT INVOLVED IN BGP SYNTHESIS AND SECRETION

SummaryOsteocalcin or bone GLA protein (BGP) is found at high levels in only two tissues, the extracellular matrix of bone and dentine. Tissue culture experiments have demonstrated that BGP is synthesized by two osteoblastic osteosarcoma cell lines (ROS 2/3 and 17/2) and by normal osteoblastic cells in primary culture. BGP was not found in rat cartilage nor in liver, kidney, lung, spleen, brain, heart, thymus, skeletal muscle. In this study secretion of BGP was assayed by RIA in the supernatants of 48-hour cultures of peripheral blood lymphocytes or monocytes. Lymphocyte cultures were carried out using RPMI-1640 supplemented with L-glutamine and antibiotics at the concentration of 1×106 cells/ml and activated by PHA (10 ng/ml). Peripheral blood monocytes were purified by adherence to plastic Petri dishes and treated with cold PBS supplemented with EDTA. Monocytes were cultured as previously described and stimulated with LPS (50 ug/ml). Cell-free supernatants were obtained by centrifugation and stored at −20°C, until the BGP assay was performed. The authors did not observe secretion of detectable amounts of BGP in the supernatants of short-term lymphocyte or monocyte cultures. These data indicate that circulating mononuclear cells are not involved in BGP synthesis and secretion.

Normal serum concentrations of 1,25 dihydroxyvitamin D in osteoporosis.

SummaryWith the aim of evaluating the role of 1,25 dihydroxyvitamin D in the pathogenesis of osteoporosis, this hormone was studied in 90 subjects. They were divided into three groups: the first group consisted of 30 normal female subjects (aged 30 to 45); the second group comprised 30 elderly female subjects (aged 67 to 90) the third group consisted of female patients (aged 65 to 87) with clinical and radiological evidence of osteoporosis. Variations of serum 1,25 dihydroxyvitamin D, after stimulation with oral P04 (1.000 mg/day for 10 days) and stimulation with oral Ca (1.000 mg/day for 10 days), were studied in 16 osteoporotic females (10 of them received P04) and six Ca (Controls). This second study was performed to evaluate the renal 1-alpha-hydroxylation. No significant variation between serum 1,25 dihydroxyvitamin D of elderly and osteoporotic females was observed when compared with normal young healthy subjects. Moreover, a significant increase in serum 1,25(OH)2D after oral P04 was found in accordance with a significant increase in serum parathormone. These data demonstrate that changes in serum 1,25(OH)2D levels did not seem to play a significant part in the pathogenesis of osteoporosis in our population neither could a deficit of renal 1-alpha-hydroxylation be demonstrated.

25-Hydroxycholecalciferol in experimental osteoporosis

SummaryThe authors, using the experimental pattern of bone rarefaction induced by a low calcium diet, tried to determine if 25-hydroxycholecalciferol, administered at doses and according to procedures similar to those used in osteoporosis, might interfere in such a process of rarefaction. The statistical evaluation of the results concerning the size of the amount of spongy bone presented evidence for the sharp decrease in the specific bone volume in rats placed on a low calcium diet as compared to control rats. Such a difference is found even between rats treated with 25-OH-D3. Nonetheless, the authors reported a difference — although not statistically significant — that indicated an increase in the amount of bone in rats on a normal diet but treated with vitamin D as compared to control rats. In conclusion: 25-OH-D3 by itself, the diet being the same, was not able to ameliorate the amount of bone.