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Fractured neck of femur in the elderly: an attempt to identify patients at risk.
1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.
Abnormalities of renal transport of sodium o-[131I]iodohippurate (Hippuran) in essential hypertension.
1. Renal function has been studied in 312 hypertensive patients by quantitative renography with sodium o-[131I]iodohippurate (131I-labelled Hippuran) and estimation of overall effective renal plasma flow. In 59% of the patients the results were normal. 2. Severe hypertension was associated not only with reduced effective renal plasma flow but also a characteristic abnormality of Hippuran transport in 10% of the patients in which there was a wider than normal variation in transit times of Hippuran through the kidney, which may reflect non-uniformity of reabsorption of filtrate by different groups of nephrons. 3. Plasma renin activity was higher in a group of 14 patients with multimodal transit time spectra than in a matched hypertensive control group, with very substantial overlap between the two groups. 4. The renographic abnormality was usually reversed by treatment.
The turnover time of calcium in the exchangeable pools of bone in man and the long-term effect of a parathyroid hormone fragment.
(1) A non-compartmental method is described for analysing the kinetics of the exchange of calcium between the bloodstream and the exchangeable bone pools. (2) This method has been applied to studies on osteoporotic patients treated with low doses of an active fragment of human parathyroid hormone. The data of Phang et al. (1969), who studied the effects of dietary calcium peturbation on normal volunteers, were also analysed. (3) It was found that in response to chronic PTH treatment the transit time of calcium in the exchangeable pools decreased. This could not be explained by the observed changes in the calcium accretion rate to the fixed bone pools, and it was necessary to postulate an alteration in the ratio of the rate constants governing the interchange of calcium between bloodstream and exchangeable pools. (4) The changes in the behaviour of the exchangeable pools in response to dietary perturbation could not be explained by the postulated increase in endogenous PTH secretion rate in response to dietary calcium restriction.