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Malnutrition is a common problem of patients undergoing liver transplantation. To treat malnutrition, it must first be identified through a nutritional assessment. Because many objective nutritional assessment parameters have limitations in end-stage liver disease, subjective nutritional indicators may be used as an alternative. Nutritional needs following transplantation are categorized as short and long term. The short-term nutritional goal, anabolism, can be complicated by the nutritional status of the patient, surgical procedures, and necessary medications. The increased nutrient needs during the early posttransplant phase require particular nutritional support. Nutrition-related problems following transplantation may include obesity, hyperlipidemia, hypertension, diabetes mellitus, hyperkalemia, edema, or osteoporosis. Dietetic advice relative to the nutritional needs of the liver transplant recipient can improve both the short- and long-term outcomes.
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PMID:Nutritional implications of liver transplantation. 208 51

The Agricultural Revolution was almost certainly associated with a substantial decrease in human calcium intake. Calcium intakes typical of contemporary humans may well be inadequate for many individuals. Various slowly developing chronic disorders such as osteoporosis, hypertension, hyperlipidemia, and colon cancer may be induced or exaggerated by the current low level of dietary calcium intake in Western societies. We propose two hypotheses relating calcium intake to diverse diseases: first, the adaptation required to adjust to low intakes is inadequate to maintain critical components of cellular calcium regulation; second, the constant, forced adaptive response to low intake itself produces untoward consequences.
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PMID:Dietary calcium and chronic diseases. 219 36

The clinical use of estrogens and progestogens for menopausal women is reviewed, discussing the indications, results of studies on effectiveness of various agents o each target organ, contraindications, risk-benefit ratio, and types of drug preparations available and used in European countries. The indications for menopausal hormone replacement are primarily to prevent myocardial infarction and osteoporosis, and also to treat early menopause, urogenital atrophy, and severe skin, mucous membrane and psychic disorders. Mechanisms of action of estrogens and progestins, and anticipated results are detailed for each of the indications. Contraindications typical of oral contraceptives usually do not apply for hormone replacement. For example, only severe acute liver disease, current thromboembolism, endometrial cancer other than I, and breast cancer within 3-5 years of primary treatment are contraindications. Neither cervical, ovarian or vulvar cancer, diabetes, varicose veins, hypertension, nor history of liver disease or thromboembolism are contraindications: in some cases progestins or transdermal estrogens are recommended. Estrogen side effects suggest overdosage. Progesterone or its derivatives rather than oral contraceptive progestins are prescribed. There is a clear benefit, comparing cost of medication to that of treating consequences of estrogen deficiency. The preparations currently used in Europe include oral micronized estradiol, conjugated estrogens, transdermal patches, local vaginal estrogens, and injectable estradiol esters for those who cannot tolerate oral or transdermal agents. Preparations should contain progesterone unless the woman has had a hysterectomy. Combinations designed to avoid withdrawal bleeding are available.
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PMID:Clinical use of oestrogens and progestogens. 221 69

Aging is characterized, besides other changes, by a progressive increase in calcium content in the arterial wall, which is enhanced by diabetes mellitus, osteoporosis, arterial hypertension, and tabagism. As to tabagism, experiments in animals have shown that nicotine can increase calcium content of the arterial wall, and clinical studies have demonstrated that cigarette smoking induces peripheral vasoconstriction, with consequent increase in blood pressure levels. In order to study the role of calcium ions in the pathogenesis of the vasoconstrictive lesions caused by "acute" smoking, the author has studied the peripheral vascular effects of the calcium-channel antagonist nifedipine, a dihydropyridine derivative, and calcitonin, a hypocalcemizing hormone which possess vasoactive actions on 12 elderly regular smokers (mean age 65.8 years). The results demonstrated that both nifedipine (10 mg sublingually 20 min before smoking) and salmon calcitonin (100 MRC U/daily intramuscularly for three days) are able to prevent peripheral vasoconstriction evaluated by Doppler velocimetry, as well as the increase of blood pressure induced by smoking. On the basis of our results, the author proposes that cigarette smoking-induced vasoconstriction is a calcium-mediated process, which can be hindered by drugs with calcium antagonist action.
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PMID:Smoking, calcium, calcium antagonists, and aging. 222 75

It is commonly accepted that the incidence of osteoporosis, as well as hypertension and diabetes, increases with age. With the expansion of the elderly portion of the population in society, the number of cases of osteoporosis and its related fractures must correspondingly increase. Regarding the effect of the level of decreased bone mass or bone mineral density of patients with vertebral body or hip fracture, the incidence rate of fractures significantly increases when the bone mass level of patients becomes less than -3 S.D. of the peak bone mass level at each of the respective sites. As a result, areas of under -3 S.D. area of te peak bone mass level are considered to be fracture risk area. When treating osteoporosis patients, special consideration must be given to other age-related complications. One third of hip fracture patients already have dementia, hypertension, or cerebrovascular disorders at the time of injury. Exercise and weight bearing are important for the treatment and prevention of osteoporosis because of their positive influence on the muscles and the bone tissue of the patients.
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PMID:[Osteoporosis--from the view point of the orthopedic surgeon]. 223 7

Currently, there is no commonly practiced tool for assessing calcium status of individuals or populations. Few biochemical markers reflect calcium status. Fasting urinary calcium:creatinine ratios may hold promise as an easy, inexpensive method to indicate recent calcium status. Calcium status may best be assessed by integrated measures of calcium assimilation, such as total-body calcium. Although bone-mass measurements do not correlate well with recent dietary intakes of calcium, long-term adequacy of calcium intake influences bone mass. Whether low calcium intakes lead to calcium deficiencies depends on one's ability to adapt and conserve calcium. The relationship between calcium status and a particular disease state, such as osteoporosis, hypertension, or colon cancer, cannot be established until a reliable indicator of calcium status is found.
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PMID:Assessing calcium status and metabolism. 224 90

Little notice has been paid in the surgical literature to problems with psychoeffective lithium, which by interfering with adenylate cyclase affects thyroid and parathyroid function, causing hypercalcemia, hyperparathyroidism, and hypothyroidism. Seven patients with lithiumogenic hyperparathyroidism occurring after years of lithium therapy underwent treatment and manifested osteoporosis (n = 2), hypertension (n = 2), nephrolithiasis (n = 1), coma (n = 1), rising hypercalcemia (n = 1), goitrous myxedema (n = 4), nephrogenic diabetes insipidus (n = 2), renal failure (n = 2), and hyperlipidemia (n = 1). Disease-directed parathyroidectomy (without morbidity) was curative. Unique laboratory findings included normal serum phosphorus and reduced urinary calcium and cyclic adenosine monophosphate values. Three separate cases of thyroid carcinoma after long-term lithium therapy were also treated, being preceded by myxedema (n = 2) and concurrent with hyperparathyroidism (n = 1). There has been only one previous report of lithium-associated thyroid carcinoma. All patients taking lithium should undergo surveillance for thyroid and parathyroid dysfunction and neoplasia, and appropriate surgical and medical treatment should be considered in each situation. Although hyperparathyroidism may be reversible with lithium discontinuance, such therapy may be obligatory for patient well-being, thus dictating parathyroidectomy.
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PMID:Lithiumogenic disorders of the thyroid and parathyroid glands as surgical disease. 224 24

Evidence has been provided that adequate physical activity prevents diseases caused by hypokinesia (hyperlipoproteinaemia, ischaemic heart disease, myocardial infarction, obesity and to a certain extent also hypertension) and that it retards the ageing process, in particular osteoporosis. It prolongs thus active life and life in general. The majority of our population suffers from lack of exercise. It is therefore necessary to promote activity and sports not only in healthy young people (in particular with a sedentary occupation) but also in older people. And in the latter group in particular in those with a mild degree of ischaemic heart disease, mild hypertension, in obese subjects, diabetics and those who come from families where these diseases occur. Even when the disease is already advanced or a relapse is imminent, a certain amount of physical activity, controlled by sports doctors on agreement with the attending physician is indicated. Sports Consulting clinics, since the foundation of the first one in 1924, served all sportsmen and visitors. During the totalitarian regime district and regional departments of sports medicine were established as well as an Institute of National Health for top sports but their activities were restricted only to contesting sportsmen and professionals. During the foreseen reorganization of health care the care of sports doctors most be extended to comprise also the above mentioned groups of non-contesting people and subjects at risk. This will be possible only if sports medicine will be included in primary health care and if eventually a department of sports medicine will be established in every institute of national health. It will serve not only sportsmen but the public as a whole.
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PMID:[Perspectives in sports medicine in Czechoslovakia]. 226 21

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro-vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle-aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long-term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non-institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.
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PMID:The Dubbo study: an Australian prospective community study of the health of elderly. 229 27

During a period of ten years, 13 children were treated for infantile spasms with ACTH. Eleven of these developed Cushing-like appearance, 9 irritability, 7 hypokalaemia, 6 metabolic alkalosis, 5 hypertension, 5 infections and 5 osteoporosis. This investigation reveals that osteoporosis is a more frequent side effect than previously recognized and, similarly, that hypertension is also a common side effect. Routine x-ray control of the thoracic spine, regular measurement of blood pressure and control of urinary calcium and serum calcium, phosphate, sodium and potassium are therefore recommended. As cases of ureteronephrolithiasis have also been observed, examination of the urine for blood and ultrasound examination of the kidneys for formation of calculi should also be considered.
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PMID:[Adverse effects in children treated with ACTH in infantile spasm]. 255 Oct 90


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