Nasal human calcitonin for tumor-induced hypercalcemia

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Efficacy and safety of the bisphosphonate Tiludronate for the treatment of tumor-associated hypercalcemia

Tiludronate is a new bisphosphonate whose efficacy has already been reported for the prevention of postmenopausal bone loss. We have evaluated its efficacy and tolerance by a dose-finding study in 19 hypercalcemic cancer patients after adequate intravenous (iv) rehydration. Treatment consisted of 3 days of iv tiludronate given at doses of 3.0 mg/kg/day (n = 3), 4.5 mg/kg/day (n = 3), or 6.0 mg/kg/day (n = 13); this iv therapy was followed by 17 days of oral tiludronate, 400 mg (n = 13) or 800 mg (n = 6)daily. Treatment had to be discontinued in 9 patients, including 3 because of evident treatment failure and 1 because of severe toxicity. After iv tiludronate, 13/18 patients had a normal Ca level, including 10/12 who had received 6.0 mg/kg/day, but Ca2+ levels were fully normalized in only 4/18 and 3/12 patients, respectively. After 6.0 mg/kg/day, Ca levels had fallen from 12.1 ± 0.3 to 10.0 ± 0.4 mg/dl (P < 0.0005), whereas fasting urinary calcium excretion went from 0.639 ± 0.099 to 0.272 ± 0.054 mg Ca/mg creatinine on d4 (P < 0.001). On the other hand, oral tiludronate was unable to normalize Ca in patients who were still hypercalcemic after the iv course, although the daily administration of 800 mg appeared to be more efficient than the 400 mg daily dosage. The administration of tiludronate caused an increase in serum phosphate levels, from 2.9 ± 0.2 to 3.7 ± 0.2 mg/dl after the iv course, probably through an increase in the TmP/GFR index, which went from 2.3 ± 0.2 to 3.6 ± 0.4 mg/dl (P < 0.05). Three patients had an increase in serum creatinine levels after the iv course, one obese patient developing an acute renal insufficiency; during oral tiludronate therapy, 5 other patients also presented an increase in serum creatinine levels. Oral tiludronate administration was also associated with occasional nausea and vomiting. In summary, compared with aminobisphosphonates, tiludronate is not indicated for the treatment of tumor-associated hypercalcemia because of the need for high iv doses which are potentially nephrotoxic.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Short-term effects of Carbetimer on calcium and bone metabolism in man

Carbetimer is a new antineoplastic agent whose limiting toxicity consists of dose- and treatment duration-dependent hypercalcemia. We examined the short-term effects of Carbetimer on calcium metabolism on days, 1, 3 and 5 during 11 5-day courses (6.5-8.2 g/m2/day given over daily 2-h infusions, q 3-4 weeks). Blood parameters were measured before and after Carbetimer, whereas urinary parameters were studied in three consecutive 2-h collections before, during and after Carbetimer infusions. Carbetimer effects were similar regardless of the infusion day. We found a consistent decrease of plasma ionized Ca (Ca2+) levels from 4.56 ± 0.05 mg/dl before infusion to 42.8 ± 0.06 mg/dl after infusion (P < 0.001) whereas total serum Ca (corrected for protein levels) did not change. The fall of Ca2+ stimulated parathyroid function, as suggested by the increased plasma PTH levels, the decreased serum phosphorus and TmP/GFR index, or the increased urinary phosphate and cyclic AMP excretion. Carbetimer infusions also induced a marked increase in urinary Ca excretion (expressed as mg Ca/mg creatinine) from 0.093 ± 0.011 before to 0.359 ± 0.042 during and 0.177 ± 0.031 after infusion (P < 0.001). These changes were best explained by Carbetimer-induced Ca chelation that we confirmed in vitro by incubating Carbetimer at various concentrations in whole blood for 2 h at 37°C, e.g. 2 mg of Carbetimer/ml lowered Ca2+ from 4.82 to 3.20 mg/dl without changing total Ca levels. On the other hand, a direct effect of Carbetimer on bone cannot be excluded since we observed an increase of serum osteocalcin levels from 2.0 ± 0.3 to 2.5 ± 0.4 ng/ml after infusion (P < 0.001). In summary, the short-term effects of Carbetimer on calcium metabolism markedly differ from the long-term effects. They mainly consist of a dose-related calcium chelation leading to a decrease in Ca2+ levels, an increase in urinary Ca excretion and a stimulation of parathyroid function.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Poetry as praxis: An exploration of poetry discourse as qualitative inquiry

To capture the essence of an experience, poetry as research may manifest itself in two ways: (i) creating a research poem from existing data, often transcripts, or (ii) using participants\u27 poetry as a data-set for harvesting patterns and themes. This research focuses on the second form of poetic inquiry as a means of praxis by using the poetry of inservice teachers, preservice teachers, and elementary students to discover themes in regard to the teaching and learning process. As literacy teacher educators, creating praxis (moving from the theoretical to the practical) remains the ultimate goal of teaching and learning experiences. We gathered poems as data-sets in order to explore the possible benefits and limitations of poetic inquiry. As we approached the notion of poetry as a form of inquiry, we probed whether this art-based inquiry might also equate educational praxis. After considering several poetry data-sets, this research provides evidence of possible benefits related to the praxis that poetry as discourse and artistic inquiry affords, and presents the caveats of the research by identifying possible limitations