Use of Aminohydroxypropylidene Bisphosphonate (Ahprbp, Apd) for the Treatment of Hypercalcemia in Patients with Renal Impairment

Aminohydroxypropylidene bisphosphonate (ACPrBP, 'APD') is a relatively new bisphosphonate which has been shown to be effective for control of hypercalcemia due to a variety of causes. Renal impairment has been reported following the use of other bisphosphonates and pre-existing renal impairment has been regarded as a contraindication to the use of AHPrBP. We report the successful use of intravenous AHPrBP to control hypercalcemia in three patients with renal impairment, one of whom was dialysis-dependent. No significant side effects were noted; in particular, there was no further deterioration in renal function. Intravenous AHPrBP may be a safe and effective agent for the control of hypercalcemia in patients with renal impairment

Blunted Parathyroid Response to Correction of Hypercalcemia in Subjects with Squamous-Cell Carcinoma

In malignancy-associated hypercalcemia (MAH) elevated plasma calcium levels are believed to inhibit parathyroid secretion independently of the underlying tumor. This predicts that correction of hypercalcemia should disinhibit circulating parathyroid hormone (PTH) levels, irrespective of the underlying disease. We have tested this hypothesis in subjects with multiple myeloma (MM) and squamous cell carcinoma (SCC) treated with pamidronate. In the MM group, PTH levels returned to normal as hypercalcemia was corrected. In contrast, PTH levels remained low in the SCC group despite a similar fall, in plasma calcium. Calcitriol levels were significantly higher and magnesium levels slightly lower in the SCC group than those in the MM group. We conclude that the parathyroid response to the correction of hypercalcemia is blunted in subjects with SCC but not MM. In addition to hypercalcemia, other factors, perhaps related to tumor secretion of PTH-related protein, may therefore contribute to suppressing PTH secretion in MAH due to SCC

Single-Dose Intravenous Pamidronate Is Effective Alternative Therapy for Pagets-Disease Refractory to Calcitonin

We have conducted an open, prospective study to investigate the efficacy of a single 60 mg infusion of pamidronate as alternative therapy in 15 subjects with severe Paget's bone disease refractory to calcitonin. Disease activity was assessed with a visual-analogue score of symptom severity, plasma alkaline phosphatase and quantitative estimation of Tc-99m-methylene biphosphonate uptake on bone scan. All indices of disease activity fell after pamidronate, reaching a nadir at 3 months. Although disease activity increased thereafter, only 3 subjects required retreatment within 12 months. Plasma calcium fell after 3 days and remained below baseline levels for 6 months associated with evidence of secondary hyperparathyroidism. Pamidronate was well tolerated; femoral neck fractures occurred in 2 subjects with severe local Paget's disease but were unlikely to be due to the drug. We conclude that pamidronate is an effective and promising alternative for treatment of patients with severe Paget's disease no longer adequately controlled by calcitonin. Calcium supplementation may be prudent to prevent secondary hyperparathyroidism associated with the use of this agent

Thyroid nodules in the population living around Chernobyl.

OBJECTIVE: To determine the baseline incidence, prevalence, and characteristics of thyroid nodules in the population living around the Chernobyl nuclear power plant and to compare the findings with unexposed populations. DESIGN: Prevalence study. Population samples from seven highly contaminated villages were compared with six nearby control villages of the same size and type. The data were obtained as part of the International Chernobyl Project conducted in 1990. SETTING: The study was conducted 4.5 years after the Chernobyl reactor accident that released large quantities of radionuclides, including radioiodine. PATIENTS OR OTHER PARTICIPANTS: Population samples of approximately 100 persons residing in both highly contaminated villages and control villages since the accident were compared. Individuals were selected on the basis of birth date as being 5, 10, 40, or 60 years old at the time of the study. All persons selected underwent a thyroid examination. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Two main outcome measures were used, both for thyroid nodularity: clinical palpation and high-resolution ultrasonography. RESULTS: There was no significant difference in thyroid nodularity between the study groups. Nodules were palpated in 0.7% of children and 2.9% of adults. Discrete nodules were found by ultrasonography in 0.5% of children and 14.9% of adults. Multinodular goiter was found in 3% of adults. Nodules were more common in females. CONCLUSIONS: Four and a half years after the Chernobyl accident, the incidence, prevalence, and characteristics of thyroid nodules were the same in population samples from both highly contaminated and control settlements and similar to results reported for unexposed populations in other countries

Administration of stable iodine to the population around the Chernobyl nuclear power plant

A very large amount (2.5 x 1017 Bq) of radioactive iodine was released as a result of the Chernobyl accident in 1986. An effective protective action that may be employed to reduce the potential radiation dose to the thyroid gland after a serious nuclear reactor accident is the administration of stable iodide in the form of potassium iodide (KI). Potassium iodide was reportedly given to nearly five and a half million persons after the Chernobyl accident. During the International Chernobyl Project, medical investigators asked the general population in both highly contaminated and control settlements about thyroid prophylaxis. Only 25% of persons currently living in the most contaminated regions reported taking potassium iodide. Sixty-six percent indicated that they did not take potassium iodide and 9% were uncertain. Of those who took stable iodine prophylactically. 44% indicated that it was in solution, 44% that it was in tablets and 12% did not remember how it was administered. Only about one third of persons were able to indicate the duration of time that they took such medication. The average was 6.2 days. It appears that iodine prophylaxis will not have a major impact on estimated collective thyroid doses to the general population living around the Chernobyl nuclear power plant. The impact that distribution of KI had upon the plant and emergency accident workers remains unknown to us