Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment.

These national clinical guidelines outlining the screening, prophylaxis and critical information required prior to initiating anti-TNF-alpha treatment have been approved by the Danish Society for Gastroenterology. Anti-TNF-alpha therapy is widely used in gastroenterology (for inflammatory bowel disease), rheumatology (for rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies) and dermatology (for psoriasis). With this background, the Danish Society for Gastroenterology established a group of experts to assess evidence for actions recommended before treatment with anti-TNF-alpha agents.

Bone mineral density in patients on home parenteral nutrition: a follow-up study.

Background And Aims: The variations of bone mineral density (BMD) during home parenteral nutrition (HPN) and their relationship with general, life style, primary disease and HPN risk factors were investigated by a follow-up study.

Design: Patients who had BMD assessment in a previous cross-sectional survey underwent a 2nd BMD at femoral neck (FN) and lumbar spine (LS). Data about risk factors were collected by a structured questionnaire.

Assessment of the longitudinal changes in bone mineral density in patients receiving home parenteral nutrition.

Background: Low bone mineral density (BMD) is commonly reported in patients receiving home parenteral nutrition (HPN), but it remains unclear whether or not an accelerated bone loss occurs during HPN therapy. We evaluated the spinal, hip, and forearm bone mass density longitudinally in a cohort of 75 patients receiving HPN.

Methods: A total of 943 regional dual-energy x-ray absorptiometry scans, 335 spinal, 318 hip, and 290 forearm, obtained between 1995 and 2003 in 75 patients receiving HPN, were used for the analysis of the annual changes in BMD.

Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition.

Background: Patients receiving home parenteral nutrition (HPN) because of intestinal failure are at high risk of developing osteoporosis.

Objective: We studied the effect of the bisphosphonate clodronate on bone mineral density (BMD) and markers of bone turnover in HPN patients.

Design: A 12-mo, double-blind, randomized, placebo-controlled trial was conducted to study the effect of 1500 mg clodronate, given intravenously every 3 mo for 1 y, in 20 HPN patients with a bone mass T score of the hip or lumbar spine of less than -1.

Prevalence of bone disease in patients on home parenteral nutrition.

Background & Aims: The epidemiology of bone disease in home parenteral nutrition (HPN) is unknown. The aim of this paper is to evaluate the prevalence and severity of reduced bone mineral density (BMD) in long-term HPN.

Design: Cross-sectional, multicentre study including patients who within the last 12 months had their BMD assessed by dual-energy-X-ray absorptiometry after at least 6 months of HPN.

Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey.

Background: Home parenteral nutrition (HPN) is a lifesaving treatment in patients with intestinal failure. Dependency of nutritional support becomes permanent for the majority of patients who had received HPN for at least 2 years. The alternative to long term HPN in selected patients is intestinal transplantation.

Alendronate increases lumbar spine bone mineral density in patients with Crohn's disease.

Background & Aims: Low bone mineral density (BMD) is a common complication of Crohn's disease and may lead to increased morbidity and mortality because of fractures. We investigated the effect of treatment with the bisphosphonate alendronate on bone mass and markers of bone remodeling in patients with Crohn's disease.

Methods: A 12-month double-blind, randomized, placebo-controlled trial examined the effect of a 10-mg daily dose of alendronate.

Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection.

Background: H2 receptor blockers and proton pump inhibitors reduce intestinal output in patients with short bowel syndrome.

Aims: To evaluate the effect of intravenous omeprazole and ranitidine on water, electrolyte, macronutrient, and energy absorption in patients with intestinal resection.

Methods: Thirteen patients with a faecal weight above 1.

Body composition by dual-energy X-ray absorptiometry in patients with Crohn's disease.

Background: To study body composition at the whole-body level in patients with Crohn's disease and a history of intestinal resection compared with healthy controls, we performed a cross-sectional study using dual-energy X-ray absorptiometry (DXA).

Methods: Thirty-one patients, 13 men and 18 women, were included. They had a history of Crohn's disease for a mean period of 20 years (range, 4-45 years).

Body composition changes measured by dual-energy X-ray absorptiometry in patients receiving home parenteral nutrition.

Background: To monitor changes in body composition in patients receiving home parenteral nutrition (HPN) and to ascertain whether changes were related to the amount of energy supplied by HPN, we studied prospectively patients with gut failure maintained on HPN.

Methods: Patients were subjected to repeated measurement of body composition by dual-energy X-ray absorptiometry (DXA), the second investigation being performed after a mean period of 20 (range, 11-26) months. Thirty-two patients were included, one patient was excluded, and five patients died during the study period.

Bone mineral content in patients with Crohn's disease. A longitudinal study in patients with bowel resections.

Background: Low bone mineral content (BMC) has been reported in patients with inflammatory bowel disease. The aim of the present study was to measure BMC in patients with Crohn's disease.

Methods: BMC was monitored for a mean period of 5.

The metabolism of [75Se]selenite in patients with short bowel syndrome.

Background: Patients on home parenteral nutrition (HPN) require significantly higher amounts of selenium compared with controls. The purpose of the present study was to investigate if selenium deficiency of patients with short bowel syndrome is caused by selenium malabsorption or by excessive intestinal or renal loss.

Methods: The metabolism of [75Se]selenite was investigated in eight selenium-depleted short bowel patients on HPN and in six control subjects.

Body composition in patients on home parenteral nutrition.

Dual energy X-ray absorptiometry (DXA) measures and separates three of the principal compartments of the body, fat mass (FM), fat-free mass (FFM), comprising muscle, inner organs and body water, and the total bone mineral content (TBMC). The aim of the present study was to determine body composition by DXA scan in 37 patients who had been on home parenteral nutrition (HPN) for 6-216 months. The height and weight of patients were significantly lower when compared to a group of healthy subjects.

Bone mineral content in patients on home parenteral nutrition.

Bone mineral content (BMC) was monitored in 15 patients with short bowel syndrome receiving home parenteral nutrition (HPN). Thirteen patients had Crohn's disease and 2 ulcerative colitis (mean age 36 years, range 23-69 years). During the study the patients received HPN for a mean period of 62 months, range 20-106 months.

Metabolism of vitamin D2 and vitamin D3 in patients on anticonvulsant therapy.

We examined the effect of short-term treatment with pharmacological doses of vitamin D2 or vitamin D3 on the serum concentration of 1,25(OH)2D metabolites in epileptic patients on chronic anticonvulsant drug therapy. Nine patients were studied before and after treatment with vitamin D2 4000 IU daily for 24 weeks and 10 before and after treatment with vitamin D3 in the same dose. Before treatment the serum concentrations of 1,25(OH)2D and 25(OH)D were significantly lower in epileptics than in normal subjects (P less than 0.

Serum concentration of vitamin D metabolites during treatment with vitamin D2 and D3 in normal premenopausal women.

Serum concentrations of vitamin D metabolites were measured in 19 healthy premenopausal women before and during treatment with 4000 IU per day of either vitamin D2 or vitamin D3 for 8 weeks. Vitamin D2 treatment increased the serum concentration of 25(OH)D2, but a corresponding decrease in 25(OH)D3 resulted in an unchanged value for total 25(OH)D. The serum concentration of the D3 dihydroxy metabolites was also significantly decreased.

Representativity of regional to total bone mineral in healthy subjects and 'anticonvulsive treated' epileptic patients. Measurements by single and dual photon absorptiometry.

Dual photon (153Gd) and single photon (125I) absorptiometry were used to measure the regional bone mineral content (BMC) and density (BMD), as well as the total body mineral content (TBBM) and density (TBBD), in sixty-nine healthy subjects and in twenty-three epileptics on phenobarbitone. The BMCs (and BMDs) of all regions were significantly correlated to each other and to the TBBM (and TBBD). No difference in the ability to discriminate between the different study groups was found for the various regions, excepting the BMD of the head.

Different metabolism of vitamin D2/D3 in epileptic patients treated with phenobarbitone/phenytoin.

Serum concentrations of vitamin D metabolites were measured before and during treatment with either vitamin D2 or vitamin D3, 4000 IU per day for 24 weeks, in 22 epileptic outpatients receiving phenobarbitone/phenytoin. The serum concentration of total 1,25(OH)2D did not change during the treatment period in any of the treatment groups. On the other hand, in the vitamin D2 group, serum 25(OH)D2, total 25(OH)D, and 24,25(OH)2D increased significantly during the trial, whereas serum concentrations of the vitamin D3 metabolites were unchanged.

Discrepancy between serum 1,25-dihydroxycholecalciferol measured by radioimmunoassay and cytosol radioreceptor assay.

A radioimmunoassay for determination of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) in serum, was compared with the radioreceptor assay using cytosol receptor from rachitic chick intestine in order to clarify whether differences in specificity can explain discrepancies in the clinical application of the two techniques. In the literature, seasonal fluctuations in serum 1,25(OH)2D3 are only observed when using radioimmunoassay. Treatment of anticonvulsant osteomalacia with vitamin D3 results in a marked increase in radioimmunologically measured 1,25(OH)2D3, but no effect on the serum 1,25(OH)2D level, measured by the radioreceptor assay, could be observed.

Different actions of vitamin D2 and D3 on bone metabolism in patients treated with phenobarbitone/phenytoin.

In 22 epileptic outpatients treated for at least 1 year with phenobarbitone/phenytoin the local and total bone mass, together with serum and urinary indices of calcium metabolism, were measured before and during treatment with either vitamin D2 or D3, 4,000 IU daily for 24 weeks. The results showed a distinct difference in the action of the two vitamins on bone metabolism during anti-convulsant treatment. The bone mass increased during treatment with vitamin D2, whereas the vitamin D3-treated patients showed unchanged values of bone mass, but an increased excretion rate of calcium, probably caused by increased intestinal calcium absorption.

Different metabolism of vitamin D2 and vitamin D3 in epileptic patients on carbamazepine.

Serum concentrations of vitamin D metabolites were measured in 30 epileptic outpatients on monotherapy with carbamazepine before and during treatment with either vitamin D2 or vitamin D3, 4000 IU per day for 24 weeks. Vitamin D2 treatment increased the serum concentration of 25OHD2, but a corresponding decrease in 25OHD3 resulted in an unchanged serum value of total 25OHD. Vitamin D3 treatment increased the serum concentration of 25OHD3.

Measurement of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in clinical settings.

A quick and simple method for the selective measurement of 25-hydroxyvitamin D3 (25OHD3) and 25-hydroxyvitamin D2 (25OHD2) is described. It includes a rapid sample preparation technique and a combination of a selective radioimmunoassay for 25OHD3 and a competitive protein-binding assay using vitamin D-binding protein for the determination of total 25OHD, including 25OHD3 and 25OHD2. The method was compared with a procedure which include methanol/methylene chloride extraction and chromatography on Sephadex LH 20, and a procedure which includes HPLC and final quantification by u.

A selective and simplified radioimmunoassay of 25-hydroxyvitamin D3.

A simple, non-chromatographic and selective assay for determination of 25OHD3 in serum is described. The serum sample is deproteinated with acetonitrile and the supernatant purified over a small prepacked cartridge, Sep-pak. In the eluate from the cartridge, 25OHD3 is measured by radioimmunoassay.