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Knowledge of the pre-rehabilitation generic status of functioning in individuals with low back pain is necessary to understand the clinical utility of rehabilitation care. We conducted a scoping review to describe the pre-rehabilitation functioning status of persons with nonspecific low back pain using the World Health Organization Disability Assessment Schedule (WHODAS)-36 or WHODAS-12. We searched multiple databases from 2010 to 2021 for studies reporting pre-rehabilitation scores using WHODAS in persons with low back pain. Reviewers independently screened articles and extracted data, and we descriptively summarized results by the duration of low back pain (acute/subacute3 months; chronic ≥3 months), and the WHODAS version. Of 1770 citations screened, eight citations were relevant. Five studies were conducted in Europe, two in America, and one in the African Region (mostly high-income countries). In persons with acute low back pain, the mean WHODAS-36 pre-rehabilitation summary score (complex scoring) was 22.8/100 (SD = 15.4) (one study). In persons with chronic low back pain, the mean WHODAS-36 summary score (complex scoring) ranged from 22.8/100 (SD = 5.7) to 41.5/100 (SD = 13.8) (two studies). For WHODAS-12 in persons with chronic low back pain, the mean summary score was 11.4/48 (SD = 8.7) or 14.4/48 (SD = 9.4) using simple scoring (two studies), and 25.8/100 (SD = 2.2) using complex scoring (one study). No floor or ceiling effects were observed in WHODAS-36 summary scores for chronic low back pain. Our scoping review comprehensively summarizes available studies reporting pre-rehabilitation levels of functioning using WHODAS in persons with low back pain. Persons with low back pain seeking rehabilitation have moderate limitations in functioning, and limitations level tends to be worse with chronic low back pain.

Recent clinical studies show that hypoglycaemia is associated with increased risk of death, especially in patients with coronary artery disease or acute myocardial infarction. This paper reviews data from cellular and clinical research supporting the hypothesis that acute hypoglycaemia increases the risk of malignant ventricular arrhythmias and death in patients with diabetes by generating the two classic abnormalities responsible for the proarrhythmic effect of medications, i.e. QT prolongation and Ca(2+) overload. Acute hypoglycaemia causes QT prolongation and the risk of ventricular tachycardia by directly suppressing K(+) currents activated during repolarisation, a proarrhythmic effect of many medications. Since diabetes itself, myocardial infarction, hypertrophy, autonomic neuropathy and congestive heart failure also cause QT prolongation, the arrhythmogenic effect of hypoglycaemia is likely to be greatest in patients with pre-existent cardiac disease and diabetes. Furthermore, the catecholamine surge during hypoglycaemia raises intracellular Ca(2+), thereby increasing the risk of ventricular tachycardia and fibrillation by the same mechanism as that activated by sympathomimetic inotropic agents and digoxin. Diabetes itself may sensitise myocardium to the arrhythmogenic effect of Ca(2+) overload. In humans, noradrenaline (norepinephrine) also lengthens action potential duration and causes further QT prolongation. Finally, both hypoglycaemia and the catecholamine response acutely lower serum K(+), which leads to QT prolongation and Ca(2+) loading. Thus, hypoglycaemia and the subsequent catecholamine surge provoke multiple, interactive, synergistic responses that are known to be proarrhythmic when associated with medications and other electrolyte abnormalities. Patients with diabetes and pre-existing cardiac disease may therefore have increased risk of ventricular tachycardia and fibrillation during hypoglycaemic episodes.

With the large number of proposed liquefied natural gas (LNG) facilities in the United States (and worldwide), many new technical personnel are becoming involved in applying and interpreting LNG standards and regulations. Also, opponents of the new LNG developments are questioning whether existing safety and security requirements are adequate. In this paper, we will begin with an overview of existing standards and regulations pertinent to LNG facilities (for both onshore and offshore applications). That discussion will include documents from the National Fire Protection Association, the European Committee for Standardization, the Department of Transportation, and the United States Coast Guard. For offshore facilities, it will discuss the guidelines from some of the international classification societies. This paper will outline what is addressed (and what is not addressed) by these standards and will then focus on and discuss the issues with those requirements and the changes that are currently under consideration by the standards organizations and federal regulators. This paper finishes with some specific recommendations for consideration by LNG facility developers. © 2005 American Institute of Chemical Engineers Process Saf Prog, 2005

It is known that nursing-home patients with vitamin D insufficiency have elevated serum parathyroid hormone (PTH) as well as raised serum alkaline phosphatase (ALP). Although it is well known that vitamin D insufficiency and secondary hyperparathyroidism are common among the elderly in western countries, there is continuing controversy over the level of serum 25-hydroxyvitamin D [25(OH)D] necessary for bone health. We approached this issue by examining the relationships between serum 25(OH)D, ionized calcium, PTH, and ALP and the urinary bone resorption markers hydroxyproline, pyridinoline, and deoxypyridinoline, corrected for creatinine (OHPr/Cr, Pyd/Cr, and Dpd/Cr, respectively), in 486 postmenopausal women of mean age 63 (SD 9.5) years, who were referred to our osteoporosis and menopause clinics for investigation. When the patients were divided into two groups with 25(OH)D above and below 20 nmol/L, 30 nmol/L, 40 nmol/L, 50 nmol/L, 60 nmol/L, or 70 nmol/L, the most significant differences between the two groups thus derived was found at a serum 25(OH)D level of 60 nmol/L (P < 0.001 for all markers). The most significant difference between groups for serum PTH was found when the patients were divided at a serum 25(OH)D of 50 nmol/L. PTH, OHPr/Cr, Pyd/Cr, and ALP were inversely related to serum 25(OH)D. PTH was inversely related to serum ionized calcium. There was a trend for ionized calcium to be positively related to 25(OH)D, but this did not reach statistical significance. We conclude that rises in three bone resorption markers and ALP can be detected in postmenopausal women when the serum 25(OH)D level falls below 60 nmol/L. Levels above this may be required for optimal bone health.

We report sequential changes in bone mineral density (BMD) at the forearm, hip and spine in 340 consecutive postmenopausal women referred by 103 general practitioners and six specialists, and who were either untreated or being treated with calcium, estrogen, norethisterone or calcitriol for a median period of 25 months (range 11–52). The mean annual rate of change in BMD at the three sites was: 1.39% in 44 women on norethisterone; 0.94% in 107 women on estrogen (both p < 0.001); 0.24% (not significant) in 52 women on calcitriol; –0.53% in 92 women on calcium; and –1.06% in 45 women on no treatment (both p < 0.01). The mean annual rate of change at the three sites in the 295 treated women was 0.43%, which was significantly positive (p < 0.001) and was 1.49 percentage points more positive than in the untreated women (p < 0.001). The greatest mean difference between treated and untreated patients was seen at the forearm, where it was 2.16 percentage points (p < 0.001). This was significantly greater than the...

Norethisterone 2.5 mg/day was administered to 26 postmenopausal women (aged 54-79 years) with varying degrees of osteoporosis and with a forearm bone mineral density value more than 2 SD below the young normal mean. Fasting blood and urine samples were collected and radiocalcium absorption measured at baseline and after treatment for a median period of 4 months. There were significant falls in serum calcium and its fractions, phosphate, alkaline phosphatase and cholesterol (HDL and LDL), and significant rises in serum chloride and parathyroid hormone. In the urine, there were significant falls in calcium, sodium and hydroxyproline. These changes were in close agreement with our previously reported responses to norethisterone 5 mg/day. We conclude that norethisterone in a dose of 2.5 mg/day is probably as effective as 5 mg/day in reducing bone resorption in postmenopausal women with low bone density.

There is controversy as to whether the rise in urinary calcium at the menopause is the cause or the result of the rise in bone resorption at that time. In an attempt to resolve this issue, we have compared the relevant biochemical variables in 102 premenopausal volunteers (mean age 37 years; range 21-52) and 86 apparently normal postmenopausal women (mean age 55 years; range 40-60). We measured the fasting serum calcium, creatinine, proteins, electrolytes and intact parathyroid hormone (PTH), and the urinary calcium and creatinine both after an overnight fast and in a 24-h collection. We calculated serum calcium fractions, creatinine clearance and the notional tubular maximum reabsorptive capacity for calcium. Creatinine excretion and clearance were lower in the post- than in the premenopausal women after correction for surface area and age. Total serum calcium was higher in the post- than in the premenopausal women but this was accounted for by the higher ligand concentrations in the former. Fasting and 24-h urinary calcium were also higher in the post- than in the premenopausal women due in part to the former's higher filtered load of calcium (due to their higher serum complexed calcium) but mainly to their reduced tubular reabsorption of calcium despite their slightly raised serum PTH. Our analysis resolves the rise in urinary calcium at the menopause into its two components: increased filtered load and reduced tubular reabsorption. The changes in these two variables, neither of which can be attributed to increased bone resorption, produce an increase in calcium requirement that is sufficient to account for postmenopausal bone loss. However, the translation of this menopausal increase in calcium requirement into an increase in bone resorption at near-normal serum PTH levels requires some menopause-dependent change in the responsiveness of the bone to calcium demand. We suggest that this change may occur at the level of the osteoclasts and that estrogen may modify the calcium feedback setpoint in these cells in a manner analogous to calcitonin. This model resolves the apparent conflict between the estrogen and calcium hypotheses and explains the synergism between these two treatment modalities.

With the aim of exploring putative correlations between serum and CSF levels of clozapine and its demethyl metabolite, lumbar puncture was performed on four male and five female schizophrenic patients during long-term treatment with clozapine. Three consecutive 6-ml fractions were collected after at least 8 h of bedrest and fasting. On comparing serum and CSF levels, a correlation was found for norclozapine in the third (13-18 ml) CSF fraction. Norclozapine in the first (0-6 ml) CSF correlated significantly with height. The CSF/serum ratio of clozapine in the first fraction was correlated significantly with body weight. No correlations were found between serum levels of clozapine and norclozapine, or between the serum and CSF levels of clozapine. The study suffers from a small number of patients (for ethical reasons), but the present results might be explicable if the first (0-6 ml) CSF fraction represents a cul-du-sac of the CSF, mirroring the previous day's drug levels. The second fraction, then, will represent the CSF level in the steady state during the night.

The relationship between calcium absorption and gastric emptying and the precision of measurement of fractional calcium absorption using a single isotope technique were evaluated in 14 normal postmenopausal women (age range 61-72 years). On two occasions separated by between 5 and 15 days, each subject was given 250 mL water containing 0.2 MBq of 45Ca in 20 mg of calcium carrier as the chloride, 20 mg kg-1 paracetamol and 9 MBq of 99mTc sulphur colloid. Venous blood samples were taken at -2, 15, 30, 45, 60, 90, 120, 150 and 180 min after consumption of the drink, and gastric emptying (GE) was monitored with a gamma camera. Fractional calcium absorption in the first hour (alpha 6) was calculated from the blood samples obtained at 15, 30, 45, 60, 90 and 120 min. An absorption rate was also derived from the 60 min sample using only a calibration curve (alpha 1). There were close correlations between radiocalcium absorption on the two study days (r = 0.89, P < 0.001 for both alpha 1 and alpha 6) and between alpha 1 and alpha 6 (r = 0.93, P < 0.001). Plasma paracetamol concentrations at 15 min were directly related to the early phase of GE (r = 0.42, P < 0.05). In contrast, calcium absorption was inversely related to GE (r = 0.45, P < 0.05). We conclude that radiocalcium absorption is not greatly influenced by gastric emptying rate and that the single blood sample procedure has similar precision to the six-blood sample test.

A total of 19 measured and derived bone-related biochemical variables were determined in 307 postmenopausal volunteers on two occasions, 5 years apart. The plasma variables with the highest coefficients of determination (r2) were plasma globulins, alkaline phosphatase, creatinine and calculated ionized and ultrafiltrable calcium. In the urine, the highest r2 values were in respect of fasting urine calcium excretion corrected for urine sodium, hydroxyproline excretion, and the maximal renal tubular reabsorption of calcium and phosphate (TmCa/GFR and TmP/GFR). The components of variance of TmCa/GFR and TmP/GFR show marked individuality but their methods determination meet the criterion for acceptable analytical goals. We conclude that most of the measured and derived bone-related biochemical variables in fasting plasma and urine are sufficiently reproducible in postmenopausal women to be useful for ranking individuals for a period up to 5 years.

The biochemical effects of a single oral dose of 10 mmol of calcium on certain blood and urine variables were studied in 20 elderly postmenopausal subjects (mean age 72.3±6.2 years) with a very low dietary calcium intake (mean 7.2±3 mmol/day). Twelve hours after calcium administration, the plasma total calcium, phosphate and bicarbonate, and the urinary calcium/creatinine ratio rose, while the plasma parathyroid hormone and chloride, and urinary hydroxyproline/creatinine and phosphate/creatinine ratios fell. These results show that a single oral dose of calcium suppresses bone resorption in elderly women with low dietary calcium intake, and that long-term supplementation may be important in the prevention of osteoporosisrelated fractures.

BrMedJ 1990;300:1056-60 In a recent review Kanis and Passmore concluded that there was no case for supplementation of the diet with calcium for the prevention or treatment of osteoporosis.1 We consider that present evidence, taken as a whole, points to a different conclusion. We consider the matter under five main headings: experimental calcium deficiency; human calcium requirements; the relation between calcium intake, bone mass, and bone loss; the relation between calcium and hip fracture; and the role of calcium in established osteoporosis.

Background. The possibility that monoaminergic neurotransmission is altered in pathological gambling was examined.Methods. Monoamines and their metabolites were measured in CSF obtained at level L4–5 from ten pathological gamblers and seven controls.Results. A decrease in dopamine and an increase in 3,4-dihydroxyphenylacetic acid and homovanilic acid was found. Noradrenaline and its metabolite 3-methoxy-4-hydroxyphenylglycol was also increased but 5-hydroxytryptamine and 5-hydroxyindoleacetic acid were unchanged.Conclusion. It is suggested that the function of the dopaminergic system, possibly mediating positive and negative reward, and the noradrenergic system, possibly mediating selective attention, is changed in pathological gambling.

It must be a source of some surprise to rational scientists that the human requirement for calcium an apparently inoffensive nutrient that contributes so much to our physical stability arouses strong emotions in many breasts. Calcium requirements and allowances seem to attract more controversy and generate more heat than do the requirements and allowances for any other nutrient the latest example of this being a recent controversy in the columns of the New York Times. The problem may be that calcium turnover is too slow and the effects of deprivation and replenishment too gradual to be easily demonstrated in humans; perhaps it is the very efficacy of the calcium homeostatic system that makes this system difficult to study. Whereas plasma concentrations of other nutrients (eg sodium potassium phosphorus and magnesium) can be lowered relatively easily and quickly by experimental deprivation plasma (ionized) calcium is so well protected through access to the reserve stores in the skeleton that it cannot be used as a marker of calcium nutrition. Although there is overwhelming evidence that calcium deprivation causes osteoporosis in experimental animals it would be both immoral and impractical to try to reproduce such experiments in humans. The calcium requirement therefore must be estimated by indirect means that even if they satisfy many of the experts in the field are open to criticism by others. Nonetheless there is no smoke without fire and it may be that this controversy does reflect a deeper reality although not perhaps the one that the critics of the calcium story envisage. (excerpt)

This study was initiated in order to describe and evaluate the effects of a therapeutic drug monitoring (TDM) routine of selective serotonin reuptake inhibitors (SSRIs) on treatment strategies and drug costs in depressed elderly patients.Blood samples were drawn from elderly depressed patients and analysed for steady-state trough serum concentrations of citalopram (n = 48), paroxetine (n = 48) or sertraline (n = 39). A global efficacy evaluation was made at baseline and after 6-9 months. Antidepressant drug costs before and after TDM were estimated.Eight samples were excluded due to technical problems or noncompliance. In 65 of the 127 (51.2%) remaining cases, the treatment strategy was changed according to the TDM outcome, in most a reduction of the prescribed dose. Bioanalytical TDM costs included the antidepressant drug costs after TDM were reduced by 10.2%.The results support the utility of TDM in the search for the individual minimum effective SSRI dose in the elderly.

The range of fat corrected distal forearm mineral content (FMC) (at a site which comprises approximately 75% cortical and 25% trabecular bone) and the effect of aging on FMC were determined in normal premenopausal women. In 106 women (mean age 39; range 18-56) the mean FMC was 1.184 (SD 148) g/cm; fat correction increased this to 1.239 (SD 148) g/cm. There were significant correlations between fat corrected FMC and height, weight and BMI (r greater than 0.16; P less than 0.05). In 43 of these women (mean age 35; range 18-51) repeat measurements of FMC were performed. The last measurement was separated from the first by a mean time interval of 27 +/- 3 months. There was no significant change in uncorrected FMC (baseline 1.185 +/- 0.21 g/cm compared with their final measurement 1.182 +/- .020 g/cm; P = 0.51). Fat-corrected FMC (baseline 1.229 +/- .021 g/cm compared with 1.223 +/- .020 g/cm later) tended to decrease although this change was not significant (P = 0.06). Age ranked cusum analysis demonstrated a non-significant fat-corrected rate of change in FMC of -.3% yr in those over 35 years of age (P less than 0.10). This data suggests that if there is any distal forearm bone loss before the menopause it is negligible.

BACKGROUND Urine calcium after an overnight fast is higher in osteoporotic than in normal post-menopausal women. The question is whether this is the cause or effect of the bone-losing state. OBJECTIVE To establish whether the elevated obligatory calcium loss in osteoporotic women is due to a raised filtered load of calcium or to reduced renal tubular reabsorption of calcium. DESIGN Covariance analysis using total plasma calcium and its fractions as the covariates. PATIENTS Eighty-two untreated post-menopausal women without vertebral compression and 137 untreated post-menopausal with vertebral compression all between the ages of 61 and 75 years. MEASUREMENTS After an overnight fast, calcium, albumin, globulins, anion gap and bicarbonate were measured in the plasma, and calcium, sodium and creatinine in the urine. The calcium fractions in plasma and the calcium/creatinine and sodium/creatinine ratios in urine were calculated. Bone density was measured in the distal forearm. RESULTS The ultrafiltrable and ionized calcium in the plasma and the calcium/creatinine ratio in the urine were significantly higher in the women with vertebral compression than in those without. On covariance analysis, neither total plasma calcium nor any of the plasma calcium fractions made a significant contribution to the difference in fasting urine calcium between normal and osteoporotic women, whether bone status was defined by vertebral compression or by bone density. CONCLUSIONS The increased obligatory calcium loss in osteoporotic women is not due to an increase in the filtered load of calcium and must therefore reflect reduced renal tubular reabsorption. This implies that the calcium loss in the urine is not the result of increased bone resorption but is more likely to be causal.

Suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, was studied in a sample of 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. The potential of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF to predict suicide risk within the first year after attempted suicide was studied by means of survival analysis after after median split subgrouping. Eleven patients (12%) committed suicide within 1 year after attempted suicide. Eight of these belonged to the below-the-median (87 nM) CSF 5-HIAA subgroup, that is, the suicide risk was 17% as compared with 7% among those with above-the-median CSF 5-HIAA. The cumulative number of survived patient-months during the first year after attempted suicide was significantly lower in the low CSF 5-HIAA subgroup. It was concluded that low CSF 5-HIAA predicts short-range suicide risk after attempted suicide in mood disorder psychiatric inpatients. These findings lend further support to the serotonin hypothesis of suicide risk.

OBJECTIVE Progestogens may be a useful therapeutic alternative to oestrogen in the treatment of post-menopausal osteoporosis. The purpose of this study was to determine the effects of norethisterone on forearm bone mineral content and bone related biochemical variables in patients with post-menopausal osteoporosis. DESIGN/PATIENTS The effects of treatment with norethisterone (5 mg/day) on bone related biochemical variables was determined in 44 women with post-menopausal osteoporosis. The effects of norethisterone on forearm bone mineral content (FMC) were evaluated by serial measurements in 39 of these women. MEASUREMENTS We measured forearm mineral content, forearm mineral density, forearm fat content and fat-corrected forearm mineral density. Biochemical measurements included plasma calcium and plasma calcium fractions (ionized, protein bound, complexed and ultrafiltrable), alkaline phosphatase, bicarbonate, phosphate, albumin and globulins, serum parathyroid hormone, osteocalcin and 1,25-dihydroxyvitamin D, radiocalcium (45Ca) absorption and fasting urinary calcium/creatinine, sodium/creatinine, phosphate/creatinine and hydroxyproline/creatinine molar ratios. RESULTS After 4 months of treatment norethisterone produced a fall in plasma calcium (mean +/- SEM from 2.40 +/- 0.14 to 2.32 +/- 0.13 mmol/l, P < 0.001), primarily in the non-ionized calcium, due to a decrease in plasma bicarbonate (from 29 +/- 0.28 to 27 +/- 0.28 mmol/l, P < 0.001). There were decreases in urinary calcium/creatinine (from 0.41 +/- 0.03 to 0.19 +/- 0.02, P < 0.01) and sodium/creatinine (from 15 +/- 1.1 to 10 +/- 0.93, P < 0.001) molar ratios and a rise in the renal tubular maximum for calcium reabsorption (TmCa) (from 2.36 +/- 0.041 to 2.55 +/- 0.059 mmol/l of glomerular filtrate, P < 0.001). Plasma phosphate, urinary phosphate/creatinine and tubular maximum for phosphate reabsorption (TMP) all fell (P < 0.01). Both the urinary hydroxyproline/creatinine (P < 0.001) and plasma alkaline phosphatase (P < 0.001) fell. Serum parathyroid hormone rose from 4.1 +/- 0.36 to 5.5 +/- 0.51 pmol/l (P < 0.02) and radiocalcium absorption increased from 0.67 +/- 0.08 to 0.81 +/- 0.10 fx/h (P < 0.01). There was no change in serum 1,25-dihydroxy vitamin D. After treatment with norethisterone for 4 months there was an increase in forearm bone mineral content (P < 0.05) and a decrease in forearm fat content (P < 0.02). After two years treatment with norethisterone fat-corrected forearm bone mineral content rose (mean change 17.0 +/- 5.5 mg/cm, P < 0.01). CONCLUSIONS These results suggest that norethisterone prevents bone loss in post-menopausal osteoporosis by decreasing bone turnover, has a vitamin-D independent effect on intestinal calcium absorption, and increases serum parathyroid hormone levels.

STUDY OBJECTIVE--The aim was to estimate fracture rates and fracture prevalence from fracture histories in normal postmenopausal women. DESIGN--Apparently healthy postmenopausal women were recruited by advertising in the media. Fracture histories were obtained by personal interview in 1983 and again by interview or questionnaire in 1988. Fracture rates were calculated prospectively and retrospectively. PARTICIPANTS--492 women (mean age 58.6 years) were selected from over 1000 applicants on the basis that they were suffering from no disease nor taking any therapy which might affect their bones. MEASUREMENTS AND MAIN RESULTS--Retrospective premenopausal and postmenopausal fracture rates were calculated in 1983, prospective rates calculated from 1983 to 1988, and retrospective rates checked again on the second occasion. The retrospective and prospective fracture rates were very similar. The five year fracture rates were low and steady until the menopause, when they rose by a factor of 10 and reached a new plateau after about 15 years. The results were comparable to those obtained from hospital statistics. CONCLUSIONS--The menopausal rise in fracture rates not only involves wrist fractures but most peripheral fractures, and probably reflects postmenopausal loss of trabecular bone. Meaningful fracture rates can be calculated from individual fracture histories in a well defined population. This technique may be particularly useful in developing countries where public health data may be incomplete.

A cross-sectional study of plasma 25-hydroxy-vitamin D (250HD) concentrations in healthy women in the age range 20-96 years is reported. Mean values decline with increasing age while abnormally low levels of plasma 250HD are more common in the elderly. The decline in vitamin D status with age is probably the result of lack of sunlight exposure associated with social factors and physical immobility.

Bone status and fracture rates were evaluated in two Yugoslav populations with very different dietary habits. In district A (Podravina) the daily calcium intake was about twice that in district B (Istra). There were similar but smaller differences in the intakes of other nutrients. In district B metacarpal cortical width was reduced in all age groups of both sexes but the difference tended to decrease with age. The proximal femur fracture rate was higher in district B than district A but there was no difference between the forearm fracture rates in the two districts. Our results confirm that bone mass at any age is clearly the result of age and sex and most probably other genetically determined factors but also show that this expression is nutrition related. The data suggest that nutrition (in particular the calcium intake) is an important determinant of bone mass in young adults but seems to have little effect on age-related bone loss in either males or females. The main determinant of cortical bone mass in the elderly seems to be the cortical bone mass in middle life. The proximal femur fractures of old people reflect declining cortical bone mass but the distal forearm fractures of middle-aged women are unrelated to cortical bone mass or nutritional status. Am. J. Clin. Nuir. 32: 540-549, 1979.

Calcium absorption can be measured in at least three ways — by the balance procedure, by intubation of the small intestine with a double or triple lumen tube and by the oral administration of radioactive calcium.

Abuse of ethyl chloride is a problem which has previously been almost unknown in Sweden. Confusion, hallucinosis, ataxia, and pronounced impairment of short-term memory--all of a transient nature--and a prolonged and uncharacteristic course of abstinence reactions are some of the symptoms that occur on sniffing of ethyl chloride. The course of events in one such case is described. The authors request that references to this article outside the professional press should not be made in such a way as to facilitate abuse.

The investigation of a patient with a suspected disorder of calcium metabolism is most rapidly and efficiently performed by observing a standard procedure, the initial stages of which are simple and mandatory, the later stages more complex and determined by the initial results and the depth of investigation required. Needless to say, the investigations are preceded by history taking and routine physical examination. The following account is a summary of available procedures, most of which have been described elsewhere in greater detail (Nordin et al., 1976a).