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Purpose: Chronic low-grade periprosthetic joint infection (PJI) of a shoulder replacement can be challenging to diagnose. 18F-FDG PET/CT is suggested as a modality to diagnose lower-limb PJI, but no studies on shoulder replacements exist. The aim of this study was therefore to determine the diagnostic accuracy of 18F-FDG PET/CT in diagnosing chronic PJI of the shoulder. Methods: Patients evaluated for a failed shoulder replacement during a 3-year period were prospectively included in the study. All patients underwent pre-operative 18F-FDG PET/CT, and were evaluated for signs of infection by three independent reviewers using shoulder-specific criteria. Interrater-agreement was calculated between the reviewers. If the patient had revision surgery, biopsy specimens were obtained and cultured with bacterial growth in the cultures serving as gold standard of infection. Results: A total of 86 patients were included in the study. Nine patients were 18F-FDG PET/CT positive for infection, with only three true positive. Using the gold standard, infection was diagnosed after revision surgery in 22 cases. All infections were chronic and caused by low-virulent microbes. The sensitivity of 18F-FDG PET/CT was 0.14 95% CI (0.03–0.36), specificity 0.91 95% CI (0.81–0.97), positive predictive value was 0.40 95% CI (0.15–0.71) and negative predictive value 0.71 95% CI (0.67–0.75). The inter-observer agreement was 0.56 (Fleiss' kappa), indicating moderate agreement of the visual FDG-PET evaluation using the shoulder-specific criteria. Conclusion: 18F-FDG PET/CT has poor diagnostic accuracy in diagnosing low-grade PJI of the shoulder. 18F-FDG PET/CT cannot be recommended as a part of the routine preoperative workup to diagnose low-grade infection of a shoulder replacement. [ABSTRACT FROM AUTHOR]

The potential for table-top production in Scandinavia is currently unknown, but may be considered more limited than in central Europe. In this study, the performance of six strawberry cultivars was studied in a table-top system using peat bags as substrate inside or outside an open polythene tunnel. The table-top system resulted in high-quality fruit production, with easy-to-pick fruit and a high percentage of marketable produce. The tunnel reduced average solar radiation and increased temperature slightly and simultaneously protected the plants from rain, this did reduce yield or fruit quality parameters compared with uncovered plots. Partly because of an increased incidence of powdery mildew (Sphaerotheca macularis) inside the tunnel, fruit brightness was reduced in the second harvest year. Of the cultivars included, 'Elsanta', 'Sonata' and 'Alice' may be considered well adapted to the system, whereas 'Honeoye', 'Florence' and 'Babette' are inferior. [ABSTRACT FROM AUTHOR]

Brandi L, Nielsen PK, Bro S, Daugaard H, Olgaard K (Rigshospitalet, University of Copenhagen, Denmark). Long-term effects of intermittent oral alphacalcidol, calcium carbonate and low-calcium dialysis (1.25 mmol L-1) on secondary hyperparathyroidism in patients on continuous ambulatory peritoneal dialysis. J Intern Med 1998; 244: 121–31. Objectives (i) To examine the effect of alphacalcidol [1α(OH)D3] given as an oral dose twice weekly in combination with CaCO3 and low-calcium dialysis (1.25 mmol L-1) on the secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD). (ii) To examine the changes in peritoneal mass transfer for calcium, phosphorus, magnesium, lactate, creatinine, urea, glucose, pH and albumin after shift to low-calcium dialysis solution. Design An open study in patients on CAPD. Setting Renal division, Rigshospitalet, Copenhagen. Subjects Thirty-nine patients were included and completed 12 weeks of treatment. Thirty of the patients completed 52 weeks of treatment. A peritoneal equilibrium test (PET) was performed in seven patients. Interventions Following two sets of blood samples obtained as basal values the calcium concentration was reduced in the dialysis fluid from 1.75 mmol L-1 to 1.25 mmol L-1. Increasing doses of oral 1α(OH)D3 were then administered under careful control of p-ionized calcium (p-Ca2+) and p-inorganic phosphate (p-Pi). Blood samples were obtained every 2–4 weeks for 52 weeks. PET was performed using standard dialysis fluid and 1 week later using low-calcium dialysis fluid after a preceding overnight dwell. Two litres of glucose 22.7 mg mL-1 were used. Main outcome measures Intact parathyroid hormone (PTH), p-Ca2+, p-Pi, doses of CaCO3, doses of 1α(OH)D3, peritoneal mass transfer for calcium, inorganic phosphate, magnesium, lactate, creatinine, urea, glucose and albumin. Results Thirty nine patients with initial PTH values 144 ± 26 pg mL-1 were followed for 12 weeks and 30 patients for 52 weeks. A negative calcium balance was induced after shifting to low-calcium dialysis fluid. After 2 weeks of treatment a significant increase of PTH by approximately 60% and a small but significant decrease of p-Ca2+ was observed. After 12 weeks of treatment with increasing doses of 1α(OH)D3 and CaCO3, PTH was again reduced to levels not significantly different from the initial values. After 52 weeks of treatment no deterioration of the secondary hyperparathyroidism was seen. Conclusions A calcium concentration of 1.25 mmol L-1 in the CAPD dialysate made it possible to reduce the amount of aluminium-containing phosphate binder, to increase the doses of CaCO3 and to use pulse oral 1α(OH)D3 without causing severe hypercalcaemia in the patients. After a short elevation of PTH, the PTH levels remained at normal or near normal levels and the long-term results clearly demonstrated that an aggravation of the secondary hyperparathyroidism could be inhibited. [ABSTRACT FROM AUTHOR]

Effects of a single dose of 200 IU of nasal salmon calcitonin (SCT) on calcium metabolism and biochemical markers of bone turnover were investigated in 12 healthy male volunteers in a randomized, placebo-controlled, cross-over design. The nasal spray was given in the morning, and subsequently blood and urine samples were collected for 26 hours. There was a significant decrease in serum ionized calcium with a nadir 4 hours after administration of nasal SCT accompanied by a significant increase in serum parathyroid hormone (P = 0.01) and serum calcitriol (P = 0.04). Nasal SCT did not reduce urinary hydroxyproline/creatinine. Urinary deoxypyridinoline/creatinine was lowered significantly 2 hours after administration of nasal SCT and throughout the first 24 hours, but remained unchanged for the last 2 hours. On a 24-hour basis, urinary deoxypyridinoline/creatinine decreased from 14.1 (3.5) nmol/mmol to 11.7 (3.2) nmol/mmol after nasal SCT (P = 0.04). Nasal SCT did not change the serum levels of alkaline phosphatase, osteocalcin, and the carboxyterminal propeptide of type 1 procollagen. The results indicate that nasal SCT given as a single dose provokes a modest decrease in bone resorption lasting several hours, but leaves bone formation unaffected. [ABSTRACT FROM AUTHOR]

The long-term effects of high dose steroid treatment with either prednisone (PDN) or deflazacort (DFZ) were examined on various parts of the skeleton in 29 patients with nephrotic syndrome. All had normal skeleton at the start of the steroid treatment. At the beginning, PDN was given as 80 mg/day and tapered down to 20 mg/day for 1 year and DFZ was given in an equipotent dosage. Twenty-three patients completed 6 months of treatment, and 18 patients completed 12 months of treatment. Beside laboratory parameters to ensure the effect of treatment on the nephrotic syndrome, all had measurements of the bone mineral content (BMC) at 0, 6 and 12 months of treatment. BMC was measured by single photon absorptiometry of both forearms and by dual photon absorptiometry of the mandible, forearms, and lumbar spine. The effect of DFZ was compared to that of PDN due to a potential ‘calcium sparing’ effect of DFZ. The therapeutic effects on the nephrotic syndrome were not different between the two drugs. Urinary 24-h protein decreased from 9.9 to 1.1 g in the DFZ-treated patients and from 8.0 to 1.4 g in the PDN-treated patients. Plasma albumin concentration normalized in both groups. Both groups of steroid-treated patients had a significant reduction of the BMC levels in all parts of the skeleton. However, the bone decay rates/month were significantly different between different bone regions and between different drug regimes. In the forearm, the bone decay rate was 5.3%/year in the PDN group and 2.0%/year in the DFZ group (P<0.001). In the mandible, decay rate was 7.0%/year in both groups, and in the lumbar spine it was 12.5% /year in the PDN group and 6.8%/year in the DFZ group (p<0.01). Thus, the bone loss in the PDN-treated group was significantly higher than that of the DFZ-treated patients, despite a similar therapeutic effect on the nephrotic syndrome. Therefore, the detrimental effect of long-term steroid treatment on the skeleton may not be abolished, but can be reduced significantly by using deflazacort instead of prednisone. [ABSTRACT FROM PUBLISHER]

Reports on a study to determine the effect of plant density and cultivar on the labour requirements in apple orchards. How dwarfing rootstocks have resulted in moderate tree growth, with early yield and high quality fruit; Data collected for the study, including labour input, plant density and yields; Average increase in plant density; Impact of different cultivars on labour input; Conclusion which found a positive correlation between the average plant density of growers and their average input of regular labour and a negative correlation between orchard area and average input of regular labour.

Interaction between hepatic and renal metabolism is found in many endocrine systems. We therefore developed a new experimental model, combining the isolated perfused rat kidney and rat liver. Krebs-Henseleit buffer with bovine serum albumin 67 g·1 and amino acids was recirculated to both organs through two rolling pumps, four 8 μm Millipore filters and two specially designed membrane lungs. The kidney was cannulated by a modification of the technique described by Nishiitsutsuji-Uwo 1967 and the liver was cannulated by a modification of the technique described by Hems 1966. Kidney function: Perfusion pressure 12.4±1.1 kPa (93±8 mmHg), flow 28±6 ml·min·g, FR 94.0±2.9%, GFR 491±191 μl·min·g, urine production 48±34 μl·min·g, FE 60±36%. Liver function: Flow 25 ml·min (fixed), portal vein pressure 12±3 cm HO, bile flow 0.18±0.13 ml·h, oxygen consumption 2.0±0.2 μmol·min·g. Only minor differences were found between single perfusions (N=25) and combined perfusions (N=6). We conclude that it is possible to combine the isolated perfused rat kidney and rat liver without impairment of the function of either. [ABSTRACT FROM AUTHOR]