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Halarachne sp. nasal mites infest harbor seals (Phoca vitulina) and southern sea otters (Enhydra lutris nereis) in California, but little is known about the pathophysiology of these infestations, or risk factors for exposure. To investigate these questions, a retrospective case-control study was performed using necropsy data from 70 mite-infested sea otters, and 144 non-infested controls. Case records for sea otters examined by pathologists from February 1999 through May 2015 were examined to assess risk factors for infestation, and lesions associated with nasopulmonary acariasis. Animals with a history of captive care within 10 days of death or carcass recovery were 3.2 times more likely to be infested with nasopulmonary mites than those with no history of recent rehabilitation. Sea otters stranding within 1 km of Elkhorn Slough in Monterey Bay were 4.9 times more likely to be infested with nasal mites than other areas; this site is characterized by high sea otter contact with sympatric harbor seals (a common host for Halarachne sp.), and a comparatively large population of rehabilitated and released sea otters. Aged adult otters were 9.4 times more likely to be infested than younger animals, and sea otters with nasopulmonary acariasis were 14.2 times more likely to have upper respiratory inflammation than un-infested animals. Additional findings in otters with nasopulmonary acariasis included lower respiratory tract bacterial infections, presence of medium-sized and/or fresh nose wounds at necropsy (indicators of recent face-to-face interaction between otters during copulation or fighting), and turbinate bone erosion. Our findings, although preliminary, suggest that captive rehabilitation and close contact with harbor seals could facilitate nasopulmonary mite transmission to sea otters. We also identified a high-risk zone for nasopulmonary acariasis in sea otters. We also provide preliminary data to suggest that nasopulmonary mite infestations can cause significant respiratory pathology in sea otters.

Two patients are described in whom the preliminary clinical and laboratory investigations suggested a diagnosis of osteomalacia, from gluten-sensitive enteropathy in one and from anticonvulsant therapy in the other. However, when the primary disease was corrected by diet and extra vitamin D, respectively, both patients developed hypercalcaemia. A standard hydrocortisone test in the second patient failed to reduce the hypercalcaemia. In both patients parathyroid tumours were found at operation. It is suggested that both patients had tertiary hyperparathyroidism in which the normally tell-tale hypercalcaemia was at first masked by the other abnormalities, and that this masking may account for some cases reported as having normocalcaemic primary (or tertiary) hyperpatathyroidism. Interpretation of total plasma-calcium is likely to be unreliable unless the 25-hydroxyvitamin-D levels can be shown or assumed to be normal.

A healthy girl of 10 years presented with lumps on her tongue, shown on biopsy to be neuromas. She had had operations to her feet for pes cavus and was relatively long-limbed but had no other 'Marfanoid' features. She had a high plasma calcitonin level. At operation a normal sized thyroid gland was totally removed. It contained two discrete masses of malignant C-cells and diffuse foci elsewhere. The plasma calcitonin fell slowly to normal on follow-up but was noted to be rising 2 1/2 years later. We stress the importance of making this diagnosis as early as possible and mention briefly another child aged 15 months, similarly diagnosed and operated upon.

Osteoporosis is defined as 'too little normal bone', the disorder being rarer in children than adults. The varied forms in childhood can be classified as those secondary to some other disease and primary forms of the disorder which include the genetically determined osteogenesis imperfecta types and idiopathic forms of osteoporosis. A plea is made for greater clinical application in attempting to discriminate differing forms of these primary disorders. Osteogenesis imperfecta it is argued is a heterogeneous condition with the evidence favouring both dominantly and recessively transmitted forms in different kindreds. Another possible osteogenesis imperfecta variant is characterized by dwarfing, scoliosis and peculiar cystic lesions of the proximal humeri. Idiopathic juvenile osteoporosis is a term reserved for the acute osteoporosis beginning in the immediate prepubertal years and may differ in its cause from idiopathic osteoporosis beginning rather earlier in childhood. It is emphasized that immobilization osteoporosis is of very great importance and may become superimposed upon other osseous dysplasias. A complete understanding of these conditions will be helped by elucidation of the basic underlying defects in collagen and other constituents of bone matrix.

We describe three patients with fibrous dysplasia of bone in whom there was evidence of hypophosphataemic osteomalacia or rickets. Two of the patients had polyostotic fibrous dysplasia and osteomalacia. The third was a child with fibrous dysplasia of the facial and cranial bones and rickets. In all cases the manifestations of osteomalacia or rickets were controlled with large doses of vitamin D. In the child the rickets and hypophosphataemia ceased when most of the bone affected by fibrous dysplasia was surgically resected. Previously reported cases of the association between fibrous dysplasia and hypophosphataemic osteomalacia are reviewed. We suggest that these cases are analogous to the syndrome of 'tumour rickets' where hypophosphataemia appears to be due to the presence of a mesenchymal tumour and regresses when the tumour is removed.

Microcrystalline calcium hydroxyapatite compound (MCHC) was given orally together with small doses of dihydrotachysterol (DHT) to a number of patients with osteogenesis imperfecta (OI). Serial calcium and phosphate balances in three patients representing wide variations in severity of OI are presented over periods from eight months to two years. The combination of MCHC and DHT resulted in an immediate positive calcium balance which was maintained throughout the period of assessment in 2 cases. However, no radiological improvement could be demonstrated. Substituting calcium gluconate for MCHC resulted in a reduction of positive balance. No adverse effects were noted. The reasons why MCHC with DHT should result in increased calcium retention are discussed. This combination of MCHC and DHT could be of benefit in many common situations of bone demineralization, such as osteoporosis.

Patients with steroid-induced, juvenile and senile osteoporosis were studied using balance techniques. The changes in calciun and phosphorus balance associated with glucocorticoid therapy were corrected with vitamin D and bendrofluazide given in combination. No hypercalcaemia occurred in osteoporotic patients who continued to receive glucocorticoids. Calcium and phosphorus balance was also improved in the osteoporotic subjects not receiving steroids, but these patients became hypercalcaemic during treatment. It is suggested that vitamin D, bendrofluazide and steroids antagonize the actions of one another on the renal tubule, gut and bone and in this way prevent the increased calciuria which occurs with glucocorticoid therapy. Since the increased calciuria and negative calcium balance induced by glucocorticoids is considered to be the result of excessive bone resorption, an adequate dose of bendrofluazide and vitamin D in combination might prevent the development of, or even reverse, steroid-induced osteoporosis.

Plasma 25-hydroxyvitamin-D(25-O.H.D.), Ca, P, and alkaline-phosphatase levels were determined in three separate periods during pregnancy in 14 Caucasian mothers, 23 vegetarian Asians, and 16 non-vegetarian Asians. Non-pregnant women from the same group were used as controls. The expected steady rise in alkaline phosphate during pregnancy due to increase in the placental isoenzyme, and the fall in total Ca due to haemodilution, were noted. No appreciable changes in 25-O.H.D. levels occurred, but throughout pregnancy the levels in the vegetarian Asians were lower than in the other two groups. The same analyses were made in maternal and cordplasmas in some of these patients. The babies' 25-O.H.D. levels averaged 87% of their mothers'. There was no clear evidence that pregnancy as such led to increased vitamin-D requirement in any case of these groups.