The authors present a group of five men who sustained a displaced fracture of the medial end of the clavicle. In all cases, the diagnosis was confirmed by computed tomographic scan. Three young men with extra-articular fractures were treated operatively with a very good result. Two older men were treated nonoperatively, one with a good result (intra-articular fracture) and one with a fair result (extra-articular fracture). The method of treatment of fractures of the medial end of the clavicle depends primarily on the type and displacement of the fracture. Treatment decisions should be always based on a computed tomographic scan, because plain radiographs do not adequately image the medial clavicle. Surgical treatment of these fractures should be considered, particularly in young or physically active individuals.

To test the hypothesis that the reduction in gonadal function can lead to bone mass loss, a group of 12 men who had undergone bilateral orchidectomy at the age of 28.2 +/- 6.8 yr was evaluated. A progressive loss of the lumbar bone density was observed as a function of time after orchidectomy. Both the biochemical indices of bone resorption (urinary hydroxyproline/creatinine ratio and plasma tartrate-resistant acid phosphatase) and bone formation (serum osteocalcin and bone isoenzyme of alkaline phosphatase) were significantly increased in the patients compared with healthy controls. A positive correlation was found between urinary hydroxyproline excretion and percent change in spinal bone mineral density per yr. Because of this increase in the biochemically indicated bone resorption, nine of the patients were studied again after 1-3 yr and were thereafter treated with intranasal calcitonin. Urinary hydroxyproline excretion normalized after 3 months of treatment, and a significant decrease, but not to normal levels, was also observed in the mean values for the other biochemical indices of bone remodeling. Thus, testosterone deficiency, like estrogen deficiency, is associated with accelerated bone loss. The increase in osteoresorption was partially corrected by calcitonin treatment.

No abstract

The effect of PTH infusion on PRA was evaluated in 22 normotensive subjects. Intravenous infusion of PTH produced an increase in PRA in studied subjects. This increase in PRA was dose dependent from 1.505 +/- 0.226 to 2.500 +/- 0.346 nmol/l/hour after administration of 100 units of PTH and from 1.648 +/- 0.189 to 4.294 +/- 0.614 nmol/l/hour after 200 units of PTH and was markedly decreased by a beta blocking drug from 1.660 +/- 0.259 to 2.498 +/- 0.485 nmol/l/hour. These responses were observed without any significant changes in plasma calcium and blood pressure. From our results we can conclude that PTH increases PRA in normotensive controls. This effect is partly blocked by beta adrenergic blockers.

Studies were performed in 86 patients with proven primary hyperparathyroidism pre-operatively and 6-7 months after parathyroidectomy. The 29% incidence of hypertension between patients with primary hyperparathyroidism is higher as compared with the incidence of hypertension in the general population. Systolic and diastolic blood pressures were significantly higher in patients with primary hyperparathyroidism before operation than after parathyroidectomy (p less than 0.001). In patients hypertensive before operation both the systolic and diastolic blood pressure significantly fell after parathyroidectomy (p less than 0.001). The blood pressure was found to have normalized in 13 of the 25 patients with hypertension. Renal damage and changes in renin levels are not the mechanisms in the production of hypertension in hyperparathyroid patients.