The introduction of new methods for studying the plasma state, renal handling, and kinetics of calcium and inorganic phosphate has rendered possible a more efficient and appropriate approach to the problems of bone-tissue metabolism and more ade quate investigation of the pathogenesis of its miscellaneous abnormalities. Used to study the metabolism of bone mineral in osteoporosis, hypo- and hyperparathy roidism, and other metabolic bone diseases, the new methods have given much valuable information. In malignancy they also promise to supplement the scantiness of the existing information better than the routine examination procedures, yet they have been used far more rarely in this field. The material presented in this work represents an attempt to marshal the facts and to answer, by the aid of recent techniques, some still open problems of bone mineral metabolism in patients with cancer. Since the new techniques involve an entirely new approach, the first two chapters are devoted to it and details of these techniques are presented in the third chapter. I realize the shortcomings of this work, but the never-ending and continuously increasing search for new discoveries makes some data obsolete at the moment of their presentation. Nevertheless, I hope that this work will give some information which will be useful in interpreting disturbances of bone-tissue metabolism in patients, both without any evidence of bone secondaries, and with widespread osseous metas tases.
Table of Contents1 General Outlines of Bone Tissue Metabolism.- 1. Structure and Function of Bone Cells.- 2. Structure and Function of Bone Matrix.- 2.1. Collagen.- Composition and Structure of Collagen.- Collagen Synthesis and Maturation.- Catabolism of Collagen.- Excretion of Hydroxy-proline.- 2.2. Ground Substance.- Composition and Structure of Ground Substance.- Synthesis of Proteoglycans and Glycoproteins.- Catabolism of Proteoglycans and Glycoproteins.- 3. Bone Mineral.- Chemistry and Structure of Bone Mineral.- Amorphous/Crystalline Mineral Composition.- Properties of Bone Mineral.- Mineralization of Bone.- Regulation of Mineralization.- Resorption of Bone Mineral.- 2 General Outlines of a Clinical Approach to Bone Tissue Metabolism.- 1. Calcium Metabolism.- Calcium Absorption.- Calcium in Body Fluids.- Renal Handling of Calcium.- Bone Calcium Accretion and Resorption.- Application of Tracer Kinetics to Calcium Metabolism.- Skeletal Hormones and Calcium Metabolism.- 2. Inorganic Phosphate Metabolism.- Phosphate in Body Fluids.- Renal Handling of Phosphate.- Application of Tracer Kinetics to Phosphate Metabolism.- Skeletal Hormones and Phosphate Metabolism.- 3. Collagen Metabolism and Urinary Hydroxyproline.- 4. Pyrophosphate Metabolism and Urinary Pyrophosphate.- 3 Methods of Studying Bone Mineral Metabolism.- 1. Plasma State and Renal Handling of Calcium and Phosphate.- General Design of Study.- Preparation and Ultrafiltration of Plasma.- Preparation of Urine.- Calculation of Diffusible Calcium and Phosphate.- Calculation of Renal Handling of Calcium and Phosphate.- 2. Kinetics of Calcium Metabolism.- General Design of Study.- Tracers.- Kinetic Study.- Preparation of Samples for Analysis and Radioactivity Determinations.- Preliminary Presentation of Data.- 3. Kinetics of Inorganic Phosphate Metabolism.- General Design of Study.- Tracer.- Kinetic Study.- Preparation of Samples for Analysis and Radioactivity Determination.- Preliminary Presentation of Data.- 4. Multicompartmental Analysis of Calcium and Phosphate Kinetics.- 5. Urinary Pyrophosphate.- 6. Other Methods.- 4 The Metabolism of Bone Mineral in Malignancy without Evidence of Bone Destruction.- 1. Metabolism of Calcium and Inorganic Phosphate.- 1.1. Clinical Material.- 1.2. Results.- Plasma State of Calcium and Inorganic Phosphate.- Renal Handling of Calcium and Inorganic Phosphate.- Calcium Kinetics.- Inorganic Phosphate Kinetics.- 2. Effects of Castration on Plasma State and Renal Handling of Calcium and Inorganic Phosphate.- 2.1. Clinical Material.- 2.2. Results.- Plasma Data.- Urinary Data.- 3. Discussion.- 3.1. Plasma State of Calcium and Inorganic Phosphate.- 3.2. Renal Handling of Calcium and Inorganic Phosphate.- Effects of Castration on Bone Mineral Metabolism.- 3.3. Calcium Kinetics.- 3.4. Phosphate Kinetics.- 5 The Metabolism of Bone Mineral in Malignancy with Bone Lesions.- 1. Patients with Plasmacytoma.- 1.1. Clinical Material.- 1.2. Results.- Plasma State of Calcium and Inorganic Phosphate.- Renal Handling of Calcium and Inorganic Phosphate.- Calcium Kinetics.- Inorganic Phosphate Kinetics.- 2. Patients with Cancer of the Breast.- 2.1. Clinical Material.- 2.2. Results.- Plasma State and Renal Handling of Calcium and Inorganic Phosphate.- Calcium Kinetics.- Oophorectomized Patients.- Postmenopausal Patients.- Inorganic Phosphate Kinetics.- 3. Discussion.- 3.1. Patients with Plasmacytoma.- 3.2. Patients with Cancer of the Breast.- General Summary.- Notations.- Analysis.- References.