202 J.-F. Dymling 



patients with generalized psoriasis who had extensive exfoHation and, consequently, 

 loss of calcium through the skin. None of the parameters of absorption measured 

 were significantly different from normal. In Group X, two patients with Paget's 

 disease showed significantly decreased values for "kj" but no significant changes in 

 any of the other measurements. In one patient with acute rheumatoid arthritis all of 

 the values were significantly decreased. When the patient was in remission on treat- 

 ment with salicylates and intramuscular gold, the measured "kj" and percent absorp- 

 tion increased, but still were significantly lower than normal subjects. The last two 

 groups shown here consist of a single patient each with Fanconi's syndrome and with 

 vitamin D resistant rickets. In Franconi's syndrome the value for "kj" and for per- 

 cent apparent absorption were markedly lower than normal and the value for "ag" 

 was greater than normal. In the patient with vitamin D resistant rickets the "k/' 

 value was greater than normal and both the "a^" and percent apparent absorption 

 were less than normal. 



From these studies it has been tentatively postulated that the value for "kj" is 

 related to the phenomenon of absorption from the gastrointestinal tract and "3.0" is 

 related both to absorption and to the avidity of the bones in the forearm for tracer. 



A new procedure, based on in vivo counting of limb, has been demonstrated to 

 yield data related to mechanism of calcium absorption in man. It has the advantages 

 of obviating the need for blood, urine and stool sampling and of yielding results 

 within three or four hours of observation. 



Bibliography 



LuTWAK, L., and J. Shapiro: Calcium absorption in man: based on large volume liquid 

 scintillation counter studies. Science 144, 1155 (1964). 



Therapeutic Results in Renal Tubular Osteomalacia with Special 

 Reference to Calcium Kinetics 



J.-F. Dymling 



Orthopaedic Research Laboratories and the Department of Internal Medicine 

 Malmo General Hospital, University of Lund, Malmo, Sweden 



Introduction 



Renal tubular osteomalacia may be defined as a clinical entity characterized by 

 hypophosphatemia, decreased renal tubular reabsorption of inorganic phosphate and 

 vitamin D resistant rickets or osteomalacia: Sporadic and familial occurence has 

 been reported, the probable mode of inheritance being sex-linked, dominant (Williams 

 et ai, 1960). 



The pathogenesis is not known. Albright et al. (1937) postulated a primary 

 defect in the intestinal absorption of calcium, complicated by secondary hyperpara- 

 thyroidism. Fanconi and Girardet (1952) postulated a primary defect in tubular 

 reabsorption of inorganic phosphate leading to hypophosphatemia. A primary 

 skeletal defect was proposed by Engfeldt ct al. (1956) and Frost (1958). Frame 



