Scandinavian journal of clinical and laboratory investigation. Supplementum
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Scand J Clin Lab Invest Suppl · Jan 2016
ReviewSerum-free light-chain analysis in diagnosis and management of multiple myeloma and related conditions.
The introduction of the serum-free light-chain (S-FLC) assay has been a breakthrough in the diagnosis and management of plasma cell dyscrasias, particularly monoclonal light-chain diseases. The first method, proposed in 2001, quantifies serum-free light-chains using polyclonal antibodies. More recently, assays based on monoclonal antibodies have entered into clinical practice. ⋯ It is also useful for risk stratification in solitary plasmacytoma and AL amyloidosis. The S-FLC measurement is part of the new diagnostic criteria for multiple myeloma, and provides a marker to follow changes in clonal substructure over time. Finally, the evaluation of S-FLC is fundamental for assessing the response to treatment in monoclonal light chain diseases.
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Vitamin D (cholecalciferol) is important for normal development and maintenance of the skeleton. The metabolites 25(OH)D and 1,25(OH)(2)D are not only important for treating rickets and osteomalacia but also for all types and clinical stages of osteoporosis. Patients with low calcium intake and a low vitamin D status are at risk to develop secondary hyperparathyroidism, increased bone resorbtion, osteopenia and fractures. ⋯ Studies and meta-analyses during the last two decades on the effect of vitamin D and calcium supplements have not resolved the controversy on the risk of falls and fractures in healthy or osteopenic elderly populations. A thorough analysis of these trials supports our clinical experience that the efficacy of vitamin D-calcium supplementation depends on factors related to patient selection, medical intervention and study design, e.g. age, mobility, preventing falls and fractures, co-morbidity, initial vitamin D status and renal function. We conclude that plain vitamin D (cholecalciferol) with sufficient calcium intake is able to reduce the risk of falls and fractures only when adopting optimal selection criteria for patients and study conditions.
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Scand J Clin Lab Invest Suppl · Jan 1996
ReviewElevations in blood lactate: overview of use in critical care.
Blood lactate measurements are being used clinically as an indicator of circulatory impairment and the overall state of oxygenation of patients in critical care. This report briefly covers the areas of usage of lactate testing, lactate biochemistry, appropriate sample handling, and clinical interpretation of lactate measurements in critical care monitoring including pediatric cardiac surgery and extracorporeal membrane oxygenation (ECMO).