1/8. Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism.BACKGROUND: We report a case of a 27-year-old (male) patient with bilateral and simultaneous rupture of the triceps tendons. He was suffering from chronic renal failure secondary to acute glomerulonephritis and for 4 years he underwent maintenance hemodialysis three times a week. This injury is extremely rare, and only one case has been reported in the international literature. Based on previous cases of tendon ruptures in patients with chronic renal failure, we believe that secondary hyperparathyroidism is the primary causative factor in his case. CASE REPORT: A primary repair was performed using heavy, nonabsorbable sutures passed through holes drilled in the olecranon with the technique described by Levy. The suture line was then protected with a figure-of-eight tension band wire. Our patient obtained full range of motion bilaterally within 3 months.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/8. Traumatic calcinosis cutis in a dialysis patient.A patient with end-stage renal disease and refractory hyperparathyroidism was evaluated for acute-onset thickening and hardening of the skin of the lower extremities. Her clinical course and physical examination findings were consistent with the recently described entity of nephrogenic fibrosing dermopathy. However, skin biopsy results showed metastatic and dystrophic calcification, without calcific uremic arteriolopathy (calciphylaxis). The patient reported a history of self-inflicted trauma; the authors postulate that trauma, in the setting of hyperparathyroidism and an elevated serum calcium phosphorous product, resulted in the subcutaneous deposition of calcium salts. To the authors' knowledge, this is the first report of metastatic and dystrophic calcification, without calciphylaxis, in a patient with refractory hyperparathyroidism. This case underscores both the rich variety of skin conditions seen in patients undergoing dialysis and recent developments in the field of dermatologic disorders associated with end-stage renal disease.- - - - - - - - - - ranking = 0.51164567474048keywords = physical (Clic here for more details about this article) |
3/8. Primary hyperparathyroidism presenting with musculoskeletal manifestations in a young patient: a case report.A 21 year old female patient was admitted to Tikur Anbessa Hospital with a diagnosis of primary hyperparathyroidism secondary to parathyroid adenoma. Her predominant presentation was with an anterior neck mass, diffuse osteoporosis and myopathy. The diagnosis was suggested by her clinical symptoms, physical findings, Laboratory studies and radiological survey. The tissue biopsy was also compatible with of the diagnosis. The parathyroid gland was removed surgically and the patient improved significantly. Primary hyperparathyroidism is extremely rare in young patients and presentation with myopathy is even more rare. Routine determination of serum calcium and phosphorus is recommended in patients with such presentations.- - - - - - - - - - ranking = 0.51164567474048keywords = physical (Clic here for more details about this article) |
4/8. adult coeliac disease, osteomalacia, hyperparathyroidism and acromegaly. Evidence for urinary losses of hydrosoluble metabolites of vitamin D3.vitamin d-deficient osteomalacia with pronounced secondary hyperparathyroidism was observed in an acromegalic patient suffering from adult celiac disease. Two oral tests with tritiated vitamin D3 showed a nearly normal absorption coefficient, contrasting with a marked steatorrhea mainly due to functional and reversible pancreatic insufficiency. The urinary excretion of the radioactive label was strikingly increased and accounted for the completely flat curve of plasma radioactivity. This urinary loss of mainly water-soluble metabolite(s) of vitamin D3 represents a unique and presently unexplained feature.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/8. Parathyroid carcinoma: clinical presentation and treatment.Parathyroid tumors account for only a small percentage of all head and neck neoplasms. The overwhelming majority of these are parathyroid adenomas that result in primary hyperparathyroidism. From 0.5% to 4% of hyperparathyroid patients, however, will be found to have a parathyroid carcinoma. In this paper, the authors relate their recent experience with such a patient and with two other such cases. Parathyroid carcinoma patients usually present with striking hyperparathyroidism and hypercalcemia, with the resultant related symptoms being more severe than those associated with parathyroid adenomas. Parathyroid carcinomas also tend to be large and may be detectable by current imaging techniques. The surgical appearance of these lesions is also distinct; the tumors are frequently multilobulated, gray-tan in color, quite firm, and often invasive. These physical findings are important since frozen section diagnosis may be difficult. The final histologic diagnosis depends on the presence of mitotic figures and capsular and vascular invasions. Preoperative medical problems, surgical approach, and prognostic factors are also discussed.- - - - - - - - - - ranking = 0.51164567474048keywords = physical (Clic here for more details about this article) |
6/8. Calcified hepatic and renal cysts in adult dominant polycystic kidney disease.We report the case of a 56-year-old woman suffering from adult dominant polycystic kidney disease, treated by hemodialysis, in whom calcifications of the wall of hepatic and renal cysts developed. The possibility that cystic calcifications might be the consequence of secondary hyperparathyroidism is discussed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
7/8. vitamin d dependent rickets: decreased sensitivity to 1,25-dihydroxyvitamin D.A patient with vitamin d dependent rickets with decreased sensitivity to 1,25-Dihydroxyvitamin D was observed. She suffered from bone pain of two years duration beginning at 12 years of age and was found to be suffering from hypocalcemia, secondary hyperparathyroidism and osteomalacia. Laboratory findings revealed normal serum 25-hydroxyvitamin D (27 ng/ml) and markedly elevated serum 1,25-dihydroxy-vitamin d (131.9 pg/ml). The hypocalcemia was refractory in spite of administration of 25,000 units of vitamin D2, but therapy with high doses of oral la-hydroxyvitamin D3 resulted in significant elevation of the serum calcium level. The clinical findings and course of the patient's disease were quite different from those of other patients with vitamin d dependent rickets reported by other authors.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
8/8. Unusual cases of hyperparathyroidism.The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets.- - - - - - - - - - ranking = 0.51164567474048keywords = physical (Clic here for more details about this article) |