1/4. vitamin d deficiency in breast-fed toddlers.SUMMARY: The evaluation of genu varum and intoeing in young toddlers is a frequent problem seen by the primary care physician and the orthopaedic surgeon. This report describes six nonwhite breast-fed toddlers with extreme genu varum. Clinical and radiographic findings were consistent with vitamin D-deficiency rickets. Within 3 to 6 months of the initiation of ergocalciferol treatment, reparative processes were evident on both radiographic and clinical examinations. Laboratory studies also showed underlying correction. With the current emphasis on the benefits of breast-feeding and the limitation of sunlight, this diagnosis must remain on the differential in the evaluation of genu varum.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. rickets. A study with case report.rickets is a pediatric disorder not commonly encountered by physicians in the US. Nevertheless, the podiatric physician should be aware that it persists and may exist in children who initially present with gait disturbances or failure to thrive. By using routine plain film radiography of the child's foot, the podiatric physician can screen one of the child's most rapid sites of secondary osseous growth, ie, the distal tibia. A brief overview of the rachitic and osteomalacic disorders is presented, followed by a discussion centered primarily on the plain film radiologic diagnosis of rickets.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
3/4. osteomalacia secondary to celiac disease, primary hyperparathyroidism, and Graves' disease.Primary hyperparathyroidism is seldom associated with other autoimmune disorders. The presence of normocalcemia in primary hyperparathyroidism should prompt the physician to look for vitamin d deficiency. This observation concerns a 34-year-old vegetarian woman with combined primary hyperparathyroidism, Graves' disease, and celiac disease. The patient presented with severe bone deformities; she was unable to walk, and had severe muscular weakness and weight loss. Biochemical findings revealed severe hyperparathyroidism with normocalcemia, hypophosphatemia, very low urinary calcium, and low 25-hydroxy vitamin D level. Thyroid tests showed hyperthyroidism with positive thyroid receptor antibodies, confirming the presence of Graves' disease. Positive antigliadin and antireticulin antibodies and complete villous atrophy on duodenal biopsy established the presence of celiac disease. The patient underwent a near-total thyroidectomy, with the removal of a parathyroid adenoma. To our knowledge, this observation is the first finding of an association between celiac disease, Graves' disease, and primary hyperparathyroidism. It emphasizes the need to rule out intestinal malabsorption in the case of normocalcemic hyperparathyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. anaphylaxis to parenteral thiamine (vitamin B1).anaphylaxis as an adverse systemic reaction to thiamine (vitamin B1) has been described in the literature since 1938. Although its precise mechanism is still uncertain, the reaction appears to involve immediate type hypersensitivity and to be exclusively related to parenteral administration. The following case report is a reminder of this reaction to thiamine which may be administered by general practitioners, emergency physicians and internists.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |