1/20. Severe anorexia nervosa associated with osteoporotic-linked femural neck fracture and pulmonary tuberculosis: a case report.We report a case study of a 38-year-old woman who had been suffering from anorexia nervosa (AN) since the age of 26. Before admittance to our clinic, she weighed 23.8 kg (at a height of 164 cm, 8.8 body mass index [BMI]) but still carried out strenuous physical activities. After good psychotherapeutic response and weight gain (34.4 kg), she accidentally fell and broke her femoral neck-favored as it was by osteoporosis. The X-ray taken before dynamic hip screw implantation coincidentally showed signs of pulmonary tuberculosis (TB), which could then be proven by computed tomography (CT) scans and cultures from a bronchoscopy. Other than lack of appetite and loss of weight, which we attributed to AN, there were no other clinical or biochemical indicators which could have pointed to an earlier TB diagnosis. As a result, the need for screening procedures is discussed. The manifestation of TB during the first weight gain after 12 years of severe malnutrition, during which there were no serious infections, seems to endorse former observations that AN patients appear to be "resistant" to some extent against infectious diseases, a "protection" which may be lost with convalescence and weight gain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/20. Partial transient osteoporosis of the hand.OBJECTIVE: To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. DESIGN AND patients: Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. RESULTS: All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. CONCLUSION: PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/20. Transient bilateral osteoporosis of the hip in pregnancy. A case report and review of the literature.osteoporosis of the hip is a rare complication of pregnancy, the diagnosis of which can only be determined by radiologic means. Differentiation between osteonecrosis and osteoporosis remains problematic in some cases. magnetic resonance imaging was reported as useful for the diagnosis of osteoporosis. Treatment of osteoporosis of the hip in pregnancy should be conservative including physical therapy, restricted weight bearing and analgetic therapy. We report an unusual case of bilateral transient osteoporosis of the hip in pregnancy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/20. Rapid increase in bone mineral density in a child with osteoporosis and autoimmune hypoparathyroidism treated with PTH 1-34.We describe a 16-year-old girl with autoimmune polyglandular syndrome type 1 including hypoparathyroidism, who had osteoporosis that improved rapidly with parathyroid hormone replacement therapy. patients with hypoparathyroidism usually have high bone mass. Our patient developed vertebral compression fractures at age 10, shortly after hypoparathyroidism was diagnosed. She continued to have low lumbar bone mass until age 16, when a dual energy x-ray absorptiometry (DEXA) revealed a Z score of - 2.2 SD. Several factors including decreased physical activity, total body magnesium depletion, and intermittent ketoconazole and short-term prednisone treatment, may have contributed to the development and progression of osteoporosis. Therapy with synthetic human parathyroid hormone (PTH) 1-34 rapidly normalized lumbar bone mass, as assessed by DEXA.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/20. trisomy 8 syndrome.trisomy 8 syndrome, with or without mosaicism, is characterized by the following clinical signs and symptoms: mental retardation, deformed skull, prominent forehad, high-arched palate, low-set and/or dysplastic ears, long and slender trunk, reduced joint mobility, and deep plantar furrows. The deep furrow or longitudinal crease of the sole may be pathognomonic for the syndrome. It should be noted that it has been seen in other rare syndromes. It is recommended that a child with mental retardation and associated multiple anomalies should be subjected to a cytogenetic study in order to define the incidence of this syndrome. Differnetial diagnosis should include: Fong's syndrome, arthrogryposis and otopalato-digital syndrome. It is interesting to note that there seem to be individuals who have had no physical abnormalities and have been identified during an evaluation for repeated abortions. The above described case of trisomy 8 mosaicism was seen and treated for many years by many different specialists without an accurate diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/20. vitamins D and K in the treatment of osteoporosis secondary to graft-versus-host disease following bone-marrow transplantation.We report a case of secondary osteoporosis treated with a combination of vitamins D3 and K2, administered orally. A 13-year-old male, diagnosed with highly differentiated acute myelogenous leukaemia, received an allogeneic bone-marrow transplantation. Chronic graft-versus-host disease persisted, thereafter, in the form of severe diarrhoea, rash and allergic conjunctivitis. Since the patient was then at risk from osteoporosis secondary to calcium malabsorption caused by the diarrhoea, dual-energy X-ray absorptiometry and ultrasound analysis were used to measure bone mineral density and bone stiffness, respectively. Both measurements were markedly lower than the average values from patients of matched age, gender and physical characteristics. The osteoporosis did not respond to active vitamin D3 0.1 microg/kg once daily, but when this therapy was combined with vitamin K2 15 mg once daily, an increase in bone mineral density and bone stiffness was observed. In conclusion, vitamin D3 and K2 combination therapy merits further evaluation for the treatment of various types of secondary osteoporosis, including steroid-induced osteoporosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/20. Advances in surgical treatment of osteoporotic fractures of the spine.INTRODUCTION: To highlight recent advances in the management of osteoporotic compression fractures of the spine. methods: A medline search was conducted from January 1975 to October 2001. Keywords included osteoporotic compression fractures, osteoporosis and spine fractures. RESULTS: osteoporotic fractures of the spine often cause significant morbidity to the elderly individual. diagnosis requires a detailed history and physical examination and investigations are usually required to exclude other causes of back pain. magnetic resonance imaging (MRI) is often helpful in excluding other causes of pathologic fracture but may not be confirmatory. Conservative treatment was the traditional approach, but newer percutaneous treatments, such as vertebroplasty and kyphoplasty, are safe and simple day surgery procedures which allow for rapid recovery of symptoms and prevention of increasing spinal deformity. Neurological deficit as a result of spinal canal compromise from retropulsed fragments, though relatively uncommon, is well recognised as a cause of significant morbidity and is a major indication for open spinal surgery. Various spinal approaches including anterior or posterior decompression combined with a variety of stabilisation techniques have been reported in the literature. rehabilitation is often required to improve physical function. CONCLUSIONS: osteoporotic fractures of the spine are a common cause of morbidity in the elderly. patients who have persistent pain despite conservative treatment require investigation to exclude other pathological causes of fracture. Percutaneous vertebroplasty and kyphoplasty are new techniques that offer much promise in the treatment of these elderly patients. Open surgery may still be required where there is significant neurologic compromise.- - - - - - - - - - ranking = 3.4455485338744keywords = physical examination, physical (Clic here for more details about this article) |
8/20. Severe transient osteoporosis of the hip during pregnancy. Successful treatment with intravenous biphosphonates.A young woman with transient osteoporosis of the hip (TOH) during pregnancy, severe pain, physical disability and marked generalized osteoporosis was treated with intravenous biphosphonates with prompt beneficial effects on both clinical symptoms and bone density. The features of this rare and sometimes underdiagnosed condition are reviewed. Intravenous biphosphonates seem to be an effective therapy for TOH.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/20. Transient osteoporosis associated with hyperhomocystinemia: a possible role for hyperbaric oxygen therapy.Transient osteoporosis of the hip is considered by some to be an early stage of avascular necrosis. Hyperbaric oxygen (HBO2) therapy, which may be of benefit in the treatment of avascular necrosis, might therefore be used in the treatment of transient osteoporosis of the hip. We present a case of transient osteoporosis associated with elevated levels of homocysteine in a 33-year-old white male, who was treated by HBO2. Treatment was administered at 2.5 ATA for 90 minutes once daily, five days per week. Regular follow-up examinations in the course of the HBO2 therapy revealed improvement in the patient's complaints and the findings of the physical examination. Repeated magnetic resonance imaging (MRI) performed after 40 and 90 sessions showed decreased edema and complete resolution of the edema, respectively. Evaluation 6 months after the completion of treatment revealed complete resolution of symptoms, with a normal physical examination.- - - - - - - - - - ranking = 4.8910970677489keywords = physical examination, physical (Clic here for more details about this article) |
10/20. TNF-alpha blockade induce clinical remission in patients affected by polymyalgia rheumatica associated to diabetes mellitus and/or osteoporosis: a seven cases report.polymyalgia rheumatica (PMR) is a chronic inflammatory condition of the elderly, characterized by aching and morning stiffness in the cervical region, shoulders and pelvic girdles. A steroid treatment course of 6-24 months is often required, but, due to important side effects, it is troublesome if the PMR patient is also affected by diabetes mellitus (DM) and/or osteoporosis. Aim of our study is to test anti-TNF alpha treatment as a steroid sparing tool in PMR patients affected by DM or osteoporosis. In particular, we hypothesise that TNF alpha blockade can be useful not only in remission maintaining, but also in the induction of clinical remission without corticosteroids in this kind of patients. In a six months follow up, patients had clinical improvement, confirmed by physical medical examination, and a statistically significant reduction in ESR and CRP mean values. Anti-TNF alpha treatment was well tolerated by all patients. These preliminary data suggest than Infliximab can be useful in the treatment of PMR patients, not only for steroid sparing purposes, but also as first line therapy in PMR patients with severe comorbidity, such as diabetes mellitus or osteoporosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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