scholarly journals P043 Fascinating phosphate: seek and you will find

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jyoti Bakshi ◽  
Clare Batten
Keyword(s):  
Back Pain ◽  
Degenerative Change ◽  
Nasal Bone ◽  
Rare Condition ◽  
Whole Body ◽  
Excision Biopsy ◽  
Small Lesion ◽  
History Of ◽  
The Right ◽  
Fgf 23

Abstract Background/Aims  A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods  The case is discussed below. Results  Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion  Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure  J. Bakshi: None. C. Batten: None.

scholarly journals A rare case of unilateral breast filariasis mimicking chronic mastitis

2021 ◽  
Vol 8 (7) ◽  
pp. 2228
Author(s):  
Varsha A. Sharma ◽  
Manmohan M. Kamat ◽  
Jeena K. Sathyan ◽  
Seema Barman ◽  
Shravani Shetye
Keyword(s):  
Benign Lesion ◽  
Rare Condition ◽  
Surgical Excision ◽  
Axillary Lymph Nodes ◽  
Excision Biopsy ◽  
Axillary Lymph ◽  
Presumptive Diagnosis ◽  
Lower Quadrant ◽  
History Of ◽  
The Right

Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.

scholarly journals P.001 Transient neurapraxic radiculopathy

2017 ◽  
Vol 44 (S2) ◽  
pp. S14-S14
Author(s):  
SK Baker
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Peak Torque ◽  
Strength Testing ◽  
Low Back ◽  
Neurologic Examination ◽  
Prone Positioning ◽  
History Of ◽  
The Right ◽  
Reversible Reduction

Background: Neurapraxia is considered to be a temporary disorder of peripheral nerve conduction due to trauma that does not cause axonopathy. However, patients with radiculopathy, confirmed by MRI, who may not have active axonal damage with evidence of spontaneous activity may still report transient give-way weaknesss. In the absence of active changes on intramuscular recording a neurophysiologic consultation may fail to substantiate any significant neurologic concern. This report documents and objectifies prone positioning-induced radicular neurapraxic weakness in an elderly man. Methods: An 83-year-old gentleman was referred for neuromuscular evaluation with regards to peripheral neuropathy. He had a history of low back pain and MRI evidence of multilevel DDD and discogenic neuroforaminal narrowing. Strength testing was performed by Biodex evaluation. Routine electrophysiologic assessments were performed. Results: On neurologic examination proximal strength iwas normal with grade 4 dorsiflexion strength. Stocking-glove loss to pinprick was absent. Preliminary objective testing of the right quadriceps revealed a peak torque of 87.1 Nm. Immediately after lying prone for 3 minutes (for paraspinal EMG), his power dropped to 33.7 Nm. Strength fully recovered by 36 hrs. Conclusions: This case documents evidence of a 61% reversible reduction in torque in the right quadriceps after prone lying. Electromyographers need to be cautious with radiculopathy patients during paraspinal testing.

scholarly journals SELF: THE LIMITS OF AUTONOMY

2017 ◽  
Vol 15 (1) ◽  
pp. 211-226 ◽  
Author(s):  
GERALD IZENBERG
Keyword(s):  
Seventeenth Century ◽  
The Self ◽  
Whole Body ◽  
Historical Explanation ◽  
Western Concept ◽  
History Of ◽  
The Right ◽  
European Thought

If one is looking for the authoritative work on the history of the modern Western concept of “self,” the place to go is Jerrold Seigel's The Idea of the Self. It is a wide-ranging, deeply insightful account of Western thinking about the nature of selfhood in Britain, France, and Germany since Descartes, framed by a powerfully argued thesis about the right way to conceptualize it. But that project was driven by what in the retrospect of Seigel's whole body of work can be seen as an even more comprehensive historical program, one both methodological and substantive. One of Seigel's basic historiographical convictions, more implicit than systematically argued, is that individual subjectivity matters for historical explanation. His broader substantive interest is in the meaning of the Western notion of “modernity,” above all in its implications and consequences for our contemporary self-understanding. Methodological conviction and substantive interest are tightly interwoven. As Seigel sees it, the process of European modernization was guided by, and in turn further developed, a historically locatable, complex, and internally conflicted version of universal selfhood—the autonomous bourgeois self. His corpus is an extended and evolving exploration of this process and its result, which he finds most clearly documented in European thought and culture from the mid-seventeenth century to the mid-twentieth.

scholarly journals PROMPT RECOGNITION OF STUMPAPPENDICITIS IS IMPORTANT TO AVOID SERIOUS COMPLICATIONS: A CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Anil Kumar M S ◽  
D. Shiva Manohar
Keyword(s):  
Psoas Abscess ◽  
Rare Condition ◽  
Late Complications ◽  
Retroperitoneal Abscess ◽  
Lower Quadrant ◽  
Stump Appendicitis ◽  
Histologic Evaluation ◽  
History Of ◽  
Appendicular Stump ◽  
The Right

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to stump appendicitis. A 50-year-old female was admitted with history of abdominal pain more in the right lower quadrant for 1 week. History of fever present since week associated with chills, History of poor stream of urine for 1 week, not associated with burning micturition. Her past medical history showed a laparoscopic appendectomy operation performed 5 months ago. Computed tomography of abdomen and pelvis showed features suggestive of right psoas abscess with possible communication with the tubular structure arising from IC junction (? appendicular stump), Ill-defined peripherally enhancing collection in presacral region and bilateral ischiorectal region -? Abscess. CECT Abdomen and pelvis showed right mild Hydroureteronephrosis. Cystoscopy + DJ stenting was done post which Exploration with drainage of retroperitoneal abscess with stump appendectomy done on 15/2/19. Intraoperatively 50cc pus with caseous material was drained, psoas was bulky. 3cm appendicular stump was noted, dissected, ligated and buried. A drain was placed in the site of the operation. Post-operative course was uneventful and he was discharged 9 days after surgery. The histologic evaluation reported suppurative stump appendicitis. Residual long stump of the appendix after appendectomy might lead to persistence of infection and possibly late complications such as intraperitoneal, retroperitoneal or iliopsoas abscess. Surgical exploration may be necessary in persistent cases of Retroperitoneal abscess, to allow for recognition and treatment of the underlying pathology.

scholarly journals A Case of Unilateral Coccidioidal Chorioretinitis in a Patient with HIV-Associated Meningoencephalitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher B. Toomey ◽  
Andrew Gross ◽  
Jeffrey Lee ◽  
Doran B. Spencer
Keyword(s):  
Risk Factors ◽  
Vision Loss ◽  
Complement Fixation ◽  
Rare Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Blurry Vision ◽  
Systemic Symptoms ◽  
The Right

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.

Thyroid tuberculosis: an unexpected diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e238795
Author(s):  
Alexandra Novais Araújo ◽  
Tânia Matos ◽  
João Boavida ◽  
Maria João Guerreiro Martins Bugalho
Keyword(s):  
Lymph Node ◽  
Positive Culture ◽  
Rare Condition ◽  
Pulmonary Involvement ◽  
Needle Aspiration ◽  
Tuberculous Infection ◽  
History Of ◽  
Right Lobe ◽  
Thyroid Tuberculosis ◽  
The Right

Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for tuberculous infection. The the thyroid gland being affected by MTB is a rare condition. A 71-year-old woman had 6 months of slight cervical discomfort. Her neck ultrasound showed, at the right lobe of the thyroid, a dominant heterogeneous nodule of 18 mm and homolateral lymph nodes with suspicious ultrasonographic features. The patient underwent fine-needle aspiration, the results of which were non-diagnostic (thyroid nodule) and reactive pattern (lymph node). A total thyroidectomy was performed and a lymph node was sampled for extemporaneous examination. Surprisingly, necrotising granulomas were documented. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection of MTB. Pulmonary involvement was excluded and she was started on antituberculous agents. In the absence of systemic, specific complaints or history of exposition, histopathology and culture of MTB remain a key step for the diagnosis.

PSEUDOHYPOPARATHYROIDISM

PEDIATRICS ◽  
1949 ◽  
Vol 4 (6) ◽  
pp. 790-797
Author(s):  
M. G. PETERMAN ◽  
J. L. GARVEY
Keyword(s):  
Physical Examination ◽  
Mental Disease ◽  
Rare Condition ◽  
Palpebral Fissure ◽  
Pituitary Extract ◽  
History Of ◽  
Convulsive Disorders ◽  
Hoarse Voice ◽  
The Right ◽  
Hospital Clinic

THIS case is presented because the circumstances provided an unusual opportunity to review and study a rare condition. The child concerned had been diagnosed as having a case of hypothyroidism and epilepsy and the parents had been advised to place her in an institution. The child was referred to the authors in a further effort to obtain relief or advice. CASE HISTORY A 12 yr. old girl was examined because of "incessant talking in a silly, immature fashion; excessive greed for food and salt; lethargy, fatigue, over-affection and clumsiness, awkwardness, inability to skate or ride a bicycle." A year before admission she began to scream in her sleep once or twice every night. Six months later she began to scream during the day. The attacks of screaming occurred suddenly without warning. She abruptly stopped what she was doing, stared ahead and screamed in a loud, hoarse voice for several seconds. Immediately afterward, she was embarrassed and tried to withdraw from the scene. Treatment elsewhere with adequate doses of phenobarbital, tridione, benzedrine, thyroid and pituitary extract had been ineffective. Report of a previous examination at a university clinic was "moderately plump girl with a round face and lethargic appearance. There was narrowing of the right palpebral fissure and mild ataxia of the lower extremities. The physical examination was otherwise unimportant. The IQ was 80." Examination later at a hospital-clinic was reported as "revealing obesity and cretinism in spite of a basal metabolic rate of minus 6 and minus 7." Mother and father are intelligent and the 4 siblings are normal and well-adjusted. There is no history of convulsive disorders or mental disease.

Bilateral Preiser Disease in a Patient with Sickle Cell Anemia

2020 ◽  
Author(s):  
Joseph Catapano ◽  
Oluwatola O. Overduin ◽  
Herbert P. von Schroeder
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Scaphoid Fracture ◽  
Rare Condition ◽  
Dominant Male ◽  
Resonance Imaging ◽  
Steroid Use ◽  
History Of ◽  
The Right ◽  
Vascularized Bone

AbstractPreiser disease is a rare condition of avascular necrosis of the scaphoid occurring in the absence scaphoid fracture or trauma. While the etiology of Preiser disease remains unknown, it has been associated with steroid use, chemotherapy, and infrequently with systemic diseases. No reports have associated Preiser disease with hemoglobinopathy. Due to the rarity of Preiser disease, management remains controversial and evidence is limited. Here, we describe the case of a 32-year-old right-hand dominant male with sickle cell anemia and a 4-year history of bilateral wrist pain. Radiographs and gadolinium-enhanced magnetic resonance imaging revealed bilateral Preiser disease. He was successfully managed with a 1,2 intercompartmental supraretinicaular artery vascularized bone graft to the right scaphoid.

scholarly journals Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jason P. Caffrey ◽  
Jason W. Adams ◽  
Isabel Costantino ◽  
Kristin Klepper ◽  
Elina Kari ◽  
...  
Keyword(s):  
High Altitude ◽  
Successful Treatment ◽  
Rare Condition ◽  
Pressure Equalization ◽  
Seventh Cranial Nerve ◽  
Commercial Airline ◽  
Bone Segment ◽  
Patient Reported ◽  
History Of ◽  
The Right

Abstract Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.

scholarly journals Symptomatic Infundibulopelvic Dysgenesis in an Adolescent

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Pitts ◽  
David Chalmers ◽  
Brian Jumper
Keyword(s):  
Complete Resolution ◽  
Left Kidney ◽  
Rare Condition ◽  
Renal Calculi ◽  
Flank Pain ◽  
Pelvicalyceal System ◽  
Retrograde Pyelogram ◽  
History Of ◽  
The Right ◽  
Collecting System

Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient’s symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms.

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