scholarly journals Chromium and cobalt intoxication mimicking mitochondriopathy

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Tim W. Rattay ◽  
Torsten Kluba ◽  
Ludger Schöls
Keyword(s):  
Diabetes Mellitus ◽  
Weight Loss ◽  
Mitochondrial Dna ◽  
Wear Debris ◽  
Hip Prosthesis ◽  
Mitochondrial Cytopathy ◽  
Whole Exome ◽  
Metal On Metal ◽  
Metal Wear ◽  
History Of

AbstractA 53-year old male with a history of progressive visual impairment, hearing loss, peripheral neuropathy, poorly controlled diabetes mellitus, cardiomyopathy, and weight loss was referred to the rare disease center due to the suspicion of mitochondrial cytopathy. In line with mitochondrial dysfunction, lactate in CSF was increased. Genetic testing by whole-exome sequencing and mitochondrial DNA did not reveal a likely cause. The case remained unsolved until he developed pain in his right hip, where he had received total hip arthroplasty 12 years earlier. An orthopedic evaluation revealed substantial shrinkage of the head of the hip prosthesis. Due to metal-on-metal wear, debris chromium and cobalt levels in serum were massively increased and significantly improved with multisystemic impairment after exchanging the defective implant.

scholarly journals Mitochondrial disease: an uncommon but important cause of diabetes mellitus

2018 ◽  
Vol 2018 ◽  
Author(s):  
Ming Li Yee ◽  
Rosemary Wong ◽  
Mineesh Datta ◽  
Timothy Nicholas Fazio ◽  
Mina Mohammad Ebrahim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Weight Loss ◽  
Lactic Acidosis ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mitochondrial Disorder ◽  
Superior Mesenteric Artery Syndrome ◽  
List Type ◽  
Presenting Symptoms ◽  
History Of

Summary Mitochondrial diseases are rare, heterogeneous conditions affecting organs dependent on high aerobic metabolism. Presenting symptoms and signs vary depending on the mutation and mutant protein load. Diabetes mellitus is the most common endocrinopathy, and recognition of these patients is important due to its impact on management and screening of family members. In particular, glycemic management differs in these patients: the use of metformin is avoided because of the risk of lactic acidosis. We describe a patient who presented with gradual weight loss and an acute presentation of hyperglycemia complicated by the superior mesenteric artery syndrome. His maternal history of diabetes and deafness and a personal history of hearing impairment led to the diagnosis of a mitochondrial disorder. Learning points: The constellation of diabetes, multi-organ involvement and maternal inheritance should prompt consideration of a mitochondrial disorder. Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes (MELAS) and maternally inherited diabetes and deafness (MIDD) are the most common mitochondrial diabetes disorders caused by a mutation in m.3243A>G in 80% of cases. Metformin should be avoided due to the risk of lactic acidosis. There is more rapid progression to insulin therapy and higher prevalence of diabetic complications compared to type 2 diabetes. Diagnosis of a mitochondrial disorder leads to family screening, education and surveillance for future complications. Superior mesenteric artery syndrome, an uncommon but important cause of intestinal pseudo-obstruction in cases of significant weight loss, has been reported in MELAS patients.

scholarly journals Evaluation of Aerosol Electrospray Analysis of Metal-on-Metal Wear Particles from Simulated Total Joint Replacement

Sensors ◽  
2019 ◽  
Vol 19 (17) ◽  
pp. 3751 ◽  
Author(s):  
Gobert von Skrbensky ◽  
Karoline Mühlbacher ◽  
Emir Benca ◽  
Alexander Kolb ◽  
Reinhard Windhager ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Wear Debris ◽  
Total Joint Replacement ◽  
Wear Particles ◽  
Particle Detection ◽  
Metal Debris ◽  
Artificial Joints ◽  
Hip Simulator ◽  
Metal On Metal ◽  
Metal Wear

Wear is a common cause for aseptic loosening in artificial joints. The purpose of this study was to develop an automated diagnostical method for identification of the number and size distribution of wear debris. For this purpose, metal debris samples were extracted from a hip simulator and then analyzed by the electrospray method combined with a differential mobility analyzer, allowing particle detection ranging from several nanometers up to 1 µm. Wear particles were identified with a characteristic peak at 15 nm. The electrospray setup was successfully used and validated for the first time to characterize wear debris from simulated total joint replacement. The advantages of this diagnostic method are its time- and financial efficiency and its suitability for testing of different materials.

scholarly journals Pseudotumor in Metal-on-metal Total Hip Arthroplasty: An Unusual Complication

2018 ◽  
Vol 52 (1) ◽  
pp. 26-30
Author(s):  
Jagandeep S Virk ◽  
Sudhir K Garg ◽  
Purnima Aggarwal ◽  
Reetu Kundu ◽  
Robin Bohat
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Wear Debris ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Unusual Complication ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Metal Wear ◽  
New Type

ABSTRACT Second-generation metal-on-metal (MoM) total hip arthroplasty (THA) was introduced to overcome the complications associated with the wear debris from ultrahigh molecular weight polyethylene (UHMWPE). However, a new type of complication began appearing, described as aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Patients with ALVAL complain of pain and, in some cases, extensive swelling around the hip joint known as “pseudotumors.” The cause is unknown and probably multifactorial. This may be an adverse reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. Surgical findings are typical and symptoms tend to resolve reliably following conversion to an alternative bearing surface. We report one such case of a 55-year-old male, who underwent a revision of bearing surfaces because of ALVAL and pseudotumor formation following an MoM THA at our institute. How to cite this article Virk JS, Garg SK, Aggarwal P, Kundu R, Bohat R. Pseudotumor in Metal-on-metal Total Hip Arthroplasty: An Unusual Complication. J Postgrad Med Edu Res 2018;52(1):26-30.

The Treatment of Femoral Neuropathy Due to Pseudotumour Caused by Metal-On-Metal Resurfacing Arthroplasty

2008 ◽  
Vol 18 (4) ◽  
pp. 313-320 ◽  
Author(s):  
P. Harvie ◽  
H. Giele ◽  
C. Fang ◽  
O. Ansorge ◽  
S. Ostlere ◽  
...  
Keyword(s):  
Wear Debris ◽  
Biological Effects ◽  
Hip Resurfacing ◽  
Pathological Process ◽  
Femoral Neuropathy ◽  
Resurfacing Arthroplasty ◽  
Metal On Metal ◽  
Metal Wear ◽  
Neurophysiological Studies ◽  
Serum Cobalt

Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on–metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly ‘toxic’ in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops.

Pancreatic Abscess in a Cat with Diabetes Mellitus

2015 ◽  
Vol 51 (3) ◽  
pp. 180-184 ◽  
Author(s):  
Minji Lee ◽  
Ji-Houn Kang ◽  
Dongwoo Chang ◽  
Ki-Jeong Na ◽  
Mhan-Pyo Yang
Keyword(s):  
Diabetes Mellitus ◽  
Weight Loss ◽  
Case Report ◽  
Clinical Signs ◽  
Abdominal Ultrasound ◽  
Pancreatic Abscess ◽  
Cytological Analysis ◽  
Glargine Insulin ◽  
Uncontrolled Diabetes ◽  
History Of

An 11 yr old spayed female Maine coon cat was referred with uncontrolled diabetes mellitus. The cat had a 2 mo history of weight loss and intermittent vomiting. An abdominal ultrasound identified the presence of a large cavity measuring a maximum of 4.6 cm in the pancreas that was filled with a homogeneous echogenic fluid. Cytological analysis and culture of the fluid obtained from the pancreatic mass indicated the presence of a bacterial abscess. The application of nonsurgical drainage and the administration of glargine insulin and antibiotics resolved the clinical signs. The size of the pancreatic abscess was reduced after 5 mo, and the cat achieved diabetic remission and remained healthy at the time this report was prepared. This case report describes the successful treatment of a pancreatic bacterial abscess concurrent with diabetes mellitus in a Maine coon cat.

scholarly journals Metal-on-metal bearing in hip prosthesis generates 100-fold less wear debris than metal-on-polyethylene

1999 ◽  
Vol 70 (6) ◽  
pp. 578-582 ◽  
Author(s):  
H Lucas Anissian ◽  
André Stark ◽  
Allen Gustafson ◽  
Victoria Good ◽  
Ian C Clarke
Keyword(s):  
Wear Debris ◽  
Hip Prosthesis ◽  
Metal On Metal

scholarly journals Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Rinne M. Peters ◽  
Pax Willemse ◽  
Paul C. Rijk ◽  
Mels Hoogendoorn ◽  
Wierd P. Zijlstra
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Prosthesis ◽  
X Rays ◽  
Total Hip ◽  
Metal On Metal ◽  
Metal Wear ◽  
Cobalt Toxicity ◽  
Ceramic On Ceramic

This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.

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