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Pagetoid Skull
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
The bones characteristically affected by the disease include the skull, spine, pelvis, femur, tibia, clavicle and humerus. Initial presentation is often pain in the affected bone. Biochemically, the serum calcium and phosphate levels are normal with an elevated alkaline phosphatase. Radiologically, the affected bone often shows expansion with loss of cortical definition and replacement of the normally well demarcated cortex and medulla by a coarse, striated pattern often denser than normal. Remodelling often follows the lines of stress, thus, the weight bearing bones (femur and tibia) tend to become bowed.
Phenytoin
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Mild biochemical changes indicative of osteomalacia (elevated alkaline phosphatase, hypocalcemia) are occasionally observed in patients taking PHT as well as other antiepileptic drugs. Most studies have evaluated patients receiving combination therapy with other antiepileptic drugs, so the role of PHT by itself is difficult to evaluate. It is most frequently observed in institutionalized patients who are treated with multiple antiepileptic drugs in high doses. The incidence of clinically significant osteomalacia varies among studies, but may be between 1 and 5%. It is more frequently seen in children and adolescents than adults. Patients with inadequate nutrition and poor sun exposure have an increased relative risk. The mechanism has been postulated to be vitamin D deficiency through a drug-induced increase in the production of less active vitamin D metabolites (54), but this is probably not the only mechanism (55).
Liver Diseases
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Primary tumors frequently occur singly in the liver, and the detection of hepatic masses usually represents metastases, the primary tumor being from other organs (lung, gastrointestinal tract, breast, and many others). Liver metastases are the most common consequence of cancer with the exception of the lymph nodes in drainage areas where the frequency of secondary manifestations is equally great.166 Extensive invasion and replacement of the liver tissue by metastatic tumor is usually asymptomatic with a few metabolic disturbances. A large proportion of the liver has to be replaced by the malignancy before jaundice or other signs of liver failure become apparent. Increased alkaline phosphatase activity in the serum represents one of the earliest biochemical changes. This finding has diagnostic importance. Elevated alkaline phosphatase activity without jaundice or other evidence of hepatocellular disease may strongly point to metastatic liver or bone tumor. Liver lectins are suggested as mediators for metastases.562 Occasionally, blockage of one main intrahepatic bile duct by invasion or pressure by the tumor mass causes jaundice.
Clinical features and high-resolution chest computerized tomography findings of children infected by the B.1.617.2 variant of coronavirus disease 2019
Published in Annals of Medicine, 2022
Chuanjun Xu, Mengya Ma, Yongxiang Yi, Changhua Yi, Hui Dai
Elevated alkaline phosphatase, lactate dehydrogenase and alpha hydroxybutyrate dehydrogenase may indicate liver damage. Previous studies have also found elevated liver enzymes in paediatric patients [35]. Decreased erythrocyte volume, haemoglobin and mean haemoglobin content suggest anaemia. Different studies have had different results regarding anaemia changes in patients. Some studies have shown that decreased haemoglobin levels in COVID-19 patients correlate with the severity of the disease [36]. However, in contrast, some studies have reported similar total haemoglobin levels in patients with COVID-19 compared with those without COVID-19 infection [37], and some studies have even reported slightly higher haemoglobin in patients with COVID-19 than in normal controls [38]. Therefore, further studies are still needed to clarify the relationship between anaemia changes and the disease in children.
The clinical features and outcomes of systemic light chain amyloidosis with hepatic involvement
Published in Annals of Medicine, 2022
Liang Zhao, Guisheng Ren, Jinzhou Guo, Wencui Chen, Weiwei Xu, Xianghua Huang
AL amyloidosis is a multisystem disorder characterized by the extracellular deposition of insoluble beta-pleated protein fibrils derived from misfolded monoclonal immunoglobulin light chain [1]. The liver is a major visceral organ of amyloid deposition, and histological evidence of liver involvement have been observed in about 70% of the cases with AL amyloidosis in one autopsy series [2], while clinically significant hepatic involvement is uncommon, with only around 20–30% of patients have clinical evidence of liver involvement [3,4]. The manifestations of hepatic involvement are varied, including fatigue, weight loss, decreased appetite, abdominal pain, ascites, hepatomegaly and elevated alkaline phosphatase (AKP) level. In rare cases, hepatic amyloidosis may also cause jaundice, spontaneous rupture of the liver and liver failure, result in fatal consequence [5–7]. The confirmation of hepatic involvement is often delayed due to the fact that the presenting symptoms are often mild or mimic other more common conditions.
Identifying new predictive factors for survival after surgery for spinal metastases: an exploratory in-depth retrospective analysis
Published in Acta Clinica Belgica, 2022
Elisabeth De Meue, Steven Smeijers, Ciska Langmans, Paul M. Clement, Bart Depreitere
In most studies, the level of the SSM does not correlate with survival. A large prospective cohort study found cervical and thoracic involvement to be associated with worse survival [18]. One study with spinal metastases from unknown primary tumours found that patients with cervical disease had worse survival than patients with non-cervical disease [33]. The latter is confirmed in the present analysis. This is not explained by a more severe preoperative neurological status, as the Frankel score was C/D and E in one-half of patients with cervical SSM, respectively, which is comparable to patients with non-cervical SSM. Cervical involvement could reflect higher disease burden or more aggressive tumours. Finally, several laboratory values were strongly associated with survival. CRP-reactive peptide is associated with mortality in patients with solid tumours [34,35]. To our knowledge, this is the first study to report the predictive value of CRP in the SSM surgery setting. The prognostic value of serum albumin level has been shown before in patients undergoing surgery for SSM [13,36] and was confirmed as a significant predictor for overall survival in this analysis. Earlier findings on elevated alkaline phosphatase levels as a predictor of worse overall survival were confirmed in the present analysis [13,37]. Elevated lactate dehydrogenase levels are known to be associated with poor survival in cancer patients [38]. The prognostic value has been shown in patients with spinal metastases from hepatocellular carcinoma [39]. We could not confirm this in the multivariate analysis.