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Investigation of Hypercalcaemia
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Mild to moderate hypercalcaemia is usually asymptomatic. Symptoms of hypercalcaemia are nonspecific, and other conditions may account for the patients’ symptoms. Symptoms include weakness, lethargy, intellectual weariness, and depression. Patients with hypercalcaemia due to PHPT are frequently asymptomatic. A history of kidney stones and osteoporosis, both suggesting chronicity and end-organ dysfunction, may provide reassurance that the cause of hypercalcaemia is not neoplastic.Malignancy-associated hypercalcaemia occurs in patients with advanced disease, and the underlying disease is the initial presenting complaint, with hypercalcaemia detected during investigation. Breast, lung, colon, and prostate cancer are the commonest solid organ tumours that metastasise to bone.
Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
WeaknessSudden onset.Gradual onset (rheumatoid tenosynovitis can cause pain, dysfunction of the tendons and finally rupture of the tendons by the proliferating synovium).Current deficit.Which portion of hand/fingers involved?Associated with sensory loss.
Neurology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Commonly there is proximal limb weakness in muscle disease but it is important to remember that other muscles can be affected, causing facial weakness, ptosis, ophthalmoplegia, speech and swallowing problems, neck weakness and respiratory problems. The pattern of weakness may help in the diagnosis.
Treatment considerations in myasthenia gravis for the pregnant patient
Published in Expert Review of Neurotherapeutics, 2023
Myasthenia gravis (MG) is an autoimmune disease where antibodies against the acetylcholine receptor (AChR) in the postsynaptic membrane at the neuromuscular junction cause the typical muscle weakness [1,2]. More rarely, pathogenic antibodies are instead directed against muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4) antigens functionally linked to AChR in the membrane. The muscle weakness can be generalized or localized. It occurs most frequently in extraocular muscles with diplopia and ptosis as troublesome symptoms. Weakness in swallowing and speech muscles as well as in facial muscles is common. Neck, shoulder, and arm muscles have frequently some weakness, whereas leg muscles are rarely affected [3]. Respiratory muscle weakness represents the major threat of MG, and myasthenic crisis with the need of ventilatory support can occur, especially during respiratory infections. Fluctuations during the day and over time are typical for MG. Repetitive and prolonged muscle use increases or precipitates the weakness.
Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Study of 12 Cases from One Institution and Literature Review
Published in Fetal and Pediatric Pathology, 2022
Eric Chang, Jasmine Vickery, Nadeen Zaiat, Eman Sallam, Abdul Hanan, Scott Baker, Mohamed Alhamar, Janet Poulik, Ereny Demian, Bahig M Shehata
The chief complaint of CRMO is continuous bone pain which occurs more often at night [4]. The sterile bone inflammation may be preceded by point tenderness, redness, swelling, and warmth over or close to the affected bones [4]. Limping and limitation of movements are also reported in CRMO [4]. CRMO most frequently involves the epiphysis and metaphysis of long bones (femur, tibia, and fibula), shoulder girdle/clavicle, thoracic wall, vertebral column, pelvic bones, and the mandible [1]. Unifocal clavicular and long bone involvement are common in children while upper chest wall (sternum) and vertebral bodies are more commonly seen in affected adults [8]. CRMO has been reported to coexist with spondyloarthritis (SPA) in which case they affect the pelvic bones causing sacroiliitis [1]. Patients may also have inflammatory arthritis (typically only seen in joints in close association with affected bone) and/or skin manifestations (acne, Palmo-Plantar Pustulosis (PPP), and psoriasis); however, this is much less common compared to SAPHO. Other symptoms include fever, weakness, and weight loss. Interestingly, an association with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) has also been described [6].
AL type cardiac amyloidosis: a devastating fatal disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Adeel Nasrullah, Anam Javed, Thejus T Jayakrishnan, Aaron Brumbaugh, Ariel Sandhu, Brent Hardman
Clinical presentation of AL type cardiac amyloidosis is varied based on the involved site. Fatigue and weakness are the most common presenting symptoms. Restrictive cardiomyopathy presents with signs and symptoms of diastolic heart failure and decreased exercise tolerance. With progression of the disease, atrial dilation occurs, which predisposes patients to atrial fibrillation and further sequelae of clot formation and systemic embolization. Cardiac conduction may be disrupted by amyloid deposition, often causing a variety of heart blocks. Soft tissue involvement has been seen as periorbital ecchymosis and macroglossia in 12.5% and 27.2%, respectively [7]. Renal AL amyloid can cause myeloma kidney and nephrotic syndrome. With underlying kidney disease, the patient may develop progressive renal failure requiring renal replacement therapy, as seen in the present case. Similar deposits in the liver and peripheral nerves can present as hepatomegaly, transaminitis, and peripheral neuropathy, respectively.