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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The signs and symptoms of hypercalcaemia include: Gastrointestinal disturbance: anorexia, nausea, vomiting, constipation, peptic ulceration and pancreatitisOther muscular dysfunction: hypertension, ECG changes (shortened QT interval) or cardiac arrestNeurological dysfunction: psychosis, confusion, stupor, comaKidney dysfunction: polyuria (which can cause dehydration leading to AKI), nocturia, polydipsia, acute or chronic kidney disease, renal calculi.Calcification: in other tissues
Acquired Disorders of the Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Cervical tuberculosis is now far less common than NTM in western communities, but it still occurs and clinicians need to be alert to make the diagnosis. It is most often found in children and adolescents who have a history of recent foreign travel and may present as a solitary ‘rubbery’ neck node with or without systemic symptoms and with or without discharge through the skin. Imaging may show a mass of nodes that have ruptured through the cervical fascia to form a ‘dumb-bell’ shaped structure, one part superficial to the fascia and one part deep (‘collar-stud abscess’). Imaging may show calcification which is highly suggestive of the diagnosis. Treatment is by antituberculous chemotherapy under the supervision of an infectious diseases clinician.
Mammography and Interventional Breast Procedures
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Calcification is the deposition of calcium salts (calcium hydroxyapatite or tricalcium phosphate) in the breast tissue [53]. Calcium deposits are extremely common in the breast tissue. Pathogenesis of calcification in the breast is variable. Some are the result of active secretion, while others form in necrotic cellular debris [53]. They may be a response to inflammation, trauma, radiation, foreign bodies, or cancer [47]. Calcifications are found within the ducts, alongside the ducts, in the lobular acini, in the vascular structures, in the interlobular stroma, in fat, and in the skin. Depending on their etiology and location they may be punctate, branching, linear, spherical, fine, coarse, cylindrical, smooth, jagged, regular in size and shape, or heterogeneous. When calcifications are lobular, they are virtually always benign and usually within dilated acini. Intraductal cancers may narrow the duct, and calcium deposits may fill the narrowed lumen, producing a characteristic fine linear pattern that branches with the duct. Most calcifications have characteristically benign morphology, but certain shapes and patterns require biopsy. A careful search for the clustered microcalcifications that may herald an early stage breast cancer should be done on all mammograms.
Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction
Published in Renal Failure, 2023
Guy F. A. Prado, Stefano Garzon, Jose Mariani, Adriano Caixeta, Breno O. Almeida, Felipe O. Ramalho, Marcelo L. C. Vieira, Claudio H. Fischer, Gilberto Szarf, Walther Ishikawa, Pedro A. Lemos
Assessment of valvular calcification in the left outflow tract can be challenging using MRI [13]. To overcome this difficulty, we used a no-contrast CT scan, which allowed for easy identification of calcification. It is noteworthy that the only instance of paravalvular leak beyond mild was observed in an older generation of a self-expandable prosthesis in association with massive and asymmetric aortic valve calcification. We are of the opinion that the utilization of contrast-enhanced CT would not have impacted our valve type or size selection. The non-contrast CT scan accurately identified substantial calcification on the valve plane and in the left ventricular outflow tract, which led to the choice of a self-expandable prosthesis over a balloon-expandable one to minimize the risk of annular rupture. The MRI and TEE accurately determined the annulus size, and the largest available valve was selected. Nonetheless, the self-expandable prosthesis that was available at that time was an older generation without a skirt-sealing device, which has been demonstrated to reduce paravalvular leaks in newer generations [18]. Combining imaging methods is also helpful for evaluating vascular access. MRI, CT, and duplex Doppler allowed the assessment of peripheral artery sizes, as well as the presence of disease, tortuosity, and calcification. All the patients were treated using transfemoral access, and no vascular complications were observed.
Outcome and negative events in thoracic disc herniation surgery: a Danish registry study
Published in British Journal of Neurosurgery, 2021
Thea Overgaard Wichmann, Mindaugas Bazys, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Peter Duel, Kestutis Valancius, Niels Katballe, Mikkel Mylius Rasmussen
Our results suggest that surgeons should consider pros and cons of each approach when allocating a patient to surgical treatment, implicating that the decision-making is not uniform and must be individualized. This adds support to the findings of previous studies. This study was performed in a retrospective manner with all the limitations inherent to that study design, including desirability and interpretation bias. Some caution must be taken in the interpretation and generalization of the results due to the small sample size, the division of approaches, the lack of standardized clinical outcome measures, the constructed symptom hierarchy and the dichotomizing of symptoms into improved or deteriorated. Our broad definition of negative events limits comparison to other studies, even though it has provided a more detailed analysis of our cohort. Moreover, we were not able to identify which herniated discs that were calcified. Calcification impacts the choice of approach and increase the surgical complexity, and thus increase the risk of poor outcomes.
Pituitary metastasis from renal cell carcinoma: case report and review of the literature
Published in International Journal of Neuroscience, 2021
Bin Li, Jian-Hua Cheng, Hai-Bo Zhu, Chu-Zhong Li, Ya-Zhuo Zhang, Peng Zhao
Craniopharyngioma is the most common congenital tumor in children, accounting for the first place in children’s sellar region tumors [31–35]. There are two craniopharyngioma subtypes: adamantinomatous and papillary. Primary manifestations are visual impairment (62–84%) and endocrine deficits (52–87%) [36]. Both computerized tomography and magnetic resonance imaging reveal that craniopharyngioma is typically a cystic tumor. The cystic component is usually, but not always, hyperintense on T1- and T2-weighted images. CT is the only way to definitively detect or exclude calcifications in craniopharyngioma tissue, which is found in approximately 90% of these tumors [37]. In our case, calcification was demonstrated on CT scan in this case. Craniopharyngioma rarely destroys the sellar bone, and blood supply is not as rich as pituitary metastases.