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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Weakly positive birefringent crystals are associated with calcium pyrophosphate deposition disease (CPPD), also known as pseudogout. This can be commonly misdiagnosed as osteoarthritis due to overlapping features but the distribution is more unusual and chondrocalcinosis is frequently present.
Test Paper 6
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Other causes of chondrocalcinosis include the following: HyperparathyroidismGoutWilson diseaseHaemochromatosisOchronosisTraumaOsteoarthritisHypothyroidismHypomagnesaemiaAcromegalyOxalosis and hydroxyapatite deposition disease (HADD)
Metabolic and endocrine bone disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Symptoms and signs are mainly due to hypercalcaemia: anorexia, nausea, abdominal pain, depression, fatigue and muscle weakness. Patients may develop polyuria, kidney stones or nephrocalcinosis due to chronic hypercalciuria. Some complain of joint symptoms, due to chondrocalcinosis. Only a minority (probably less than 10%) present with bone disease; this is usually generalized osteoporosis rather than the classic features of osteitis fibrosa, bone cysts and pathological fractures.
Rare Association between Sarcoidosis and Smoldering Multiple Myeloma: A Case Report
Published in Cancer Investigation, 2021
Brooke N. Learned, Wazhma Nasiri-Ahad, James E. Davis, Alpa G. Desai, Alan Chang
The patient was admitted and treated with intravenous normal saline and intramuscular calcitonin, which resulted in modest improvement in serum calcium levels. Studies obtained to determine the etiology of hypercalcemia revealed appropriately suppressed intact parathyroid hormone of <3.0 pg/mL (reference range: 15.0–65.0 pg/mL), low 25-hydroxy vitamin D of 21 ng/mL (30–80 ng/mL), and elevated 1,25-hydroxy vitamin D of 130.0 pg/mL (19.9–79.3 pg/mL) consistent with hypercalcemia of granulomatous disease. Parathyroid hormone-related peptide (PTHrP) was elevated at 3.1 pmol/L (0.0–2.3 pmol/L) and serum protein electrophoresis revealed M-spike of 2.1 g/dL. Skeletal survey was notable for chondrocalcinosis of several joints but no lytic lesions (Figure 2). Computed tomography (CT) of the chest revealed mass-like fibrosis of the upper lobes and extensive perilymphatic and coalescent nodules of all lobes of the bilateral lungs, as well as traction bronchiectasis and calcified hilar and mediastinal lymph nodes (Figure 3). The aforementioned findings prompted a leading diagnosis of sarcoidosis. This was further supported by elevated serum angiotensin converting enzyme (70 U/L, reference range: 9–67 U/L) as well as restrictive pattern with decreased diffusion capacity on pulmonary function testing (FEV1/FVC 108%, FVC 43%, TLC 39%, and DLCO 39% of predicted value).
The need for computed tomography imaging to differentiate the crowned dens syndrome from vertebral osteomyelitis
Published in Scandinavian Journal of Rheumatology, 2020
G Kenny, P MacMahon, P Dempsey, E Muldoon, G Sheehan, GM McCarthy
After 6 weeks of treatment, CRP remained elevated at 42 mg/L and his neck pain remained. A right knee radiograph was obtained owing to a new complaint of pain and swelling. This showed chondrocalcinosis within the tibiofemoral joint space (Figure 1). This finding, as well as persistent elevation of inflammatory markers, prompted a rheumatology review and consideration of calcium pyrophosphate disease (CPPD) as a cause of his presentation. Rheumatology advised cervical spine computed tomography (CT), which showed linear attenuation posterior to the dens representing calcium pyrophosphate (CPP) crystal deposition in the transverse ligament, and punctate focal calcification within the alar ligaments consistent with the clinical diagnosis of crowned dens syndrome (Figure 2). He was treated with oral prednisolone 10 mg daily, with significant improvement in his symptoms. After 6 weeks of steroid treatment he had minimal residual neck stiffness and CRP was 3 mg/L. Because of the residual neck stiffness, colchicine was added as prednisolone was tapered over 6 months, by which point the patient had returned to full activity.
Laryngeal manifestations in acromegaly: A systematic review of the literature
Published in Acta Oto-Laryngologica Case Reports, 2020
A total of 68 articles were identified on the primary search. Of these, 34 records remained after duplicates were removed. Of those, 16 articles were excluded (non-English article, Irrelevancy to subject, pediatric population). Eighteen articles were fully included in the quantitative analysis [1,3–16]. A flow chart detailing the screening and selection process is presented in (Figure 4). In total, 26 cases were reported in the literature. The mean age of patients was 51 years with 22 male patients (22/26) and 4 female patients (4/26). Nine patients (9/26) underwent surgery as a primary treatment modality for hypophyseal adenoma; 6 (6/26) patients received a radiation therapy treatment and 4 (4/26) patients received a somatostatin analog medical therapy (Table 1). Treatment in the remaining cases remains unclear. Obstructive sleep apnea syndrome (OSAS) was reported in 6 patients, although it was not systematically evaluated in all the included studies. Dyspnea was the most reported symptom followed by stridor and dysphonia. Indirect laryngoscopy findings were characterized mainly by pharyngo-laryngeal soft tissue hypertrophy and edema (22 patients), followed by bilateral and unilateral VF immobility seen in 15 and 3 patients respectively. Cervical computed tomography (CT) scan was performed in 9 patients and showed signs of chondrocalcinosis of the CA joint in 3 of them. All of them had VF immobility on FL and showed no restoration of VF mobility after treatment.