Renal Disease; Fluid and Electrolyte Disorders
John S. Axford, Chris A. O'Callaghan in 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
Mammography and Interventional Breast Procedures
Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack in 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.
Skull base tumors
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
This patient is a 16-year-old female who presented with amenorrhea. On initial evaluation, her pediatrician attributed her symptoms to aggressive athletic training with her track and field team since the age of 15. Evaluation by a pediatric endocrinologist did not reveal any abnormalities in her hormonal levels. These hormone levels were evaluated again 6 months later and remained unremarkable. Due to ongoing symptoms, her family requested additional testing. A magnetic resonance imaging (MRI) scan of the brain was performed. These images revealed a suprasellar enhancing mass with both solid and cystic components compressing the optic chiasm and hypothalamus (Figure 38.1a and b). Several areas of calcification were seen on a computed tomography (CT) scan (Figure 38.1c). Due to the calcifications and the heterogeneous appearance, this mass was believed to be most consistent with a craniopharyngioma.
Leg ulceration with histological features of pseudoxanthoma elasticum
Published in Baylor University Medical Center Proceedings, 2021
Usman Asad, Sheevam Shah, Palak Parekh
PXE-like elastic fibers have also been seen in patients with calciphylaxis.1 However, these fibers tend to be straight with transverse fractures, unlike the crinkled-looking fibers seen in PXE. Often, they are accompanied by luminal thrombi and calcification of vessel walls.1 Lupus-associated renal failure, idiopathic hypercalcemia with secondary calcinosis cutis, necrobiosis lipoidica, exposure to saltpeter, and osteoectasia are other documented conditions of abnormal calcium metabolism showing histological findings of PXE without clinical manifestations.5–8 Hypotheses have included an atypical form of PXE being a predisposing factor to the development of calciphylaxis and chronically elevated levels of calcium saturate fibrillin leading to calcification and fragmentation of elastic fibers. The calcification observed in our patient may also have simply been due to chronic inflammation (dystrophic calcification).
Lumbar idiopathic intervertebral disc calcification associated with ossification of the ligamentum flavum in adult: a case report
Published in British Journal of Neurosurgery, 2018
The etiology of idiopathic intervertebral disc calcification in adult has not been fully understood. Calcification is thought to be related to the developmental changes in the nucleus pulposus, and unknown triggers (microtrauma, infection, impaired blood flow, and metabolic diseases) may initiate an inflammatory response. Logically, trauma may serve as an initiator for the inflammatory response; however, most cases reported have no history of trauma.1 In our case, no constitutional signs (i.e. no fever) or laboratory findings suggestive of inflammation was found, and no history of prior trauma was elicited, but microtrauma was thought to trigger the calcification. Reported histological findings of ligamentum flavum revealed the appearance of a large number of calcium deposition among the fibrous tissues of ligamentum flavum and fibroblasts hyperplasia proliferation. No signs of inflammation, malignancy, or neovascularization could be found.2
Newly approved devices for endovascular treatment of femoropopliteal disease: a review of clinical evidence
Published in Expert Review of Cardiovascular Therapy, 2019
Stefanos Giannopoulos, Ehrin J. Armstrong
The DISRUPT BTK study was a prospective, non-randomized, multicenter feasibility and safety trial. Brodmann et al. enrolled 20 patients in order to investigate the short-term safety and efficacy of intravascular lithotripsy in calcified infrapopliteal lesions with greater than 50% stenosis and a lesion length up to 150 mm (mean 52.2 mm) [73]. The average calcified length was 72.1 mm, while the mean lumen diameter was 0.9 mm (mean diameter stenosis 72.6%). Moderate and severe calcification were observed in 11 (55%) and 9 (45%) patients, respectively. Success (≤50% residual stenosis) was achieved in all but 1 procedure, in which the Shockwave® catheter could not be positioned. Acute mean lumen gain was 1.5 mm representing an average post-treatment diameter stenosis of 26.2%. Although 10 adverse events were observed in five patients, none of the events were device-related, providing evidence that intravascular lithotripsy use is safe in infrapopliteal lesions.
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