Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease. Nevertheless, a pathological fracture revealing primary hyperparathyroidism is not commonly ...described.
We present the case of a 30-year-old male patient who was admitted with a subtrochanteric pathologic fracture of her left femur after a trivial fall. Due to suspicion of bone metastases, a thoraco-abdomino-pelvic CT scan was requested. It revealed multiple irregular circumscribed lytic bone lesions in the ribs, the right scapula, the dorsal spine, and the pelvic girdle; bilateral renal lithiasis; and a nodule contiguous to the left posterior thyroid lobe. A surgical biopsy of the bone lesion was performed. Histopathological examination confirmed the diagnosis of primary hyperparathyroidism with a brown tumor. Laboratory tests showed increased both calcium and PTH levels. The patient underwent cephalomedullary nail fixation with bipolar locking. After that, a parathyroidectomy was performed. At six months' follow-up, the functional result was satisfactory.
Primary hyperparathyroidism is the most common cause of hypercalcemia. It occurs as a result of a parathyroid adenoma in 80 % of cases. Definitive diagnosis should be made by clinical history, radiological findings and confirmed by biochemical tests including serum parathyroid hormone (PTH), alkaline phosphatase, calcium, phosphate, and vitamin D levels.
This case report emphasizes the need of including brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to ensure appropriate treatment.
•Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease•Pathological fracture revealing a primary hyperparathyroidism is not commonly described.•Pathological fractures due to brown tumors are usually found in severe or neglected cases of hyperparathyroidism•The main treatment of brown tumors is surgical removal of the hyperfunctioning parathyroid gland.
Clavicle fractures are among the most common fractures in adults. Nevertheless, bilateral fractures are rarely reported in the literature. We present the case of a 35-year-old male patient who was ...admitted with a bilateral clavicle fracture following a motorcycle accident. The patient underwent open reduction and bilateral intramedullary fixation with Kirschner wires. After six months of follow-up, the functional result was satisfactory; the patient achieved full range of motion in both shoulders and was free from pain. X-rays showed a complete fusion of the fracture on both sides.
We present the case of a 24-year-old male who sustained a fall from a motorcycle resulting in a rare combination of injuries, including avulsion fractures of the posterior cruciate ligament (PCL) and ...femoral lateral collateral ligament (LCL), along with an ipsilateral diaphyseal tibia fracture. This case report aims to highlight the importance of early diagnosis, appropriate management, and comprehensive rehabilitation for such complex knee injuries. We discuss the patient's presentation, radiographic findings, surgical intervention, postoperative care and long-term outcomes.
To our knowledge this kind of injury has never been documented in the literature.
Isolated distal radioulnar joint (DRUJ) dislocation is a rare injury. Reports of isolated DRUJ luxations, volar or dorsal, are often case reports and rarely a series of cases. We present a case of an ...isolated acute dorsal dislocation of the distal radioulnar joint in a 25-year-old man. The patient underwent closed reduction and a transcutaneous radioulnar pinning was done followed by cast immobilization in neutral rotation during 6 weeks. After six months follow -up, the functional result was satisfactory, patient experienced no pain and had no restrictions in work or sports-related activities.
Objectives
The long‐term side effects of stavudine (d4T) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe.
Methods
...Patients taking combination antiretroviral therapy (cART) in EuroSIDA with follow‐up after 1 January 2006 were included in the study. cART was defined as d4T‐containing d4T plus at least two other antiretrovirals (ARVs) from any class or non‐d4T‐containing (at least three ARVs from any class, excluding d4T). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T.
Results
A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months 95% confidence interval (CI) 19–20%. d4T use declined fastest in Northern Europe 26% (95% CI 23–29%) per 6 months, and slowest in Eastern Europe 17% (95% CI 16–19%) per 6 months. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months adjusted incidence rate ratio (aIRR) 0.86; 95% CI 0.80–0.91. Factors associated with initiating d4T were residence in Eastern Europe (aIRR 4.31; 95% CI 2.17–9.98) versus other European regions and HIV RNA > 400 copies/mL (aIRR 3.11; 95% CI 1.60–6.02) versus HIV RNA < 400 copies/mL.
Conclusions
d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in Eastern Europe, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV‐positive patients are aware of the potential harmful effects associated with d4T.
A protocol was originally designed to study breathing control during and following cardiac arrest in humans, taking advantage of the period of pulseless ventricular fibrillation (PVF) produced while ...testing a newly implanted cardioverter-defibrillator device. A patient aged in his 60s with New York Heart Association class III heart failure (HF) (left ventricular ejection fraction of 25%) who was originally part of this study displayed permanent periodic breathing (PB) and was then excluded from the final data analysis; his response is presented in this report. The 8- to 9-s PVF was incidentally produced during the ascending phase of a PB cycle, followed by another 12-s recovery period of low BP. PVF and its recovery had no effect on PB characteristics (period or amplitude). This occurred despite a profound change in P aco2 , cerebral blood flow, and perfusion of the carotid bodies. It is concluded that PB in patients with HF could be produced by primary oscillations originating from the central pattern generator.
INTRODUCTIONPrimary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease. Nevertheless, a pathological fracture revealing primary hyperparathyroidism is ...not commonly described. CASE PRESENTATIONWe present the case of a 30-year-old male patient who was admitted with a subtrochanteric pathologic fracture of her left femur after a trivial fall. Due to suspicion of bone metastases, a thoraco-abdomino-pelvic CT scan was requested. It revealed multiple irregular circumscribed lytic bone lesions in the ribs, the right scapula, the dorsal spine, and the pelvic girdle; bilateral renal lithiasis; and a nodule contiguous to the left posterior thyroid lobe. A surgical biopsy of the bone lesion was performed. Histopathological examination confirmed the diagnosis of primary hyperparathyroidism with a brown tumor. Laboratory tests showed increased both calcium and PTH levels. The patient underwent cephalomedullary nail fixation with bipolar locking. After that, a parathyroidectomy was performed. At six months' follow-up, the functional result was satisfactory. CLINICAL DISCUSSIONPrimary hyperparathyroidism is the most common cause of hypercalcemia. It occurs as a result of a parathyroid adenoma in 80 % of cases. Definitive diagnosis should be made by clinical history, radiological findings and confirmed by biochemical tests including serum parathyroid hormone (PTH), alkaline phosphatase, calcium, phosphate, and vitamin D levels. CONCLUSIONThis case report emphasizes the need of including brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to ensure appropriate treatment.
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