ABSTRACT
Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.
ABSTRACT
The incidence of parathyroid hyperfunction is high and its clinical manifestations are diverse. Some patients develop chest tightness and palpitations as the main discomfort, which may be caused by the hypocalcemia and hypercalcemia related to negative calcium balance and parathyroid hyperfunction. We report a case of 53 years old male with parathyroid hyperfunction who was diagnosed with osteoporosis before and received conventional regular supplementation of vitamin D and calcium supplements. However, his condition worsened and he developed chest tightness and palpitation. After 1 month of sufficient supplementation of calcium, the symptoms of chest tightness and palpitation disappeared completely. Then we continued to provide the patients enough vitamin D and calcium supplementation actively. After 1 year of follow-up, the patient's condition was stable. His discomfort of chest tightness and palpitation never recurred, and all the bone metabolism indicators returned to normal.
ABSTRACT
Osteoporosis is a common age-related disease which has become a severe public health problem in China. Anti-osteoporosis drug is important to treat osteoporosis, but some patients have poor efficacy after using anti-osteoporosis drugs, which may be associated with anti-osteoporosis drugs related parathyroid hyperfunction or hyperparathyroidism. As a emergency drug for hypercalcemia crisis, anti-osteoporosis drug can cause a significant decrease in serum calcium. With the current recommended doses of vitamin D and calcium supplementation, some patients presented with a decreased level of serum calcium and negative calcium balance after receiving anti-osteoporosis drugs, stimulating parathyroid hyperplasia and enlargement, leading to parathyroid hyperfunction or hyperparathyroidism. During the treatment of anti-osteoporosis drugs, sufficient vitamin D and calcium supplementation on the basis of closely monitoring of serum calcium, parathyroid hormone (PTH) and related bone metabolism indicators is beneficial to maintain the stability of serum calcium and PTH, preventing anti-osteoporosis drugs related parathyroid hyperfunction or hyperparathyroidism. Furthermore, it can efficiently prevent and treat bone loss, fractures, height shortening, hunchback, systemic musculoskeletal and joints pain, metastatic vascular calcification and calcinosis universalis, improve the efficacy of anti-osteoporosis drugs, reduce adverse reactions, comprehensively improve the prognosis of osteoporosis patients, and protect people’s health.
ABSTRACT
Anti-osteoporosis drug is important to treat osteoporosis. However, systemic musculoskeletal and joints pain and other adverse events in some patients are unrelieved or even aggravated after using anti-osteoporosis drugs, which may be associated with anti-osteoporosis drug related parathyroid hyperfunction or hyperparathyroidism. We report a case of 78 years old female with osteoporosis who, on the basis of conventional regular supplementation of Vitamin D and calcium supplements, presented with a decreased level of serum calcium and negative calcium balance after receiving anti-osteoporosis drugs, resulting in hyperparathyroidism, significant pain in bilateral knee joints and inability of walking independently. After sufficient supplementation of vitamin D and calcium, the pain was significantly relieved, bone metabolism indicators returned to normal, the patient was able to walk without assistance and had no recurrence after 1 year of follow-up.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the association between high-density lipoprotein cholesterol (HDL-C) level and rate of ischemic stroke recurrence.</p><p><b>METHODS</b>A total of 1 059 patients with ischemic stroke were enrolled from 5 community health centers and underwent baseline surveys during the period of January 2003 to December 2006. After baseline surveys, patients were followed up every 6 months until December 31, 2008. The new stroke events were recorded as the primary study endpoint. The association between HDL-C, HDL-C/TC and ischemic stroke recurrence was analyzed by Cox regression analysis.</p><p><b>RESULTS</b>The proportions of stroke patients with high ( ≥ 1.55 mmol/L), moderate (1.04-1.54 mmol/L) and low (<1.04 mmol/L) HDL-C levels were 15.58% (165/1 059) , 54.58% (578/1 059) and 29.84% (316/1 059) respectively. During a mean of (3.21 ± 1.04) years follow-up, recurrent ischemic stroke was recorded in 137 patients. Compared with HDL-C ≥ 1.40 mmol/L group, multivariate Cox regression analysis showed that stroke recurrence rates of patients with HDL-C ≤ 1.00 mmol/L and ranged from 1.01 to 1.19 mmol/L increased by 0.944 (HR = 1.944, 95%CI:1.033-3.659, P = 0.039) and 1.027 (HR = 2.027, 95%CI:1.116-3.682, P = 0.020)fold , respectively. Recurrence rates increased 1.237 (HR = 2.237, 95%CI:1.208-4.144, P = 0.010) fold in patients with HDL-C/TC ≤ 0.19 mmol/L compared to patients with HDL-C/TC ≥ 0.28 mmol/L.</p><p><b>CONCLUSION</b>The risk of ischemic stroke recurrence increases with decreasing HDL-C level or HDL-C/TC ratio.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cholesterol, HDL , Blood , Follow-Up Studies , Recurrence , Risk Factors , Stroke , Blood , EpidemiologyABSTRACT
Objective To estimate the prevalence and related risk factors of post-stroke depression (PSD) in ischemic stroke survivors from community-based medical centers in urban areas of Beijing.Methods Five community-based medical centers in urban areas of Beijing were selected.Patients with first-ever or recurrent ischemic stroke were evaluated from January 2003 to December 2006. The prevalence of PSD was evaluated by Self-Rating Depression Scale (SDS), and the information on the onset of stroke, vascular risk factors and living style was also collected.Results Totally 1089 stroke patients were registered, 1074 cases among which had complete information and met inclusion criteria. The mean age of the patients was (65.0 ± 8.9) years with a median stroke course of 13.0 months. The overall prevalence of PSD was 49.9% (536/1074), and the proportions of mild, moderate and major PSD were 52.2%, 36.0% and 11.8%, respectively. There were no significant differences in prevalence of PSD among different stages of stroke and the prevalence of PSD was 51.3% within 6 months after stroke onset, 47. 1% during 6-18 months and 53.2% after 18months. Low education, activities of Daily Living (ADL) dependence, cognition impairment and recurrence of stroke were independent risk factors for PSD.Conclusions The prevalence of PSD among ischemic stroke patients is higher in community-based medical centers, but most of PSD patients are mild or moderate. More effective early intervention should be adopted to decrease PSD,promote the recovery of neural function and improve their quality of life.