Severe Hypocalcemia as an Atypical Manifestation of Seronegative Celiac Disease in a Patient with Systemic Lupus Erythematosus: Case Report

Aim: To describe the clinical picture and diagnosis of an episode of severe hypocalcemia in a patient with systemic lupus erythematosus (SLE) in remission, with chronic diarrhea that led to the diagnosis of celiac disease (CD). Case presentation: 22-year-old patient, diagnosed with SLE at age 10, in remission. He consulted for a two-month history of paresthesias, muscle spasms, myalgias, and episodes of tetany in the previous week, associated with malabsorptive postprandial diarrhea. His laboratory tests showed severe hypocalcemia, vitamin D deficiency, severe hypomagnesemia, and mild hypokalemia. In the study for CD, serology reported normal anti-tissue transglutaminase IgA, antigliadin IgA, and IgG and low total IgA levels. Enteroscopy revealed erosive bulbo-duodenitis, with villous atrophy and increased intraepithelial lymphocytes in the pathology, which, together with the immunohistochemical study, allowed the diagnosis of CD, Marsh 3a type. Management was initiated with a gluten-free diet, with a positive clinical response. Conclusion: CD should be suspected in patients with SLE who present with diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia. In rare seronegative CD cases, other causes of villous atrophy, mainly infectious, toxic, and immunological, must be ruled out. There is an association between CD and SLE, so diagnosis must be early and timely with the best testing scheme available to achieve effective treatment before complications occur.

Objetivo: Describir la presentación clínica y diagnóstico de un episodio de hipocalcemia grave en un paciente con lupus eritematoso sistémico (LES) en remisión, con diarrea crónica que condujo al diagnóstico de enfermedad celíaca (EC). Presentación del caso: Paciente de 22 años, con diagnóstico de LES a los 10 años, en remisión. Consultó por 2 meses de evolución de parestesias, espasmos musculares, mialgias y episodios de tetania en la semana previa, asociado a diarrea posprandial malabsortiva. Sus laboratorios mostraron hipocalcemia grave, déficit de vitamina D, hipomagnesemia grave e hipopotasemia leve. En el estudio para EC la serología reportó antitransglutaminasa tisular IgA, antigliadina IgA e IgG normales y niveles de IgA total bajos. La enteroscopia evidenció bulboduodenitis erosiva, con atrofia de las vellosidades y aumento de linfocitos intraepiteliales en la patología, que junto al estudio inmunohistoquímico permitieron concluir el diagnóstico de EC, tipo Marsh 3a. Se inició el manejo con una dieta libre de gluten, con una respuesta clínica positiva. Conclusión: La EC debe sospecharse en pacientes con LES que inicien con diarrea, dolor abdominal, náuseas/vómitos, aftosis oral recurrente y anemia. En los casos de EC seronegativa, los cuales son poco comunes, se deben descartar otras causas de atrofia de las vellosidades principalmente infecciosas, tóxicas e inmunitarias. Existe una asociación entre EC y LES, por lo cual el diagnóstico debe ser precoz y oportuno con el mejor esquema de pruebas disponible para lograr realizar un tratamiento efectivo antes de que se presenten las complicaciones.

Crisis celíaca y tetania aguda en pediatría. Reporte de un caso / Celiac crisis and acute tetany in pediatrics. Case report

RESUMEN La enfermedad celíaca es una enfermedad sistémica inmunomediada, con un gran espectro de presentaciones clínicas. El término crisis celíaca describe la forma aguda y potencialmente fatal. Clínicamente se caracteriza por diarrea severa, deshidratación y alteraciones metabólicas. Se reporta el caso de un paciente masculino de 7 años de edad que asiste a guardia con tetania, edema en miembros inferiores, esteatorrea y pérdida de peso de 8 meses de evolución, con hallazgos analíticos de hipocalcemia, hipomagnesemia, hipopotasemia y coagulopatía. El diagnóstico de crisis celíaca se realizó sobre la base de hallazgos serológicos y clínicos compatibles con enfermedad celíaca en el contexto de anomalías metabólicas graves y desnutrición aguda, confirmado posteriormente por anatomía patológica. La importancia de este reporte radica en repasar las características de esta grave entidad, que requiere un elevado índice de sospecha para su diagnóstico.

ABSTRACT Celiac disease is an immune-mediated systemic disease with a wide spectrum of clinical presentations. The term celiac crisis describes the acute and potentially fatal form. Clinically it is characterized by severe diarrhea, dehydration, and metabolic disturbances. The case of a 7-year-old male patient attending the ward with tetany, lower limb edema, steatorrhea and weight loss of 8 months of evolution is reported, with analytical findings of hypocalcemia, hypomagnesemia, hypokalemia and coagulopathy. The diagnosis of celiac crisis was made on the basis of serological and clinical findings compatible with celiac disease in the context of severe metabolic abnormalities and acute malnutrition, later confirmed by pathological anatomy. The importance of this report lies in reviewing the characteristics of this serious entity, which requires a high index of suspicion for its diagnosis.

Hypomagnesemia in dairy cattle in Uruguay / Hipomagnesemia em bovinos leiteiros no Uruguai

An outbreak of hypomagnesemia is reported in Holstein dairy cattle grazing lush oat (Avena sativa) pasture in Uruguay. Nine of 270 (3.3%) cows died in May-July (autumn-winter) 2017. These nine cows were from 2 to 9-years-old (1st-6th lactation), with 22 to 194 days of lactation and 15.8 to 31.4L of daily milk production. Two cows with acute sialorrhea, muscle spasms, lateral recumbency, weakness, opisthotonos, and coma, were euthanized and necropsied. No significant macroscopic or histological lesions were found. One untreated clinically-affected cow and eight out of 14 clinically healthy cows of the same group under similar management and production conditions had low serum levels of Mg (lower than 0.7mmol/L). Secondarily, both clinically affected cows and six out of 14 healthy cows had low serum Ca levels. The K/(Ca+Mg) ratio of two oat forages, corn silage, and ration was 5.10, 7.73, 2.45, and 0.85, respectively. A K/(Ca+Mg) ratio lower than 2.2 represents a risk for hypomagnesemia. The difference between the contribution-requirement of minerals in the diet was established and a daily deficiency of Mg (-0.36g/day), Na (-25.2g/day) and Ca (-9.27g/day) was found, while K (184.42g/day) and P (12.81g/day) were in excess. The diet was reformulated to correct the deficiencies and the disease was controlled by the daily administration of 80g of magnesium oxide, 80g of calcium carbonate and 30g sodium chloride per cow. It is concluded that hypomagnesemia is a cause of mortality in dairy cattle in Uruguay, and that the condition can be prevented by appropriate diet formulation.(AU)

Descreve-se um surto de hipomagnesemia em bovinos leiteiros da raça Holandês com alimentação a base de pastagens de aveia (Avena sativa) em crescimento no Uruguai, nos meses de maio a julho (outono-inverno) de 2017. De um rebanho de 270 vacas em ordenha, nove (3,3%) morreram. As nove vacas tinham entre dois e nove anos, estavam entre a primeira e a sexta lactação e a produção diária era de 15,8 a 31,4 litros de leite. Duas vacas que apresentaram sialorreia, espasmos musculares, decúbito lateral, debilidade, opistótono e posteriormente, estado comatoso foram eutanasiadas e necropsiadas. Não foram observadas lesões macroscópicas ou histológicas significantes. Uma vaca com sinais clínicos, não tratada, e oito de 14 vacas sem sinais clínicos, do mesmo rebanho, apresentaram baixos níveis séricos de Mg (menos de 0,7mmol/L). Adicionalmente, as duas vacas com sinais clínicos e seis das 14 vacas sem sinais clínicos apresentaram baixos níveis de Ca sérico. A relação do risco tetanizante K/(Ca+Mg) de duas pastagens de aveia, silagem de milho e ração concentrada foi estimada em 5; 10; 7,73; 2,15 e 0,85, respectivamente. Uma relação K/(Ca+Mg) maior de 2,2 é um indicador do potencial tetanizante da forragem, A diferença entre o aporte e os requerimentos dos minerais foi estabelecida constatando-se deficiência diária de Mg (-0,36g/dia), Na (-25,2g/dia) e Ca (-9,27g/dia). O potássio (K) (184,42g/dia) e o fósforo (P) (12,81g/dia) estavam em excesso. A dieta foi reformulada para corrigir as deficiências e a doença foi controlada mediante a administração diária de 80g de MgO, 80g de CaCO3 e 30g de NaCl por vaca. Conclui-se que a hipomagnesemia é uma doença de importância crescente em gado leiteiro no Uruguai e que deve ser prevenida mediante a formulação correta da dieta.(AU)

Clinical analysis of 14 cases of pseudohypoparathyroidism in children / 国际儿科学杂志

Objective@#To analyze the clinical characteristics and treatment of pseudohypoparathyroidism(PHP) in children and to increase clinicians′understanding of this disorder.@*Methods@#From January 2008 to November 2018, a total of 14 PHP patients at our hospital were retrospectively analyzed, as regarding the clinical manifestation, laboratory examination and imaging data.The patients were further divided into two groups according to onset age: group A(under 1 year) and group B(over or equal to 1 year). The laboratory findings were compared between the two groups.@*Results@#Of the 14 patients(10 boys and 4 girls), the median age of onset was 12 years(range: 1 day to 16 years). Epilepsy is one of the most common manifestations of PHP.Laboratory findings include hypocalcemia(1.06-2.18mmol/L), hyperphosphatemia(2.1-3.5 mmol/L), and elevated concentrations of PTH(105.6-733.0 pg/ml). PTH levels were significantly lower in the group A than in group B(Z=2.07, P=0.042). Five patients were found to have calcifications in bilateral basal ganglia and cerebral parenchyma by head CT.All the patients were improved after treatment, which included calcium gluconate injection to control tetany, calcium supplement combined with vitamin D and/or calcitriol orally.@*Conclusion@#For children who presented frequent hypocalcemia tetany and calcifications in head CT, serum calcium, phosphorus, PTH levels should be further investigated to make a correct diagnosis.Calcium supplement combined with vitamin D or its metabolites is an effective therapy for PHP children.

Clinical analysis of 14 cases of pseudohypoparathyroidism in children / 国际儿科学杂志

Objective To analyze the clinical characteristics and treatment of pseudohypoparathyroidism (PHP) in children and to increase clinicians'understanding of this disorder.Methods From January 2008 to November 2018,a total of 14 PHP patients at our hospital were retrospectively analyzed,as regarding the clinical manifestation,laboratory examination and imaging data.The patients were further divided into two groups according to onset age:group A (under 1 year) and group B (over or equal to 1 year).The laboratory findings were compared between the two groups.Results Of the 14 patients (10 boys and 4 girls),the median age of onset was 12 years (range:1 day to 16 years).Epilepsy is one of the most common manifestations of PHP.Laboratory findings include hypocalcemia (1.06-2.18mmol/L),hyperphosphatemia (2.1-3.5 mmol/L),and elevated concentrations of PTH (105.6-733.0 pg/ml).PTH levels were significantly lower in the group A than in group B (Z =2.07,P =0.042).Five patients were found to have calcifications in bilateral basal ganglia and cerebral parenchyma by head CT.All the patients were improved after treatment,which included calcium gluconate injection to control tetany,calcium supplement combined with vitamin D and/or calcitriol orally.Conclusion For children who presented frequent hypocalcemia tetany and calcifications in head CT,serum calcium,phosphorus,PTH levels should be further investigated to make a correct diagnosis.Calcium supplement combined with vitamin D or its metabolites is an effective therapy for PHP children.

Tetania severa por uso de enemas fosfatados, reporte de caso / Tetany secondary to phosphate enema toxicity, case report

Los enemas fosfatados son utilizados frecuentemente en el tratamiento de la constipación. Errores en la posología pueden producir complicaciones graves. Objetivo: Reportar un caso de toxicidad grave por enema fosfatado en un pre escolar sin factores de riesgo. Caso clínico: Paciente de 2 años con constipación funcional, evaluada en servicio de urgencia por dolor abdominal a quién se le diagnosticó un fecaloma impactado. Recibió 2 dosis de enema de fosfato, “medio frasco” de Fleet® adulto (Synthon, Chile) por vez, sin resolución de su fecaloma, decidiéndose hospitalización para proctoclisis. Posterior al ingreso presentó un cuadro clínico de tetania. Ingresó a la Unidad de Paciente Crítico donde se confirmó una hiperfosfemia e hipocalcemia secundaria. Se realizó corrección electrolítica progresiva, retiro de enema fosfatado residual del recto e hiperhidratación forzando diuresis. La tetania cedió 2 horas después del ingreso sin otras complicaciones. Se realizó proctoclisis y fue dada de alta a los 3 días. Conclusión: Los enemas fosfatados pueden presentar complicaciones graves en niños sin factores de riesgo. Errores en la posología son la causa más frecuente de toxicidad en este grupo, pero esta puede estar favorecida también por una administración y eliminación inadecuadas. Pediatras y personal de salud que atiende a niños deben conocer factores de riesgo, signos y síntomas de intoxicación por enemas fosfatados.

Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. Objective: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. Conclusion: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.

To analyze the risk factors of tetany in patients with hyperventilation syndrome / 天津医药

Objective To explore the risk factors causing tetany in patients with hyperventilation syndrome. Meth?ods A total of 103 patients with hyperventilation syndrome treated in our hospital were included in this study. According to whether there was tetany, patients were divided into tetany group and non-tetany group. Values of gender, age, electrolyte, pH and p(CO2) were analysed between two groups. The factors of P0.05). It was revealed that the younger age, the lower level of the serum K+, serum phosphorus and p(CO2) were the risk factors of tetany through binary Logistic regression analysis. Conclusion The risk factors of tetany in patients with hyperventilation syndrome include younger age, lower level of serum K+and serum phosphorus and reduced p(CO2).

A Rare Case of Salbutamol Induced Tetany Pooja Shukla1*, Mohd Tariq Salman1, R K Dixit2, Shiv Sagar Gupta3, V K Verma1, Ali Ahmad1

A 25-year-old female, housewife, Nonsmoker, with complains of Dysnoea and pain in chest was diagnosed with Bronchial asthma in the Out Patient Department of Pulmonary Medicine of our institute. As per the GINA guidelines she was prescribed nebulization with Salbutamol 5 mg for confirming the diagnosis of bronchial asthma. Within minutes of nebulization she started to have involuntary contraction involving all four limb and developed hand posture associated with tetany. The nebulization was stopped and symptoms were relieved after 15 minutes of the calcium administration. The causal relationship between the suspected drug and the adverse event was assessed to be probable and thus clinicians should always be aware of the possibility of tetany due to salbutamol

Clinical and laboratory characteristics of neonatal hypocalcemia

PURPOSE: To describe the clinical characteristics of full-term neonates with hypocalcemia and to suggest factors associated with neonatal hypocalcemia METHODS: The medical records of full-term neonates with hypocalcemia were reviewed. Hypocalcemia was defined as an ionized calcium (iCa) concentration of <4 mg/dL. Parathyroid hormone (PTH) insufficiency was defined as a serum PTH level of <60 pg/mL or a serum phosphorus level higher than the serum calcium level in the presence of hypocalcemia. RESULTS: Fifty-three neonates were enrolled. The median age at diagnosis of hypocalcemia was 3 days. In all the neonates, formula feeding predominance was observed. Thirty-eight neonates (69.8%) were compatible with PTH insufficiency. The number of formula-fed neonates was significantly higher than that of breast-fed patients among neonates with PTH insufficiency (P=0.017). Intact PTH was negatively correlated with serum phosphorus levels. Twelve out of 14 neonates (85.7%) had 25-hydroxy vitamin D (25OHD) levels <20 ng/mL and 9 neonates (64.3%) had 25OHD levels <10 ng/mL. Twenty-one neonates had hypocalcemic tetany. The serum calcium and iCa concentrations of neonates with tetany were 4.2-8.3 mg/dL and 1.85-3.88 mg/dL, respectively. Three neonates showed symptomatic hypocalcemia with calcium levels over 7.5 mg/dL. Among the 16 neonates who underwent electroencephalography (EEG), 12 had abnormalities, which normalized after 1-2 months. CONCLUSION: Formula milk feeding, PTH insufficiency and low serum vitamin D concentration are associated with the development of neonatal hypocalcemia. Symptoms such as tetany and QT interval prolongation can develop in relatively mild hypocalcemia. Moreover, transient neonatal hypocalcemia can cause transient EEG abnormalities.

Morfologia e histoquímica do tecido muscular esquelético de ratos após estiramento / Morphological and histochemical skeletal muscle tissue of rats after stretch

A lesão muscular constitui parte integrante do processo de adaptação a certos tipos de treinamento físico. Em atletas altamente treinados, a lesão muscular, representa uma resposta capaz de acelerar o turnover protéico. O presente trabalho teve por finalidade avaliar a morfologia, e as características metabólicas e contráteis dos tipos de fibras musculares. Foram utilizados 10 ratos Wistar com peso corporal médio de 350g com idade de 70 dias. Os animais foram submetidos a um estímulo elétrico (tetania) e a um estímulo mecânico (estiramento). Após 48h os animais foram eutanasidos mediante uma dose de pentobarbital sódico. Fragmentos da cabeça medial do músculo gastrocnêmio foram imersas em N-Hexana a -70º Cortes (8 µm) obtidos em um micrótomo criostato, (–20ºC), foram corados pela HE e outros submetidos as reações NADH-TR e m ATPase, (pH 4,6 e 10,4). O padrão fascicular mostrou-se desorganizado. Ao lado de várias fibras com diferentes estágios de fagocitose, observou-se um intenso infiltrado plasmolinfocitarios, com elevado numero de macrófagos, células miosatélites e células mesenquimatosas, e áreas com ausência de células musculares. A atividade oxidativa revelou-se levemente aumentada em todos os tipos de fibras normais e muito diminuída nas fibras em fase de fagocitose. Conforme revelado pela reação m-ATPase, após pré-incubação alcalina e ácida, lesões foram observadas nas fibras de contração lenta (Tipo I) e nas de contração rápida (Tipo II). Assim, decorridas 48h após o estímulo de tetania e estiramento mecânico, a lesão de fibras acompanhada de processo de fagocitose e o infiltrado de células miosatélites, macrófagos e células mesenquimatosas, foram os eventos mais evidentes. Em nível do tipo de fibras, as lesões comprometeram ambos os tipos.

Muscular injury constitutes an integral part of the adaptation process to certain types of physical training. In highly trained athletes, muscular injury, or so it seems, represents a response capable of speeding up the protein turnover. The goal of the present work was to evaluate the degree of morphologic alteration, as well as the metabolic and contractile characteristics of types of muscle fibers. Ten Wistar rats were used with an average corporal weight of 350g. The animals were submitted to both an electrical stimulation (tetany) and a mechanical stimulation (stretching). After 48h the animals were euthanized by means of a dose of pentobarbital, followed by the removal of the medial head of the gastrocnemius muscle. The muscular samples were first immersed in N-Hexan at -70°C, and then placed in a microtome cryostat at -20°C, where transversal cuts (8 µm) at the longest axle of staple fibers were obtained. Some cuts were submitted to HE and others to the reactions for NADH-TR and mATPase, (pH 4.6 and 10.4). In addition to some staple fibers in different stages of phagocytosis, an intense infiltration was observed, with a large number of macrophages, mesenchyma and myosatellite type cells, and areas with an absence of muscular cells. The oxidative activity was seen to be slightly augmented in all types of normal fibers but significantly decreased in fibers in the phagocytosis phase. As revealed by the m ATPase reaction after the acid and alkaline pre-incubation phase, lesions were observed in the two types of fibers, slow and fast contraction (Type I e II). Thus, 48 hours after the tetany/stretching, the lesion of fibers followed by the phagocytosis process and the infiltration of myosatellite cells, macrophages and mesenchymal cells were the most observed events. Regarding the types of fibers, the lesion seems to compromise both types.

Tétanos generalizado: caso clínico y revisión del tema / Generalized tetanus: clinical case report and review of the literature

Tetanus is a severe and potentially mortal disease, which affects the Nervous System, caused by the bacteria Clostridium tetani. It's endemic in developing countries, presenting in Chile with a rate of 0,02 cases per 100.000 habitants, but the antitetanic vaccine has reduced its incidence in developed countries. We present here a case report of a patient with generalized tetanus from our hospital. The clinical presentation was characterized by generalized increased muscle tone and trismus, and the patient was hospitalized in the Intensive Care Unit. The neurologic manifestations were important for a period of 3 weeks, but then they started decreasing until the patient was discharged, without complications and being able to sit and walk with assistance. In relation to this case, we will review the actualizations in the subject of Tetanus. The recommended treatment includes support therapy, prevention of complications, antibiotics, muscle relaxants and anti-tetanospasmin immunoglobulin; all therapies that our patient received partially. The disease has a mortality that reaches the 50 percent in some series, but the ones who survive have a good prognosis and full recovery. This is why the presentation of this case is important, being an infrequent disease that must be diagnosed timely and be treated adequately.

Introducción: El tétanos es una enfermedad grave y potencialmente mortal, que afecta al sistema nervioso y causada por la bacteria Clostridium tetani. Es endémica en países en desarrollo, teniendo en Chile el año 2007 una tasa de 0,02 casos por cien mil habitantes. La vacuna con el toxoide antitetánico ha disminuido ostensiblemente su incidencia en países desarrollados. Caso clínico: Se presenta el caso clínico de un paciente de 18 años con tétanos generalizado ingresado a nuestro hospital. Clínicamente se manifestó con un aumento del tono muscular generalizado y trismo. Se hospitalizó en la Unidad de Cuidados Intensivos. Los síntomas y signos neurológicos tuvieron una máxima intensidad de aproximadamente cuatro semanas; posteriormente fueron disminuyendo sin presentar complicaciones severas. Al alta el enfermo lograba sentarse y caminar con ayuda. Discusión: A propósito de este caso se hace una revisión de la literatura y actualización de esta grave enfermedad. El tratamiento recomendado incluye terapia de soporte, prevención de complicaciones, antibioterapia, relajantes musculares e inmunoglobulina antitetánica; terapias que este paciente recibió. Si bien esta enfermedad tiene una letalidad promedio de un 50 por ciento, los pacientes que sobreviven tienen buen pronóstico y recuperación completa. Por ello, la presentación de este caso clínico es importante, sobre todo siendo una condición poco frecuente, que debe diagnosticarse con prontitud y, así, recibir el tratamiento adecuado.

Tetany: Possible adverse effect of bevacizumab.

Background: Bevacizumab a recombinant humanized monoclonal antibody was approved in 2004 by US FDA for metastatic colorectal cancer. It is reported to cause potentially serious toxicities including severe hypertension, proteinuria, and congestive heart failure. Aim: To correlate adverse event tetany with the use of bevacizumab. Materials and Methods : World Health Organization's Uppsala Monitoring Centre, Sweden, for reporting of adverse drug reactions from all over the world, identified 7 cases with tetany-related symptoms to bevacizumab from four different countries. These 7 patients reported to UMC database developed adverse events described as musculoskeletal stiffness (1), muscle spasm (1), muscle cramps (1), lock jaw or jaw stiffness (4), and hypertonia (1), with hypocalcaemia. Results: After detailed study of the possible mechanism of actions of bevacizumab and factors causing tetany, it is proposed that there is a possibility of tetany by bevacizumab, which may occur by interfering with calcium metabolism. Resorption of bone through osteoclasts by affecting VEGF may interfere with calcium metabolism. Another possibility of tetany may be due to associated hypomagnesaemia, hypokalemia, or hyponatremia. Conclusions: Tetany should be considered as a one of the signs. Patient on bevacizumab should carefully watch for tetany-related symptoms and calcium and magnesium levels for their safety.

Hypocalcemic Tetany in a 13-Year-Old Girl with Wilson's Disease / 대한소아소화기영양학회지

Wilson's disease is an autosomal recessive disorder marked by disruptions in copper metabolism which leads to accumulation of copper in the liver, brain, cornea, and other tissues. Manifestations of this disease are more likely to be hepatic during early childhood and neurologic in adolescent. In addition, abnormalities that develop during disease progression may result in other manifestations such as hematologic, endocrine, or renal findings. Here we report a 13-year-old girl who presented with hypocalcemic tetany shortly after being diagnosed with Wilson's disease. Despite aggressive calcium, magnesium, and vitamin D replacement therapy, the hypocalcemia and hypomagnesemia did not promptly respond. Mineral levels in the blood took longer than 3 weeks to normalize. We speculate that a parathyroid insufficiency and disrupted vitamin D metabolism caused by copper accumulation and hepatic dysfunction resulted in hypocalcemic tetany.

Stretch injuries of skeletal muscles: experimental study in rats' soleus muscle / Lesión por estiramiento de los músculos esqueléticos: estudio experimental con el músculo soleus de ratas

The study aimed to verify the physiological injury behavior by stretching the soleus muscle of rats, using a noninvasive experimental model. Twenty-four rats were used and divided into three groups of eight animals: control group (A), group that performed tetanus followed by electrical stimulation and a sudden dorsiflexion of the left paw performed by a device equipped with a mechanism of muscle soleus rapid stretching (B); and a group that only received the tetanus (C). Three days later, the animals were killed, and the soleus muscle was resected and divided into three segments. Morphological changes indicative of muscle damage appeared in all three segments of group B. In a lesser degree, similar changes were also detected in muscles subjected to only tetanus. This model was effective; reproducing an injury similar to what occurs in human sports injuries.

El estudio tuvo como objetivo verificar el comportamiento fisiológico de la lesión por estiramiento de los músculos soleos de ratas, utilizando un modelo experimental no invasivo. Veinticuatro ratas se utilizaron y se dividieron en tres grupos de ocho animales: Grupo A control; Grupo B se realiza tetanización por la estimulación eléctrica seguida de una repentina flexión dorsal de la pierna izquierda, realizado por un dispositivo equipado con un mecanismo rápido de estiramiento del músculo sóleo y Grupo C los animales sólo recibieron la tetanización. Tres días después, los animales fueron sacrificados, el músculo sóleo fue resecado y dividido en tres segmentos. Cambios morfológicos indicativos de daño muscular aparecieron en los tres segmentos del grupo B. En menor grado, cambios similares se detectaron en los músculos sometidos solamente al tetanización. El modelo fue eficaz, la reproducción de la lesión fue similar a lo que ocurre en las lesiones deportivas humanas.

Effects of the infrared lamp illumination during the process of muscle fatigue in rats

In this study the effects of infrared lamp illumination during the muscle fatigue process was studied. Three different groups (n=5) were used: one control group and two treated (Infrared Lamp 780-1400nm), with the energy densities of 0.5 and 1.0 J/cm² and time of illumination of 300 seconds. The treated animals were illuminated in one point directly in the tibialis muscle, after the first tetanic contraction out of six, with an interval between each tetany. The results were registered in an electrophysiograph and the intensity of the force of contraction in grams was analysed. It was observed that the control group presented a reduction in the intensity of the force of contraction, while the treated group managed to maintain it, which was clearly evident in the energy density of 0.5 J/cm². It was concluded that the use of the infrared lamp illumination was efficient concerning resistance to muscle fatigue.

Neste estudo investigamos o efeito da irradiação da lâmpada infravermelha durante o processo de fadiga muscular. Foram utilizados 3 grupos diferentes (n=5), sendo 1 grupo controle e 2 irradiados (Lâmpada de Infravermelho 780-1400nm), nas densidades de energia 0,5 e 1,0J/cm² e tempo de irradiação 300 segundos. Os animais irradiados receberam 1 irradiação em 1 ponto, diretamente no músculo tibial, após a primeira contração tetânica de um total de seis, com um intervalo entre cada tetania. Os resultados foram registrados em eletrofisiógrafo e analisado a intensidade da força de contração em gramas. Foi observado que o grupo controle apresentou uma redução na intensidade da força de contração, já os grupos irradiados conseguiram mantê-la, sendo mais evidente quando irradiado com densidade de energia (DE) de 0,5J/cm². Conclui-se que a utilização da irradiação da lâmpada infravermelha é eficaz na resistência a fadiga muscular.

A case of idiopathic hypoparathyroidism combined with hypothyroidism diagnosed by tetanic symptom during treatment for idiopathic epilepsy / 대한내과학회지

Idiopathic hypoparathyroidism is activating mutation of the calcium sensor receptor lead to inhibition of parathyroid hormone (PTH) secertion at inappropriately low serum ionized calcium levels and are a cause of autosomal dominant hypoparathyroidism. This disease often show slight mental retardation and associated endocrine abnormalities, most commonly hypothyroidism (without goiter) and hypogonadism. We diagnosed this in 20 year old male who presented with left foot pain with rigidity during he was treated for idiopathic epilepsy and had goiter. We report this case with a review of the literature.

A case of idiopathic hypoparathyroidism combined with hypothyroidism diagnosed by tetanic symptom during treatment for idiopathic epilepsy / 대한내과학회지

Idiopathic hypoparathyroidism is activating mutation of the calcium sensor receptor lead to inhibition of parathyroid hormone (PTH) secertion at inappropriately low serum ionized calcium levels and are a cause of autosomal dominant hypoparathyroidism. This disease often show slight mental retardation and associated endocrine abnormalities, most commonly hypothyroidism (without goiter) and hypogonadism. We diagnosed this in 20 year old male who presented with left foot pain with rigidity during he was treated for idiopathic epilepsy and had goiter. We report this case with a review of the literature.

A Case of Severe Hyperphosphatemia and Hypocalcemic Tetany after Sodium Phosphate Administration in a Patient with Normal Renal Function / 대한신장학회잡지

Oral sodium phosphate (NaP) is increasingly used to prepare patients for gastrointestinal procedures such as colonoscopy. Severe hyperphosphatemia may complicate bowel-cleansing preparation using oral NaP. The risk of hyperphosphatemia is known to increase with excessive and/or repeated doses, increased intestinal absorption, or impaired renal excretion of phosphate. Hyperphosphatemia may produce acute renal failure, but the mechanism is not yet clear. Some authors suggest that renal injury is caused by intrarenal calcium-phosphate deposition, but others suggest that direct tubular toxicity or a disturbance in renal hemodynamics may induce renal injury. A 74-year-old woman was admitted with generalized weakness after taking NaP for colonoscopy. She had no underlying diseases such as renal disease. She was hypotensive and had carpopedal spasm with hypocalcemia, severe hyperphosphatemia, metabolic acidosis, and non-oliguric acute renal failure. She was treated with aggressive hydration, calcium replacement and aluminum-containing antacid, but hyperphosphatemia was aggravated (35.6 mg/ dL). Hemodialysis was done and phophate concentration was lowered to 5.5 mg/dL. It is suggested that caution should be taken when using phosphate- containing laxatives especially for elderly patients even if they have no underlying diseases.

Espasmofilia familiar. Valoración de algunos aspectos psicológicos / Family spasmophilia. Assessment of some psychologic aspects

Se presenta la valoración realizada en las pesquisas y estudios psicológicos en una familia afectada por esta enfermedad, perteneciente al área de Salud Previsora, en el período del 1 o de enero de 1999 al 1 o de enero del 2001, ambos inclusive. Se precisan los aspectos clínicos y los psicológicos relacionados con esta enfermedad, al mismo tiempo que señalamos las orientaciones realizadas para elevar la calidad de vida de esta familia que, al tener un componente hereditario importante, nos motivó a insistir en el control preconcepcional y manejo integral de los miembros de la familia.

An assessment performed in the injuries and psychological studies in a family affected by this disease, belonging to the health area of Previsora, within the period from january 1 st, 2001 both included, was presented. Clinical and psychologic aspects related with it are determmined, at the same time, we present orientations carried out for increassing life quality in this group which has a hereditary component important and motivated us to emphasize in the preconceptional control and integral management of family members.