ABSTRACT
OBJECTIVE: To describe a case of adult-onset hypophosphatemic osteomalacia treated with orally administered phosphate and complicated by tertiary hyperparathyroidism. METHODS: We present pertinent clinical, radiologic, and laboratory details of the study patient for a period of more than 20 years and discuss the few reported cases of tertiary hyperparathyroidism attributable to prolonged phosphate therapy. RESULTS: A 49-year-old Jordanian man, who had been diagnosed at age 26 years as having sporadic adult-onset hypophosphatemic vitamin D-resistant osteomalacia, presented with severe right hip pain, severe osteopenia with lytic bone lesions, and hypercalcemia after prolonged oral treatment with phosphate and vitamin D. These clinical, radiologic, and biochemical findings, in conjunction with a very high serum parathyroid hormone level, indicated the diagnosis of tertiary hyperparathyroidism, which was substantiated histopathologically. CONCLUSION: Physicians should be aware of the potential for development of tertiary hyperparathyroidism in patients receiving prolonged oral phosphate therapy.
Subject(s)
Hyperparathyroidism/etiology , Hypophosphatemia/drug therapy , Osteomalacia/drug therapy , Phosphates/adverse effects , Alkaline Phosphatase/blood , Biopsy , Bone and Bones/diagnostic imaging , Bone and Bones/pathology , Bone and Bones/physiopathology , Calcifediol/blood , Humans , Hypercalcemia/etiology , Hyperparathyroidism/diagnosis , Hyperparathyroidism/surgery , Hypophosphatemia/complications , Jordan , Magnetic Resonance Imaging , Male , Metabolic Clearance Rate , Middle Aged , Muscle Weakness , Osteomalacia/etiology , Osteomalacia/pathology , Osteomalacia/physiopathology , Pain , Parathyroidectomy , Phosphates/administration & dosage , Phosphates/pharmacokinetics , Phosphorus/blood , Radiography , Vitamin D/administration & dosage , Vitamin D/therapeutic useABSTRACT
This report discusses 27 patients with sigmoid volvulus treated at Jordan University Hospital (JUH) during a 15-year period. These patients represented 4.7 percent of adult patients treated for intestinal obstruction in the same period. The average age was 54.5 years, and none of the patients was institutionalized. Twenty-five patients presented with acute symptoms, and two had chronic symptoms. Sigmoidoscopic detorsion was achieved in 15 patients. Emergency resection was required in two of these patients: for the development of gangrene a few hours after detorsion in one patient and for recurrence within 24 hours in the other despite the presence of a rectal tube. Early recurrence occurred in two other patients and was managed endoscopically. Emergency surgery was performed in 10 other patients: for a failed endoscopic detorsion in three patients, for ulcerated and bleeding mucosa forecasting gangrene in another, and as a primary treatment in six patients who were either misdiagnosed or suspected to have gangrenous bowel. Elective resection was performed in 13 patients. The mortality rate was 15 percent (4/27) for the whole series and 33.3 percent (1/3) for those with gangrenous bowel.
Subject(s)
Intestinal Obstruction , Sigmoid Diseases , Adult , Aged , Aged, 80 and over , Colectomy , Colon, Sigmoid/pathology , Female , Gangrene , Humans , Intestinal Obstruction/complications , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/pathology , Intestinal Obstruction/therapy , Male , Middle Aged , Radiography , Recurrence , Sigmoid Diseases/complications , Sigmoid Diseases/diagnostic imaging , Sigmoid Diseases/pathology , Sigmoid Diseases/therapy , SigmoidoscopyABSTRACT
We present 7 patients (5 adult females and 2 neonate males) with adrenal cysts. The cysts included 1 hydatid, 1 lymphatic and 5 pseudocysts. Three cysts were diagnosed preoperatively and all were resected surgically. The existence of true epithelial cysts of the adrenal gland is doubted by many authors; the present series includes most types of adrenal cyst.
Subject(s)
Adrenal Gland Diseases/diagnosis , Cysts/diagnosis , Adrenal Gland Diseases/surgery , Adrenalectomy , Adult , Aged , Cysts/surgery , Female , Humans , Infant, Newborn , Male , Middle AgedABSTRACT
Pilonidal sinus of the umbilicus is rarely reported, and there are only 17 reported cases. On reviewing the records from Jordan University Hospital, 24 patients who were treated surgically for a discharging umbilical sinus were found. Three patients had known causes for their umbilical sepsis, namely stitch sinus, urachal remnant and an umbilical polyp. Of the remaining 21 patients, seven had clinical and pathological evidence of hair in their umbilicus. Most of our patients were young men who presented with discharge, soreness or pain, swelling, and cellulitis. Treatment by umbilical excision, leaving the skin defect to heal by secondary intention, proved satisfactory. The resultant scar resembles a normal umbilicus.
Subject(s)
Pilonidal Sinus/surgery , Umbilicus/surgery , Adolescent , Adult , Female , Humans , Male , Methods , Pilonidal Sinus/etiologyABSTRACT
A 55-year-old male patient who had melena and intussusception that proved to be due to malignant melanoma of the small intestine is described. History and close examination failed to show any evidence of a primary lesion. The diagnosis was made after a biopsy was performed on two lesions in the neck. This was followed by a palliative and incomplete resection of an involved ileal segment. The patient did not receive chemotherapy, radiotherapy, or immunotherapy. He is now alive 8 years after diagnosis without evidence of malignancy. This case represents spontaneous regression of malignant melanoma of the small intestine that is considered either a primary intestinal tumor or a metastatic tumor from an occult regressed primary. The latter assumption makes this case unique in that spontaneous regression occurred twice, once in the occult primary lesion and once in the intestinal metastases.