RESUMO
We ascertained the incidence of hypercalcemia in 79 consecutive patients with active pulmonary tuberculosis and a control group of 79 patients with chronic obstructive pulmonary disease. Twenty-two patients developed hypercalcemia (serum calcium greater than 10.5 mg/dl) within 4 to 16 weeks after initiation of chemotherapy for tuberculosis. The duration of hypercalcemia ranged from 1 to 7 months, and remission occurred spontaneously in all patients. The mean daily vitamin D supplement was greater in hypercalcemic patients than in the normocalcemic group. There was a positive correlation between daily vitamin D supplement and degree and duration of hypercalcemia. Mean serum calcium in patients with tuberculosis was higher than in patients with chronic obstructive pulmonary disease supplemented with the same dose of vitamin D. Hypercalcemia appears to be related to the activity of pulmonary tuberculosis and the intake of vitamin D; the exact mechanism, however, remains unknown.
Assuntos
Hipercalcemia/etiologia , Tuberculose Pulmonar/complicações , Adulto , Idoso , Doenças Ósseas/etiologia , Cálcio/sangue , Humanos , Pessoa de Meia-Idade , Prostaglandinas E/metabolismo , Vitamina D/administração & dosagem , Vitamina D/uso terapêuticoRESUMO
A patient with advanced breast cancer who had undergone a total bilateral adrenalectomy in the past refused adrenal steroid replacement therapy with the idea that this would be the easiest and quickest way to end her life. However, she continued to live for more than eight days. Survival under these circumstances is unusual, and the terminal course of her illness is described.
Assuntos
Corticosteroides/fisiologia , Adrenalectomia , Neoplasias da Mama/terapia , Cortisona , Atitude Frente a Morte , Atitude Frente a Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Fatores de TempoRESUMO
Four months after a cadaver kidney transplant, kidney stones were found in the renal allograft. Three major predisposing causes of nephrolithiasis were found in the patient, including hyperparathyroidism, renal tubular acidosis, and urinary tract infection. Hypercalcemia was corrected by parathyroidectomy. During the subsequent three years there was no enlargement of the renal stones and adequate kidney function was maintained. Renal tubular acidosis was not severe and seemed to be related to chronic rejection. Urinary tract infection was readily corrected with antibiotics and did not recur after the immediate post-transplant period. Surgical therapy for nephrolithiasis involving a kidney allograft was defferred since urinary flow was not obstructed. This course of management is recommended for use in patients with calculi complicating renal transplantation.
