RESUMO
We describe an elderly man who presented with hypercalcemia associated with suppressed intact parathyroid hormone (PTH) levels. Despite renal insufficiency the circulating 1,25-dihydroxyvitamin D (1,25(OH)2D) was in the upper part of the normal range. Known causes of hypercalcemia were absent and mild hypercalcemia with suppression of intact PTH persisted until after bilateral hip replacement for severe arthritis (1 year after presentation). After hip replacement the ionized calcium normalized, intact PTH normalized, and 1,25(OH)2D decreased markedly. We believe the abnormalities in mineral homeostasis were related to production of 1,25(OH)2D by inflammatory mononuclear cells associated with arthritis.
Assuntos
Artrite/metabolismo , Di-Hidroxicolecalciferóis/metabolismo , Hipercalcemia/metabolismo , Idoso , Artrite/complicações , Prótese de Quadril , Humanos , Hipercalcemia/complicações , Masculino , Monócitos/metabolismo , Hormônio Paratireóideo/sangueRESUMO
Ten cadaver legs were mounted on a loading frame, and normal values for quadriceps excursion and tibial force were established with a constant quadriceps tension. The mean excursion of the quadriceps was 66.2 +/- 5.51 millimeters from zero to 90 degrees of knee flexion. After examining each 10-degree increment of motion we found that the maximum excursion of the quadriceps (9.49 +/- 1.35 millimeters) occurred between 30 and 40 degrees. The minimum excursion of 5.40 +/- 0.67 millimeters was found between 80 and 90 degrees of knee flexion. Incremental excursion of the quadriceps during 10-degree increments of knee flexion showed a correlation coefficient of 0.94 when compared with mean tibial torque (p less than 0.001). Patellectomy decreased excursion of the quadriceps to 51.3 +/- 1.30 millimeters from zero to 90 degrees of knee flexion. Torque was decreased by roughly 40 per cent of maximum from zero to 40 degrees of knee flexion.
