Cases reported "Metabolic Diseases"

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1/6. growth and metabolic disturbances in a patient with total parenteral nutrition: a case of hypercalciuric hypercalcemia.

    hypercalciuria is a common side effect during total parenteral nutrition (TPN). We report a patient with long-term TPN, who demonstrated hypercalciuria, hypercalcemia and growth retardation. The patient is a six-year-old Japanese girl with hirschsprung disease (jejunal agangliosis). jejunostomy was performed at one-month old and since then her nutrition has depended mostly on TPN. When she was 3 years old, continuous TPN was switched to cyclic TPN (on TPN for 11 hrs and off TPN for 13 hrs). The urinary calcium level has been elevated (Ca/Cre ratio, 1.0) since 3 months of age, whereas serum calcium levels stayed within normal range for a while. The serum calcium levels started to elevate to 12 to approximately 13 mg/dl when she was 3 years and 8 months old. She showed growth retardation (height SD score was -4.2SD when she was 5 years and 8 months old) and deteriorated renal tubular function with renal glycosuria, elevated beta 2-microglobulin (beta2-MG) and N-acetyl-beta-D-glucosaminidase. She was referred to our division for the investigation and treatment of growth disturbance and Ca metabolism. Her bone age was delayed (BA/CA 0.62) and serum IGF-I level was decreased but her GH response to provocation test was normal. Bilateral nephrocalcinosis was revealed by renal echogram and CT scan. By reducing calcium content in TPN solution, the serum and urinary calcium levels could be maintained within normal range and her renal function and growth velocity was improved.
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keywords = bone
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2/6. calcium pyrophosphate dihydrate deposition disease without chondrocalcinosis.

    The pseudogout syndrome is usually associated with radiographic evidence of articular cartilage calcification. Eight patients who had joints containing calcium pyrophosphate dihydrate crystals were studied. Extensive radiographic evaluation was obtained in seven patients and a limited evaluation in the other. None had evidence of chondrocalcinosis. Six had distinctive radiographic abnormalities of the wrists consisting of radiocarpal joint space narrowing and sclerosis, and subchondral cystic degeneration of the carpal bones. We conclude that calcium pyrophosphate dihydrate deposition disease and pseudogout can occur without radiographic evidence of chondrocalcinosis and that the diagnosis can be suggested by characteristic radiographic abnormalities of the wrists.
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keywords = bone
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3/6. hyponatremia, hypophosphatemia, and hypouricemia in a girl with macrophage activation syndrome.

    macrophage activation syndrome, a life-threatening complication of rheumatic disorders, is accompanied by the overproduction of cytokines. We describe a girl with macrophage activation syndrome complicating systemic-onset juvenile arthritis who developed hyponatremia, hypophosphatemia, and hypouricemia associated with a high level of serum tumor necrosis factor alpha. Renal proximal tubule dysfunction was considered to be the cause, which may be attributable to tumor necrosis factor alpha.
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ranking = 511.77226966276
keywords = macrophage
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4/6. Infantile sialic acid storage disease associated with renal disease.

    A child with infantile sialic acid storage disease is reported. ultrasonography demonstrated fetal ascites. At birth, the infant appeared hydropic and presented with numerous dysmorphic features, including sparse white hair, coarse facies, hypertelorism, epicanthal folds, anteverted nostrils, and a long philtrum. In addition, he had visceromegaly, bilateral inguinal hernias, and a slight gibbus deformity. lymphocytes were vacuolated and bone marrow contained large numbers of foam cells. There were generalized vacuolations of both reticuloendothelial and parenchymal cells in the examined tissues. Neuropathologic studies revealed wide-spread neuronal storage, myelin loss, axonal spheroids, and gliosis. neurons, endothelial cells, and kupffer cells stained with wheat germ agglutinin indicated an accumulation of sialic acid. Free sialic acid was significantly increased in urine and serum, as well as in liver, heart, and brain tissues. The alpha-neuraminidase activity was normal. It is assumed that the basic defect of infantile sialic acid storage disease lies in impaired transport of sialic acid across the lysosomal membrane.
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5/6. Hermansky-pudlak syndrome and interstitial lung disease: report of a case with lavage findings.

    Clinical and pathologic evidence for interstitial pulmonary fibrosis occurring in some patients with the Hermansky-Pudlak syndrome is well described in the literature, but data on immunologic mechanisms operating in this form of lung disease have not been published. In this case report, we describe bronchoalveolar lavage (BAL) findings in a patient with this syndrome. Recovered alveolar macrophages (AM) contained the characteristic ceroidlike material previously described in interstitial macrophages in pathologic specimens. The BAL analysis was similar to that seen in idiopathic pulmonary fibrosis, with increased levels of immunoglobulins and numbers of IgG and IgA secreting cells, and normal percentages of putative helper and suppressor T-cell subsets. In addition, superoxide production by stimulated AM was increased, possibly secondary to phagocytosis of the ceroidlike material. The lavage in this patient was compatible with a mild inflammatory process that was consistent with gallium scan results and the patient's clinical course.
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ranking = 204.70890786511
keywords = macrophage
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6/6. Myelodysplasia and deficiency of uridine diphosphate-galactose 4-epimerase.

    A 4-year-old girl known to have peripheral uridine diphosphate-galactose 4-epimerase deficiency was examined for bruising and thrombocytopenia. She had dysplastic peripheral blood and bone marrow changes, with a global platelet function defect. uridine diphosphate-galactose-4-epimerase participates in a metabolic pathway that provides substrates for posttranslational glycosylation of secreted and membrane glycoproteins, including hematopoietic growth factors and their receptors; there may be a causal relationship between the two disorders.
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