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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Repeated efforts to induce beriberi heart disease by experimental thiamine deficiency (B1d) have failed in many species. To test the hypothesis that magnesium deficiency (Mgd) might be the cofactor necessary for heart failure, 10-week-old Syrian golden hamsters were divided into four groups-control (C), B1d, Mgd, and combined MgB1d-and were fed the diets ad libitum for 3 weeks. On day 21, animals were studied under intraperitoneal pentobarbital anesthesia (50 mg/kg). Electrocardiograms were taken and right and left ventricular pressures were measured by transthoracic needle puncture. Cardiac output was measured by the direct Fick method. The complete study was performed in 9 C, 13 B1d, 9 Mgd, and 14 MgB1d animals. B1d was proven by low red blood cell transketolate high B1 pyrophosphate effect, and was accompanied by tachycardia and hypercalcemia. B1 did not differ from C in any other parameter. Mgd was characterized by hypomagnesemia, hypercalcemia, prolongation of the PR interval, widening of the QRS interval, low O2 consumption, low cardiac output, and increased heart weight to body weight ratio (HW/BW) as compared to control. No differences were observed in right and left ventricular pressures or peak /dt. MgB1d was characterized by hypomagnesium, hypercalcemia, low red blood cell transkeotlase, and high B1 pyrophosphate effect. MgB1d minimized the deleterious effects of Mgd: animals were more active and the mortality was low, the PR interval remained normal, the QRS interval widened significantly less, cardiac output remained normal, and HW/BW increased significantly less. Although, once again, beriberi heart disease was not produced, B1d appeared to exert a protective effect upon the Mg-deficient myocardium.
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PMID:Protective effect of coexistent thiamine deficiency upon the experimental cardiomyopathy associated with acute magnesium deficiency in the Syrian golden hamster. 120 11

A 41-year-old male quadriplegic patient with bilateral TMJ ankylosis was admitted for surgery under general anesthesia. Preoperative tests showed abnormal lung function and a low total serum calcium level. Premedication consisted of diazepam 10 mg orally and glycopyrrolate 0.2 mg intramuscularly 90 minutes before the start of the operation. Because of an inability to open the mouth more than 0.5 cm, a nasal fiberoptic endoscopic intubation was done under sedation and local anesthesia. For maintenance of anesthesia the patient received nitrous oxide 50% in oxygen, halothane, and alfentanil. No muscle relaxant was administered. The 2-hour operation was completed uneventfully and the patient needed no ventilatory support afterward. Major anesthetic problems of spinal injury patients can be compared to those with cervical cord transection. The stage that the condition has reached determines the dominant anesthetic problems. The chronic stage (greater than 3 months postinjury, as in this patient) is usually characterized by sympathetic overactivity. Anesthetic problems during this stage may include risk of hyperkalemia from succinylcholine, cardiovascular instability and autonomic hyperreflexia, impaired thermoregulation, anemia, chronic infections, risk of hypercalcemia, and alveolar hypoventilation. None of these problems was encountered in this patient. A surprising finding was that the low serum calcium concentration did not influence the anesthetic outcome.
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PMID:Anesthesia for temporomandibular arthroplasty in a quadriplegic patient: a case report. 142 89

During recent years the total number of patients undergoing surgery for hyperparathyroidism has markedly increased, but the annual number of cases with substantial hypercalcemia has remained unchanged. Parathyroid carcinoma and water clear cell hyperplasia cause more severe hypercalcemia than other kinds of hyperparathyroidism. Grave hypercalcemia due to hyperparathyroidism is more common among the elderly, but can occur during pregnancy and also among children. Occasionally, a patient with hyperparathyroidism can also have another cause of the hypercalcemia and does not become normocalcemic until adequately treated for both. The suspicion of grave hypercalcemia should arise due to its clinical features. Determination of serum calcium and intact parathyroid hormone concentrations establishes the diagnosis. The basic treatment of grave hypercalcemia is to rehydrate the patient and to restore the sodium losses. To further lower the serum calcium value we have found bisphosphonates to be very effective. The definitive treatment of grave hypercalcemia due to hyperparathyroidism is surgery. As a last resort, frail patients with grave hyperparathyroidism can undergo surgery under local anesthesia. Repeat operations can improve the prognosis of patients with metastatic parathyroid carcinoma. Selective venous catheterization with blood sampling for determination of intact parathyroid hormone can be helpful in localizing recurrent disease.
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PMID:Management of hyperparathyroid patients with grave hypercalcemia. 176 39

A personal series of 256 cases of acromegaly/gigantism seen over a 20-year period from 1963 is described. The insidious nature of the condition resulted in delay in diagnosis which was often made by a doctor when seeing the patient for an unrelated problem. Other features which commonly led to the diagnosis being made were headache, change in appearance, carpal tunnel syndrome, amenorrhoea and diabetes. The Hardy system for grading the radiological appearance of the pituitary tumour was used. Widely invasive tumours were not common but tended to occur in patients with younger age of onset and high GH levels. The occurrence of various symptoms and clinical features was noted and the changes resulting from reducing the GH level to normal. The incidence of hypertension, but not of coronary artery disease, is increased and the blood pressure may be reduced following successful treatment. The effects on the upper and lower respiratory tract are reported as well as sleep apnoea and problems associated with anaesthesia. Skin manifestations included sweating, pigmented skin tags, acanthosis nigricans and cutis verticis gyrata. In the skeletal system the incidence of kyphoscoliosis and osteoarthritis especially of the hip is reported: the question of hip replacement is discussed. Diabetes mellitus disappeared in most cases if the acromegaly was cured. In men but not in women the incidence of colloid nodular goitre was increased as was hyperthyroidism in middle-aged women. In two patients a parathyroid adenoma was present: hypercalcaemia was present in five additional patients, but the cause was not determined. The common occurrence of amenorrhoea in the younger women was noted, it was not always associated with hyperprolactinaemia, and often responded to successful treatment of the acromegaly. The association of acromegaly with hirsutism and galactorrhoea is confirmed. The incidence of impotence and loss of libid in the men is discussed: in a proportion of those in whom the acromegaly was cured, potency returned, but in a number depression occurred and what was believed to be psychogenic impotence persisted. Hyperprolactinaemia was found in 49 out of 151 patients with active acromegaly in whom the prolactin level was measured. Previous reports have indicated a doubling of death rates in acromegalics. In this series there were 47 deaths observed compared to 37.2 expected. The increased death rate was in women of all ages and in men under the age of 55, The increased deaths in the women were from cardiovascular and cerebrovascular causes and from breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acromegaly. 330 90

Four cases of secondary hyperparathyroidism were treated by total parathyroidectomy with autotransplantation into the sternocleidomastoid muscle. These total parathyroidectomy patients are presented to demonstrate the reliability of parathyroid autotransplantation into the sternocleidomastoid muscle. Our technique is described in detail, and all procedures were successful. In one case, the patient was found, in retrospect, to have an adenoma in the transplanted parathyroid tissue. When the patient developed graft-dependent hypercalcemia, a portion of the graft was easily excised under local anesthesia and the patient became normocalcemic. Parathyroid tissue should be transplanted into the sternocleidomastoid muscle rather than other sites because of easy accessibility, one operative site, less graft ischemia, a low incidence of infection, and a high success rate due to excellent blood supply.
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PMID:Autotransplantation of parathyroid tissue into sternocleidomastoid muscle. 335 95

Alterations in the calcium metabolism are a characteristic paraclinical finding in patients with oliguric acute renal failure associated with rhabdomyolysis. A 20-year-old male operated on under general anesthesia developed non-oliguric acute renal failure due to malignant hyperthermia with rhabdomyolysis (urine myoglobin greater than 20,000 nmol/l; reference range less than 0.85 nmol/l). On the 20th postoperative day hypercalcemia was found, reaching a maximum serum level of 3.74 mmol/l (reference range 2.18-2.65 mmol/l) on the 27th postoperative day. Delayed hypercalcemia in non-oliguric acute renal failure associated with rhabdomyolysis has not been reported previously. This case suggests that prolonged control of the serum calcium level should be performed in patients with rhabdomyolysis, even in the absence of oliguria.
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PMID:Delayed hypercalcemia after non-oliguric acute renal failure associated with rhabdomyolysis. 341 9

From October 1981 to the end of 1984, 13 patients with primary hyperparathyroidism (PHPT) and 17 with secondary hyperparathyroidism (SHPT) received fresh autografts of diseased parathyroid tissue into their subcutaneous abdominal adipose tissue. Because of previous surgery to treat hyperparathyroidism (HPT) (23%), concomitant thyroid surgery (26%), and a high proportion of multiglandular disease (73%), the patients were at high risk for HPT. During the follow-up period, hypercalcemia was diagnosed in five patients and successfully treated in four: by graft excision in two patients, by excision of a fourth gland from the neck in one patient, and with prednisolone in a patient with sarcoidosis. At follow-up (an average of 30 months after grafting), one patient had HPT and 29 others were euparathyroid. Parathyroid tissue can survive and function in adipose tissue, as was demonstrated by normocalcemia in 14 patients (whose only probable remaining parathyroid tissue had been transplanted into fat), by the demonstration that graft-dependent hypercalcemia could be eliminated by excision of the transplant, and by the demonstration of viable parathyroid tissue by microscopic examination of excised grafts. Autotransplantation of diseased parathyroid tissue into fat is simple and reliable. In cases of recurrent HPT, all or a portion of the graft can be removed while the patient is under local anaesthesia. If infiltrating growth occurs, broad excisions can be performed without sacrificing vital structures.
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PMID:Autotransplantation of diseased parathyroid glands into subcutaneous abdominal adipose tissue. 357 47

It is very rare for a patient to have to be submitted for surgery and anaesthesia with severe hypercalcaemia unresponsive to medical treatment. Problems which may be anticipated are hypertension, hypotension, cardiac dysrhythmias and renal failure. Anaesthesia for liver transplantation also requires a full appreciation of the biochemical, haematological and haemodynamic problems involved. In the present report a patient scheduled for hepatic transplantation had a consistently raised serum calcium level (4 mmol/litre) due to the secretion of a parathyroid-type hormone by hepatic tumour cells. The pre-operative management of hypercalcaemia and intra- and postoperative management of liver transplantation in this patient are presented and discussed.
Anaesthesia 1985 Feb
PMID:Severe hypercalcaemia due to a parathyroid-type hormone-secreting tumour of the liver treated by hepatic transplantation. A rare combination of biochemical problems and discussion of their management. 388 41

Ultrasonography (US) has become the gold standard of the preoperative detection of parathyroid masses. Provided that it is performed by sonographists aware of the normal and pathological anatomy of the neck, US can detect more than 80 per cent of the parathyroid masses. Ectopic masses, especially when they are intramediastinal, are rare but their diagnoses rely on more sophisticated procedures such as TI-Tc scintigraphy, CT, arteriography, MR, superselective venoius sampling. The specialized surgeons emphasize the lack of reliability of parathyroid US because of its operator-dependance. However, the accuracy of the technique enables some new treatments, percutaneous alcoolization and focal surgery under local anesthesia. One can regret that US is too often used as a diagnostic criterion of hyperparathyroidism, but this trend is explainable because of the difficulty to interpret monosymptomatic hypercalcaemia, especially in the elderly. The contribution of diagnostic imaging is undoubtfully worthwhile in persisting or recurrent hyperparathyroidisms, which are more often related with intracervical masses than with intramediastinal ones.
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PMID:[Imaging of parathyroid glands]. 785 80

This study evaluated the potency and time course of action of vecuronium in patients with primary hyperparathyroidism (HPT) and marked hypercalcaemia during nitrous oxide-opioid anaesthesia. Twenty ASA physical status I and II patients were studied by measuring the force of contraction of the adductor pollicis in response to stimulation of the ulnar nerve: ten control patients and ten patients with HPT and ionized calcium concentration over 2.80 mEq.L-1. After induction of anaesthesia with thiopentone and maintenance with N2O/O2 and fentanyl, vecuronium was administered to determine cumulative dose-response curves. When maximum block had been obtained, twitch height was maintained at 10% of baseline value over 20 min by adjusting the infusion rate of a syringe-pump containing vecuronium and vecuronium plasma concentration (EC90ss) was determined. During spontaneous recovery, after termination of infusion, the recovery index, the time from 25 to 75% recovery, was measured. The dose to produce 90% block was greater in the HPT than in control group: 69 (24) vs 54 (18) micrograms.kg-1 (P < 0.02). The calculated ED50 was also greater in HPT: 42 (4) vs 31 (5) micrograms.kg-1 in controls (P < 0.001). (Values are given as mean and coefficient of variation). The slope of the dose-response curve, the dose necessary to maintain 90% block, and the EC90ss did not differ. The RI25-75 was slower in the HPT group although the difference did not reach statistical significance. It is concluded that hyperparathyroidism with hypercalcaemia increases vecuronium requirement; only during the onset of neuromuscular blockade.
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PMID:Pharmacodynamic behaviour of vecuronium in primary hyperparathyroidism. 792 17


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