Przełom hiperkalcemiczny z powodu pierwotnej nadczynności przytarczyc — przegląd piśmiennictwa i opis przypadku

Hypercalcaemic crisis is an uncommon and potentially life-threatening manifestation of primary hyperparathyroidism, and it is associated with rapid deterioration of the central nervous system, and cardiac, gastrointestinal, and renal function. We present the case of a 76 year-old man in a sudden coma due to hypercalcaemic crisis as a first manifestation of primary hyperparathyroidism. At first, the patient was treated conservatively, his mental status gradually improved in the next three days. On the ninth day after the initiation of therapy, a minimally invasive radio-guided parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens, suggesting adenoma. Calcaemia level and PTH were normalised in the immediate postoperative period. A systematic review was performed by consulting PubMed MEDLINE for publications from 1958 to 2011. This review found a total of 499 reported cases of hypercalcaemic crisis due to primary hyperparathyroidism. Manifestations are neurological alterations, and cardiac, renal and gastrointestinal dysfunctions associated with markedly elevated serum calcium and parathyroid hormone levels. The most frequent histology is the parathyroid adenoma. In untreated cases, mortality is 100%. Despite advances in its management, the mortality rate is still 93.5% in patients treated only conservatively. Medical therapy followed by expeditious parathyroidectomy should be considered as the treatment of choice for patients affected by hypercalcaemic crisis due to a primary hyperparathyroidism. (Endokrynol Pol 2012; 63 (6): 494–502)Przełom hiperkalcemiczny jest rzadkim choć potencjalnie zagrażającym życiu objawem pierwotnej nadczynności przytarczyc i jest skojarzony z gwałtownym pogorszeniem funkcji ośrodkowego układu nerwowego, serca, przewodu pokarmowego i funkcji nerek. W pracy zaprezentowano przypadek 76-letniego mężczyzny, u którego pierwszym objawem pierwotnej nadczynności przytarczyc był przełom hiperkalemiczny w postaci nagłej śpiączki. Na początku pacjent był leczony zachowawczo i jego stan psychiczny zaczął ulegać stopniowej poprawie w ciągu pierwszych 3 dni. Dziewiątego dnia terapii wykonano u niego mini inwazyjny zabieg usunięcia przytarczyc pod kontrolą RTG. Histologicznie guz składał się z gęsto ułożonych dużych komórek pozytywnych badaniem imunohistologiczno-chemicznym dla antygenów PTH, sugerując gruczolak. Stężenie wapnia i PTH znormalizowano w bezpośrednim okresie pooperacyjnym. Dokonano systematycznego przeglądu publikacji PubMed MEDLINE w latach 1958–2011. Przegląd zawiera łącznie 499 odnotowanych przypadków przełomu hiperkalcemicznego jako objawu pierwotnej nadczynności przytarczyc. Przejawy to zmiany neurologiczne, dysfunkcja nerek, przewodu pokarmowego i serca związanych ze znacznie podwyższonym stężeniem wapnia i parathormonu w surowicy. W badaniu histologicznym najczęściej diagnozowany jest gruczolak przytarczycowy. W przypadkach nieleczonych odnotowuje się 100-procentową śmiertelność. Mimo postępów w leczeniu, przy terapii tylko zachowawczej, śmiertelność jest nadal wysoka — 93,5%. Leczenie zachowawcze plus szybkie usuniecie przytarczyc powinny być uważane za leczenie z wyboru u pacjentów dotkniętych przełomem hiperkalcemicznym z powodu pierwotnej nadczynności przytarczyc. (Endokrynol Pol 2012; 63 (6): 494–502

Clinical pathophysiology: the essentials

ПОСОБИЯФИЗИОЛОГИЯПАТОЛОГИЯМЕДИЦИНА КЛИНИЧЕСКАЯСЕРДЕЧНО-СОСУДИСТАЯ СИСТЕМА /ПАТОФИЗИОЛОГИЯДЫХАТЕЛЬНАЯ СИСТЕМА /ПАТОФИЗИОЛОГИЯЖЕЛУДОЧНО-КИШЕЧНЫЙ ТРАКТ /ПАТОФИЗИОЛОГИЯПЕЧЕНЬ /ПАТОФИЗИОЛОГИЯПОЧКИ /ПАТОФИЗИОЛОГИЯЭНДОКРИННАЯ СИСТЕМА /ПАТОФИЗИОЛОГИЯНЕРВНАЯ СИСТЕМА /ПАТОФИЗИОЛОГИЯПАТОФИЗИОЛОГИЯИНОСТРАННЫЕ СТУДЕНТЫВ издании рассматриваются вопросы патофизиологии заболеваний основных систем организма, а также обсуждаются патофизиологические основы диагностики, профилактики и лечения заболеваний человека

Understanding Time-Activity Curve and TimeIntegrated Activity Variations in Radiopharmaceutical Therapy:Experience from the TACTIC AAPM Grand Challenge 2023

Aim/Introduction: The process of determining time-activity curves (TACs) for radiopharmaceutical therapy (RPT) relies heavily on user- and site-specifc steps, impacting time-integrated activity (TIA) and, efectively, absorbed dose calculations. Despite TIA’sclinical signifcance, there is no consensus on data processing methods nor an understanding of how user-dependent TAC calculation afects personalized RPT dosimetry. In 2023, the TACTIC AAPM Grand Challenge was created to address these challenges. This work presents results and insights from the challenge. Materials and Methods: Launched in January 2023, the TACTIC challenge consisted of three phases: warm-up (P0), individual patient-based TAC ftting (P1), and population-based TAC ftting (P2). Participants were provided with pre-processed synthetic biokinetic data of [177Lu]Lu-PSMA-617 (kidney, blood, and tumor) and tasked with modeling the TAC and calculating TIA values for each target organ. Additionally, participants submitted information about the TAC type and parameters used for ft optimization. The best-performing team in P1 and P2 was determined by the lowest total root mean squared error (RMSE) error over the organs. Results: A total of 132 individuals from over 30 countries registered for the challenge, representing a diverse mix of highly experienced dosimetry groups, industryprofessionals, and newcomers to RPT dosimetry. Among them, 73 participants requested data, of which 35 (P0), 35 (P1) and 28 (P2) submitted their results. Across the three phases, 13 diferentft functions were utilized, with varying advanced model selection criteria and levels of uncertainty incorporation. Notably, the biexponential function was most prevalent, utilized in 51% (P1) and 32% (P2) of submissions, while the least square objective functionwas the primary choice for 40% of submissions (P1). Despite the challenge’s nature, only a minority of participants—6 in P1 and 8 in P2—incorporated uncertainty budgets into their TIAC calculations. Population-based information was utilized in only 7 submissions during P2. Interestingly, no correlations were found between choice of ft function, objective function, uncertainty i ncorporation, or population information use and participants’ performance. Winners in each phase employed diverse models and objective functions. However, the top-performing participants consistently integrated uncertainty information when selectingthe most suitable TAC model. A decrease in some participants’ performance from P1 to P2 when including uncertainty or population-based information suggests that more guidance and training is needed to use them efectively. Conclusion: The TACTIC challenge results ofer insights into global TAC modeling practices, revealing signifcant variations in result quality. This underscores the importance of education in TAC ftting methodologies

Pathological Anatomy. Lecture course

УЧЕБНО-МЕТОДИЧЕСКИЕ ПОСОБИЯАНАТОМИЯПАТОЛОГИЧЕСКАЯ АНАТОМИЯPATHOLOGICAL ANATOMYLECTURE COURSEЧАСТНАЯ ПАТОЛОГИЯПАТОЛОГИЯВ пособии представлены наиболее важные темы, охватывающие полный курс патологической анатомии

Lectures on internal medicine propaedeutics

Курс лекцій для студентів третіх курсів медичних факультетів з пропедевтики внутрішньої медицини за англійською формою навчання на англійській мові. Розглядаються підхід, методи обстеження та основні клінічні синдроми пацієнтів з захворюваннями дихальної, серцево-судинної, травної, видільної, кістково-м’язової, сполучної, кров’яної та ендокринної систем.Lecture 1 Propaedeutics as an introduction to the clinic of internal medicine Lecture 2 Approach to the patient Lecture 3 Approach to the patient with disease of the respiratory system Lecture 4 Approach to the patient with disease of the cardiovascular system Lecture 5 Approach to the patient with gastrointestinal tract diseases Lecture 6 Approach to the Patient with diseases of the hepatobiliary tract and pancreas Lecture 7 Approach to the patient with affection and disease of the kidneys Lecture 8 Approach to the patient with affection and disease of the musculoskeletal system and connective tissue Lecture 9 Approach to the patient with affection and disease of the blood Lecture 10 Approach to the patient with affection and disease of the endocrine system Lecture 11 Syndromes of respiratory system diseases Lecture 12 Syndromes of cardiovascular system diseases Lecture 13 Syndromes of gastrointestinal tract diseases Lecture 14 Syndromes of hepatobiliary tract and exocrine pancreas diseases Lecture 15 Syndromes of kidneys diseases Lecture 16 Syndromes of the musculoskeletal system and connective tissue diseases Lecture 17 Syndromes of the blood system diseases Lecture 18 Syndromes of the endocrine system disease

Benign Parathyroid Adenoma Presenting with Unusual Parathyroid Crisis, Anemia and Myelofibrosis

Although the clinical symptoms of patients with benign parathyroid adenoma are usually nonspecific and benign, a malignant presentation of the benign disease may sometimes occur. Here, we report a case of a 58-year-old woman who presented with aggravated sacrum pain, general malaise, and polydipsia. Initial laboratory findings revealed hypercalcemia, normocytic anemia, and impaired renal function. Acute hyper-calcemic crisis manifested and primary hyperparathyroidism was diagnosed together with myelofibrosis on account of the result of bone marrow biopsy. Excision of a parathyroid adenoma was performed, and the anemia and bone marker regressed later. These findings suggested that benign parathyroid adenoma may mimic the clinical presentation of parathyroid carcinoma, releasing excess parathyroid hormone and resulting in hyperparathyroid crisis. In addition, primary hyperparathyroidism can be associated with anemia and myelofibrosis. [J Formos Med Assoc 2007;106(2 Suppl):S13-S16

Benign Parathyroid Adenoma Presenting with Unusual Parathyroid Crisis, Anemia and Myelofibrosis

Although the clinical symptoms of patients with benign parathyroid adenoma are usually nonspecific and benign, a malignant presentation of the benign disease may sometimes occur. Here, we report a case of a 58- year-old woman who presented with aggravated sacrum pain, general malaise, and polyclipsia. Initial laboratory findings revealed hypercalcemia, normocytic anemia, and impaired renal function. Acute hypercalcemic crisis manifested and primary hyperparathyroidism was diagnosed together with myelofibrosis on account of the result of bone marrow biopsy . Excision of a parathyroid adenoma was performed, and the anemia and bone marker regressed later. These findings suggested that benign parathyroid adenoma may mimic the clinical presentation of parathyroid carcinoma, releasing excess parathyroid hormone and resulting in hyperparathyroid crisis. In addition, primary hyperparathyroidism can be associated with anemia and myelofibrosis