Adult Asian osteomalacia

Twenty-four patients from the Indian sub-continent with osteomalacia were treated with calciferol 1·25 mg daily for periods of up to 8 years. Despite the large dose of calciferol, no vitamin D toxicity (hypercalcaemia) occurred.     

骨软化性氟骨症动物模型的研究

给大白鼠以玉米为主的偏食饲料,同时经饮水投予氟化钠200ppm,为期两个月,造成典型的骨软化性氟骨症模型。饲料中补充适量钙盐(1000ppm碳酸钙)可消除偏食本身的影响。这种氟骨症模型复制方法简便,实验周期短,形态指标明确,有利于筛选有效防治药物及对氟骨症发生机理与影响因素的研究。     

经电子支气管镜放置支架治疗肿瘤所致气道狭窄31例分析

目的 观察电子支气管镜直视下置入镍钛记忆合金支架对气管、支气管狭窄等的治疗效果.方法 武汉市中心医院呼吸内科近7年来31例肿瘤所致气道狭窄患者,在电子支气管镜直视下进行气管(或支气管)支架置入,其中被膜支架34个,裸体支架7个.观察支架置入前后患者症状、血气分析变化及相关并发症.结果 所有患者术后喘息等不适症状明显缓解,动脉血氧分压提高;食管-气管瘘患者呛咳减轻,可以进食;未出现严重并发症.结论 电子支气管镜下气道支架置入治疗肿瘤所致气道狭窄,可以明显改善症状,提高患者生活质量.     

Oncogenic osteomalacia: strange tumours in strange places

Two patients presented with hypophosphataemic osteomalacia and were subsequently found to have small tumours unusual histopathology and location causing the osteomalacia. Each tumour was found after an intensive search for occult masses. Studies of vitamin D metabolism and renal tubular function before and after surgery yielded further insight into the pathophysiology of oncogenic osteomalacia. These cases demonstrate that microscopic quantities of tumour are capable of causing the syndrome and further illustrate the high index of suspicion often necessary to locate causative tumours in patients with hypophosphataemic osteomalacia.     

Safety of treatment for subclinical osteomalacia in the elderly

Forty one elderly patients admitted to hospital for acute illnesses were also found to have subclinical osteomalacia. Immediately before discharge, therefore, all were randomised to receive either vitamin D2 25 micrograms daily, alfacalcidol 0.5 micrograms daily, or placebo. Treatment was given for at least three months, those allocated to placebo then being switched to an active drug. Within the first three months of treatment with either of the active drugs most patients had exhibited a fall to normal in osteoid values. In only four treatment periods was there a mild increase in serum calcium concentration, and in no patient was this accompanied by deterioration in renal function. Any increase in serum creatinine concentration was invariably attributable to the underlying disease for which the patient had been admitted in the first place. Subclinical osteomalacia in the elderly may be corrected by relatively low doses of alfacalcidol (0.5 micrograms daily) or vitamin D2 (25 micrograms daily) given for three months. Such treatment is safe and not accompanied by a serious risk of hypercalcaemia or renal impairment.     

Clinical features and detection of osteomalacia in the elderly

Fifteen elderly patients with osteomalacia were investigated in 2½ years in a geriatric unit. Although they all had bone pain the diagnosis in some cases was overshadowed by other common diseases with which they were referred to hospital, such as impaired balance or mental confusion. The bone pain had been present for weeks or months and was often attributed to arthritis. Biochemical investigations showed a low serum calcium and low or low-normal serum phosphate levels and a moderate to large increase in alkaline phosphatase above 15 KA units/100 ml. Only six patients had radiological signs of osteomalacia but all had histological evidence on bone biopsy.     

肿瘤性骨软化症患者的骨显像特征分析

目的 研究肿瘤性骨软化症(TIO)患者的^99mTc标记的亚甲基二膦盐(^99mTc-MDP)全身骨显像特征,探讨全身骨显像在TIO的诊断和鉴别诊断中的应用价值。方法 回顾性分析3例经病理证实的TIO患者的全身骨显像特征,所有患者确诊前均在核医学科行全身骨扫描,其中2例实施了⁶⁸Ga标记的1,4,7,10-四氮杂环十二烷-1,4,7,10-四乙酸-D-苯丙氨酸1-酪氨酸3-苏氨酸8-奥曲肽(⁶⁸Ga-DOTATATE)正电子发射断层成像术(PET)/CT扫描。结果 3例患者骨显像示脊柱放射性摄取增高,肋骨多发局灶性点状放射性浓聚灶(类似“串珠样”改变),承重骨关节处可见线、片状放射性浓聚影,类似骺板的假性再激活;其中2例患者的原发灶在骨显像上均呈阳性表现。结论 全身骨显像对TIO的筛查、诊断和疗效评价都有重要价值。     

磷酸盐尿性间叶瘤继发低磷骨软化症1例

This case report concerns a 34-year-old woman who had been diagnosed with ankylosing spondylitis (AS), fibromyalgia syndrome (FMS), osteoarthritis (OA), lumbar disc herniation and the like in different hospitals during the past 18 months. She had progressive osteoarthrosis, significant muscle weakness, gait abnormalities in weight-bearing areas, however without typical inflammatory low back pain, while the treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was invalid, with normal inflammation index, negative results for rheumatic factor (RF) and human leukocyte antigen (HLA)-B27, and normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). She had hyphosphatemia, normal serum calcium, 1, 25-(OH)2-D3 reduction, elevated alkaline phosphatase (ALP) and normal parathyroid hormone (PTH), however with elevated urinary phosphorus. Finally, the medial thigh nodule was found in the subcutaneous of her inner leg by careful examination and imaging scans including B-ultrasound and PET/CT. The final pathology confirmed that the nodule was phosphate urinary mesenchymal tumors. After the tumor was removed, the patient was treated with anti-osteoporosis and phosphorus supplementation. The symptoms of bone pain and muscle weakness were alleviated, and hypophosphatemia was corrected. It was confirmed that the patient had low-phosphorus osteomalacia due to tumor. Tumor-induced hypophosphatemia osteomalacia (TIO) was a rare paraneoplastic syndrome which was caused by excessive phosphorus excretion induced by the tumor, and was thus categorized as an acquired hypophosphatemic osteomalacia. TIO had an occult onset and was associated with a high rate of misdiagnosis, although TIO has some typical clinical features. Early diagnosis, correctly positioning of the tumor, and surgical resection can achieve good outcomes.     

误诊为脊柱关节病的成人散发性低磷性骨软化症1例报告

脊柱关节病(spondyloarthropathy)即血清类风湿因子阴性脊柱关节病,是一组相互关联的多系统的炎性关节疾病[1],包括强直性脊柱炎、反应性关节炎、银屑病关节炎、炎性肠病性关节炎及未定型脊柱关节病等.慢性炎性腰背痛是脊柱关节病的主要临床特点.低磷性骨软化症是一种由于低磷血症造成的骨基质不能以正常方式进行矿化的代谢性骨病[2],该病临床少见,疾病初期易因腰背痛、非甾类抗炎药治疗有效等类似炎性腰背痛的临床表现而误诊为脊柱关节病.本文总结1例曾误诊为脊柱关节病的成人低磷性骨软化症患者的临床资料,并结合文献复习低磷性骨软化症与脊柱关节病的诊断及鉴别诊断方法,旨在提高临床的诊断水平.     

Purpura associated with hypergammaglobulinemia, renal tubular acidosis and osteomalacia.

Two patients with hyperglobulinemia associated with purpura were studied. One had features of Sjögren's syndrome, while the other appeared to have a primary condition -- "chronic benign purpura". Both patients also had renal tubular acidosis, osteomalacia and renal calculi, with disturbed calcium metabolism and acid-base balance. Autoantibodies were detected in the serum of both patients, and mononuclear cell infiltrates were noted in skin and kidney biopsies from both.     

Treatment of vitamin D deficient osteomalacia may unmask autonomous hyperparathyroidism.

Two cases of vitamin D deficient osteomalacia with secondary hyperparathyroidism are presented. In both cases treatment with vitamin D replacement therapy resulted in elevated calcium levels and a failure of parathormone levels to normalise, indicating autonomous parathyroid activity. Subsequent surgery in one case resulted in removal of a parathyroid adenoma. The importance of osteomalacia and its complications are discussed.