Журнал клинических случаев

Sacral fractures are underdiagnosed and often undertreated. We report the second case of presentation and surgical management of a 56-year-old man with traumatic sacral U-shape fracture secondary to a grand mal epileptic seizure. We then discuss risk factors and mechanism of such fracture in epileptic patients.

Background: The most widely recognized endocrine problem is Polycystic Ovary Syndrome (PCOS) that shows during puberty with menstrual irregularities, acne and hirsutism. The fundamental imperfections in PCOS are still unclear, so insulin resistance and metabolic syndrome are most common in both healthy weight and as well as in obese patients. Numerous treatments are offered for women related to PCOS including weight loss, gonadotropins, metformin, DASH diet, letrozole and laparoscopic ovarian diathermy.

Case presentation: This case report 35-years-old female presented for evaluation of obesity, menstrual irregularity and amenorrhea, and had no received any kind of hormonal treatment. Luteinizing hormone and serum testosterone level were elevated, while follicle stimulating hormone and estradiol level was normal.

Conclusion and Outcome: Metformin and DASH diet was best treatment choice for PCOS patient that requires further examination before to being suggested on a long term basis and successful treatment outcome.

Denosumab is an effective human monoclonal antibody used for postmenopausal women with osteoporosis at high risk for fracture. There are serious adverse effects associated with the use of denosumab, such as hypocalcemia, hypophosphatemia, hypomagnesemia, and increased blood alkaline phosphatase. Hypocalcemia associated with the use of denosumab can lead to central nervous system complications (seizure) in chronic kidney disease patients (CKD 4-5D). The patient, in this case, had osteoporosis and started a denosumab regimen (60 mg subcutaneous injection every 6 months for 2 years) with normal renal function and magnesium and calcium levels but developed reversible convulsion, amnesia, irritability hallucination, marked elevation Gamma-Glutamyl Transferase (GGT), and slight elevations in alkaline phosphatase and Aspartate Aminotransferase (AST). In all previously documented cases, CNS events after the administration of denosumab were associated with hypocalcemia or renal impairment. We hereby report a case of reversible convulsion following denosumab administration for the treatment of osteoporosis in postmenopausal women with normal renal functions, endocrine, and metabolic profiles. The findings of this study suggest careful monitoring of serum levels of calcium, phosphorus, and magnesium and symptoms of CNS events before initiation and during denosumab therapy.

Acute digital ischemia is relatively rare due to collateral blood supply to the hand from ulnar and radial arteries. We present a case of thumb ischemia secondary to embolic occlusion of the princeps pollicis artery, a branch of the radial artery, with concomitant atherosclerotic occlusion of the ipsilateral subclavian artery. This case highlights the importance of thorough investigation for systemic causes of distal upper extremity ischemia.

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