Hypervitaminosis d
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Hypervitaminosis D, or vitamin D toxicity, is characterized by hypercalcemia and elevated 25(OH)D levels over 150 ng/ml. It can occur endogenously due to granulomatous disorders or lymphoma, or exogenously from high dosage vitamin D supplement intake without medical supervision. Symptoms include neuropsychiatric effects, GI issues, cardiovascular and renal problems. Diagnosis is based on calcium, vitamin D, and PTH levels. Treatment involves discontinuing supplements, limiting calcium intake, hydration, glucocorticoids to reduce calcium absorption, and bisphosphonates to decrease bone resorption. While rare, hypervitaminosis D can be life-threatening if not properly
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Presentation11
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A complete blood count (CBC) examines components of blood including red blood cell (RBC), white blood cell (WBC), and platelet counts. The CBC provides information about anemia, infection, blood cell production/destruction. Low or high RBC, WBC, or platelet counts can indicate conditions like bleeding, bone marrow damage, inflammation, infection, cancer, nutritional deficiencies. The CBC also measures hemoglobin, hematocrit, and RBC indices to characterize anemias and help identify their cause. An elevated erythrocyte sedimentation rate often relates to inflammation.
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Vitamin D is a fat-soluble vitamin that is obtained through sunlight exposure and dietary sources like fatty fish and fortified foods. It plays an important role in bone and immune health by aiding in calcium absorption and bone mineralization. Testing for vitamin D levels has increased in recent years due to research linking vitamin D deficiency to diseases like cancer, heart disease, diabetes and depression. While vitamin D shows promise for many health benefits, more research is still needed to fully understand its therapeutic potential.
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This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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Hypervitaminosis d
- 2. • Hypervitaminosis D also know as vitamin D toxicity characterised by hypercalcemia , hypercalciuria , and elevated 25(OH)D > 150 ng/ml • Increased intake of vitamin D supplements by the general population and large number of therapeutic prescriptions with high doses without medical mknito might result in a greater risk of exogenous hypervitsminosis D with symptoms of hypercalcemia
- 3. • Two types • Endogenous • Exogenous • Endogenous : • Granulomatous disorders • Lymphoma • Idiopathic infantile hypercalcemia
- 4. • In lymphoma etiology of VDT is multiple, and fully not recognised • In IIH , dysfunction of 24 hydroxylase activity , an enzyme responsible for degradation of both 25(OH)D and 1,25(OH)²D results in uncontrolled severe hypercalcemia • Williams syndrome – hypersensitivity to 25(OH)D AND 1,25(OH)D²
- 5. • Exogenous • High dosage intake • Serum 25(OH)D > 150 ng/ml • With hypercalcemia and hypercalciuria , low parathyroid hormone • Hyper calcemia and hypercalciuria first measurable manifestation in VDT • 1,25(OH)D² in exogenous VDT slightly increased or normal in range as it is down regulated by inhibition activity of 1 alpha hydroxylase and increased activity of 24(OH) hydroxylase
- 6. • In endogenous VDT hypercalcemia is related to increased activity or sensitivity of 1,25(Oh)D² • While in exogenous VDT it’s due to high 25(OH)D concentration
- 7. • In 40s , massive dose of vitamin D were considered an effective treatment for chronic illness such as tuberculosis and rheumatoid arthrtis • But later on due to hypercalcemia and related symptoms , these massive doses were discontinued • Other causes – food fortification mainly Milk
- 8. Pathophysiology • In hypervitsminosis D • Concentration of vitamin D metabolites such as , 25(OH)D , 24,25(OH)², 25,26(OH)D² increase significantly • Abnormally increased metabolites exceed the vitamin D binding protein (VDBP) and leaves 1,25(OH)D² as a free metabolite which is an active form • Reason behind this is , 1,25 molecule has lower affinity for VDBP compared to others , but as it’s an active form it enters the target cells by diffusion and acts through the vitamin D receptors • Proving increased serum level of 25(OH) molecule and normal or slightly raised 1,25 molecule •
- 9. Signs and symptoms • Neuropsychiatric symptoms : • Decreased concentration • Confusion • Drowsiness • Depression • Psychosis • In extreme cases coma • • GI symptoms : • Vomiting • Abdominal pain • Polydipsia • Anorexia • Constipation • Pancreatitis
- 10. • Cardiovascular : • Hypertension • Heart block • • Renal : • Polyuria • Hypercalciuria • Dehydration • Renal stones • Acute renal failure • Painful peri articular calcinosis
- 11. Diagnosis • Determined mainly clinically and detailed drug history • Laboratory findings : • Serum calcium , vitamin D level , PTH level • Renal profile
- 12. Treatment • Discontinuation of vitamin d supplements • Reduction of dietary calcium intake • Isotonic sodium chloride solution to correct dehydration and restore kidney function • Glucocorticoids (hydrocortisone) 100mg/day • Decreases plasma calcium level by reducing intestinal calcium absorption • Increasing urinary calcium excretion • Anti resorption therapy : • Bisphosphonates , calcitonin to suppress osteoclastic activity and bone resorption
- 13. • VDT resulting in hypercalcemia js rare, but can be life threatening condition if not identified and treated accordingly
- 14. Thank you