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Journal Article 2016; 37(3): 193-201 PubMed PMID: 27618607 Citation  Keywords:  Adult, Cervical Cord:injuries, Female, Follow-Up Studies, Humans, Longitudinal Studies, Lung Diseases:etiology, Male, Middle Aged, Muscle Strength, Prospective Studies, Quadriplegia:etiology, Respiratory Function Tests, Respiratory Muscles:physiopathology.   

OBJECTIVES: Respiratory complications are most common cause of morbidity/mortality in patients with cervical spinal cord injury (cSCI) due to respiratory muscle weakness and lower diaphragm position resulting in limited availability of inspiration, reduced thorax mobility and limited forced expiration. Differences in respiratory dysfunctions (RDs) in patients with motor complete versus incomplete cSCI were assessed.

DESIGN: Prospective longitudinal study, serial measurement.

SETTING: University hospital and ambulatory departments.

METHODS: Twenty two patients with acute cSCI were recruited. Neurological level of injury and severity according to ISNCSCI were used as criteria for recruitment. Patients were divided into two groups - motor complete and incomplete. Standardized pulmonary function tests (PFT) were used - spirometry and respiratory muscle strength (RMS) measurement. Motor score of key muscles assessments for upper (UEMS) and lower (LEMS) limbs were used. Tests were performed in 5 measurement sessions starting on (medians) 14.5 days (M1), then 6.7 weeks, 3.2 months, 6.3 months and 1.0 year (M5).

RESULTS: Significant differences in measurement sessions M2-M5 between groups in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), expiratory reserve volume (ERV), maximal static inspiratory/expiratory pressures (MIP, MEP) and UEMS were proved. Consequently, prominent differences in courses of particular parameters were found. No intergroup changes in UEMS were found during study.

CONCLUSIONS: Obvious differences in parameters of spirometry, respiratory muscles and limb muscles strength between motor complete and incomplete group were found. Carefull monitoring of RDs by functional assessments (i.e., PFT and UEMS/LEMS tests) within one year after SCI seems to be clinically important....

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Case Reports 2010; 31(4): 451-453 PubMed PMID: 20802446 Citation  Keywords:  Adenoma:complications, Adult, Female, Humans, Parathyroid Neoplasms:complications, Quadriplegia:etiology, Treatment Outcome, Vitamin D:therapeutic use, Vitamin D Deficiency:complications,.   

OBJECTIVE: Parathyroid adenomas (PA) are benign tumors. We report an unusual case of delayed diagnosis of a PA and concomitant Vitamin D deficiency presenting as tetraparesia.

METHODS: A 30-year-woman was admitted to our clinic with an inability to walk. Our examination revealed tetraparesia and common, severe muscular atrophy.

RESULTS: Laboratory investigations showed the following: creatinine phosphokinase (CK): 37 IU/L (15-130), calcium (Ca): 11.5 mg/dL (9-11), phosphorus (P): 1.5 mg/dL (2.5-5), parathyroid hormone (PTH): 736.1 pq/mL (15-65), 25-hydroxyvitamin D (25-OHvit D): 4 ng/mL (11-43), and alkaline phosphatase (ALP): 1029.5 lU (64-300). Parathyroid scintigraphy revealed PA. A year after Vitamin D replacement, the patient's neurological status and laboratory findings improved.

CONCLUSION: We suggest that the physicians always keep in mind the primary hyperparathyroidism (HPT) and concomitant Vitamin D deficiency in the differential diagnosis of hypercalcemia when facing atypical neurological symptoms such as tetraparesia....

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