Primary cardiac sarcomas represent a group of rare and aggressive malignant mesenchymal neoplasms with a notoriously poor prognosis. They comprise a relatively small percentage of all primary neoplasms of the heart
Introduction: Patients with active celiac disease are more likely to have osteoporosis and increased risk of fractures. Studies show that gluten-free diet may help improve bone mass to some extent. Here, we report a premenopausal woman... more
Introduction: Patients with active celiac disease are more likely to have osteoporosis and increased risk of fractures. Studies show that gluten-free diet may help improve bone mass to some extent. Here, we report a premenopausal woman with celiac disease with progressively declining bone mineral density (BMD) into severe osteoporosis range, who demonstrated a remarkable improvement in BMD after one year of gluten-free diet and oral bisphosphonates. Clinical case: A 44-year old premenopausal female had a low screening bone density at the ankle at 39 years of age, and was confirmed to have low BMD by central DXA, with osteoporosis at the spine and osteopenia at the hips. Celiac antibodies were positive and she was recommended gluten free diet (GFD), which she stopped after a year. Her primary care also started her on supplemental calcium and vitamin D with stabilization of BMD over the next three years. Subsequent BMD 2 years later showed 7.6% decrease in bone density at the lumbar spine (T-score-3) and 5.8% decline at the total hip (T-score-2.7) and she was referred for osteoporosis evaluation. Workup revealed high bone turnover with an elevated PTH of 162pg/mL, low normal serum calcium of 8.8mg/dL, normal vitamin D levels and low urine calcium levels, suggestive of secondary hyperparathyroidism. At this time, review of systems revealed a questionable history of gluten sensitivity, but she denied any diarrhea or bloating. A duodenal biopsy revealed villous atrophy and positive antibodies against tissue transglutaminase, compatible with active celiac disease. She was started on a gluten-free diet and alendronate was also added in view of low bone density and high bone resorption. Bone density performed one year later revealed a remarkable 14.1% increase at the level of the lumbar spine and 8.9% increase at the level of total hip compared to prior BMD. Conclusion: This is the first case of such a remarkable increase in BMD on gluten-free diet and concomitant bisphosphonate use, suggesting a cumulative benefit of this strategy that is greater than using either of these interventions alone.
Osteoporosis is a skeletal disorder characterized by decreased bone mineral density and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis,... more
Osteoporosis is a skeletal disorder characterized by decreased bone mineral density and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. This review focuses on some of the common causes of osteoporosis, addressing the underlying mechanisms, diagnostic approach and treatment of low bone mass in the presence of these conditions.
Surgical removal of the spleen, splenectomy, is a procedure that has significantly decreased in frequency as our understanding of the infectious complications of the asplenic state increased. The full spectrum and details of splenic... more
Surgical removal of the spleen, splenectomy, is a procedure that has significantly decreased in frequency as our understanding of the infectious complications of the asplenic state increased. The full spectrum and details of splenic function, however, have yet to be fully outlined. As a result, our comprehension of the long-term consequences of splenectomy remains incomplete. We review the evidence relating to the effects of splenectomy on infection, malignancy, thrombosis, and transplantation. Perhaps the best-defined and most widely understood complication of splenectomy is the asplenic patient's susceptibility to infection. In response to this concern, novel techniques have emerged to attempt to preserve splenic function in those patients for whom surgical therapy of the spleen is necessary. The efficacy of these techniques in preserving splenic function and staving off the complications associated with splenectomy is also reviewed in this article.
Fetal antigens are allogeneic to the mother's immune system and should theoretically elicit an immune response. The fact that this does not occur and that the fetus thrives for so long in the mother without undergoing rejection by her... more
Fetal antigens are allogeneic to the mother's immune system and should theoretically elicit an immune response. The fact that this does not occur and that the fetus thrives for so long in the mother without undergoing rejection by her immune system is a scientific mystery. There are five main theories that could explain the fetus's success in evading the mother's immune system. These are the mother's overall immune suppressed state, maternal tolerance to fetal antigens, down-regulation of fetal antigens, the presence of a barrier between maternal immunity and the fetus, and local immune suppression at the site of the placenta. None of these mechanisms can fully explain this phenomenon despite the varying degrees of evidence in support of each. The last mechanism (local immune suppression) seems to be the most plausible one according to current thinking. The actual explanation of this paradox may well lie in a combination of several different factors rather than a single account. K Ke ey y w wo or rd ds s: : immune system, fetus, pregnancy.
