Clinical calcium
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Almost all bone metastases of cancer with pain are indicated to radiotherapy (RT). Pathological fracture, impending fracture at lower extremities and radio-resistant tumor should receive preceding surgery. RT is set up to fix lesional bone and consists of 30Gy÷10fr÷2w to rectangular fields opposed anteroposteriorly in general. ⋯ RT has, however, adverse effects, for example, radio-induced dermatitis and bone marrow suppression. Pay attention for large field or high dose. Optimum field and dose fraction schedule should be considered.
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Complex regional pain syndrome is atypical post-traumatic reaction on the extremity, which indicates hyper-algesia, allodynia, swelling, edema, skin and hair disorder. As mechanism of this syndrome has not been revealed, now it is recognized as refractory disease. In this paper, diagnosis criteria and treatments for this syndrome are described.
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Exercise program on hip fracture patients is important for recovering from functional deficit after operation, and disuse prevention for a maintenance phase. Previous reports demonstrated that specific exercise therapy were effective in consequence of this fracture patient, but the review showed there was not enough evidence in each exercise program. Multidisciplinary rehabilitation approach was recommended after hip fracture surgery.
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Hyperphosphatemia is a serious complication which has been linked with an increased risk of cardiovascular mortality in patients with chronic kidney disease. Lanthanum carbonate is a novel non-calcium, non-aluminum phosphate-binding agent, and has approved for clinical use in patients on hemodialysis in Japan on March in 2009. ⋯ There is no evidence of bone toxicity and neurotoxicity of lanthanum carbonate previously reported for aluminium hydroxide. However, further studies are needed to address the longer term toxic effect on bone and other organs.
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It has been clarified that even mild primary hyperparathyroidism without typical symptoms ie, nephrolithiasis, bone disease, influences bone status and reduced bone density and increased fracture risk can be improved with parathyroidectomy. Therefore, parathyroidectomy should be recommended for patients with asymptomatic primary hyperparathyroidism. Guideline and recommendation by an international work shop on primary hyperparathyroidism has presented for the surgical indications. Non invasive localization studies including ultrasound and sestamibi scan, and intraoperative parathyroid hormone assay can achieve successful minimally invasive focused parathyroidectomy.