Postgraduate medical journal
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A patient with hypocalcaemia and hypomagnesaemia secondary to small bowel resection and malabsorption was treated with synthetic vitamin D analogue, 1-alpha hydroxy vitamin D3. A prompt rise in serum calcium concentration and some days later a smaller and transient rise in serum magnesium concentration was observed. These changes in extracellular fluid composition presumably resulted from enhanced calcium and magnesium absorption associated with vitamin D activity.
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Severe narcosis occurred in a patient with hypoparathyroidism given therapeutic doses of codeine phosphate.
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Growth hormone (GH), prolactin (PRL) and thyrotrophin (TSH) responses to thyrotrophin-releasing hormone (TRH) were studied in 15 insulin-dependent diabetic patients. Basal plasma GH levels were raised above 5 mu./l in 6 patients and following the injection of TRH there was a significant rise in plasma GH levels in 9. ⋯ Basal PRL and TSH levels were normal and rose normally in response to TRH. GH release may be qualitatively abnormal in some diabetics and any such loss of specificity of GH-releasing mechanisms would further contribute to the raised GH levels found in many diabetics which would be of importance if GH is a factor in the aetiology of diabetic microangiopathy.
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Bacterial pyomyositis is common in the tropids but is rare in temperate climates. A patient with aplastic anaemia who had never left the continental United States developed bacterial pyomyositis secondary to Staphylococcus aureus which responded to antibiotics and surgical drainage. Bacterial pyomyositis should be considered in the differential diagnosis of fever and myalgias in the immunocompromised patient.