Internal medicine
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Case Reports
A Bone Histomorphometric Analysis of Hypophosphatasia-related Osteoporosis after Teriparatide Treatment.
A 79-year-old man was admitted with a compression fracture of the first lumbar vertebra. His alkaline phosphatase (ALP) level was 35 IU/L, and his dual energy X-ray absorptiometry T score was -3.7 standard deviations, indicating osteoporosis. A genetic analysis showed a mutation of the alkaline phosphatase biomineralization-associated gene encoding tissue-nonspecific alkaline phosphatase. ⋯ A bone biopsy performed after three years of teriparatide treatment showed that cancellous bone was adynamic. In cortical bone, tetracycline double-labeling indicates enhanced bone formation. Teriparatide may thus be a viable treatment option even in patients with hypophosphatasia.
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A 54-year-old man whose awake percutaneous arterial oxygen saturation (SpO2) was 94% was diagnosed with obstructive sleep apnea by polysomnography (PSG). His apnea-hypopnea index (AHI) was 138.8 (AI: 4.7 and HI: 134.1), so he was treated with continuous positive airway pressure (CPAP), and his condition was considered well-controlled by the CPAP tracking system (AHI=3.4), with improvement seen in his symptoms when he left our hospital. ⋯ His hypercapnia improved following voluntary hyperventilation. Idiopathic central alveolar hypoventilation was diagnosed, with the AHI considered to be well-controlled by the CPAP tracking system but not at all according to PSG.
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Editorial Comment
Subcutaneous Edema in Polymyositis and Dermatomyositis.