#Wilsons disease

[mcatmemoranda]

There are multiple risk factors for the development of osteoporosis. These include but are not limited to advanced age, cigarette smoking, chronic glucocorticoid therapy, low body weight, previous fractures, history of rheumatoid arthritis, and excessive alcohol intake.

Antiepileptic drugs (AEDs) are associated with adverse effects on bone health. The AEDs most commonly associated with altered bone metabolism are those that induce the cytochrome P450 enzyme system. Specifically, the AED phenytoin has a direct inhibitory effect on intestinal calcium absorption and can stimulate osteoclastic bone resorption.

A score of less than -2.5 on DEXA scanning would indicate osteoporosis, a score of -1.0 to -2.5 would indicate osteopenia, and a score greater than -1.0 indicates normal bone density. Additionally, a fragility fracture (fracture from minor trauma such as a fall from a standing height or less) is diagnostic of osteoporosis without any further workup.

Bottom Line: The risk factors for osteoporosis include advanced age, cigarette smoking, chronic glucocorticoid therapy, physical inactivity, poor intake of calcium and vitamin D, body weight less than 127 lb, previous fractures, anticonvulsant use, hyperthyroidism, celiac disease, rheumatoid arthritis, and excessive alcohol intake.

The characteristic need for the child to use his hands to push himself to an upright position when arising from the floor is the Gower sign. It results from weakness in the proximal lower extremity muscles. Physical examination reveals pseudohypertrophy of the calf, lumbar lordosis, a waddling gait, shortening of the Achilles tendons, hypotonia, and hyporeflexia or areflexia. Patients usually use wheelchairs by age 12 or 13. Additional complications include delayed growth, dilated cardiomyopathy, increased fractures, progressive scoliosis with impaired pulmonary function, cognitive impairment, and eventual respiratory insufficiency.

Bottom Line: Elevated laboratory markers in the setting of Duchenne muscular dystrophy include serum creatine kinase, aspartate aminotransferase, and alanine transaminase.

COMBANK Insight: DMD is a progressive, myopathic disorder inherited in an X-linked, recessive fashion and caused by a defective gene on the X chromosome responsible for dystrophin production. Dystrophin normally serves to stabilize and prevent the breakdown of muscle fibers. Loss of dystrophin thus leads to muscle fiber degeneration, resulting in muscle weakness.

Wilson Disease, also known as hepatolenticular degeneration, is an autosomal recessive defect involving an ATPase, Cu2+ -transporting, β-polypeptide. In this disease state, copper is deposited in tissues of the brain, liver, kidneys, and Descemet membrane of the cornea (known as Kayser-Fleischer rings, which are seen in the exhibit). Parkinsonian-like tremor and dementia may be evident when the nervous system is affected. Renal tubular damage occurs in the kidneys and cirrhosis can develop in the liver. Diagnosis can be made with the observation of decreased serum ceruloplasmin. Treatment includes penicillamine, which creates a soluble complex with the metal that can be excreted through the urine.

Bottom Line: A Kayser-Fleischer ring is a golden brown ring observed in the Descemet layer of the cornea as a result of copper deposition and is seen in Wilson disease. Labs reveal low serum ceruloplasmin and treatment with penicillamine can stop the progression of this degenerative disease state.

The types of cancers that metastasize to the bone most commonly are lung, breast, thyroid, renal, and prostate. Multiple myeloma and lymphoma can both form lytic lesions from their origins within the marrow.

A SPEP and UPEP are sensitive for multiple myeloma and should be obtained along with a measurement of the patient's total protein and globulin levels.

Bottom Line: The initial workup of a new lytic lesion generally involves a CT chest/abdomen/pelvis, SPEP/UPEP, bone scan, basic labs, and mammogram or PSA

[drpedi07]

Wilsons Disease Scoring System (Leipzig Score) Calculator

Diagnostic algorithms for Wilson’s disease based on the Leipzig Score [44].

[disaster-bay-leaf]

wilson: almost solves house’s moby dick case

house: undresses him with his eyes

[patchwork7987]

Hes like a starving aggressive stray pitbull and Wilson's the white woman, feeding it, taking it home and putting a onesie on it

[secondstar-acorn]

I would genuinely listen to an entire series of Anthony Burch talking to himself and exploring the kiddads’ lives between the end of season 1 to the beginning of season 2

like they are so Fucked Up and I know why but I just wanna know MORE I wanna annotate their lives and put sticky notes over significant moments and write essays on their trauma I’m. fucking losing it

[hugeegosorry]

r/housemd except not really

[littleguy-pi]

I’m so sad we never got an episode where Wilson was the patient of the week, and I know we got the cancer arc, but I really really wanted an episode where Wilson collapses out of the blue or something and House and friends need to figure out what’s wrong with him and House has a breakdown because he doesn’t wanna lose his best friend and also the team has to look through House and Wilson’s apartment and it sucks cause I’ve searched ao3 quite a bit and I’ve only been able to find one fic like that. I would write one but I can’t decide on a disease

[local-limebug]

jason todd has so many underrated canon love interests. essence, isabel, artemis, and rose are all characters i love with him. like those are good ships. why is everyone ignoring them?

[sneckoil]

Was it ever explained why house chose to specialize in nephrology? it’s such a small but interesting detail to me

[andy-888]

Ok I started watching House to see the hillson hype and while s1 was like meh for me I find it insane that one of the first things they show us is Wilson being like "I'd rather spend Christmas with you than with my WIFE" LIKE OK I GUESS???

Then one of my top 3 hillson moment is when Wilson cut House cane in half and made him fall mid walk. I've never seen a man hornier than House in that moment. Insane then the sync scene. They are married ok we get it.

Wilson fully convinced that House was asking him for a romantic weekend??? Ok.

Then House saying that Cameron is nice to ugly ppl bc she feels bad for being beautiful and adding that that's why she and Wilson get along. I know Wilson thinks House was calling him ugly, but I know better and I KNOW House thinks Cameron and Wilson have the same issue with their white knight complex, therefore he was calling him pretty and I stand on this hill.

Now in s3 this cop arc is ruining my life bc is like watching your parents get divorced and I want to shake House till some blood reaches his brain bc if Wilson screamed at me and looked at me with those sad puppy eyes bc of something I did, I'd give myself to the police idc. Wilson amiga sal de ahí

[her-soliloquies]

So I have a question. If you are sick (fever, nausea, cough, that sorta thing), is it advisable to rewatch House?

[abarbaricyalp]

Hey Elisabeth! Okay, so for the SamBucky ask game - either 💋 Almost Kiss or 🚨 The Moment a Mission Goes Awry please

Excellent choices! From this list

💋 Almost Kiss

"Can you see them?" Bucky asked and promptly stepped on Sam's toes.

Sam cursed under his breath, tripping into Bucky's chest because his feet were pinned and now his head was on a swivel. "If you'd give me five uninterrupted seconds, I could do a better job scouting."

Around them, better dancers than they were twirling in intricate patterns, dresses flowing seamlessly, snappy shoes always out of the way of hidden heels. A symphony played overhead--Liszt maybe. The arrangement was too large for the smaller band playing live. This was one of their sanctioned breaks.

This had not been Bucky's idea. He was an excellent dancer, he wanted it noted. He still had his old swing dances carved into the meat of him. He had not stepped on anyone's feet since he was thirteen and grew three shoe sizes over night.

Regency style dances though? Absolutely not. The outfit was uncomfortable, even half unbuttoned. The shoes were awkward. The dances were complicated. He kept having to let go of Sam to trade partners. Their marks were getting further and further down the ballroom from them.

Sam was not faring any better.

"We have to get out of this sextet," Bucky said under his breath. "We have to move further down."

Sam half glared at him, holding his palm against Bucky's as they circled around each other. "There's no way to move down," he said for the split second they came together before stepping away and switching partners for another rotation of the dance.

Bucky tried to keep his eyes on the far end of the ballroom as they moved around new dancers, continuously knocking elbows and knees for his efforts. He was pretty sure he and Sam had pissed off everyone else around them by this point.

When he finally had Sam back to himself, he snagged his wrist and pulled him away from the formation of the dance. There was mostly irritation at their leaving, but he was sure there was a bit of elation as well.

"You said you could dance," Sam snapped as they moved down the length of the ballroom as inconspicuously as they could.

"So did you," Bucky snapped back.

"They've definitely made us. They made us the first time you tried to take me off of my feet."

Bucky seethed next to Sam, but he didn't have a response ready before he was pulling him back into the dance just as the music was changing to another song and another form.

They bowed to each other as the music picked up. Bucky kept his eyes on Sam's face, which proved to be a mistake because Sam looked up at him too, long eyelashes fluttering over his deep brown eyes. Bucky had never noticed how nice Sam's eyes were. They were darker than usual right now, under the low lighting and the irritation coursing through him, and it was almost as captivating as the honey gemstone color they turned in the sun.

Bucky's heart tripped over itself in his chest for no damn good reason.

They met each other in the middle of the floor, palms coming together again, hands hooked near their thumbs as they stepped forward and backward from each other. It was only Bucky's instincts for other people's movements that had him slipping an arm around Sam's waist in time--he certainly wasn't counting--and holding him flush with a hand on the small of his back as Sam held his hand and draped the other arm over Bucky's shoulder.

Sam smelt good too. His cologne was fighting against the shimmery flush of sweat across his skin, warm from exertion and maybe just a bit of nerves.

This dance allowed them to move again, grand sweeping steps, but Bucky had lost their targets when everyone had lined up for the dance.

In a breath, Sam had taken control of the dance, stepping into the lead role even as Bucky half dug his heels in like a mule. It made Bucky's stomach swoop right out from under him.

"You are terrible at this," Sam hissed. "You're a terrible dancer and you're a terrible spy."

"If you'd just let me take care of it outside, we wouldn't be in here at all."

"We don't need them dead. We need to see their contact."

"No one is meeting business contacts in a dance club."

As usual, when Sam's righteous fury was directed at him, the rest of the world kind of melted away. Bucky forgot, again, about keeping an eye on ye-olde-wannabe-gentry because he couldn't keep his eyes off of Sam's flashing gaze. He wasn't sure how exactly he kept going with the dance. It was probably a testament to Sam's ability to lead, not that Bucky would ever say that out loud. He also didn't know how they were avoiding the other couples because he'd forgotten about them too.

"Oh, because you know so much about conducting illicit business?"

"Actually, I do. I'm much more interesting than you, remember?"

Sam stopped dancing then. They were practically chest to chest. Bucky could feel Sam's breathing. "If you traded information the way you spy or the way you dance, I wouldn't take your advice with all the grains of salt in all the world."

"I wouldn't give you advice anyway," Bucky retorted petulantly. "You'd do it all wrong. Too good for your own needs."

Sam's sharp eyes were steady and burning on Bucky's face. When Bucky had to look away or risk being incinerated, his gaze didn't drop far. Just to Sam's mouth, which was parts just a little, just enough for his tongue to snake out and wet his lower lip.

Bucky's racing heart had joined his swooping stomach, left behind somewhere several spins ago. He ducked his head just a little, just to be closer to Sam, to feel his breath instead of just his breathing. Sam turned his face up towards Bucky too, lips parting further, tongue so damn close to Bucky's mouth.

"I'm sorry to disappoint your criminal heart," Sam breathed.

"I'm sorry to disappoint your heroic one," Bucky agreed.

Sam pitched closer, fingers tightening in Bucky's suit jacket, around his fingers.

The discordant notes of a harp being knocked over snapped straight through their moment. They both whipped around at the same moment to see three men making a break for the wings of the orchestra stage.

"You're a terrible spy!" Sam shouted once more for emphasis as they took off after the bad guys. The crowd was murmuring and parting, which was nice at least. Late, but nice.

"So are you!" Bucky agreed. He rubbed his hand over his tingling mouth and willed his heart to return to his chest. The dance wasn't over yet.

[mhaccunoval]

wilson’s disease || mine, 24 nov 2022

[ace-with--a-mace]

houses head wilsons heart crushed me wtf doctors...

[joyflameball]

Random loading screen tidbits that fill my life with autism

[anjanahalo]

As a thing to say this Pride Month, part of accepting I was aroace was asking myself if I really wanted to get some sort of romantic partner. The answer was...not really? I like my own company. I don't feel any big urge to have "One True Love" in my life. Social contact was serviced well through close friends. Sex and Romance didn't need involvement. Maybe I'll die a single spinster, but spinning yarn was an occupation that could earn a woman enough money to live on her own. Thus the equation of spinster to older single woman. She is strong, independant, anddon'tneednoman. Wanting a man is cool, but I don't even really want one of that. There are aspects of kink culture I enjoy, but I most enjoy the things that don't really involve intercourse. I also enjoy whump writing, but that's because it's another form of intimacy that doesn't deal with sex. Hell, I realized I don't like most Top 40 songs because most of them are about being in love or someone asking to get back with someone after cheating on them. The former I find boring because I can't relate (and I can listen to a song about being a tree and relate), and the latter has me hoping the singer purposefully cast themselves as the bad guy in their own song. Anyway, my big move when I embraced my sexuality is to stop looking for a romantic partner on apps. They didn't work well for me anyway. "Swipe Right if you like them!" it says. How do I know I like them? I can tell if they're conventionally attractive, sure, but a picture and a short curated bio don't tell me enough to even consider them. Deleting those apps and thinking "I don't need or want a romantic partner" made me feel free. Thank goodness my parents aren't pushing me to marry or have kids, and my brother's successfully continued the genetic family line so I don't have to. Happy Pride Month from a relaxed Asexual, a proud Aromantic, and, bonus points, and pondering egg cracking its shell.