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(PTHrP), which has tertiary structural homologies to PTH and causes bone resorption and hypercalcemia similar to those of PTH The clinical features of the hypercalcemia of cancer can closely simulate hyperparathyroidism Serum phosphate is often low, but the plasma level of PTH by IRMA is low Serum PTHrP may be elevated Multiple myeloma is a common cause of hypercalcemia in the older population Many other hematologic cancers, such as monocytic leukemia, T cell leukemia and lymphoma, and Burkitt s lymphoma, have also been associated with hypercalcemia Multiple myeloma causes renal dysfunction; resultant increased levels of carboxyl terminal PTH may cause it to be confused with hyperparathyroidism if a carboxyl terminal PTH assay is used Serum protein and urine electrophoresis and bone marrow biopsy establish the diagnosis



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(a) What is the efficiency of the motor at full load (b) What are the speed and efficiency of the motor if it is operating at an armature current of 35 A (c) Plot the torque-speed characteristic for this motor SOLUTION (a) The output power of this motor at full load is





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Pathologic fractures are more common in patients with hyperparathyroidism than in the general population Urinary tract infection due to stone and obstruction may lead to renal failure and uremia If the serum calcium level rises rapidly, clouding of sensorium, renal failure, and rapid precipitation of calcium throughout the soft tissues may occur Peptic ulcer and pancreatitis may be intractable before surgery Insulinomas or gastrinomas may be associated, as well as pituitary tumors (MEN type 1) Pseudogout may complicate hyperparathyroidism both before and after surgical removal of tumors Hypercalcemia during gestation produces neonatal hypocalcemia In secondary hyperparathyroidism due to renal failure, high serum calcium and phosphate levels may cause disseminated calcification in the skin, soft tissues, and arteries (calciphylaxis); this can result in painful ischemic necrosis of skin and gangrene, cardiac arrhythmias, and respiratory failure The actual serum levels of calcium and phosphate have not correlated well with calciphylaxis, but a calcium (mg/dL) phosphate (mg/dL) product over 70 is usually present

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Macrophages and perhaps other cells present in granulomatous tissue have the ability to synthesize 1,25(OH)2D3 Hypercalcemia has been reported in patients with sarcoidosis, tuberculosis, berylliosis, histoplasmosis, coccidioidomycosis, leprosy, and even foreign-body granuloma Increased intestinal calcium absorption and hypercalciuria are more common than hypercalcemia Serum levels of 1,25(OH)2D3 are elevated In patients with sarcoidosis, serum levels of angiotensin-converting enzyme (ACE) are usually elevated 18FDGPET scanning may localize hypermetabolic foci of active disease Ketoconazole is an antifungal agent that inhibits macrophage 1-hydroxylation of 25-hydroxyvitamin D, thereby improving the hypercalcemia of sarcoidosis and tuberculosis In all conditions, treatment is directed at the underlying disorder

The quest to break 10-Mbps network speeds in the Ethernet world started in the early 1990s By then 10BaseT Ethernet had established itself as the most popular networking technology (although other standards, such as IBM s Token Ring, still had some market share) The goal was to create a new speed standard that made no changes to the actual Ethernet frames themselves By doing this, the 8023 committee ensured that different speeds of Ethernet could interconnect, assuming you had something that could handle the speed differences and a media converter if the connections were different

Ingestion of large amounts of calcium (usually as an antacid) or vitamin D can cause hypercalcemia, which is reversible following its cessation If it persists, the possibility of associated hyperparathyroidism should be strongly considered In vitamin D intoxication, patients may take large amounts of vitamin D for unclear reasons, so a check of all medications is important Hypercalcemia may persist for several weeks Serum levels of 25-hydroxycholecalciferol (25[OH]D3) are helpful to confirm the diagnosis A brief course of corticosteroid therapy may be necessary if hypercalcemia is severe

A report of hypercalcemia may be due to laboratory error or excess tourniquet time and should always be repeated Hypercalcemia may be due to high serum protein concentrations; in the presence of high or low serum albumin concentrations, a serum ionized calcium is more dependable than the total serum calcium concentration Hypercalcemia may also be seen with dehydration; spurious elevations in serum calcium have been reported with severe hypertriglyceridemia, when the calcium assay uses spectophotometry

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