Intractable hypercalcaemia during pregnancy and the postpartum secondary to pathogenic variants in CYP24A1.

Summary: Parathyroid-independent hypercalcaemia of pregnancy, due to biallelic loss of function of the P450 enzyme CYP24A1, the principal inactivator of 1,25(OH)2D results in hypervitaminosis D, hypercalcaemia and hypercalciuria. We report two cases of this disorder, with intractable hypercalcaemia, one occurring during gestation and into the postpartum, and the other in the postpartum period. Case 1, a 47-year-old woman with a twin pregnancy conceived by embryo transfer, presented with hypercalcaemia at 23 weeks gestation with subnormal serum parathyroid hormone (PTH) and normal serum 25-OH D levels.

Patient change processes in psychotherapy: development of a new scale.

There is considerable interest in understanding and augmenting the process of change in psychotherapy. In this study qualitative and quantitative analyses were used to examine patient processes associated with change in recorded psychotherapy sessions from the Christchurch Psychotherapy for Depression Study. The sample consisted of 177 outpatients with a primary diagnosis of major depressive disorder randomized to receive weekly therapy sessions of Cognitive Behavior Therapy or Interpersonal Psychotherapy.

Bizarre leiomyoma of the vagina: report of a case.

Smooth muscle tumors are the most common mesenchymal tumors of the adult vagina, but no case of bizarre (also referred to as atypical, symplastic, or pleomorphic) leiomyoma has been described at this site. We present such a case in a 44-year-old woman.

Anencephalic conjoined twins.

A case of anencephaly in female thoracophagus conjoined twins is presented and discussed.