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This patient's age, speech delay, bilateral lower-extremity weakness, apparent increase in calf diameter, and history of a wheelchair-bound uncle are typical of Duchenne muscular dystrophy (DMD). DMD is the most common muscular dystrophy of childhood that affects boys who have inherited a defective dystrophin gene on X-chromosome p21. Weakness begins in the proximal lower-extremity muscles and manifests as difficulty walking, running, jumping, and climbing stairs. Boys may push their arms on their thighs (Gower sign) to transition from sitting to standing.
Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1). MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum.
Warfarin is an anticoagulant medication - it is used to slow down the blood-clotting process. Anticoagulants are used to prevent blood clots which may cause vein blockages, heart attack and stroke. Warfarin is known under the brand names Warfant, Jantoven, Coumadin, Lawarin, Marevan, and Waran.
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