Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Amorphous breast calcifications: is BI-RADS 4a appropriate? / Calcificações amorfas mamárias: BI-RADS 4a é adequado?

Abstract Objective: To evaluate the positive predictive value (PPV) of amorphous calcifications and to analyze the imaging variables that could alter the risk of malignancy associated with this finding. Materials and Methods: This was a retrospective study of 138 stereotactically guided percutaneous vacuum-assisted biopsies of amorphous calcifications, performed between January 2012 and December 2017. All of the patients included were referred for radiological follow-up for a minimum of one year (if the histopathology showed a benign lesion) or for surgical treatment (if the histopathology showed malignancy or a lesion of uncertain malignant potential). Results: We found that the PPV of amorphous calcifications was 9.42%. However, most of the malignant amorphous calcifications were in cases of invasive carcinoma or high-grade ductal carcinoma in situ, indicating clinically relevant disease. The relative risk of malignancy associated with amorphous calcifications was 6.15 times higher in patients with a family or personal history of breast or ovarian cancer. Neither being postmenopausal nor having dense breasts was found to be predictive of malignancy in patients with amorphous calcifications. Conclusion: Amorphous calcifications in the breast had a PPV for malignancy of 9.42%, indicating the possibility of placing the finding in subcategory 4a, which requires histopathological analysis. Our finding that the risk of malignancy associated with this subtype of calcifications is up to 6.15 times higher in patients with a family or personal history of breast cancer warrants greater concern regarding the clinical, radiologic, and histopathologic correlations after biopsy.

Resumo Objetivo: Avaliar o valor preditivo positivo (VPP) das calcificações amorfas e possíveis variáveis clínicas e de imagem que possam influenciar no risco de malignidade deste achado de imagem. Materiais e Métodos: Foram revisados, retrospectivamente, 138 resultados de biópsias percutâneas estereotáxicas a vácuo de calcificações amorfas, entre janeiro de 2012 e dezembro de 2017. Todas as pacientes incluídas apresentavam seguimento radiológico mínimo de um ano (histopatológico benigno) ou tratamento cirúrgico (histopatológico maligno). Resultados: O VPP das calcificações amorfas foi de 9,42%. As lesões malignas corresponderam predominantemente a carcinomas invasivos, indicando doença clinicamente relevante. O risco relativo de malignidade das calcificações amorfas foi 6,15 vezes maior em pacientes com história familiar ou pessoal de neoplasia de mama ou ovário. Status pós-menopausa e mamas densas não foram preditores de malignidade nessas pacientes. Conclusão: As calcificações amorfas na mama apresentaram VPP de malignidade de 9,42%, sugerindo possibilidade de classificação do achado na subcategoria 4a, com necessidade de investigação histopatológica. Em pacientes com história familiar ou pessoal de câncer de mama, o risco de malignidade deste subtipo de calcificações pode ser até 6,15 vezes maior, justificando maior preocupação na correlação clínica, radiológica e histopatológica após biópsia.

Concern about the prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated metastatic vascular calcification or calcinosis universalis / 中华内分泌外科杂志

Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Prevalence of soft tissue calcifications in the maxillofacial region: a radiographic study

Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher's exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age

Tumoral calcinosis on thigh in a hemodialysis patient and literature review / 中华肾脏病杂志

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Calcinose em área de queimadura tardia: relato de caso e discussão da conduta / Calcinosis in an area of late burn: a case report and management discussion

Introdução: Calcinose cutânea é uma doença rara caracterizada por precipitações de cristais de cálcio no tecido cutâneo. Pode ser localizada ou generalizada, distrófica, metastática, iatrogênica ou idiopática. Relato do Caso: Paciente feminina, 66 anos, vítima de queimaduras de segundo e terceiro graus por fogo em abdome inferior e coxas aos 8 anos de idade atingindo 25% de superfície corpórea. Após 58 anos, recebeu o diagnóstico de calcinose distrófica na cicatriz da queimadura, contemplado através de biópsia e análise histopatológica. Submetida a exérese cirúrgica associada a rotação de retalho dermogorduroso de abdome superior e enxertia de pele total para correção de cicatrizes. Conclusão: Embora a melhor escolha terapêutica ainda não seja clara, o tratamento de complicações que podem culminar em incapacidade funcional é fundamental para reduzir a morbidade e aumentar a qualidade de vida do paciente.

Introduction: Cutaneous calcinosis is a rare disease characterized by the precipitation of calcium crystals in the skin tissue. It can be localized, generalized, dystrophic, metastatic, iatrogenic, or idiopathic. Case Report: Female patient, 66 years old, victim of second and third-degree burns by fire in the lower abdomen and thighs at 8 years old, reaching 25% of the body surface. After 58 years, she was diagnosed with dystrophic calcinosis in the burn scar, which was confirmed through biopsy and histopathological analysis. She underwent surgical excision associated with rotation of the upper abdomen dermal-fat flap and total skin graft for scar correction. Conclusion: Although the best therapeutic choice is still unclear, treating complications leading to functional disability is essential to reduce morbidity and increase the patient's quality of life.

Calcinosis escrotal idiopática: Reporte de un caso / Idiopathic scrotal calcinosis. A case report

Resumen El calcio participa en muchos procesos fisiológicos. La calcinosis cutis es una enfermedad de depósito de calcio en la dermis. La calcicosis escrotal idiopática (CEI) es una forma común de calcinosis cutis idiopática. Se presenta el caso de un paciente masculino de 28 años de edad, con clínica de masas múltiples en escroto, de color blanco, tamaños variados, no dolorosas. Los niveles de calcio y fósforo se mostraron dentro de los rangos normales, característico de calcinosis de tipo idiopática, mientras que la vitamina D y la PTH se mostraron fuera de los límites normales. Se realiza una cirugía menor de las lesiones nodulares circunscritas, de diversos tamaños y de bordes regulares. El examen histológico post-biopsia confirmó el diagnóstico de calcinosis cutis. Se prescribió una dieta baja en calcio como método preventivo a largo plazo. A pesar de lo infrecuente de esta condición debe tenerse en cuenta al realizar un diagnóstico diferencial. Su etiología es aún desconocida y puede presentarse de manera asintomática. Lo importante es brindar al paciente una mejor calidad de vida, evitar incomodidades y baja autoestima debido al aspecto estético.

Abstract Calcium participates in many physiological processes. Calcinosis cutis is a disease caused by calcium deposition in the dermis. Idiopathic scrotal calcinosis (ICS) is a common form of idiopathic calcinosis cutis. A 28-year-old male patient was evaluated, with symptoms of multiple white masses in the scrotum, of various sizes, not painful. Calcium and phosphorus levels were within normal ranges, characteristic of idiopathic calcinosis, while vitamin D and PTH were outside the normal limits. Minor surgery was performed on circumscribed nodular lesions of various sizes with regular borders. Post-biopsy histological examination confirmed the diagnosis of calcinosis cutis. A low-calcium diet was prescribed as a long-term preventive method. Despite the infrequency of this condition, it should be taken into account when making a differential diagnosis. Its etiology is still unknown and it can present asymptomatically. The important thing is to provide the patient with a better quality of life, avoid discomfort and low self-esteem due to the aesthetic aspect.

Juvenile dermatomyositis in Thai children: Retrospective review of 30 cases from a tertiary care center

Background: Juvenile dermatomyositis is a rare condition, but it is the most common idiopathic inflammatory myopathy in pediatric patients. Aim: To study the clinical manifestations, investigations, treatment, clinical course, and outcomes of juvenile dermatomyositis in Thai children. Method: This retrospective study included juvenile dermatomyositis patients treated at Siriraj Hospital, a 2,300-bed national tertiary referral center in Bangkok, Thailand, from 1994 to 2019. Results: Thirty patients (22 females and 8 males) were included with a female to male ratio of 2.7:1. Median age at diagnosis was 5.1 years (range, 2.6-14.8 years). Median duration of illness before diagnosis was 6.5 months (range, 0.3-84.0 months). Acute and subacute onset occurred in the majority of patients. Presenting symptoms included muscle weakness in 27/30 (90%), skin rash in 26/30 (86.7%), muscle pain in 17/26 (65.4%), and arthralgia in 4/18 (22.2%) of patients. Dermatologic examination revealed Gottron’s rash, heliotrope rash, and periungual telangiectasia in 25/30 (83.3%), 21/30 (70.0%), and 15/24 (62.5%) of patients, respectively. Interestingly, scalp dermatitis was found in 8/21 (38.1%) of patients. The most commonly used treatment regimen in this series was a combination of prednisolone and methotrexate. During the median follow-up of 3.1 years (range, 0.0-18.5 years), only one-third of patients were seen to have monocyclic disease. Extraskeletal osteosarcoma at a previous lesion of calcinosis cutis was observed in one patient at 12 years after juvenile dermatomyositis onset. Limitations: This was a retrospective single-center study, and our results may not be generalizable to other healthcare settings. Prospective multicenter studies are needed to confirm the findings of this study. Conclusion: juvenile dermatomyositis usually poses a diagnostic and therapeutic challenge, which can be compounded by the ethnic variations in the clinical presentation, as observed in this study. Asian patients tend to present with acute or subacute onset of disease, and arthralgia and/or arthritis are less common than in Caucasian patients. Scalp dermatitis is not uncommon in pediatric juvenile dermatomyositis patients. An association between juvenile dermatomyositis and malignancy, though rare, can occur

Clinical characteristics and risk factors of juvenile dermatomyositis with relapses / 中华风湿病学杂志

Objective:To analyze the clinical characteristics and risk factors of juvenile dermatomyositis (JDM) with relapses by comparing clinical features, treatment and disease course among JDM patients with and without relapses.Methods:A retrospective analysis of 102 JDM patients from Children's Hospital of Nanjing Medical University between March 2017 and March 2021 was carried out. Patients were divided into two groups based on whether a JDM relapse had occurred or not. Initial clinical features, laboratory tests and treatment were compared between the two groups. T-test or Mann-Whitney U test was used for measurement data, chi-square test or fisher exact probability was used for count data. The features associated with risk of relapses were analyzed by multivariate logistic regression. Results:Among 102 children with JDM, twenty patients (19.6%) relapsed during drug reduction or after drug withdrawal. The mean duration to the first relapse was 3.24 years (range: 9 months to 7 years). Myositis specific antibodies (MSA) were positive for 8 (40.0%) patients with relapses. With 5 cases were anti-nuclear matrix protein 2 positive, 2 cases were anti-transcription interme-diary factor 1 gamma positive, 1 case was anti-signal recognition particle (SRP) positive, the other 12 cases were MSA negative. By binary logistic regression analysis, we found that peripheral calcinosis [ OR(95% CI)=17.54(1.55, 198.64), P=0.021], and interstitial lung disease [ OR(95% CI)=3.83(1.27, 11.59), P=0.017] were independently related to JDM with relapses. Fifty-three patients (51.9%) received methylpre-dnisolone pulse therapy for initial treatment and 13 (65.0%) patients with relapses received methylprednisolone pulse for initial treatment. There was no significant difference between the two groups ( χ2=1.70 , P=0.193). Tumor necrosis factor alpha antagonist combined with methotrexate (MTX) had achieved good results in clinical treatment in children with relapses. Conclusion:The risk of relapses is high in children with JDM. Calcinosis and interstitial lung disease at disease onset can predict a relapsing disease course. Aggressive treatment is urgently demanded for patients with JDM, especially those with relapses.

The correlation analysis between plasma sclerostin levels and bone turnover markers and inflammation factors in hemodialysis patients / 中国医师进修杂志

Objective:To explore the correlation between plasma sclerostin (SOST) and bone turnover markers and inflammatory factors in hemodialysis patients.Methods:One hundred and eight patients admitted to Changsha Central Hospital Affiliated to Nanhua University from January 2018 to May 2019 were selected. The levels of plasma SOST at admission and at 3, 6 and 12 months of dialysis were determined by enzyme-linked immunosorbent assay. They were divided into low- SOSTgroup (56 cases) and high- SOSTgroup (52 cases) based on the mean value of SOST. The levels of serum bone turnover markers β-Ⅰ collagen carboxy-terminal peptide (β-CTX) and osteocalcin (OC), propeptide of type Ⅰ procollagen (PINP), full parathyroid hormone (iPTH), N-terminal osteocalcin (N-MID-OC), inflammatory factors interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) were compared between the two groups, abdominal aortic calcification (ACC) score was performed, and Pearson linear correlation analysis was used to analyze the relationship between SOST level of hemodialysis patients and bone turnover markers, inflammatory factors and ACC scores.Results:The baseline levels of β-CTX, OC, PINP, iPTH, and N-MID-OC in the low- SOST group were higher than those in the high- SOST group: (976.03 ± 205.27) ng/L vs. (781.34 ± 150.45) ng/L, (175.31 ± 50.49) ng/L vs. (125.75 ± 40.17) ng/L, (321.45 ± 82.14) μg/L vs. (259.41 ± 75.36) μg/L, (345.26 ± 102.65) ng/L vs. (198.52 ± 45.71) ng/L, (19.96 ± 5.01) μg/L vs. (17.41 ± 4.23) μg/L, the differences were statistically significant ( P<0.05). The baseline levels of IL-1β, IL-6, CRP, TNF-α and ACC scores in the low- SOST group were higher than those in the high- SOST group: (19.31 ± 6.01) ng/L vs. (15.23 ± 4.75) ng/L, (76.85 ± 20.34) ng/L vs. (57.98 ± 15.02) ng/L, (8.15 ± 2.36) mg/L vs. (7.23 ± 1.79) mg/L, (178.37 ± 55.52) ng/L vs. (157.42 ± 10.15) ng/L, (5.96 ± 1.78) scores vs. (5.11 ± 1.15) scores, the differences were statistically significant ( P<0.05). After treated for 3, 6 and 12 months, the levels of β-CTX, OC, PINP, iPTH, N-MIC-OC in hemodialysis patients were increased, the level of SOST was decreased, the levels of IL-1β, IL-6, CRP, TNF-α increased and ACC scores were increased, the differences were statistically significant ( P<0.05). The Pearson linear correlation analysis showed that SOST level and bone turnover markers β-CTX ( r = -0.465, P<0.001), OC( r = -0.498, P<0.001), PINP( r = -0.511, P<0.001), iPTH ( r = -0.396, P = 0.012), N-MID -OC ( r = -0.323, P = 0.031) and inflammatory factors IL-1β( r = -0.305, P = 0.046), IL-6( r = -0.318, P = 0.041), CRP( r = -0.327, P = 0.034) and TNF-α( r = -0.378, P = 0.024) in hemodialysis patients were negatively correlated, and negatively correlated with abdominal aortic calcification scores ( r = -0.301, P = 0.048). Conclusions:Plasma SOST level in hemodialysis patients is lower, which is negatively correlated with bone turnover markers, inflammatory factors, and calcification scores. Low SOST level can induce vascular calcification by mediating bone metabolism disorders and aggravating the body′s inflammatory response, and increase the risk of hemodialysis vascular calcification.

Calcinose distrófica cutânea na doença venosa crônica de membros inferiores / Dystrophic calcinosis cutis in chronic venous disease of the lower limbs

Resumo As úlceras de membros inferiores, secundárias à doença venosa crônica (DVC), constituem um problema significativo de saúde pública no Brasil e representam cerca de 70% do total dessas úlceras. Apesar dos recentes avanços tecnológicos e das diversas opções terapêuticas utilizadas para essas lesões crônicas, existem diversos fatores que podem estar implicados na resistência ao tratamento. A calcificação distrófica cutânea (CDC) é uma condição rara e frequentemente subdiagnosticada, que, quando associada à DVC, pode estar associada à refratariedade no processo cicatricial. Neste artigo, relatamos um caso de CDC em paciente portador de DVC e discutimos a sua etiologia, fisiopatologia e possíveis opções de tratamento.

Abstract Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Differential diagnosis for an unusual calcification in the maxillary sinus: case report / Diagnóstico diferencial para calcificação incomum em seio maxilar: relato de caso

ABSTRACT The aim of this study was to report a rare case of an asymptomatic calcification of unusual size and shape, inside the maxillary sinus identified on a cone beam computed tomography exam and to discuss the importance of knowledge of the anatomy of maxillary sinus and its changes carefully evaluating the entire volume of the images, regardless of the region of interest. An 83-year-old female patient underwent a cone beam computed tomography exam for other diagnostic purposes in the maxillofacial region. When analyzing the entire volume, an image of unusual limits, hyperdense and calcified was found in the right maxillary sinus, close to the anterior and medial wall, with a rounded and homogeneous shape, occupying approximately one third of the maxillary sinus. There was no lytic or erosive lesions on the maxillary sinus wall. The main diagnostic hypotheses raised were giant anthrolith, mucous retention phenomenon and osteoma. Due to the anatomical complexity of the maxillary sinus, diagnosis in this region becomes a challenge. Considering the limitations of 2D exams, the cone beam computed tomography exam can be used to evaluate these structures. Knowledge of differential hypotheses is extremely important for the case to be conducted correctly, but it does not replace biopsy and histopathological examination.

RESUMO O objetivo desse estudo foi relatar um caso raro de uma calcificação assintomática de tamanho e formato incomum, no interior do seio maxilar, diagnosticado em um exame de tomografia computadorizada de feixe cônico, além de discutir a importância do conhecimento da anatomia do seio maxilar e suas alterações, avaliando cuidadosamente todo o volume das imagens, independentemente da região de interesse. Paciente do sexo feminino, 83 anos de idade, realizou uma tomografia computadorizada de feixe cônico para outros fins de diagnóstico na região bucomaxilofacial. Ao analisar todo volume da tomografia encontrou-se uma imagem de limites incomuns, hiperdensa e calcificada, no seio maxilar direito, próximo a parede anterior e medial, com formato arredondado e homogêneo, ocupando aproximadamente um terço do seio maxilar, com as suas paredes intactas e sem nenhuma lesão lítica ou erosiva. As principais hipóteses diagnosticas levantadas foram antrólito gigante, fenômeno de retenção mucoso e osteoma. Devido a complexidade anatômica do seio maxilar, o diagnóstico nessa região se torna um desafio. Considerando as limitações dos exames 2D, a tomografia computadorizada de feixe cônico pode ser empregada para a avaliação dessas estruturas. O conhecimento do raciocínio diagnóstico e das hipóteses diferenciais são de extrema importância para o que o caso seja conduzido corretamente, porém não substituem a biópsia e o exame histopatológico.

Oral Use of Phenytoin to Reduce Calcification in Bovine Pericardium and Porcine Aortic Leaflets Implants in Rats

Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). Conclusion: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.

Calcinosis Cutis Secondary to Trauma in a Patient with Systemic Lupus Erythematosus and Ovarian Cancer

Summary@#Calcinosis cutis is characterized by the accumulation of insoluble calcium salts in the cutaneous and subcutaneous tissue. This condition is classified into four subtypes of calcification: dystrophic, metastatic, idiopathic and iatrogenic. Here, we describe a case of calcinosis cutis in a patient with systemic lupus erythematosus (SLE) who was recently diagnosed with ovarian cancer. Following total hysterectomy with bilateral salphingo-oophorectomy, she developed a painful erythematous plaque over the anterior aspect of the left forearm which turned into single thin yellowish plaque over the following days. Multiple attempts of intravenous cannulation for intravenous fluids occurred at the site. Skin biopsy revealed calcification in the dermis and subcutaneous fat associated with altered dermal collagen. Von Kossa stain demonstrated the presence of calcium deposition. She responded to topical calcineurin inhibitor which resulted in a complete resolution of the skin lesion.

A family of primary familial brain calcification caused by myogenesis regulating glycosidase gene mutation / 中华神经科杂志

Objective:To analyse the clinical presentation and pathogenic gene mutations of a family diagnosed with primary familial brain calcification (PFBC).Methods:A pedigree with primary familial brain calcification was recruited. The clinical data of the proband who was admitted to the Affiliated Hospital of Guizhou Medical University in March 2020 and the family members were collected. The DNA sequence of myogenesis regulating glycosidase (MYORG) gene was detected by Sanger sequencing in the proband and some available family members.Results:The proband is a male, 30 years old. There was only one patient of PFBC in this family. The first symptom of the proband was vagueness of speech, and gradually extrapyramidal symptoms such as slow and flexible movement and advanced cognitive impairment appeared. The brain CT of the proband and his second brother showed extensive symmetrical calcifications, mainly located in the bilateral cerebellar hemispheres, basal ganglia and thalamus. A homozygous mutation in the exon 2 of the MYORG gene [c.1967T>C(p.I656T)] was identified in the proband and an asymptomatic patient. The heterozygous mutation of MYORG gene was also detected in four healthy family members.Conclusions:All patients with homozygous mutations of MYORG gene showed calcification in CT scan, and most of the lesions were located in basal ganglia, cerebellum, subcortical white matter and thalamus. Compared with the patients with autosomal dominant gene mutation, the patients with MYORG gene mutation had more extensive intracranial calcification lesions, and the pontocerebellar lesions were more common. The most common symptoms of MYORG gene mutation patients were dyskinesia, mainly tremor paralysis and unclear speech.

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report / The Japanese Journal of Rehabilitation Medicine

Shoulder subluxation, a risk factor for hemiplegic shoulder pain, is an important target to treat during stroke rehabilitation. Calcific tendinitis is an idiopathic condition characterized by calcium deposition over fibrocartilaginous tenocyte metaplasia that inhibits the efficacy of occupational therapy for the treatment of stroke. To provide comprehensive occupational therapy, we provided repetitive facilitative exercise under continuous neuromuscular electrical stimulation and robot-assisted training, while controlling pain, for fourteen weeks in a case of convalescent post-stroke hemiplegia with rotator cuff calcific tendinopathy and shoulder subluxation. As a result, this comprehensive occupational therapy not only improved upper-extremity function and the ability to manipulate objects, but also reduced calcified deposits. Shoulder subluxation with calcifying tendinitis is rare. There is a possibility that calcified deposits below the acromion may push down the humeral head. Sufficient rest and non-steroidal anti-inflammatory drugs during the acute inflammatory stage may be helpful for the melting and resorption of calcified deposits. In addition, the appropriate and comprehensive occupational therapy may contribute to the effects of upper-extremity hemiplegia with calcific tendinitis and shoulder subluxation.

Research progress in genetic susceptibility genes and related pathogenic factors and treatment of neoplastic calcinosis / 国际生物医学工程杂志

Tumor calcinosis(TC) has different clinical and biochemical patterns. The existence of chronic injury as well as calcium and phosphorus metabolism disorder has been gradually proved to be the important link in the occurrence of TC. In this paper, the related basic diseases with the pathophysiological mechanism of calcium and phosphorus metabolism disorder were reviewed, and the pathophysiological mechanism of phosphate metabolism disorder in various diseases was summarized.In addition, the phosphate homeostasis genes including GALNT-3, FGF-23 and α-KLOTHO were described. The relevant research results have showed that mutations in any of these three genes will lead to defects in the synthesis or action of FGF-23, which will increase the reabsorption of phosphate by renal tubules, resulting in hyperphosphatemia and severe ectopic calcification of soft tissue.At present, surgical resection is still the main treatment of TC. New technologies such as cinalcet peritoneal dialysis, ultrasound-guided aspiration of TC lesions and local injection of sodium thiosulfate (STS), as well as the successful application of lanthanum carbonate and other drugs, provide alternatives to TC treatment.In this paper, the research literatures on TC at home and abroad in recent years were introduced and the genetic susceptibility genes, related pathogenic factors and the latest treatment progress of TC were reviewed.