ABSTRACT
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.
Subject(s)
Humans , Male , Aged , Venous Insufficiency , Calcinosis/therapy , Lower Extremity/blood supply , Leg Ulcer/therapy , Wound Healing , Calcinosis/physiopathology , Chronic Disease , Leg Ulcer/physiopathologyABSTRACT
Abstract Introduction: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. Methods: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. Results: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). Conclusion: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thromboembolism/etiology , Calcinosis/complications , Heart Valve Diseases/complications , Mitral Valve/physiopathology , Atrial Fibrillation/physiopathology , Stroke Volume/physiology , Thromboembolism/physiopathology , Calcinosis/physiopathology , Echocardiography , Logistic Models , Prospective Studies , Risk Factors , Sensitivity and Specificity , Statistics, Nonparametric , Risk Assessment/methods , Metabolic Syndrome/complications , Metabolic Syndrome/physiopathology , Heart Valve Diseases/physiopathologyABSTRACT
A calcinose escrotal idiopática é uma entidade rara, benigna. Não costuma ter outros sintomas associados. O caso reportado se trata de um paciente de 30 anos com diversos nódulos calcificados em bolsa escrotal, com 15 anos de evolução. Como medida terapêutica, foi realizada excisão cirúrgica completa dos nódulos, apresentando boa evolução cirúrgica e resultados estético e funcional satisfatórios.
Idiopathic scrotal calcinosis is a rare benign entity. Patients affected by scrotal calcinosis usually do not have other associated symptoms. We report the case of a 30-yearold man with several calcified nodules in the scrotal sac with onset at age 15 years. A complete surgical excision of the nodules was performed, and the patient recovered well with satisfactory aesthetic and functional results.
Subject(s)
Humans , Female , Adult , Pathology, Surgical/methods , Scrotum/surgery , Scrotum/physiopathology , Calcinosis/surgery , Calcinosis/physiopathology , Plastic Surgery Procedures/methodsSubject(s)
Female , Humans , Middle Aged , Aortic Valve Stenosis/pathology , Aortic Valve Stenosis/surgery , Aortic Valve/pathology , Calcinosis/pathology , Calcinosis/surgery , Heart Valve Prosthesis Implantation , Lupus Erythematosus, Systemic/pathology , Aortic Valve Stenosis/etiology , Aortic Valve Stenosis/physiopathology , Aortic Valve/physiopathology , Aortic Valve/surgery , Calcinosis/etiology , Calcinosis/physiopathology , Echocardiography , Fatal Outcome , Fever/etiology , Heart Failure/etiology , Heart Failure/pathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/physiopathology , Risk FactorsABSTRACT
The aim of this study is to report the case of a patient with Fahr's Disease in order to describe the main stomatognathic and vocal changes that can be found in individuals with this disease. In order to establish the diagnosis, an assessment of the conditions of orofacial motor system and speech production, as well the efficiency of swallowing, was realized. Based on these assessments, there were difficulties in coordinating and sustaining muscle during speech and presence of oropharyngeal dysphagia. Speech disorders found in Fahr's disease manifest themselves in complex and cover various aspects of phonological knowledge and the diseases that affect the basal ganglia have similar frames of speech-language disorders of the stomatognathic system, being able to present a picture of dysarthria.
O objetivo deste estudo consiste em relatar o caso de uma paciente com Doença de Fahr buscando descrever as principais alterações estomatognáticas e vocais que podem ser encontradas em indivíduos com essa doença. A fim de estabelecer o diagnóstico fonoaudiológico, foi realizada avaliação das condições motoras orofaciais e produção da fala, além de eficiência da deglutição. Com base nessas avaliações, observaram-se dificuldades na coordenação e na sustentação muscular durante a fala e presença de disfagia orofaríngea. Os achados fonoaudiológicos na Doença de Fahr manifestam-se de forma complexa, incluindo disfagias e disartria e as doenças que acometem os núcleos da base apresentam quadros semelhantes de alterações fonoaudiológicas do sistema estomatognático, podendo apresentar quadro de disartria.
Subject(s)
Aged , Female , Humans , Basal Ganglia Diseases/complications , Calcinosis/complications , Deglutition Disorders/etiology , Neurodegenerative Diseases/complications , Speech Disorders/etiology , Stomatognathic System/physiopathology , Basal Ganglia Diseases/physiopathology , Calcinosis/physiopathology , Neurodegenerative Diseases/physiopathology , Voice QualityABSTRACT
INTRODUÇÃO: As biopróteses valvares cardíacas estão relacionadas a eventos tromboembólicos, infecciosos e degenerativos. Seu desgaste é atribuído principalmente à desnaturação do colágeno. O glutaraldeído, método predominante de preservação de biopróteses, favorece o processo de calcificação e limita sua durabilidade. Diversas técnicas tentam conter o processo degenerativo das biopróteses. OBJETIVO: Avaliar o processo de calcificação, in vivo, de heteroenxertos pulmonares valvados, preservados em meio não-aldeídico (L-Hydro®). MÉTODOS: Dezessete carneiros foram submetidos à substituição do tronco da artéria pulmonar por enxerto tubular valvado de pericárdio bovino. Os animais foram distribuídos em dois grupos: Grupo L-Hydro® (teste / n=14) e Grupo Glutaraldeído (controle /n=3). Cerca de 150 dias pós-implante os animais foram sacrificados, necropsiados e as próteses submetidas a estudo anatomopatológico, avaliação radiológica e dosagem do cálcio por espectrofotometria de absorção atômica. A análise estatística foi obtida por meio dos testes exato de Fisher, T de Student ou Mann-Whitney (significância: 5%). RESULTADOS: A avaliação radiológica, macroscopia, microscopia e dosagem de cálcio por espectrofotometria de absorção atômica demonstraram maior calcificação nas próteses do Grupo Glutaraldeído, quando comparadas às próteses do Grupo L-Hydro® (P=0,001). Sete animais do Grupo L-Hydro® (50%) apresentaram aderência das cúspides à parede do tubo (P=0,228). CONCLUSÕES: As próteses preservadas em L-Hydro® demonstraram-se mais resistentes à calcificação, quando comparadas às preservadas em glutaraldeído.
INTRODUCTION: The cardiac bioprostheses are related to thromboembolic events, infectious and degenerative diseases. Wear is mainly attributed to the denaturation of collagen. Glutaraldehyde, the predominant method of preservation of bioprostheses, favors the calcification process and limits their durability. Several techniques try to contain the degenerative process of bioprostheses. OBJECTIVES: To evaluate the process of calcification in vivo pulmonary valve heterografts preserved in non-aldehydic (L-Hydro®). METHODS: Seventeen sheep underwent replacement of the pulmonary artery valved tubular grafts of bovine pericardium. The animals were divided into two groups: Group L-Hydro® (test / n = 14) and Group Glutaraldehyde (control / n = 3). About 150 days after implantation the animals were sacrificed, necropsied and implants subjected to a pathological study, radiological evaluation and measurement of calcium by atomic absorption spectrophotometry. Statistical analysis was obtained through the Fisher's exact test, Student's t or Mann-Whitney test (significance: 5%). RESULTS: The radiological evaluation, the macroscopic and microscopic measurement of serum calcium by atomic absorption spectrophotometry showed increased calcification of the prosthetic group Glutaraldehyde, when compared to denture-HydroR Group L (P = 0.001). Seven animals in Group L-Hydro® (50%) had adherence of the leaflets to the wall of the tube (P = 0.228). CONCLUSIONS: Prostheses preserved in L-Hydro® were more resistant to calcification when compared with glutaraldehyde preserved.
Subject(s)
Animals , Bioprosthesis , Calcinosis/physiopathology , Glutaral , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/methods , Pulmonary Artery/surgery , Pulmonary Valve/surgery , Calcinosis/pathology , Calcium/blood , Prosthesis Design , Prosthesis Failure , Pulmonary Artery/pathology , Pulmonary Artery , Sheep , Spectrophotometry, Atomic , Time FactorsABSTRACT
OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, contraindicando o procedimento. O implante minimamente invasivo transcateter de valva aórtica parece ser alternativa, reduzindo a morbimortalidade. A avaliação dos resultados clínicos, segurança e eficácia do procedimento são o objetivo desse estudo. MÉTODOS: Uma prótese transcateter, balão expansível foi utilizada em 33 casos de alto risco. EuroScore médio foi de 39,30% e STS score de 30,28%. Oito pacientes apresentavam disfunção de bioprótese e o restante, estenose aórtica calcificada. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Através de minitoracotomia esquerda, as próteses foram implantadas pelo ápice ventricular, sob estimulação de alta frequência ou choque hemorrágico. Foram realizados controles clínicos e ecocardiográficos. RESULTADOS: A correta liberação da prótese foi possível em 30 casos. Três conversões ocorreram. A mortalidade operatória foi de um caso e a mortalidade em 30 dias, 18,18%. O gradiente médio reduziu de 43,58 para 10,54 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual esteve presente em 30,30% dos pacientes. Ocorreu uma complicação vascular periférica e um caso de bloqueio atrioventricular total. Um paciente apresentou acidente vascular cerebral. A mortalidade em 30 dias foi de 18,18%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é procedimento seguro e com resultados de médio prazo satisfatórios. São necessários estudos de longo prazo com maior poder amostral no intuito de determinar resultado hemodinâmico, qualidade de vida e sobrevida em longo prazo.
OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Calcinosis/surgery , Cardiac Catheterization/adverse effects , Heart Valve Prosthesis Implantation/methods , Aortic Valve Stenosis/physiopathology , Brazil , Calcinosis/physiopathology , Feasibility Studies , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/mortality , Kaplan-Meier Estimate , Risk Assessment/methods , Treatment OutcomeABSTRACT
Cardiovascular disease is a frequent complication of renal failure and is the most common cause of death in patients with chronic kidney disease (CKD). Accelerated atherogenesis has been widely documented in CKD and diabetic nephropathy is the leading cause of renal failure worldwide. Furthermore, CKD promotes hypertension and dyslipidemia, which in turn may contribute to the progression of renal failure. All together, hypertension, dyslipidemia and diabetes are considered major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Elevated inflammatory mediators and activation of the renin-angiotensin system contribute through enhanced production of reactive oxygen species, to atherogenesis in CKD. Vascular calcification is also important. Calcification of arteries occurs in the intima in association with atherosclerosis, where it may contribute to plaque formation, and in the media, where it causes stiffening. Increased serum levels of calcification promoters, such as hyperphosphatemia, and a decrease in circulating and local inhibitors of calcification, favor vascular calcification. On the other hand, transdifferentiation of vascular smooth muscle cells to osteblast-like cells would be the pivotal event in calcification. Bone morphogenetic protein agonists and antagonists are playing a role in this osteogenic differentiation. Accelerated atherosclerosis and media calcification will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with CKD.
Subject(s)
Humans , Cardiovascular Diseases/etiology , Kidney Failure, Chronic/complications , Calcinosis/etiology , Calcinosis/physiopathology , Cardiovascular Diseases/physiopathology , Endothelium, Vascular/physiopathology , Kidney Failure, Chronic/physiopathology , Risk FactorsABSTRACT
Osteoporosis and atherosclerosis are chronic degenerative diseases which have been considered to be independent and whose common characteristic is increasing incidence with age. At present, growing evidence indicates the existence of a correlation between cardiovascular disease and osteoporosis, irrespective of age. The morbidity and mortality of osteoporosis is mainly related to the occurrence of fractures. Atherosclerosis shows a high rate of morbidity and especially mortality because of its clinical repercussions such as angina pectoris, acute myocardial infarction, stroke, and peripheral vascular insufficiency. Atherosclerotic disease is characterized by the accumulation of lipid material in the arterial wall resulting from autoimmune and inflammatory mechanisms. More than 90 percent of these fatty plaques undergo calcification. The correlation between osteoporosis and atherosclerosis is being established by studies of the underlying physiopathological mechanisms, which seem to coincide in many biochemical pathways, and of the risk factors for vascular disease, which have also been associated with a higher incidence of low-bone mineral density. In addition, there is evidence indicating an action of antiresorptive drugs on the reduction of cardiovascular risks and the effect of statins, antihypertensives and insulin on bone mass increase. The mechanism of arterial calcification resembles the process of osteogenesis, involving various cells, proteins and cytokines that lead to tissue mineralization. The authors review the factors responsible for atherosclerotic disease that correlate with low-bone mineral density.
Subject(s)
Animals , Humans , Atherosclerosis/physiopathology , Calcinosis/physiopathology , Osteoporosis/physiopathology , Atherosclerosis/complications , Atherosclerosis/metabolism , Bone Density , Bone and Bones/metabolism , Calcinosis/complications , Calcinosis/metabolism , Cardiovascular Diseases/etiology , Osteoporosis/complications , Osteoporosis/metabolism , Risk FactorsABSTRACT
BACKGROUND: Fahr's disease (basal ganglia calcification) is characterized by bi hemispherical calcium deposition in basal ganglia, dentate nucleus and semioval center. Its clinical manifestations are a rigid hypokinetic syndrome, mood disorders and cognitive impairment. AIM: To report to the results of a neurological assessment of three siblings with Fahr disease. PATIENTS AND METHODS: Three sisters, aged 55, 56 and 58 years, were studied. All had a rigid hypokinetic clinical picture associated with cerebellar involvement and a cognitive impairment that progressed in 8, 6 and 10 years respectively. Brain CAT scans showed symmetric and extensive calcifications of cerebellar white matter and dentate nuclei, pons, mesencephalon, lenticular nuclei, thalami and semioval centers. Hypoparathyroidism was ruled out. Cognition was assessed with WAIS and Benton tests and Weschler memory scale. The time of reaction to visual stimuli was studied. The processing speed of visual information and the interhemispheric conduction time of such information, were calculated. Cognitive evoked potentials (P 300) were also studied. RESULTS: Cognitive impairment involved verbal and visual-spatial memory, planning, attention and concentration capacities and visual constructive skills. There was a prolongation of reaction time latencies and loss of the normal asymmetry of interhemispheric transmission (without right to left facilitation). P 300 evoked potentials were absent. CONCLUSIONS: These observations suggest that the pathogenesis of cognitive and motor changes in Fahr's disease is based in a dysfunction of cortico basal connections and their interhemispheric relations. This defines a subcortical dementia secondary to mineral deposits in subcortical structures.
Subject(s)
Humans , Female , Middle Aged , Calcinosis/complications , Dementia/etiology , Basal Ganglia Diseases/complications , Hypokinesia/etiology , Cognition Disorders/etiology , Calcinosis/physiopathology , Calcinosis , Dementia , Basal Ganglia Diseases/physiopathology , Basal Ganglia Diseases , Time Factors , Hypokinesia , Siblings , Evoked Potentials, Visual , Tomography, X-Ray Computed , Cognition DisordersABSTRACT
Tres pacientes jóvenes con podagra presentaron caracteríticas clínicas, de laboratorio y radiológicas de inflamación por sales básicas de calcio. Dos eran mujeres. En dos casos se practicaron exámenes de laboratorio y en ambos los niveles de ácido úrico fueron normales. En los tres sujetos, las radiografías mostraron depósitos calcáreos amorfos en el área de inflamación. En uno de los pacientes el material aspirado consistió de grumos amorfos sin cristales de urato monosódico o pirofosfato de calcio. Los casos se analizan en el contexto del diagnóstico diferencial de la podagra
Subject(s)
Humans , Male , Female , Adult , Toe Joint/physiopathology , Toe Joint/pathology , Calcaneus , Calcinosis/diagnosis , Calcinosis/physiopathology , Calcium Phosphates , Diagnosis, Differential , Gout/diagnosisABSTRACT
Se presenta un paciente de 68 años, de sexo masculino, con extensas calcificaciones subcutáneas en miembros inferiores, secundarias e insuficiencia venosa crónica. Se analizan los factores fisiopatogénicos, aspectos radiológicos y tratamiento
Subject(s)
Humans , Male , Aged , Calcinosis , Venous Insufficiency/complications , Arteries/pathology , Calcinosis , Calcinosis/diagnosis , Calcinosis/physiopathologyABSTRACT
Se describe el caso de una paciente femenina de 65 años de edad, en quien se realizó angioplastía percutánea, con balón, de la vena cava inferior. La paciente tenía calcificación extensa de aurícula derecha, anillo y válvula tricúspide, lo que producía estenosis de la misma. Estaba involucrada la vena cava inferior con obstrucción. Como único factor predisponente a dicha calcificación, es una derivación ventrículo-atrial por cisticercosis cerebral por un periodo prolongado de tiempo (32 años). Se había realizado valvuloplastía tricuspídea percutánea 2 años y medio previamente, con éxito. Se realizó dilatación con balón obteniendo mejoría angiográfica significativa en la obstrucción. Se describe la técnica utilizada, se hace énfasis en lo poco frecuente de esta patología, así como en algunos eventos que sucedieron después de la dilatación. Concluimos que la angioplastía con balón puede ser una alternativa más, a la cirugía convencional en obstrucciones de la vena cava inferior
Subject(s)
Aged , Humans , Female , Angioplasty, Balloon/methods , Angioplasty, Balloon/rehabilitation , Calcinosis/physiopathology , Calcinosis/therapy , Tricuspid Valve Stenosis/diagnosis , Tricuspid Valve Stenosis/therapy , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Vena Cava, Inferior/physiopathologyABSTRACT
Se comunica un caso de calcinosis cutis en una paciente del sexo femenino, de 44 años de edad, hipertensa, con insuficiencia renal crónica de 3 años de evolución e hiperparatiroidismo secundario. Clínicamente presentó placas duro-pétreas en ambos miembros inferiores, algunas con úlceras dolorosas en su centro, de evolución tórpida. El estudio histopatológico con técnicas específicas reveló la presencia de calcio en vasos dérmicos y en hipodermis. Se efectuó el tratamiento local de las úlceras, obteniéndose una buena granulación de las mismas. Finalmente, la paciente fallece debido a descompensación del cuadro de insuficiencia renal. La baja frecuencia de esta entidad y su difícil tratamiento motivan esta presentación
Subject(s)
Humans , Female , Adult , Calcinosis/diagnosis , Calciphylaxis/physiopathology , Renal Insufficiency, Chronic/complications , Calcinosis/classification , Calcinosis/physiopathology , Calciphylaxis/complications , Calciphylaxis/diagnosis , Skin ManifestationsABSTRACT
La calcificación metastática ocurre frecuentemente en paciente con insuficiencia renal crónica en hemodiálisis de mantenimiento (HN). Existe dos variedades de la misma: a) calcificación visceral: pulmón, corazón, riñones, cerebro; b) calcificación no visceral: 1-arteria, ojo, piel; 2-tumoral: articular, periarticular y tejido subcutáneo. Referimos el caso de una paciente en quien se observó la infrecuente asociación de ambos tipos de calcificación. Se presentan la evolución radiológica y las tomografías computadas que se efectuaron para realizar el diagnóstico y diagnósticos diferenciales y los datos clínicos que acompañaron esas manifestaciones. Sobre la base de este caso clínico se realizan los mecanismos fisiopatogénicos de la calcificación visceral y no visceral. Se destaca la progresiva evolución del hiperparatiroidismo secundario como responsable del aumento del producto fosfocálcico en una paciente que no cumplía con la medicación instituída, lo que motivó la progresión de las calcificaciones no viscerales. Se sugiere como posible tratamiento el control de los niveles de fosfatemia a fin de disminuir el depósito de sales de calcio y sus complicaciones en el área no visceral y la necesidad de tener en cuenta a la calcificación visceral en el diagnóstico diferencial de la enfermedad cardíaca o respiratoria del paciente en HM
Subject(s)
Humans , Female , Middle Aged , Calcinosis/physiopathology , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/complications , Calcinosis/prevention & control , Calcinosis , Calcium Metabolism Disorders/physiopathology , Calcium Phosphates/metabolism , Calcium/blood , Aluminum/adverse effects , Aluminum/therapeutic use , Hypercalcemia/complications , Phosphorus/blood , Phosphorus Metabolism Disorders/physiopathologyABSTRACT
O presente trabalho relata um caso de microlitíase alveolar d eum paciente do sexo feminino, 23 anos de idade, com história de tosse seca e dispnéia havia seis meses. A radiografia de tórax revelava micronodulaçäo fina, afetando difusamente ambos os pulmöes. O exame anatomopatológico da biópsia pulmonar mostrou numerosas concreçöes clacificadas laminadas (calcosferitos) preenchendo os espaços alveolares, sendo realizado diagnóstico de microlitíase alveolar. A etiologia e a patogênese desta rara entidade säo discutidas
Subject(s)
Adult , Humans , Female , Calcinosis/physiopathology , Lung Diseases/diagnosis , Lung/pathology , Pulmonary Alveoli/pathology , Radiography, Thoracic/methods , Biopsy , Bronchoscopy , Pneumothorax/etiology , Pulmonary Fibrosis/etiologyABSTRACT
Estudiamos 8 niños con dermatomiositis con el objeto de detectar las anormalidades inmunológicas relacionadas al padecimiento. Las inmunoglobulinas séridas IgG, IgM e IgA, fueron determinadas por nefelometría, resultando normales en todos los casos, excepto en 2 enfermos, en quienes se notó un ligero incremento sin relación con la fase de actividad de la enfermedad. Sólo un paciente tuvo descenso de C4 asocaido a miopatía activa, pero no con vasculitis. No detectamos hipogamaglobulinemia y la prueba de VDRL fue negativa en todos los niños. El factor reumatoide fue positivo en 4 casos con títulos menores de 1:80 por la técnica de Waaler Rose. Los anticuerpos antinucleares por inmunofluorescencia indirecta estuvieron presentes en 5 niños, predominando el patrón moteado, resultados que no tuvieron relación con la exacerbación del padecimiento. No hubo anticuerpos anti-DNAn, o contra antígenos nucleares extraibles. Los anticuerpos anti-Jo-1, Mi-1 y Mi-2 fueron negativos. Los anticuerpos anti-toxoplasma de la clase IgG por la prueba de inmunofluorescencia indirecta estuvieron presentes en 7 pacientes. En ningún caso de encontró historia de toxoplasmosis ni datos de este padecimiento al momento del estudio o durante el seguimiento. Los anticuerpos anti-músculo liso fueron positivos en un caso. Ninguna de estas anormalidades mostró correlación con la actividad del padecimiento.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Male , Female , Antibodies, Antinuclear/immunology , Connective Tissue/immunology , Dermatomyositis/etiology , Dermatomyositis/immunology , Calcinosis/physiopathology , Electrocardiography , Enzyme-Linked Immunosorbent Assay , Serologic TestsABSTRACT
Se presenta el primer caso de calcinosis tumoral, descrito en la literatura actual. Se trata de una entidad tumoral calcificante de los tejidos blandos, posiblemente producida por una anormalidad congenita en el efecto fosfaturico de la parathormona. Bioquimicamente se caracteriza por niveles normales de calcio y parathormona y tendencia elevada del fosforo. Tiene cuadro radiologico e histologico caracteristicos. Su tratamiento seria con quelantes del fosforo como el hidroxido de aluminio. La cirugia tiene un papel paliativo al resecar masas incapacitantes y dolorosas. Es una entidad con una frecuencia muy baja; solo se han descrito 150 casos en la literatura.
Subject(s)
Adult , Humans , Male , Calcinosis , Calcinosis/physiopathology , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/etiology , Soft Tissue Neoplasms/therapy , Calcium/metabolism , Colombia , Phosphorus/metabolismABSTRACT
Con el fin de evaluar los hallazgos ecocardiográficos en pacientes con calcificación del anillo mitral (CAM) (Fig 1) se estudiaron los ecocardiogramas en modo M de 57 pacientes con diagnóstico de CAM por ese método. Para evaluar la prevalencia en ambos sexos se consideró un grupo de 100 pacientes consecutivos mayores de 50 años derivados para estudio ecocardiográfico. Las mediciones ecocardiográficas se compararon con las de 100 ecocardiogramas normales correspondientes a pacientes de sexo y edad similar. La CAM aislada (CAMA) se presentó más frecuentemente en mujeres que en varones (p <0,01). La CAMA se observó a edad más temprana que la CAM asociada a esclerosis valvular aórtica (EVA) o insuficiencia aórtica (IA) en el sexo femenino (p < 0,01). La edad de pacientes varones con CAMA, CAM e IA, y CAM y EVA fue menor que la de las mujeres, siendo la diferencia estadísticamente significativa en el último caso (p < 0,01). La CAM se presentó en forma aislado en 28% de los casos y asociada a EVA en 47%, a IA en 19%, a estenosis aórtica (EA) en 47% y a enfermedad aórtica (Enf A) en 2%. Las medias del diámetro diastólico del ventrículo izquierdo (DDVI) y de la aurícula izquierda (AI) fueron mayores en los grupos con CAMA, CAM y EVA y CAM e IA en comparación con el grupo control en ambos sexos (p < 0,05). El septum interventricular en diástole (SIVD) fue superior en la CAMA, CAM y EVA, y CAM e IA en comparación con el grupo control pero la diferencia fue estadísticamente significativa sólo en el sexo femenino (p < 0,05). Se hallaron las siguientes alteraciones individuales: aumento de la AI 40%, disminución de la fracción de acortamiento 30%, aumento del DDVI 30%, del SIVD 30%, de la pared posterior en diástole 16% y del ventrículo derecho 4%. Estas alteraciones fueron más frecuentes en los pacientes con CAM asociada a EVA, IA, EA o Enf A que en CAMA