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PubMed1990

[Progression to ischemic heart disease in subjects with coronary calcification as evaluated by computed tomography].

It is well known that coronary artery calcification develops in patients with advanced coronary sclerosis. Currently, it can be easily detected by computed tomography (CT). We studied the correlation of CT-detected coronary calcification with its progression to myocardial infarction, and further with the prognosis in various patients who did not have symptoms suggesting ischemic heart disease. The subjects consisted of 241 patients (136 males, 105 females) with a mean age of 61 years, categorized as a calcified coronary artery group (82 patients) and a non-calcified coronary artery group (159 patients). In all the subjects nonenhanced serial cardiac-CT scans were performed with a GECT/T 9800 for detecting coronary calcification. The mean follow-up period was four years in both groups. Among the 82 patients with coronary calcification, four developed myocardial infarction (4.9%) and 14 patients died (17%). Among the 159 patients without coronary calcification, none progressed to myocardial infarction, but 17 patients died unrelatedly (11%). Although there was no significant difference in mortality between the two groups, there was a statistical significance (p less than 0.005) as to the incidence of progression to myocardial infarction. In males, there was no significant difference (13 vs 12%) in mortality between the two groups, but the calcified group had a higher incidence of progression to myocardial infarction than that of the non-calcified group (5.5 vs 0%). In females, the calcified group had higher mortality (26 vs 8.9%) and a more frequent incidence of myocardial infarction (3.7 vs 0%) than did the non-calcified group. In conclusion, patients with coronary artery calcification are likely to develop coronary artery disease rather rapidly, even though asymptomatic. Therefore, detection of coronary calcification by non-enhanced CT is helpful for estimating the prognosis of coronary artery disease.

Calcinosis↗
PubMed1989

[Intervertebral disk calcification in children].

Thirty one intervertebral space calcifications (I.S.C.) were studied in 21 children (12 boys, 9 girls), with mean age of 7 years; 25 calcifications had been followed for an average of 71.5 months. The main symptom was pain (Crisis) which relieved in a delay of 1 month in 70 per cent of cases. "Crisis" and radiographic fragmentation of the calcification are both criteria of going out of 18 calcifications, in a delay ranged from 28 days to 6 months. The calcification appears as a sign which disclose a general disease of spine, interesting vertebral body, growth plate, and disc; therefore we have observed 15 lesions due to growth disorders in 16 cervical I.S.C., at dorsal level we have described 4 cases of intrasomatic cavitation containing calcified material, opened in the intervertebral space. This growth disturbance has been noted either on first radiograph, or has appeared later, after disappearance of the I.S.C.; we found more over absence of listel and lesion of multiple plates distant from the calcification. This disease is identified to vertebral osteochondrosis where residual deformities are more worrying than the benign calcification; they have concluded management of I.S.C. as early as possible to avoid great deformities of vertebral bodies.

Adolescent↗
PubMedDate not supplied

The incidence and significance of intracytoplasmic calcifications in nipple aspirate specimens.

Intracytoplasmic deposits demonstrated to be calcifications have been identified in nipple aspirates from 3.6 per cent of breasts with satisfactory cytology. The deposits occurred almost exclusively in epithelial groups, and their structure ranged from dust-like particles and spiculated forms to psammoma bodies; all exhibited characteristic density, refractility and well-defined, irregular borders. Nipple aspirates containing calcifications were typically characterized by the presence of numerous epithelial groups, frequently of papillary type. This association was supported histologically by the fact that 11 of the 14 available tissue specimens contained papillary lesions in the duct system, including three with papillary carcinoma in situ. Cytologic abnormality was significantly associated with the presence of calcifications, and marked cellular changes were found four times as often in this group as in the total population with satisfactory cytology. Calcific deposits were found in six of the fourteen available tissue specimens, four of which contained breast carcinoma. Calcifications were noted in only 23 per cent of 97 available mammograms, but further investigation has revealed other significant radiologic findings. Cytologic calcifications were found most frequently in aspirates from women between the ages of 41 and 60 and were often associated with clinical findings of breast disease. Preliminary findings indicate an increased prevalence of breast carcinoma in patients with cytologic calcifications and suggest that such patients may require closer than normal follow-up.

Adult↗
PubMed1987

[Calcifications in leukokorias: ultrasonic study].

We have performed an ultrasound study of 46 eyes with Leucocoria. The results obtained demonstrate that 20 eyes (43.5%) were affected by retinoblastoma. Of these, 17 eyes (85%) showed calcifications and 3 eyes (15%) did not show calcifications. In the remaining 26 eyes, in 6 cases there were intraocular calcifications, and in two of these the calcifications were found within the pathological intraocular mass showing retinoblastoma. The eyes with intraocular calcifications were diagnosed as: uveitis, retrolental fibroplasia, Coats disease, retinal dysplasia. Because of these, we conclude that, although the existence of calcifications is a meaningful datum, there are uncalcified retinoblastomas and calcifications in entities other than retinoblastoma.

Calcinosis↗
PubMed1985

Onset and progression of experimental bioprosthetic heart valve calcification.

Calcification, the major cause of bioprosthetic heart valve failures, is a serious clinical problem with uncertain pathogenesis. The objectives of the present study were to define the progressive chemical and morphologic sequence of mineralization in glutaraldehyde-treated porcine aortic valve cusps implanted subcutaneously in rats and to compare the pathology and pathophysiology of calcification in subcutaneous implants with that of orthotopic valve replacements in calves. Cusps were implanted subcutaneously in 3-week-old rats for 24 hours to 18 weeks. Cuspal calcium was 114 +/- 18 micrograms/mg of dry weight (mean +/- SEM) at day 21 and 218 +/- 6 at day 56 of implantation and unchanged thereafter. The earliest mineral deposits, noted at 48 hours, were associated with devitalized porcine connective tissue cells, but by 7 days, mineral deposits also involved collagen bundles. Scanning electron microscopy with energy-dispersive x-ray analysis demonstrated predominant accumulation in the spongiosa with a spongiosa to fibrosa energy-dispersive x-ray analysis count ratio of calcium of 15 at 21 days. In stent-mounted glutaraldehyde-preserved porcine valves implanted in five calves as mitral replacements for 69 to 142 days, cuspal calcium was 86 micrograms/mg (mean) (range 47 to 128). Calf implants also had cell oriented and collagen calcification predominating in the valvar spongiosa. In both rat subcutaneous and calf mitral valve models, early diffuse calcific microcrystals evolved into confluent nodules that disrupted tissue architecture. It is concluded that calcification of glutaraldehyde-preserved porcine aortic valves implanted subcutaneously in rats begins within 48 hours, earliest deposits are localized to residual porcine connective tissue cells, but latter deposits also involve collagen fibrils, mineralization is most prominent in the spongiosa, the pathology of calcification in rat subcutaneous implants and calf mitral replacements is comparable, suggesting a common pathophysiology, and calcific nodule formation most likely initiates clinical features.

Animals↗
PubMedDate not supplied

A review of soft tissue calcifications.

The deposition of calcium and phosphorous salts in the soft tissues can be classified into three categories: metastatic calcification, dystrophic calcification, and calcinosis. Metastatic calcification occurs when the calcium-phosphorous levels are elevated. The calcifications involve normal tissues. Associated disease include hyperparathyroidism, neoplasms, milk-alkali syndrome, hypervitaminosis D, and tumoral calcinosis. Dystrophic calcification occurs in the presence of normal metabolism in damaged or devitalized tissues. Disorders included in this classification are: Ehlers-Danlos syndrome, pseudoxanthoma elasticum, arteriosclerosis obliterans, venous calcifications, crystal deposition disorders, and calcification resulting from neurologic disorders. Calcinosis is also found in persons with normal metabolism. It occurs most often in subcutaneous tissues, skin, and related connective tissues. Associated disorders include: calcinosis universalis, calcinosis circumscripta, scleroderma, dermatomyositis, and systemic lupus erythematosus.

Arteriosclerosis↗
PubMed1977

Mitral annular calcification. Clinical and echocardiographic correlations.

Clinical, echocardiographic, and radiographic findings in 41 patients with mital annular calcification are presented. Clinical diagnosis included rheumatic heart disease (32%), noninflammatory calcific disease (34%), and chronic renal failure (32%). Mitral annular calcification is recognized echocardiographically as a dense echo band beneath the posterior mitral leaflet with motion paralleling that of the free left ventricular wall. Only two patients of 41 (5%) with mitral annular calcification had calcification on routine x-ray films, and six of 16 (38%) on cinefluoroscopy. The left atrial size is enlarged, and the mitral leaflets are thickened, with reduced motion (D-E) in rheumatic heart disease, but the leaflet motion is well preserved in the nonrheumatic patients. The association of mitral annular calcification with idiopathic hypertrophic subaortic stenosis, chronic renal failure, and bacterial endocarditis is discussed. Echocardiography appears to be a sensitive method of detecting mitral annular calcification and may be helpful in differentiating rheumatic and nonrheumatic etiologies.

Adult↗
PubMed1982

[Metacarpophalangeal calcifications in diffuse chondrocalcinosis. Radiologic study of ten cases (author's transl)].

The authors report ten cases of metacarpophalangeal calcifications in chondrocalcinosis. These calcifications are associated with a calcification of the triangular ligament of the wrist in the all cases. Cartilaginous calcifications of the wrist are found in 9 cases. Metacarpophalangeal calcifications concern mostly the third (9 cases) and the second (6 cases) metacarpophalangeal joint. They are present frequently on radial side (29 joints) rarely on cubital side (5 joints) with a calcification on radial and cubital side in 4 joints and a calcification on cubital side only in one joint. Calcic deposit concern almost the synovial and capsule, it is rarely cartilaginous one. The authors discuss the possibility of calcic deposit of the glenoidal fibrocartilage of the metacarpophalangeal joint.

Aged↗
PubMed1984

[Reticulated and necrotic purpura (necrotic angiodermatitis type) due to arterial calcifications in chronic renal insufficiency].

Hyperparathyroidism secondary to chronic renal failure is often accompanied by metastatic calcification with involvement of the skin. The cutaneous lesions appear to be of two types: in the first there was massive calcification of the skin and the subcutaneous tissue; in the second there was necrotic purpura due to intimal proliferation and medial calcification of the cutaneous arterioles. We report the case of a 75-year-old-woman with osteodystrophy who had painful necrotic ulcer and reticulated purpura of the legs (fig. 1 a, b). The new lesions progressed by lateral extension and central necrosis. Biopsy of the skin underlying the purpuric areas revealed intimal proliferation with narrowing of the lumen (fig. 2 a, 3). The most prominent feature was the considerable intimal and internal elastic membrane calcification in several small arteries (fig. 4 a, 5). Von Kossa's stain showed calcium to be present (fig. 2 b, 4 b). There was no calcification of the tunica media. Serum calcium phosphorus product was increased (table I). Tubular reabsorption of phosphate was abnormally low. The serum immunoreactive parathyroid hormone was normal. An iliac crest biopsy revealed the classical lesions of osteodystrophy. Her skin lesions showed spontaneous resolution without parathyroidectomy: the ulcers were healing within two months. A progressive reticulated necrotic purpura has previously been reported in chronic renal failure with secondary hyperparathyroidism. These black ischemic lesions bear a strong resemblance to those accompany atheromatous necrotic angiodermatitis. The metastatic calcification seen in uremia often involves the media; the present case is the first to be reported with intimal calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Cell injury and calcification of rat aorta in vitro.

In order to study the mechanism of dystrophic calcification of vascular connective tissue as a result of cell injury, anoxic incubation and organ culture in CMRL 1066 of fresh and freeze thawed rat aorta and serum incubation of fresh rat aorta were performed. Calcium concentration of the culture medium was adjusted to 2.5mM and phosphate to 0.9mM. Calcium depletion from the culture medium continued for 3 weeks and then plateaued. In every experiment, calcification was seen predominantly in association with the membranous cellular degradation products derived from degenerated smooth muscle cells. These were morphologically similar to the matrix vesicles. In the areas of massive necrosis, particularly in the freeze thawed aortic tissue, massive calcification extending to collagen and elastic fibers was seen. Of the various membranous cellular degradation products, mitochondrial inner membrane also appeared to serve as one of the nidi of calcification. Influx of extracellular Ca2+, which results from suppression of ion pumps upon cell injury, to PO4(3-) rich cytosol is thought to play a pivotal role in dystrophic calcification. Phosphatidyl serine located along the inner surface of the plasma membrane or the membranous vesicle may serve as the substrate for heterogeneous nucleation of apatite. Calcification of the cellular degradation products which was more pronounced in freeze thawed aorta is apparently non-energy dependent. Calcification of the elastic and collagen fibers evidently occurs as an extension from the calcified cellular degradation products.

Animals↗
PubMed1983

Pineal calcification among black patients.

A postmortem histopathological study was done in 233 pineal glands of black patients. Among them, 70 percent showed microscopic evidence of calcification in the pineal parenchyma. The frequency of calcification increased with age. However, the severity of calcification reached the peak in the 60 to 69 year old age group and then gradually declined. As compared to males, females had slightly higher frequency and reached the peak of severity in younger age groups. When pineal calcification was compared among patients with various malignancies, a higher frequency and more severe calcification were observed in patients with carcinoma of the prostate and the pancreas. A lower frequency and less severe calcification were observed in patients with carcinoma of the breast and the cervix. The results of this study emphasize the important role of sex hormone in genesis of pineal calcification.

Adolescent↗
PubMed1983

[Diagnostic significance of brain tumor calcifications in the computerized tomogram].

CT investigations of 783 cases of brain tumors, which were covered by histology, were checked with regard to frequency and configurations of calcifications. As expected the calcifications were detected more frequently by CT than by conventional radiology because of higher resolution. Most frequently calcifications were detected in craniopharyngeomas (72%) and in oligodendrogliomas (51%). The calcifications shown by CT can be changed by variation of technical parameters. Certain patterns of calcifications can be differentiated, if constant and best technical conditions are used. One single pattern cannot be specific. A homogeneous calcification of the tumor as a whole has been observed in meningeomas only. For other brain tumors calcifications are useful for the diagnosis, if localisation, density, and reaction of the surrounding tissue after injection of contrast medium and clinical data are known.

Adenoma↗
PubMed1978

Calcification in cervical arteries in life and at autopsy.

In the clinical part of the study routine neck PA radiographs taken with the mouth open were compared with soft tissue films with the mouth closed for detection of calcification in the carotid arteries. Only 5.5% of 90 hospitalized patients showed foci of calcification in routine films. But foci of calcification were seen in 22% of the soft tissue radiographs of the whole series. In the autopsy part of the study large foci of calcification were found at the carotid bifurcations in 12 out of 20 cadavers by radiography. In an additional five cases contact radiographs also showed smaller foci of calcification. The vascular endothelium over the calcification was often ulcerated. The significance of the large arterial foci of calcification demonstrated in the neck radiographs as a sign of atherosclerosis and as a source of cerebral thromboembolism is discussed.

Adult↗
PubMed1982

Calcifications of cardiac valve bioprostheses. Biochemical, histologic, and ultrastructural observations in a subcutaneous implantation model system.

To study the process of calcification in bioprosthesis, 108 glutaraldehyde-treated porcine aortic valve leaflets were implanted subcutaneously in rabbits and removed 1 day to 6 months later; morphologic findings were correlated with biochemically determined levels of calcium (Ca++) and gamma-carboxyglutamic acid (Gla), a vitamin K-dependent Ca++-binding amino acid known to be present in a variety of tissues with pathological calcification. Gla and Ca++ levels began to increase about 2 months after implantation and increased progressively with time. Ca/Gla molar ratios were comparable to those in leaflets of bioprostheses explanted from patients, 22 to 64 months after implantation. Morphologically evident calcification began at the same time that Gla and Ca++ increases were detected biochemically and also increased in severity with time. Electron microscopy showed that calcification primarily involved the surface of collagen fibrils and the interfibrillar spaces. The biochemical and morphological findings in this experimental system are similar to those described in calcified porcine bioprosthetic valve leaflets removed from patients, but occurred much more rapidly. As with pathological calcification of other tissues, progressive calcification was accompanied by increased Gla levels, suggesting that Gla plays a role in the calcification of the leaflets. This model allows rapid comparative evaluation of large numbers of valve leaflets maintained under similar host conditions.

1-Carboxyglutamic Acid↗
PubMed1982

Renal calcifications: a complication of long-term furosemide therapy in preterm infants.

During the last four years ten premature infants developed renal calcifications while receiving long-term furosemide therapy. The drug was used in infants with present ductus arteriosus and later in the same infants with chronic lung disease. They had received furosemide in a dose of at least 2 mg/kg/day for at least 12 days before calcifications were noted on abdominal roentgenograms. Calcifications included small flecks, isolated stones, staghorn calculi, and nephrocalcinosis. Analysis of stones received from our infants showed calcium oxalate and calcium phosphate. Infants who were not receiving furosemide had no calcifications. The infants with renal calcifications had rates of calcium excretion ten to 20 times that of normal, age-matched premature infants in our nursery. When chlorothiazide was given to the infants, in addition to furosemide, a four- to 15-fold decrease in calcium excretion and a radiologic dissolution of the renal calcifications were documented. It is concluded that furosemide, in doses of at least 2 mg/kg/day for at least 12 days can be associated with renal calcifications. The probable mechanism of the stone formation is hypercalciuria, primarily caused by furosemide.

Ductus Arteriosus, Patent↗
PubMed1982

[A case of nodular calcification of the ligamentum flavum with ossification of the posterior longitudinal ligament in the cervical spine].

A 72-year-old male noted weakness in the right lower extremity in August 1979, and clumsiness of the finger movement in the right hand in April 1980. In June 1980, he became tetraplegic and was unable to stand or walk. He also developed hypesthesia in the four extremities and difficulty in voiding. On admission to this hospital (July 12, 1980), neurological examination showed spastic tetraparesis, more pronounced on the right side. Deep tendon reflexes were markedly increased in the four extremities. Chaddock reflex in the right lower extremity and Trömner reflex in the both upper extremities were elicited. Hypesthesia below the level of C4 was present with anesthesia in the Th9-11 region. Plain film and tomogram of the cervical spine showed ossification of the posterior longitudinal ligament from C3 to C6 and a lobulated nodular calcification in the posterior part of the spinal canal at the level of C4,5 intervertebral space. CT scan revealed nodular calcifications in the ligamentum flavum not only at the level of C4 but also at the level of C6. Laminectomy from C3 to C6 was performed on August 21. The ligamentum flavum with nodular calcifications was removed. His postoperative course was uneventful. Seven weeks postoperatively the patient was able to walk without assistance and had no difficulty in voiding. He was discharged on October 14 with excellent activities of daily life. The content of the nodular calcification was identified as a kind of calcium phosphate by the physico-chemical analysis. Ossification and/or calcification of the ligamentum flavum in the cervical spine is rare, while ossification of the posterior longitudinal ligament is frequently encountered in the cervical spine. Only two cases with nodular calcification of ligamentum flavum in the cervical spine have been reported. To our knowledge, this is the first case of the nodular calcification of the ligamentum flavum in the cervical spine associated with ossification of the posterior longitudinal ligament. Two dimensional analysis by CT scan was very useful in locating the lesion and deciding the operative procedure.

Aged↗
PubMed1994

Onset and progression of calcification in porcine aortic bioprosthetic valves implanted as orthotopic mitral valve replacements in juvenile sheep.

The purpose of this study was to characterize the onset and progression of mineralization in porcine bioprosthetic valves implanted in sheep and to test the hypothesis that such valves simulate calcification that is observed clinically and in other experimental models. Hancock I porcine aortic bioprosthetic valves (Medtronic Heart Valve Division, Irvine, Calif.) were implanted as orthotopic mitral valve replacements in juvenile sheep, retrieved after 1 to 124 days, and analyzed as follows: gross inspection, radiography, light, transmission, and surface scanning electron microscopy, and calcium analysis by absorption spectroscopy. Mineralization increased with increasing time after implantation in both valve cusps and adjacent aortic wall. Mean cuspal calcification was 80 micrograms/mg in valves removed after 3 to 4 months. Nevertheless, considerable variability among valves was apparent in the level of calcification noted at specific time intervals. Virtually all aspects of the morphologic characteristics were identical to those previously noted for clinical explants and experimental specimens, both subcutaneous and circulatory. In particular, ultrastructural examination revealed that the earliest calcific deposits were associated with devitalized cuspal connective tissue cells and their fragments. Collagen calcification was sparse. Both surface scanning and transmission electron microscopy indicated a lack of endothelial or blood-derived cells on the valves at all sampling times. We conclude that porcine bioprosthetic valves implanted as mitral valves in sheep provide a useful calcification model, simulating morphologic and pathobiologic events that occur clinically and in noncirculatory models. However, sufficient specimen replicates must be done to overcome variability in calcification among valves and sampling sites.

Animals↗
PubMed1994

The significance of sinonasal radiodensities: ossification, calcification, or residual bone?

PURPOSE: To determine whether very radiodense material within a sinonasal soft-tissue mass on CT can be differentiated as calcification, ossification, or residual bone. METHODS: We retrospectively described the radiodensities within 235 sinonasal soft-tissue masses as discrete, solitary or multiple, or as a diffuse process with either a well-defined or poorly defined margin. They were also classified as calcification, ossification, or residual bone. Findings were correlated with pathologic specimens. RESULTS: Residual bone was underdiagnosed; calcification was overdiagnosed. A solitary discrete density was most likely to be calcification within an inflammatory mass. However, multiple discrete densities were as likely to be in a tumor as in an inflammatory lesion. If the process was diffuse with a well-defined margin, it was most likely to be a benign fibroosseous lesion. If the process was diffuse with a poorly defined margin, it was most likely to be a high-grade sarcoma. Densities within inverted papillomas were shown to be residual bone, not calcifications; densities within esthesioneuroblastomas were calcifications. CONCLUSION: Radiodensities may help in refining a CT diagnosis, but one may not know based on CT whether the density is a calcification, ossification, or residual bone.

Calcinosis↗