Calcific discitis: MRI changes in discs without visible calcification.
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Calcium detected by radiography was compared in 10 pairs of aortic and mitral glutaraldehyde-treated porcine bioprosthetic heart valves explanted from 10 patients (7 men and 3 women), aged 19 to 68 years (mean 43). Both valves of 6 pairs of valves had undergone primary tissue failure (revealed by cardiac catheterization and angiography) and 1 valve of the other 4 pairs of valves had undergone primary tissue failure. These porcine valves had been implanted from 2 1/4 to 9 years (mean 5 3/4). All 20 explanted valves contained calcium. The grade of calcium was the same in 4 pairs of valves (grade 2+ or 3+), and 1 grade different in 4 pairs of valves (grade 1+ to 4+), with the greater calcium evenly divided between the 2 valve positions. There was more than 1 grade greater mitral valve calcium in 2 pairs of valves (grade 3+ and 4+ mitral vs 1+ and 2+ aortic, respectively). Thus, calcium is usually present in both aortic and mitral valve positions when bioprosthetic valves of this type in either valve position fail as a result of primary tissue failure, and radiographic calcium in porcine bioprosthetic valves is usually similar in grade in both the aortic and mitral valve positions.
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In a case of primary hyperparathyroidism, ocular changes were observed as vacuoles in the basal cells of the corneal epithelium, and by staining procedures, calcium was found in the corneal and conjunctival epithelia, the corneal endothelium and in the sclera. By electron microscopy, needle-like crystals of calcium hydroxyapatite precursors were found intracellularly, also in keratocytes. The crystals in the epithelial cells were often confined to the nucleus. In a case of idiopathic hypercalcaemia of infancy, similar crystals were found intracellularly in the corneal epithelial and stromal cells, and in this case extracellular deposits, morphologically identical with extracellular deposits in conjunctival biopsies from patients with renal failure, were also seen. These extracellular aggregations were probably also composed of hydroxyapatite. The difference in morphology between intracellular and extracellular deposits is discussed in the light of the serum values of the mineral ions found in the three groups of cases.
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