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PubMed2005

Hyperhomocysteinaemia and aortic calcification are associated with fractures in patients on haemodialysis.

BACKGROUND: Fractures and atherosclerosis are common in patients with renal failure; this may be due to hyperhomocysteinemia. AIM: To examine the relationships between fractures, vascular calcification and homocysteine levels in haemodialysis patients. DESIGN: Cross-sectional survey. METHODS: We enrolled 37 men and 15 women who had been on haemodialysis for at least 1 year. We identified prevalent spine fractures by radiographs. Non-spine fractures were identified by self-report and confirmed by review of radiographs or radiology reports. We classified the presence and severity of lumbar aortic calcifications with lateral lumbar radiographs. We measured serum homocysteine in all subjects within 30 days of study entry. RESULTS: After adjusting for age and weight, increased levels of homocysteine were associated with an increased risk fracture (OR per mmol/l increase in homocysteine 1.6, 95%CI 1.2-2.0), as was the presence of aortic calcification (OR 1.6, 95%CI 1.2-2.1). Homocysteine and lumbar aortic calcification were highly correlated (r = 0.86). DISCUSSION: Hyperhomocysteinaemia may explain the relationship between fractures and atherosclerosis in patients with renal failure.

Aged↗
PubMed1980

Surgical treatment of subcutaneous calcifications of polymyositis or dermatomyositis.

The "tumoral" calcifications seen with polymyositis and dermatomyositis are frequently large and painful. Many surgeons believe such calcifications should not be removed surgically, arguing that the surgical trauma induces further calcification that is probably ever more severe. However, we believe that surgical removal of these large masses is less traumatic than cyclical, spontaneous extrusion of the calcium with secondary healing. We present 2 patients in whom chronically draining and painful dystrophic calcifications were treated surgically without recurrence.

Buttocks↗
PubMed1983

X-ray calcifications as the only basis for breast biopsy.

Two hundred fifty-one consecutive patients were treated between 1964 and 1982 with mammographic calcifications as the only reason for breast biopsy. Patients with either clinical or x-ray findings other than calcifications were excluded. A correlation of the x-ray, pathology, and clinical experience is the basis of this report. Specimen radiography with paraffin section histology (i.e., no frozen section) was performed on all biopsy material. The procedure of specimen radiography that was utilized is described. A team approach involving radiologists, pathologists, and surgeons has been essential both to confirm excision of the calcifications and localize them for pathology study. Carcinoma was found in 45 patients (17%). A retrospective study of the calcifications was also undertaken to determine characteristics that would permit definitive radiographic diagnosis of benign or malignant disease.

Biopsy↗
PubMed1993

Calcific band keratopathy on a keratoprosthesis.

We describe a case of calcific band keratopathy in a patient with a nut-and-bolt keratoprosthesis. To our knowledge, this is the first reported case of this condition involving a prosthesis. The patient had initially suffered lye burns to both eyes. The prosthesis was placed in the right eye; numerous procedures had to be undertaken to maintain it. The patient was also treated surgically and pharmacologically for glaucoma. Seventeen years after initial implantation, white flakes appeared on the prosthesis in the classical band pattern. Pathologic examination revealed them to be calcific. Theories concerning corneal and contact lens calcific deposition are evaluated to assess their applicability to this case. We conclude that multiple factors may be responsible for calcific deposition on the keratoprosthesis and that this may call into question previous explanations of this disorder.

Adult↗
PubMed1988

Periarticular calcification in immunosuppressed cardiac transplant patients.

A retrospective study was performed to determine whether the likelihood of developing periarticular calcification in the hands is increased significantly in cardiac transplant patients. Two groups of patients were identified: those whose transplant occurred before the routine use of Cyclosporine as an immunosuppressive agent and those who received Cyclosporine at the time of transplantation. Seven of nine patients in the former group demonstrated periarticular calcification at multiple sites in the hands, but no patient in the post-Cyclosporine group had calcification at more than one site. Cardiac transplant patients on high dose systemic steroids for an extended period of time are likely to develop periarticular calcification. This appears to be related to steroid dose and duration of treatment and also may be influenced by other immunosuppressive agents.

Arteries↗
PubMedDate not supplied

Clinical significance of cavernous carotid calcifications encountered on head computed tomography scans performed on patients seen in the emergency department.

PURPOSE: To determine whether the presence of calcification in the cavernous segment of the internal carotid artery seen on head computed tomography (CT) performed in the emergency department shows any relationship to the existence of systemic disease. Significant and consistent relationships could be used as predictors in suggesting the presence of systemic disease in those patients receiving head CTs for unrelated symptoms. METHODS: A retrospective investigation was performed on 295 consecutive patients presenting to the Massachusetts General Hospital emergency department for head CT scan during the course of 1 month. Head CT images were analyzed for carotid siphon calcifications. Data regarding multiple predictors of disease including gender, age, hypertension, diabetes, smoking, hypercholesterolemia, cardiac disease, and alcohol and intravenous drug abuse were abstracted from the medical record for each patient. RESULTS: Strong univariate correlation was noted in the comparison between the presence of carotid siphon calcification and gender, age, diabetes, hypertension, smoking, and cardiac disease while alcohol and intravenous drug abuse correlated poorly. Multivariate models including categorized age and gender demonstrated a consistently strong interaction with diabetes, cardiac disease, and smoking while hypertension and hypercholesterolemia showed a loss of significance. Interaction term analysis indicated a strong (ie, significant) interaction between gender and both hypertension and hypercholesterolemia. CONCLUSIONS: Carotid siphon calcifications are strong predictors of existing medical disease in simple cases. In patients with a combination of diseases, a strong interaction between covariates is noted, suggesting a more complex interaction contributing to the formation of carotid siphon disease.

Adolescent↗
PubMed1982

The endoscopic diagnosis of gastric calcification.

The endoscopic diagnosis of gastric calcification has not been previously reported. We describe the endoscopic and histologic features of gastric calcification in a patient with diffuse interstitial pulmonary calcification of unknown etiology. It is suggested that this investigation may provide a convenient additional method of diagnosis, in a patient with suspected metastatic calcification.

Calcinosis↗
PubMed1992

67Ga uptake at sites of heterotopic calcification: a report of three cases.

Heterotopic calcification occurs commonly in spinal cord injured patients and following joint trauma or surgery. 99Tcm-methylene diphosphonate is useful in the detection of these lesions, many of which are subclinical. Three patients are presented with heterotopic calcification, one with severe hypoxic encephalopathy and two following major trauma. Intense 67Ga uptake within areas of heterotopic calcification was noted in all three patients. Two of the patients also underwent 99Tcm-methylene diphosphonate bone scanning and showed uptake of the bone agent corresponding to the areas of 67Ga uptake. In predisposed patients, heterotopic calcification should be considered in the differential diagnosis of a focal area of 67Ga uptake.

Adult↗
PubMed1995

Incidence of calcifications in the breast after surgical reduction and liposuction.

Liposuction of the breast in combination with vertical mammaplasty was applied to 250 breasts among 386 reductions of large breasts performed in 2 years (1989 to 1991). To evaluate the possible damage to the breast caused by this combined procedure, especially in terms of the occurrence of the postoperative development of calcifications, a comparative study of preoperative and postoperative mammograms was undertaken in 60 randomly selected cases (120 breasts), 34 with and 26 without liposuction. Altogether, 13 calcifications (11 percent) were discovered during the 6- to 30-month follow-up, representing the lowest rate reported in the literature. Deep intraparenchymal calcifications were more frequent after liposuction; most (5 of 7) were macrocalcifications. None could be confused with malignant calcifications because they were more scattered, more regular, and less numerous. Attempts to evaluate the fat content of breasts via preoperative mammography failed to prove this examination a useful way to predict the viability of breast liposuction.

Adult↗
PubMed2002

CME review: sclerochoroidal calcification: the 2001 Harold Gifford Lecture.

Sclerochoroidal calcification is a recently recognized ocular condition that is characterized by typical geographic yellow-white fundus lesions that usually occur bilaterally in adults. It can clinically simulate a number of intraocular tumors like choroidal metastasis, choroidal melanoma, and choroidal osteoma. Clinical evaluation with ultrasonography, computed tomography, and some histopathologic studies have supported the fact the condition represents calcium deposition in the sclera and choroid. Early reports suggested that sclerochoroidal calcification was usually associated with hypercalcemic conditions such as hyperparathyroidism and pseudohypoparathyroidism. Subsequently, many patients with sclerochoroidal calcification have had no apparent systemic associations and have been classified as idiopathic. However, very recent studies have suggested that this ocular condition can also be associated with Gitelman syndrome or Bartter syndrome. These are autosomal recessive conditions of hypokalemic alkalosis associated with hypomagnesemia and deposition of calcium salts in various tissues. Ophthalmologists should be familiar with fundus features and systemic associations of sclerochoroidal calcification.

Calcinosis↗
PubMed1979

Idiopathic arterial calcification of infancy.

Idiopathic arterial calcification of infancy is an uncommon disease of unknown etiology, characterized by calcification along the internal elastic membrane and intimal proliferation of almost all the arteries of the body. When the diagnosis is made premortem, it is usually done by radiographic demonstration of arterial calcification. Because of its edge enhancement effect, xeroradiography should be useful in detecting the soft tissue calcifications of this disease.

Angiography↗
PubMed1998

Serum concentration of calcium, 1,25 vitamin D and parathyroid hormone are not correlated with coronary calcifications. An electron beam computed tomography study.

BACKGROUND: The amount of coronary artery calcification, measured using electron beam computed tomography, is correlated with the volume of coronary artery atherosclerotic plaque, the severity of stenosis by angiography, and with the likelihood of future cardiovascular events. The deposition of calcium in atherosclerotic plaques may also be influenced by determinants of calcium metabolism, thus contributing to the variance of the relation between coronary artery calcification and extent of atherosclerosis. Our objective was to determine whether this variance could be explained by differences in the parameters of calcium metabolism. DESIGN AND METHODS: We measured serum concentrations of calcium, 1,25(OH)2 vitamin D and parathyroid hormone (PTH) in 50 subjects undergoing angiography for clinical indications, and evaluated the correlations between these concentrations and calcium deposition in the coronary arteries, and the ratio of calcium deposition to extent of atherosclerosis using coronary angiography. RESULTS AND CONCLUSIONS: Serum concentrations of calcium 1,25(OH)2 vitamin D and PTH were not correlated with coronary calcification or the ratio of coronary calcification to the extent of coronary stenosis. We conclude that, in subjects undergoing coronary angiography, the variance of the relationship between coronary atherosclerosis and coronary calcium is not a result of differences in serum concentrations of calcium, 1,25(OH)2 vitamin D or PTH.

Aged↗
PubMed2003

Case report: "Popcorn" dystrophic ileal calcification in a patient with Crohn's disease.

Small bowel calcification is a rare finding, often associated with chronic infection or small intestinal neoplasms. The authors report a patient who developed dystrophic ileal calcification in the setting of medically refractory Crohn's disease. The patient had longstanding, obstructive ileal Crohn's disease, treated with corticosteroids for a 10-year period. Diffuse terminal ileal calcification was evident on radiographic studies, including plain films as well as abdominal CT scan. The patient underwent successful resection of the diseased segment of small bowel and has done well over the ensuing 3-year period. Dystrophic calcification is a rare complication of long-standing chronic inflammation in Crohn's disease that may occur in the absence of adenocarcinoma or chronic infection.

Calcinosis↗
PubMed2002

The effects of sevelamer hydrochloride and calcium carbonate on kidney calcification in uremic rats.

The control of serum phosphorus (P) and calcium-phosphate (Ca x P) product is critical to the prevention of ectopic calcification in chronic renal failure (CRF). Whereas calcium (Ca) salts, the most commonly used phosphate binders, markedly increase serum Ca and positive Ca balance, the new calcium- and aluminum-free phosphate binder, sevelamer hydrochloride (RenaGel), reduces serum P without altering serum Ca in hemodialysis patients. Using an experimental model of CRF, these studies compare sevelamer and calcium carbonate (CaCO(3)) in the control of serum P, secondary hyperparathyroidism (SH), and ectopic calcifications. 5/6 nephrectomized rats underwent one of the following treatments for 3 mo: uremic + high-P diet (U-HP); UHP + 3% CaCO(3) (U-HP+C); UHP + 3% sevelamer (U-HP+S). Sevelamer treatment controlled serum P independent of increases in serum Ca, thus reducing serum Ca x P product and further deterioration of renal function, as indicated by the highest creatinine clearances. Sevelamer was as effective as CaCO(3) in the control of high-P-induced SH, as shown by similar serum PTH levels, parathyroid (PT) gland weight, and markers of PT hyperplasia. Also, both P binders elicited similar efficacy in reducing the myocardial and hepatic calcifications induced by uremia. However, sevelamer caused a dramatic reduction of renal Ca deposition (29.8 +/- 8.6 micro g/g wet tissue) compared with both U-HP (175.5 +/- 45.7 micro g/g wet tissue, P < 0.01) and the U-HP+C (58.9 +/- 13.7 micro g/g wet tissue, P < 0.04). Histochemical analyses using Von Kossa and Alizarin red S staining of kidney sections confirmed these findings. The high number of foci of calcification in the kidney of uremic controls (108 +/- 25) was reduced to 33.0 +/- 11.3 by CaCO(3) and decreased even further with sevelamer (16.4 +/- 8.9, P < 0.02 versus CaCO(3)). Importantly, the degree of tubulointerstitial fibrosis was also markedly lower in U-HP+S (5%) compared with either U-HP+C (30%) or U-HP (50%). It is concluded that in experimental CRF in rats, despite a similar control of serum P and SH, sevelamer is more effective than CaCO(3) in preventing renal Ca deposition and tubulointerstitial fibrosis, including better preservation of renal function. These findings cannot be extrapolated to human disease, and further studies in patients are necessary to determine the benefits of either P binder.

Animals↗
PubMed2004

Arterial calcifications and bone histomorphometry in end-stage renal disease.

Arterial calcification (AC) is a common complication of end-stage renal disease (ESRD). The mechanisms responsible are complex, including disturbances of mineral metabolism and active expression of various mineral-regulating proteins. An inverse relationship between AC and bone density has been documented in uremic patients. In the study presented here, which included 58 patients with ESRD on hemodialysis (HD), bone-histomorphometry characteristics were compared with the AC scores (0 to 4) determined according to the number of arterial sites with calcifications. Patients with AC scores of 0 (no calcifications), or 1 or 2 (mild calcifications) had similar serum parathyroid hormone levels and bone histomorphometry, with larger osteoclast resorption, higher osteoclast numbers, and larger osteoblastic and double tertracycline-labeled surfaces. In contrast, patients with high AC scores (3 and 4) were characterized by lower serum parathyroid hormone, low osteoclast numbers and osteoblastic surfaces, smaller or absent double tetracycline-labeled surfaces, and high percentages of aluminum-stained surfaces. According to multivariate analysis, AC score was positively associated with age (P < 0.0001), daily dose of calcium-containing phosphate binders (P = 0.009), and bone aluminum-stained surfaces (P = 0.037), and an inverse correlation was observed with osteoblastic surfaces (P = 0.001). A high AC score is associated with bone histomorphometry suggestive of low bone activity and adynamic bone disease. These findings suggest that therapeutic interventions associated with excessive lowering of parathyroid activity (parathyroidectomy, excessive calcium or aluminum load) favor lower bone turnover and adynamic bone disease, which could influence the development and progression of AC.

Aluminum↗
PubMed2006

Surgical treatment of destructive calcific lesions of the cervical spine in scleroderma: case series and review of the literature.

STUDY DESIGN: An independent retrospective chart review combined with a review of current literature. OBJECTIVES: To describe a series of destructive, calcific masses of the cervical spine causing pain, neurologic dysfunction, and instability in patients with scleroderma and detail the surgical interventions required. To review benign, calcific cervical spine lesions associated with scleroderma and collagen vascular disorders. SUMMARY OF BACKGROUND DATA: Little is know about the diagnosis and management of the destructive, calcific lesions of scleroderma in the cervical spine. METHODS: The medical and radiographic records of 3 patients with scleroderma lesions in the cervical spine were reviewed. A computer-based literature search of Ovid and PubMed databases was used to compile a comprehensive review of the topic. RESULTS: The perioperative and surgical management of 3 cases of scleroderma of the cervical spine are discussed in the context of a complete literature review on the topic. These complex lesions were found to require significant resources with regard to diagnosis and management. CONCLUSIONS: Destructive, calcific masses in the cervical spine associated with scleroderma and an indication for surgical treatment are rare. Treatment is complex and not without significant risk to the patient.

Aged↗
PubMed2005

Differences in association of bone mineral density with coronary artery calcification in men and women: the Rancho Bernardo Study.

OBJECTIVE: Whether osteoporosis and calcification of atherosclerotic plaque are two independent, age-related processes or linked by similar mechanisms of bone mineralization and plaque calcification is unknown. This study examines the sex-specific association between bone mineral density (BMD) and coronary artery calcification with a particular focus on hormone therapy (HT). DESIGN: Participants were 180 men (aged 47-86 years) and 186 women (aged 58-81 years) without a history of heart disease who had hip and spine BMD assessed by dual-energy x-ray absorptiometry and coronary artery calcium score (CACS) measured by electron-beam computed tomography. Calcium scores were categorized into none/minimal ( or=400). Ordinal and binary logistic regressions examined the associations between site-specific BMD and CACS. RESULTS: In men and women not using HT, there was no age-independent association between BMD at any site and CACS. In contrast, among current HT users an inverse association of BMD with coronary artery calcification was observed at the total hip (odds ratio [OR] = 0.56, 95% CI, 0.33-0.95), trochanter (OR = 0.55, 95% CI, 0.32-0.93), and intertrochanter area (OR = 0.60, 95% CI, 0.41-0.86) after adjustment for age and other risk factors. Other skeletal sites showed similar, but not statistically significant, associations (P < 0.1). CONCLUSION: Lack of association between BMD and CACS in men and women not using HT and the inverse association in women on HT suggest that the association between coronary and bone calcium might be mediated by estrogen.

Absorptiometry, Photon↗
PubMed2006

Topical thrombin-related corneal calcification.

PURPOSE: To report a highly unusual case of corneal calcification after brief intraoperative use of topical thrombin. METHODS: A 44-year-old man underwent sclerouvectomy for ciliochoroidal leiomyoma, during which 35 UNIH/mL lyophilized bovine thrombin mixed with 9 mL of diluent containing 1500 mmol/mL calcium chloride was used. From the first postoperative day, corneal and anterior lenticular capsule calcifications developed, and corneal involvement slightly enlarged thereafter. RESULTS: A year later, 2 corneal punch biopsies confirmed calcification mainly in the Bowman layer. Topical treatment with 1.5% ethylenediaminetetraacetic acid significantly restored corneal clarity. Six months later, a standard extracapsular cataract extraction with intraocular lens placement improved visual acuity to 20/60. CONCLUSION: This case suggests that topical thrombin drops with elevated calcium concentrations may cause acute corneal calcification in Bowman layer and on the anterior lens capsule.

Adult↗