11/55. Idiopathic calcinosis cutis of the vulva in an elderly woman. A case report.BACKGROUND: Idiopathic calcinosis cutis of the vulva is a rare condition of unknown etiology. Only seven cases have been reported to date, and all of them were in children. We report the first case in an elderly woman. CASE: A 68-year-old woman presented with a labial lesion of unknown etiology. Excisional biopsy was performed, and histopathologic evaluation showed subepidermal calcification. Follow-up biochemical and hormonal analysis and screening tests for collagen vascular diseases revealed normal results. CONCLUSION: After diagnosis of calcinosis cutis, a laboratory workup to rule out abnormalities of calcium and phosphorus metabolism, malignant processes and collagen vascular diseases must be carried out. This approach in the evaluation of calcinosis cutis could lead to diagnosis of the underlying disease at an early stage.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
12/55. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation.OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental research, Inc., Clear water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.- - - - - - - - - - ranking = 2.8348069393633keywords = diabetic (Clic here for more details about this article) |
13/55. Cartilaginous metaplasia in calcified diabetic peripheral vascular disease: morphologic evidence of enchondral ossification.The mechanism of arterial calcification is not clear. We examined histological sections of major arteries from lower extremities of two patients with longstanding type II (or non-insulin-dependent) diabetes mellitus, and found morphological evidence of cartilaginous metaplasia and ectopic ossification with associated severe medial arterial calcification and atherosclerosis. hematoxylin and eosin, alcian blue, and toluidine blue stains were applied for the demonstration of cartilage cells and their specific matrix proteins, and immunohistochemical studies for type II collagen. To our knowledge, cartilaginous metaplasia has not previously been described in medium-sized human muscular arteries. This observation supports the hypothesis that active enchondral ossification may be a pathway leading to arterial calcification in diabetic obstructive peripheral vascular disease.- - - - - - - - - - ranking = 4.8623391161361keywords = vascular disease, diabetic (Clic here for more details about this article) |
14/55. Cardiovascular calcifications in pediatric patients receiving maintenance dialysis.Cardiovascular disease is a major cause of morbidity and mortality in adult patients with end-stage renal disease receiving maintenance dialysis. Coronary artery calcifications (CAC) contribute to the high prevalence of cardiac disease and are associated with hyperphosphatemia, an elevated calcium-phosphorus product (CaxP), and prolonged time on dialysis. Chronic inflammation and malnutrition are also associated with an increased risk for development of cardiac calcifications. Young adults receiving maintenance dialysis develop cardiac calcifications at a degree out of proportion to healthy adults of the same age and gender. Many of these young adults initiated dialysis as children or teenagers. risk factors associated with the development of CAC are also seen in the pediatric dialysis population. To date, reports of cardiac calcifications in pediatric patients receiving maintenance dialysis are limited to post-mortem studies. We present two pediatric patients with ANCA-positive vasculitis diagnosed with cardiac calcifications while receiving maintenance dialysis. hyperphosphatemia and an elevated CaxP product were seen in both patients and probably contributed to the development of extraskeletal calcifications. In addition, both patients had an underlying systemic inflammatory disease and significant weight loss/malnutrition that may have contributed to the early and rapid onset of cardiac calcifications.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
15/55. Diabetic muscle infarction: an unusual cause of acute limb swelling in patients on hemodialysis.Acute muscle infarction in diabetic patients on dialysis has rarely been reported. We present a small case series of 4 patients with unusally "inflammatory" presentations that caused diagnostic challenges. Diabetic muscle infarction should be in the differential diagnosis of acutely swollen lower limbs in dialysis patients.- - - - - - - - - - ranking = 0.47246782322722keywords = diabetic (Clic here for more details about this article) |
16/55. Off-pump coronary artery revascularization: ideal indication for patients with porcelain aorta and calcification of great vessels.patients with porcelain aorta and severe calcification of the great vessels are a challenging dilemma for the cardiovascular surgeon regarding bypass technique, choice of conduit, and selection of proximal anastomotic sites due to the high incidence of devastating thromboembolization and aortic injury. No currently proposed surgical approach avoids manipulation of the heavily calcified ascending aorta. Three patients presented with unstable angina and decreased ventricular function secondary to significant left main coronary artery stenosis and 3-vessel coronary artery disease. In addition to the coronary artery disease, severely calcified ascending aorta and great vessels were discovered. One patient presented with near total distal abdominal aortic occlusion, severe peripheral vascular disease, history of stroke, and carotid endarterectomy. Surgical coronary revascularization was indicated. coronary artery bypass grafting using internal thoracic artery and greater saphenous vein composite arterial inflow grafts in combination with off-pump beating heart surgery was successfully used. cardiopulmonary bypass and clamping of the aorta was avoided. No new neurologic deficit was observed. Coronary revascularization with internal thoracic artery composite grafts and avoiding cardiopulmonary bypass and clamping the calcified aorta is an effective method to prevent clamp injury and thromboembolization. Off-pump coronary artery bypass grafting seems to be an ideal indication in patients with porcelain aorta because the surgical techniques of "no-touch" and "no-cannulation" can be applied.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
17/55. Pancreatic carcinoma associated with chronic calcifying pancreatitis.A total of 160 Japanese patients with pancreatic carcinoma were treated in the Department of Surgery I, Kyushu University faculty of medicine, Fukuoka, japan, from January 1976 to December 1991. Four of these patients had an accompanying pancreatic calcification with a 2.5% incidence of pancreatic carcinoma. Those four patients consisted of 52, 75, 75, and 82 year-old men. Three complained of jaundice and another developed an abdominal mass. Two of the four patients were diabetic and had a past history of heavy alcoholic intake. Three pancreatic carcinomas were located in the head of the pancreas, including two with multiple small calcifications in the entire pancreas and one with a solitary large calcification in the head. Another pancreas body carcinoma was associated with diffuse small calcifications both in and distal to the mass. In three pancreatic carcinomas, pancreatic calcification was demonstrated proximal and distal to the pancreatic carcinomas. All four patients died within 14 months after the clinical diagnosis of pancreatic carcinoma. Although we cannot draw a definitive conclusion on the link because of the limited number of cases in this retrospective study, followup studies on patients with chronic calcifying pancreatitis are needed for clarification.- - - - - - - - - - ranking = 0.47246782322722keywords = diabetic (Clic here for more details about this article) |
18/55. Fulminant dermatomyositis after removal of a cancer.dermatomyositis developed suddenly in a diabetic patient with crest syndrome after the removal of a malignant tumor. Scrupulous physical examination excluded further systemic or cutaneous involvement. We raise certain still unsolved aspects regarding the association between dermatomyositis and neoplastic disorders.- - - - - - - - - - ranking = 0.47246782322722keywords = diabetic (Clic here for more details about this article) |
19/55. Rapid postanoxic calcification of the basal ganglia.A 22-year-old male diabetic on hemodialysis suffered a cerebral anoxic event. Serial CT showed the development of basal ganglia calcification over a period of no more than 17 days. It appears that the basal ganglia may develop petechial hemorrhage, necrosis, calcification, or combinations of these following an anoxic insult. The neuropathologic substrate and mechanism of rapid postanoxic calcification are unknown.- - - - - - - - - - ranking = 0.47246782322722keywords = diabetic (Clic here for more details about this article) |
20/55. brain lactic alkalosis in Aicardi-Goutieres syndrome.Aicardi-Goutieres syndrome is a rare progressive encephalopathy characterized by acquired microcephaly, basal ganglia calcification, and chronic CSF lymphocytosis, raised levels of interferon alpha in CSF and plasma and chill-blain type lesions. A possible mechanism of injury is cytokine related microangiopathy. We report brain imaging and proton (1H) and phosphorus-31 (31P) magnetic resonance spectroscopy (MRS) findings during the first year after birth in two patients. In patient 1 the evolution of brain metabolite ratios and intracellular pH obtained from serial 1H (long TE) and 31P MRS studies are described; in patient 2 a single 1H (short TE) MRS study is described. Imaging findings included basal ganglia calcifications, cerebral atrophy, and leukodystrophy. The MRS results demonstrated that Aicardi-Goutieres syndrome is associated with reduced NAA/Cr, reflecting decreased neuronal/axonal density or viability, increased myo-inositol/Cr, reflecting gliosis or osmotic stress and a persisting brain lactic alkalosis. A brain lactic alkalosis has also been observed in those infants surviving perinatal hypoxia-ischaemia but with a poor neurodevelopmental outcome. A possible mechanism leading to brain alkalosis is up-regulation of the Na /H transporter by focal areas of ischaemia related to the microangiopathy or by pro-inflammatory cytokines. Such brain alkalosis may be detrimental to cell survival and may increase glycolytic rate in astrocytes leading to an increased production of lactate.- - - - - - - - - - ranking = 2.6014172851556keywords = microangiopathy (Clic here for more details about this article) |
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