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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:303-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Inflammatory pseudotumor of the liver" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "303" "paginaFinal" => "304" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seudotumor inflamatorio del hígado" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sergio Cerrato Delgado, Maria Jesus Castro Santiago, Lidia Atienza Cuevas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Sergio" "apellidos" => "Cerrato Delgado" ] 1 => array:2 [ "nombre" => "Maria Jesus" "apellidos" => "Castro Santiago" ] 2 => array:2 [ "nombre" => "Lidia" "apellidos" => "Atienza Cuevas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320305364" "doi" => "10.1016/j.medcli.2020.06.043" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320305364?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003983?idApp=UINPBA00004N" "url" => "/23870206/0000015700000006/v2_202201010922/S2387020621003983/v2_202201010922/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Usefulness of plain radiography in monitoring the treatment of calciphylaxis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "304" "paginaFinal" => "305" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jose Castiñeiras González, Noemí Eiris Salvado, Manuel Ángel Rodríguez Prieto" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Jose" "apellidos" => "Castiñeiras González" "email" => array:1 [ 0 => "jcastigon@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Noemí" "apellidos" => "Eiris Salvado" ] 2 => array:2 [ "nombre" => "Manuel Ángel" "apellidos" => "Rodríguez Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología y Venereología Médico-Quirúrgica, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la radiología simple en la monitorización del tratamiento de la calcifilaxis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1098 "Ancho" => 2500 "Tamanyo" => 133496 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Anteroposterior X-ray of the right elbow showing soft-tissue calcification (the upper and lower arrows point to the netlike pattern). (B) Disappearance of the calcium deposits and the netlike pattern on the plain X-ray of the right elbow after six months of treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calciphylaxis or calcific uremic arteriolopathy is a rare, but potentially fatal, disease characterized by cutaneous necrosis and vascular calcification. Its associated mortality, of around 60–80%, results from an infection of the lesions, sepsis, or multiorgan failure. Although this condition is more prevalent among patients with chronic kidney disease under hemodialysis, cases have also been described in non-uremic patients in relation to diabetes, obesity, treatment with certain drugs, and protein C and S deficiency, among others.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most widely accepted hypothesis of its cause of onset is an imbalance between the promoters and inhibitors of vascular calcification. Phosphocalcic metabolism alterations, the accumulation of uremic toxins, hypercoagulability, and endothelial dysfunction can trigger the transformation of smooth muscle cells of blood vessels into osteoblastic cells, thus initiating the calciphylaxis process.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Because secondary cutaneous necrosis due to vascular occlusion can manifest in several ways, a high level of suspicion is required to reach the diagnosis. However, the most frequent clinical findings are <span class="elsevierStyleItalic">livedo reticularis</span>, retiform purpura, and erythematous plaques and/or nodules that can progress into cutaneous necrosis and extremely painful ulcers on the affected skin area. The most commonly affected sites are the buttocks, abdomen, breasts, and limbs, and the prognosis of the condition varies according to the distribution of these lesions, with a survival rate of 25% associated with proximal lesions and of 75% with distal ones.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this paper we present the case of a 70-year-old woman with chronic kidney disease, diabetes, and hypertension who was admitted to our department for a two-month history of multiple, very painful, necrotic ulcers in both legs reaching the muscle and tendon layers. The patient had previously been admitted to the Vascular Surgery Department, where amputation of both her legs was proposed as a therapeutic option. Laboratory tests revealed that she had a chronic kidney disease, secondary hyperparathyroidism, poorly controlled diabetes, and hypoalbuminemia. A skin biopsy revealed calcification of small and medium blood vessels, together with intimal hyperplasia and perieccrine calcification. Plain X-rays of the upper and lower limbs were carried out, detecting several calcified areas with a characteristic netlike pattern, even in regions located far from the clinically affected areas, such as the elbow (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), which led us to arrive to the diagnosis of calciphylaxis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment with intravenous sodium thiosulfate at a dosage of 25 g dissolved in 200 ml of saline solution administered five times per week was consequently started, achieving a quick clinical response and pain relief after just two doses. In addition, the patient also underwent surgery to have the lesions debrided and partial skin grafts placed, exhibiting a progressive improvement of her ulcers and total resolution after six months. Four months later, follow-up X-rays confirmed the disappearance of the netlike calcification pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Calciphylaxis requires an early identification and meticulous correlation between the clinical and histological findings. The diagnostic screening tests should include a determination of the phosphocalcic product and the serum levels of parathyroid hormone, as well as a core biopsy with calcium-specific staining, such as that achieved with the Von Kossa protocol. Perieccrine calcification has previously been reported as a highly specific finding that enables the diagnosis of calciphylaxis in the appropriate clinical context.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Rapid initiation of treatment with sodium thiosulfate and early diagnosis significantly improve the disease’s prognosis. Although surgery is not the first line of treatment in patients with acute calciphylaxis lesions, as soon as the disease has been controlled with medical treatment, partial-thickness skin grafts may help accelerate healing of the ulcers, which would otherwise be doomed to heal by secondary intention. Although the presence of calcium deposits has been described with several imaging techniques, only the “netlike” pattern viewed in plain X-rays has proved to be a specific finding (total specificity of 90%) and can be observed in regions located far from the clinically affected areas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Disappearance of the calcium deposits following treatment has been detected through computed tomography and scintigraphy scans, but never through plain X-rays until this case. This finding confirms the usefulness of plain X-rays and other imaging tests in diagnosing the disease and also opens the door to their use in its post-treatment monitoring.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors of this paper declare that they have not received funding for this work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castiñeiras González J, Eiris Salvado N, Rodríguez Prieto MÁ. Utilidad de la radiología simple en la monitorización del tratamiento de la calcifilaxis. Med Clin (Barc). 2021;157:304–305.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1098 "Ancho" => 2500 "Tamanyo" => 133496 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Anteroposterior X-ray of the right elbow showing soft-tissue calcification (the upper and lower arrows point to the netlike pattern). (B) Disappearance of the calcium deposits and the netlike pattern on the plain X-ray of the right elbow after six months of treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calciphylaxis: from the disease to the diseased" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.M. Oliveira" 1 => "J.M. Frazão" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40620-015-0192-2" "Revista" => array:6 [ "tituloSerie" => "J Nephrol" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "531" "paginaFinal" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25835730" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of calciphylaxis in CKD: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Udomkarnjananun" 1 => "K. Kongnatthasate" 2 => "K. Praditpornsilpa" 3 => "S. Eiam-Ong" 4 => "B.L. Jaber" 5 => "P. Susantitaphong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ekir.2018.10.002" "Revista" => array:6 [ "tituloSerie" => "Kidney Int Rep" "fecha" => "2019" "volumen" => "4" "paginaInicial" => "231" "paginaFinal" => "244" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30775620" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet for the treatment of calciphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Robinson" 1 => "J.J. Augustine" 2 => "N.J. Korman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.2.152" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "152" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17309995" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous calciphylaxis: a retrospective histopathologic evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Mochel" 1 => "R.Y. Arakaki" 2 => "G. Wangs" 3 => "D. Kroshinsky" 4 => "M.P. Hoang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31827c7f5d" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2013" "volumen" => "35" "paginaInicial" => "582" "paginaFinal" => "586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328789" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Net-like pattern of calcification on plain soft-tissue radiographs in patients with calciphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Shmidt" 1 => "N.S. Murthy" 2 => "J.M. Knudsen" 3 => "R.H. Weenig" 4 => "M. Amanda Jacobs" 5 => "A.M. Starnes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2012.05.037" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "1296" "paginaFinal" => "1301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22841657" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000006/v2_202201010922/S2387020621004356/v2_202201010922/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000006/v2_202201010922/S2387020621004356/v2_202201010922/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621004356?idApp=UINPBA00004N" ]
