Calcifying splenic hematoma in a hemophilic newborn

A 7-day-old hemophilic newborn presented several hemorrhagic manifestations, notably, a large cephalohematoma, intracranial hemorrhage and a splenic hematoma. This was clearly identified on X-rays and at 4 weeks of age showed gross ring-like calcification. Involvement of the spleen in hemophilia is rare, at all ages. Also uncommon are hemorrhagic manifestations of hemophilia during the neonatal period. Calcified splenic hematomas in hemophilic patients have apparently never been described.     

Calcium redistribution,calcification and stone formation in the parotid gland during experimental stimulation and hypercalcaemia

Summary Distribution and redistribution of intra- and pericellular calcium was investigated in the parotid gland of rats under secretory stimulation and hypercalcaemia. The effects of hypercalcaemia and secretory stimulation and of the combination of both were compared. Calcium content was determined by atomic absorption spectrometry. Calcium distribution within the tissue was demonstrated by light microscopical (GBHA) staining and electron microscopical (pyroantimonate method) cytochemistry in combination with X-ray microanalysis. Typical calcium depot sites were the basal and cellular membranes, the calcium buffer organelles (i.e. mitochondria) the secretory granules and the acinar lumina. After stimulation (by isoprenalin) a decrease of calcium-enriched secretory granules and a depletion of intracellular calcium buffer organelles occurred. During hypercalcaemia (induced by dihydrotachysterol), a calcium overloading of the cell membrane and intracellular buffer organelles without calcification was observed. Combined stimulation and hypercalcaemia induced an excessive calcium overloading of all intra-and extracellular calcium depots with excessive calcium release into the acinar lumina resulting in calcium phosphate aggregates and stone formation. Secretory stimulation and simultaneous hypercalcaemia exert potentiating effects on intracellular and intraluminal calcification proposing an importance for pathogenesis of human sialolithiasis.Supported by Sonderforschungsbereich 34 Endokrinologie     

Mammographic screening for non-palpable breast cancer in Japan

In Japan, mammography was endorsed for breast cancer screening in women aged 40 and over by the Ministry of Health, Labor and Welfare in 2004. The spread of mammographic screening has caused an increase in the incidence of non-palpable breast cancer. Precision reading for mammography is necessary to detect non-palpable breast cancer. When mass and focal asymmetric density is noted, it is important to analyze the density, density gradient, internal structure, margin and associated findings. Calcifications are classified by morphology and distribution mainly. It is necessary to distinguish secretor-type calcifications from necrotic-type calcifications. The Iwate Cancer Association performed a population-based screening program for breast cancer using mammography combined with clinical breast examination of 42,065 women in Iwate Prefecture from 1999 to 2003. A total of 2,329(5.7%)women were recalled and the 112 cases(0.27%) of cancer were detected in 114 breasts. Of 114 breast cancers, 40 (35%) were non-palpable and 74(65%) were palpable. The early breast cancer (stage 0 and I) rate of the non-palpable group was significantly higher than that of the palpable group (90% and 47%, p = 0.0003). The node-negative rate of the non-palpable group was significantly higher than that of the palpable group (92% and 68%, p = 0.011). It is expected that mammographic screening will be expanded and that the mortality rate from breast cancer in Japan will decrease, as in Europe and the United States.     

Effect of fluoride and penicillin on post-eruptive maturation of rat molars

The purpose of this work was to compare the phenomenon of post-eruptive maturation in molars of conventional and germfree rats fed non-cariogenic diets. The effects of topical application of fluoride and feeding penicillin on maturation were studied.The molars of conventional rats (fed a chow diet) treated topically with a 1% NaF solution and the molars of conventional rats fed a chow diet supplemented with 1% penicillin showed a significantly greater degree of maturation than did the molars of littermate rats fed chow and treated with water. On the other hand, the molars of germfree rats treated topically with a 1% NaF solution showed no significant difference in degree of maturation from the molars of similar control rats topically treated with water. These data are consistent with an hypothesis that in a normal environment the mineralization (maturation) process is opposed by a demineralization process. The demineralization process is a result of production of acid by bacteria metabolizing the diet impacted in the sulci of molars. It is proposed that in conventional animals fluoride and penicillin may influence maturation by inhibiting the demineralization process. In the germfree animals the demineralization process is absent because the oral microflora is absent.

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Zusammenfassung Der Zweck dieser Arbeit war ein Vergleich des nach dem Durchbruch auftretenden Reifungsphänomens der Backenzähne von gewöhnlich und von keimfrei gehaltenen Ratten, die mit einer nicht-cariogenen Diät ernährt wurden.Es wurden die Auswirkungen von topisch angewendetem Fluorid, verbunden mit Penicillin-Fütterung auf die Reifung untersucht. Die Backenzähne der gewöhnlich gehaltenen Ratten (mit Chow-Diät ernährt), die mit einer 1%igen Na-Fluoridlösung topisch behandelt wurden, und solchen deren Chow-Diät zu 1% mit Penicillin versetzt wurde, zeigten einen erheblich größeren Reifungsgrad als die Backenzähne von Tieren des gleichen Wurfes, die nur mit der Chow-Diät und Wasser ernährt wurden.Diese Resultate stimmen mit der Hypothese überein, daß in einer normalen Umgebung dem Mineralisationsprozeß (Reifung) ein Demineralisationsprozeß entgegenwirkt. Der Demineralisationsprozeß ist durch eine Säureproduktion von Bakterien bedingt, welche die in die Zahnfurchen eingepreßten Nahrungsbestandteile metabolisieren.Es wird die Annahme vorgeschlagen, daß Fluoride und Penicillin bei den gewöhnlich gehaltenen Tieren die Reifung durch eine Inhibition des Demineralisationsprozesses beeinflussen. Bei keimfrei gehaltenen Tieren findet dagegen kein Demineralisationsprozeß statt, da die orale Mikroflora fehlt.

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Résumé L'objet de ce travail était de comparer le phénomène de la maturation postéruptive dans les molaires des rats ordinaires et sans germes à qui on a donné à manger un régime «non-cariogène». On a étudié les effets de l'application topique du fluorure et de la nourriture de la penicilline sur la maturation.Les molaires des rats ordinaires (nourris d'un régime «chow» — aliment mixte pour les animaux préparé d'habitude sous la forme d'une farine ou en boulettes) traités topiquement avec une solution à 1% de NaF et les molaires des rats ordinaires nourris d'un régime «chow» complété avec la penicilline à 1% ont montré un degré de maturation significativement plus grand que les molaires des rats de la même portée nourris de «chow» et traités avec de l'eau. De l'autre côté, les molaires des rats sans germes traités topiquement avec une solution à 1% de NaF n'ont montré aucune différence significative dans le degré de maturation des molaires de rats de contrôle semblables traités topiqument avec l'eau. Ces résultats sont en accord avec l'hypothèse que dans un milieu normal le procédé de minéralisation (maturation) est opposé par un procédé de déminéralisation. Le procédé de déminéralisation est un résultat de la production d'acide par des bactéries qui métabolisent les aliments encastrés dans les «sulci» des molaires. On propose que dans les animaux ordinaires le fluorure et la penicilline peuvent influencer la maturation en empêchant le procédé de déminéralisation. Dans les animaux sans germes le procédé de déminéralisation est absent parce que la microflore orale est absente.

     

Ultramicroanalysis of pH,P_{CO_2 } and carbonic anhydrase activity at calcifying sites in cartilage

The mechanism by which (HCO ₃ ^– ) is elevated in extracellular cartilage fluids (C_fl) of rat tibial growth plates was investigated. Inin vitro studies, the pH- curves in a synthetic lymph were not detectably altered by proteinpolysaccharides or by a cationic protein. Also, (HCO ₃ ^– ) in C_fl aspirated from isolated incubates of growth cartilage decreased rapidly as a function of time. Results of both of these experiments mitigated against a role for cartilage secretions as the cause of blood-C_fl (HCO ₃ ^– ) gradientsin vivo. Acetazolamide administered to ratsin vivo reduced the blood-C_fl (HCO ₃ ^– ) gradient to an undetectable level. This effect could not be attributed to systemic acidosis produced by acetazolamide since control rats with a similar degree of systemic acidosis resulting from NH₄Cl treatment, maintained a substantial blood-C_fl (HCO ₃ ^– ) gradient. The distribution of carbonic anhydrase activity in epiphyseal and metaphyseal tissues of similar rats was determined by microassay. Enzymatic activity was not detected in cartilage samples, but was found in significant amounts in adjacent structures.This carbonic anhydrase activity measured in adjacent structures was hypothesized to represent sites of HCO ₃ ^– secretion. The possible involvement in HCO ₃ ^– secretion of epiphyseal or metaphyseal capillaries and bone cells is discussed.

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Zusammenfassung Der mechanismus, durch welchen (HCO ₃ ^– ) in extrazellulären Knorpelflüssigkeiten (_fl) der Wachstumsplatten von Rattentibiae erhöht ist, wurde untersucht. Beiin vitro Versuchen mit einer synthetischen Lymphe waren die pH- Kurven weder durch Proteinpolysaccharide noch durch kationisches Protein nachweisbar verändert. In C_fl, welche aus isolierten Inkubaten von Wachstumsknorpel entnommen wurden, nahm (HCO ₃ ^– ) in Funktion der Zeit ebenfalls rasch ab. Die Resultate beider Experimente sprechen dagegen, daß die Knorpelsekretein vivo als Ursache der Blut-C_fl (HCO ₃ ^– )- Gradienten in Betracht kommen. Acetazolamid, das Ratten verabreicht wurde, erniedrigte den Blut-C_fl (HCO ₃ ^– )-Gradienten auf ein nicht mehr nachweisbares Niveau. Dieser Effekt konnte nicht einer durch Acetazolamid hervorgerufenen generalisierten Acidose zugeschrieben, werden, da Kontrollratten mit einem ähnlichen Grad von generalisierter Acidose, welche von einer NH₄Cl-Behandlung herrührte, einen ansehnlichen Blut-C_fl (HCO ₃ ^– )-Gradienten aufrechterhielten. Die Verteilung der Kohlensäureanhydrase-Aktivität in epiphysären und metaphysären Geweben von gleichartigen Ratten wurde durch Mikroanalyse bestimmt. Eine enzymatische Aktivität konnte in den Knorpelproben nicht nachgewiesen werden, wurde jedoch in signifikanten Mengen in den angrenzenden Geweben gefunden. Es wurde die Hypothese aufgestellt, daß die Stellen, wo diese Kohlensäureanhydrase-Aktivität in angrenzenden Geweben gemessen wurde, den Sekretionsstellen von HCO ₃ ^– entspricht. Die mögliche Beteiligung von epiphysären und metaphysären Capillargefäßen und von Knochenzellen an, der HCO ₃ ^– -Sekretion wird diskutiert.

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Résumé Le mécanisme de l'élévation du (HCO ₃ ^– ) dans les liquides extracellulaires du cartilage (C_fl) a été étudié au niveau, de métaphyses tibiales de Rat. Au cours d'étudesin vitro, les courbes pH- dans une lymphe synthétique ne sont pas modifiées de façon nette par des protéines-polysaccharides ou par une protéine cationique. (HCO ₃ ^– ) de C_fl, aspiré à partir de pièces métaphysaires, incubées isolément, décroit rapidement en fonction du temps. Les résultats de ces deux expériences semblent infirmer un rôle des sécrétions cartilagineuses comme cause de gradients sang— C_fl (HCO ₃ ^– ) in vivo. L'acétazolamide, administré à des ratsin vivo, réduit le gradient sang —C_fl (HCO ₃ ^– ) jusqu'à, un seuil non dosable. Cette action ne peut être attribuée à l'acidose généralisée, produite par l'acétazolamide, étant donné que les rats témoins, ayant une acidose généralisée similaire, provoquée par un traitement à NH₄Cl, présentent un gradient sang —C_fl (HCO ₃ ^– ) net. La répartition de l'activité en anhydrase carbonique dans les tissus épiphysaires et métaphysaires de rats identiques est déterminée par micro-analyse. L'activité enzymatique n'est pas détectée dans des échantillons cartilagineux, mais est retrouvée, de façon significative, dans les structures adjacentes.L'activité en anhydrase carbonique, mesurée dans les structures adjacentes, est considérée comme les lieux de sécrétion d'HCO ₃ ^– . Le rôle éventuel des capillaires épiphysaires et métaphysaires et des cellules osseuses dans la sécrétion d'HCO ₃ ^– , est envisagé.

     

Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up

Background: Simple renal cysts are rare in children and managed conservatively unless symptomatic. Objective: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. Materials and methods: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n=1), hypertension (n=1), and increasing cyst size and urinary tract infection (n=1). The mean follow-up period was 5.5 years (range 3–7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. Results: Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. Conclusions: Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up.     

High signal intensity of intervertebral calcified disks on T1-weighted MR images resulting from fat content

Objective To explain a cause of high signal intensity on T1-weighted MR images in calcified intervertebral disks associated with spinal fusion.Design and patients Magnetic resonance and radiological examinations of 13 patients were reviewed, presenting one or several intervertebral disks showing a high signal intensity on T1-weighted MR images, associated both with the presence of calcifications in the disks and with peripheral fusion of the corresponding spinal segments. Fusion was due to ligament ossifications (n=8), ankylosing spondylitis (n=4), or posterior arthrodesis (n=1). Imaging files included X-rays and T1-weighted MR images in all cases, T2-weighted MR images in 12 cases, MR images with fat signal suppression in 7 cases, and a CT scan in 1 case. Histological study of a calcified disk from an anatomical specimen of an ankylosed lumbar spine resulting from ankylosing spondylitis was examined.Results The signal intensity of the disks was similar to that of the bone marrow or of perivertebral fat both on T1-weighted MR images and on all sequences, including those with fat signal suppression. In one of these disks, a strongly negative absorption coefficient was focally measured by CT scan, suggesting a fatty content. The histological examination of the ankylosed calcified disk revealed the presence of well-differentiated bone tissue and fatty marrow within the disk.Conclusion The high signal intensity of some calcified intervertebral disks on T1-weighted MR images can result from the presence of fatty marrow, probably related to a disk ossification process in ankylosed spines.     

Idiopathic arterial calcification in childhood

Idiopathic arterial calcification in infancy is usually fatal with death in early life and diagnosis at post mortem. This report describes a unique, late presentation with hypertension and cardiac failure in a child aged 33 months, found to have widespread arterial calcification at radiological imaging. The calcium-phosphate axis was normal and there was no other demonstrable cause for calcification. Additionally, the histological features of arterial calcification at renal biopsy paralleled the findings in infants with this disorder. The late presentation in this case is unusual and has not been previously reported. Ultrasound and CT are sensitive for calcification, and the disease should be suspected in children presenting with cardiac or respiratory manifestations and features of arterial calcification, where no metabolic cause is established.     

Treatment of calcifying tendinitis of the shoulder by acetic acid iontophoresis: a double-blind randomized controlled trial

OBJECTIVE: To assess the effects of acetic acid iontophoresis on the treatment of calcifying tendinitis of the shoulder. DESIGN: Double-blind randomized controlled trial. SETTING: Ambulatory academic hospital in Quebec, Canada. PARTICIPANTS: Thirty-six subjects with a calcifying tendinitis of the shoulder. INTERVENTIONS: Subjects were randomized into 1 of 2 groups: physiotherapy during 6 weeks (10 sessions) plus acetic acid iontophoresis for the treatment group (n=18) and sham acetic acid iontophoresis for the control group (n=18). MAIN OUTCOME MEASURES: The Shoulder Pain and Disability Index (SPADI), shoulder range of motion (ROM); and radiologic evaluation of shoulder calcifications. RESULTS: Nine patients dropped out, leaving 27 assessable subjects for analysis. Interim analysis showed that, in both groups, treatment led to improvement, as measured by the SPADI score (P=.004), ROM of the shoulder for abduction (P<.001), internal rotation (P=.001), external rotation (P<.001), and the mean number of calcifications per subject (P=.010). Although no formal significant intervention effects (P=.13) were found for the primary endpoint (SPADI), exploratory analyses suggest a greater improvement in the treatment group (P=.001) than in the control group (P=.33). CONCLUSIONS: Despite a trend toward greater improvement in the SPADI score in the treatment group, the use of acetic acid iontophoresis and physiotherapy for the treatment of calcifying tendinitis of the shoulder did not result in better clinical and radiologic effects than those observed in subjects treated by physiotherapyalone.     

Association of osteopontin with ischemic axonal death in periventricular leukomalacia

Osteopontin (OPN) is a bone matrix protein expressed my macrophages and related to the process of tissue calcification, and is also known to protect ischemic cells. To understand how OPN is involved in the process of ischemic axonal death in periventricular leukomalacia (PVL), we examined the immunoreactivity of OPN and ionized calcium binding adaptor molecule 1 (Iba1; microglia/ macrophage marker) at various stages of PVL. OPN immunoreactivity paralleled the number of Iba1-positive foam cells; a finding which suggests the production of OPN protein by foam cells. OPN immunoreactivity was not found in either normal white matter or acute PVL lesions, but was detected at the subacute and chronic stages in swollen and calcified axons bordering the ischemic zone. These findings suggest that OPN is closely associated with death of swollen axons at the periphery of the ischemic zone, regulating the presence or absence of calcification. Received: 20 January 1999 / Revised, accepted: 21 September 1999