Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Analysis of the clinical characteristics and therapeutic effect of refractory juvenile dermatomyositis to tofacitinib / 中华儿科杂志

Objective: To elucidate the clinical features of patients with refractory juvenile dermatomyositis (JDM), and to explore the efficacy and safety of tofacitinib in the treatment of refractory JDM. Methods: A total of 75 JDM patients admitted to the Department of Rheumatology and Immunology in Shenzhen Children's Hospital from January 2012 to January 2021 were retrospectively analyzed, and to analyze the clinical manifestations, efficacy and safety of tofacitinib in the treatment of refractory JDM. Patients were divided into refractory group with using of glucocorticoids in combination with two or more anti-rheumatic drugs for treatment, and the presence of disease activity or steroid dependence after a one-year follow-up. The non-refractory group is defined as clinical symptoms disappeared, laboratory indicators were normal, and clinical remission was achieved after initial treatment, and the clinical manifestations and laboratory indexes of the two groups were compared. The Mann-Whitney U test, Fisher's precision probability test was used for intergroup comparison. Binary Logistic multivariate regression analysis was used to identify risk factors for refractory JDM. Results: Among the 75 children with JDM, 41 were males and 34 were females with a age of onset of 5.3 (2.3, 7.8) years. The refractory group consisted of 27 cases with a age of onset of 4.4 (1.5, 6.8) years, while the non-refractory group consisted of 48 cases with a age of onset of 5.9 (2.5, 8.0) years. Compared with 48 cases in the non-refractory group, the proportion of interstitial lesions and calcinosis in the refractory group was higher than that in the non-refractory group (6 cases (22%) vs. 2 cases (4%), 8 cases (30%) vs. 4 cases (8%), both P<0.05). Binary Logistic regression analysis showed that observation group were more likely to be associated with to interstitial lung disease (OR=6.57, 95%CI 1.22-35.31, P=0.028) and calcinosis (OR=4.63, 95%CI 1.24-17.25, P=0.022). Among the 27 patients in the refractory group, 22 cases were treated with tofacitinib, after treatment with tofacitinib, 15 of 19 cases (86%) children with rashes showed improvement, and 6 cases (27%) with myositis evaluation table score less than 48 score both were improved, 3 of 6 cases (27%) had calcinosis were relieved, and 2 cases (9%) had glucocorticoid-dependence children were successfully weaned off. During the tofacitinib treatment, there was no increase in recurrent infection, blood lipids, liver enzymes, and creatinine were all normal in the 22 cases. Conclusions: Children with JDM with calcinosis and interstitial lung disease are more likely to develop refractory JDM. Tofacitinib is safe and effective for refractory JDM.

Burned-out testicular germ cell tumors: a clinicopathological analysis of three cases / 中华病理学杂志

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 μg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.

Clinical significance of distally located periurethral calcification in patients with lower urinary tract symptoms of benign prostate hyperplasia / 亚洲男科学杂志(英文版)

This study evaluated the association of periurethral calcification (PUC) with uroflowmetric parameters and symptom severity in male patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). The data were collected from a prospectively maintained database of 1321 men with LUTS of BPH who visited Chonnam National University Hospital (Gwang-ju, Korea) from January 2015 to December 2019. PUC severity and location were evaluated on the midsagittal plane during transrectal ultrasonography. Relationships among age, prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were assessed. Among the 1321 patients in this study, 530 (40.1%) had PUC. Patients with PUC had significantly higher IPSS (mean ± standard deviation [s.d.]: 15.1 ± 8.7 vs 13.1 ± 7.9; P < 0.001) and lower peak flow rate (Qmax; mean ± s.d.: 12.4 ± 6.6 ml s-1 vs 14.7 ± 13.3 ml s-1; P < 0.001), compared with patients who did not have PUC. Analyses according to PUC severity revealed that patients with severe PUC had higher prostate-specific antigen (PSA) level (P = 0.009), higher total IPSS (P < 0.001), lower Qmax (P = 0.002), and smaller prostate volume (P < 0.001), compared with patients who had non-severe (mild or moderate) PUC. Multivariate analysis showed that distal PUC was independently associated with high total IPSS (P = 0.02), voiding symptom score (P = 0.04), and storage symptom score (P = 0.023), and low Qmax (P = 0.015). In conclusion, PUC was significantly associated with worse LUTS parameters in terms of IPSS and Qmax. Furthermore, distally located PUC was independently associated with worse LUTS of BPH in men.

Mechanism of the Notch1 signaling pathway regulating osteogenic factor influences lumbar disc calcification / 中国骨伤

OBJECTIVE@#To explore the mechanism of the Notch1 signaling pathway in regulating osteogenic factors and influencing lumbar disc calcification.@*METHODS@#Primary annulus fibroblasts from SD rats were isolated and subcultured in vitro. The calcification-inducing factors bone morphogenetic protein-2 (BMP-2) and basic fibroblast growth factor (b-FGF) were added to separate groups to induce calcification, which were referred to as the BMP-2 group and the b-FGF group, respectively. A control group was also set up, which was cultured in normal medium. Subsequently, cell morphology and fluorescence identification, alizarin red staining, ELISA, and quantitative real-time polymerase chain reaction (QRT-PCR) were performed to determine the effect of calcification induction. Cell grouping was performed again, including the control group, the calcification group (adding the inducer BMP-2), the calcification + LPS group(adding the inducer BMP-2 and the Notch1 pathway activator LPS), and the calcification + DAPT group (adding the inducer BMP-2 and the Notch1 pathway inhibitor DAPT). Alizarin red staining and flow cytometry were used to detect cell apoptosis, ELISA was used to detect the content of osteogenic factors, and Western blot was used to detect the expression of BMP-2, b-FGF, and Notch1 proteins.@*RESULTS@#The induction factor screening results showed that the number of mineralized nodules in fibroannulus cells in BMP-2 group and b-FGF group was significantly increased, and the increase was greater in the BMP-2 group Meanwhile, ELISA and Western blot results showed that BMP-2, b-FGF and mRNA expression levels of BMP-2, b-FGF and Notch1 in the induced group were significantly increased (P<0.01). The results of the mechanism of Notch1 signaling pathway affecting lumbar disc calcification showed that compared to calcified group, the number of fibroannulus cell mineralization nodules, apoptosis rate, BMP-2, b-FGF content, the expression levels of BMP-2, b-FGF, and Notch1 proteins were further increased significantly However, the number of mineralization nodules, apoptosis rate, BMP-2 and b-FGF levels, BMP-2, b-FGF and Notch1 protein expression levels were decreased in the calcified +DAPT group (P<0.05 or P<0.01).@*CONCLUSION@#Notch1 signaling pathway promotes lumbar disc calcification through positive regulation of osteogenic factors.

Effect of Calcified Lymph Nodes on Thoracoscopic Lobectomy in Chronic Obstructive Pulmonary Disease Patients with Lung Cancer / 中国医学科学院学报

Objective To observe the effect of calcified lymph nodes on video-assisted thoracoscopic surgery (VATS) lobectomy in the chronic obstructive pulmonary disease (COPD) patients with lung cancer. Methods A retrospective analysis was conducted on the COPD patients with lung cancer who underwent VATS lobectomy in the Department of Thoracic Surgery in the First Affiliated Hospital of Hebei North University from May 2014 to May 2018.The patients were assigned into a calcified lymph node group and a control group according to the presence or absence of calcified lymph nodes in CT,and the size,morphology,and calcification degree of the lymph nodes were recorded.The operation duration,intraoperative blood loss,chest tube retention time,hospitalization days,and overall complication rate were compared between the two groups. Results The 30 patients in the calcified lymph node group included 17 patients with one calcified lymph node and 13 patients with two or more calcified lymph nodes,and a total of 65 calcified lymph nodes were recorded.The calcified lymph nodes with the size ≤5 mm were the most common (53.8%),and complete calcification was the most common form (55.4%) in lymph node calcification.The mean operation duration had no significant difference between the calcified lymph node group and the control group (t=-1.357,P=0.180).The intraoperative blood loss (t=-2.646,P=0.010),chest tube retention time (t=-2.302,P=0.025),and hospitalization days (t=-2.274,P=0.027) in the calcified lymph node group were higher than those in the control group. Conclusion Calcified lymph nodes increase the difficulty and risk of VATS lobectomy in the COPD patients with lung cancer.The findings of this study are conducive to predicting the perioperative process of VATS lobectomy.

Prevalence of soft tissue calcifications in the maxillofacial region: a radiographic study

Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher's exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age

Calcificaciones pulmonares metastásicas, 3 casos clínicos / Metastatic pulmonary calcifications: three clinical cases

Las calcificaciones pulmonares metastásicas, hacen referencia a una enfermedad metabólica, caracterizada por depósitos de calcio en tejido pulmonar sano. La etiología es amplia e incluye enfermedades malignas y benignas, siendo la falla renal la causa más frecuente. Es una condición, que, a pesar de ser frecuente, suele ser subdiagnosticada, por presentar pocos o ningún síntoma. Presentamos tres casos clínicos asociados a enfermedad renal crónica, pre y post trasplante.

Metastatic pulmonary calcifications refer to a metabolic disease, characterized by calcium deposits in healthy lung tissue. The etiology is broad and includes malignant and benign diseases, the kidney failure being the most frequent cause. It is a condition, which, despite being frequent, is usually underdiagnosed, because it presents few or no symptoms. We present three clinical cases associated with pre- and post-transplant kidney disease.

Promotion effect of FGF23 on osteopenia in congenital scoliosis through FGFr3/TNAP/OPN pathway / 中华医学杂志(英文版)

BACKGROUND@#Congenital scoliosis (CS) is a complex spinal malformation of unknown etiology with abnormal bone metabolism. Fibroblast growth factor 23 (FGF23), secreted by osteoblasts and osteocytes, can inhibit bone formation and mineralization. This research aims to investigate the relationship between CS and FGF23.@*METHODS@#We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region. FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured. Receiver operator characteristic (ROC) curve analyses were conducted to evaluate the specificity and sensitivity of FGF23. The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3 (FGFr3)/tissue non-specific alkaline phosphatase (TNAP)/osteopontin (OPN) in primary osteoblasts from CS patients (CS-Ob) and controls (CT-Ob) were detected. In addition, the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.@*RESULTS@#DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins, accompanied by increased mRNA levels. CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography (CT) values compared with controls. The FGF23 mRNA levels were negatively correlated with the CT value of the spine, and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS. Additionally, significantly increased levels of FGF23, FGFr3, OPN, impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob. Moreover, FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels, while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob. Mineralization of CS-Ob was rescued after FGF23 knockdown.@*CONCLUSIONS@#Our results suggested increased peripheral blood FGF23 levels, decreased bone mineral density in CS patients, and a good predictive ability of CS by peripheral blood FGF23 levels. FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP / OPN pathway.

Calcificación anillo mitral: reemplazo mitral con prótesis mecánica en posición supra anular / Mitral annular calcification: mitral valve replacement with mechanical prosthesis in supra annular position

Abstract: An 84 year old woman presented with recurrent severe heart failure. She had a heavily calcified mitral valve annulus. Radiological images before and after a mechanical valve was implanted in a supra annular position are shown.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Calcinose distrófica cutânea na doença venosa crônica de membros inferiores / Dystrophic calcinosis cutis in chronic venous disease of the lower limbs

Resumo As úlceras de membros inferiores, secundárias à doença venosa crônica (DVC), constituem um problema significativo de saúde pública no Brasil e representam cerca de 70% do total dessas úlceras. Apesar dos recentes avanços tecnológicos e das diversas opções terapêuticas utilizadas para essas lesões crônicas, existem diversos fatores que podem estar implicados na resistência ao tratamento. A calcificação distrófica cutânea (CDC) é uma condição rara e frequentemente subdiagnosticada, que, quando associada à DVC, pode estar associada à refratariedade no processo cicatricial. Neste artigo, relatamos um caso de CDC em paciente portador de DVC e discutimos a sua etiologia, fisiopatologia e possíveis opções de tratamento.

Abstract Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Oral Use of Phenytoin to Reduce Calcification in Bovine Pericardium and Porcine Aortic Leaflets Implants in Rats

Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). Conclusion: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.

Caracterização Histológica das Lesões da Valva Mitral de Pacientes com Cardiopatia Reumática / Histopathological Characterization of Mitral Valvular Lesions from Patients with Rheumatic Heart Disease

Resumo Fundamentos: Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos. Objetivo: O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos. Métodos: Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares. Ocorreu fibrose moderada a acentuada mais frequentemente em válvulas reumáticas do que em válvulas controle (100% vs. 29%; p<0,001). Ocorreu calcificação em 35% das valvas reumáticas, principalmente entre as valvas estenóticas, associada à área valvar mitral (p=0,003). Conclusões: Apesar do intenso grau de fibrose, o processo inflamatório permanece ativo na valva mitral reumática, mesmo em doença tardia com disfunção valvar. A calcificação predominou em valvas estenóticas e em pacientes com disfunção ventricular direita.

Abstract Background: The underlying mechanisms by which rheumatic heart disease (RHD) lead to severe valve dysfunction are not completely understood. Objective: The present study evaluated the histopathological changes in mitral valves (MV) seeking an association between the pattern of predominant valvular dysfunction and histopathological findings. Methods: In 40 patients who underwent MV replacement due to RHD, and in 20 controls that underwent heart transplant, histological aspects of the excised MV were analyzed. Clinical and echocardiographic data were also collected. Histological analyses were performed using hematoxylin-eosin staining. Inflammation, fibrosis, neoangiogenesis, calcification and adipose metaplasia were determined. A p value<0.05 was considered to be statistically significant. Results: The mean age of RHD patients was 53±13 years, 36 (90%) were female, whereas the mean age of controls was 50±12 years, similar to the cases, with the majority of males (70%). The rheumatic valve endocardium presented greater thickness than the controls (1.3±0.5 mm versus 0.90±0.4 mm, p=0.003, respectively), and a more intense inflammatory infiltrate in the endocardium (78% versus 36%; p=0.004), with predominance of mononuclear cells. Moderate to marked fibrosis occurred more frequently in rheumatic valves than in control valves (100% vs. 29%; p<0.001). Calcification occurred in 35% of rheumatic valves, especially among stenotic valves, which was associated with the mitral valve area (p=0.003). Conclusions: Despite intense degree of fibrosis, the inflammatory process remains active in the rheumatic mitral valve, even at late disease with valve dysfunction. Calcification predominated in stenotic valves and in patients with right ventricular dysfunction.

Prevalence of pineal gland and choroid plexus calcification among iraqi patients attending CT scan units / Prevalencia de calcificación de la glándula pineal y del plexo coroideo entre pacientes iraquíes que asisten a las unidades de tomografía computarizada

SUMMARY: Pineal gland calcification is the most common physiological intracranial calcification followed by the choroid plexus calcification. The objective of the study was to determine the prevalence of the pineal gland and choroid plexus calcification among the Iraqi population attending computed tomography scan units in Baghdad, estimate the mean diameters of the pineal gland calcification, and to detect any correlation between these calcifications with age and sex. This multi-centric cross-sectional study examined 485 CT scans of Iraqi patients between the ages of 1 and 100 years attending CT scan units in the period 1 December 2018 to 1 April 2019. Descriptive and inferential statistics were used. The prevalence of pineal gland calcification was found to be 68 % with the 30-39 age group and male sex predominance. It was found to increase after the first decade of life without real consistency. The mean for pineal gland calcification anterior-posterior diameter was 4.55±2.13 and the mean of the right-left diameter was 3.95±1.54. These diameters were found to differ according to sex and age. Choroid plexus calcification was found to have a prevalence of 53.6 %. In most cases, choroid plexus calcification was found bilaterally (77.3 %). There was no difference in sex, but choroid plexus. In conclusion, calcification was noticed to increase gradually according to age. Both pineal gland and choroid plexus calcification have a relatively high prevalence. While pineal gland calcification formation was demonstrated to have a close relation to age and sex, choroid plexus calcification formation was noticed to relate only to age.

RESUMEN: La calcificación de la glándula pineal es la calcificación intracraneal fisiológica más común después de la calcificación del plexo coroideo. El objetivo del estudio fue determinar la prevalencia de calcificación de la glándula pineal y del plexo coroideo entre la población iraquí que asiste a las unidades de tomografía computarizada en Bagdad, estimar los diámetros medios de la calcificación de la glándula pineal y detectar la posible correlación entre estas calcificaciones con la edad y el sexo. Este estudio transversal multicéntrico examinó 485 tomografías computarizadas de pacientes iraquíes entre 1 y 100 años de edad que asistieron a unidades de tomografía computarizada en el período del 1 de diciembre de 2018 al 1 de abril de 2019. Se utilizaron estadísticas descriptivas e inferenciales. Se encontró una prevalencia de calcificación de la glándula pineal del 68 % con predominio del sexo masculino en el grupo de 30 a 39 años. Se observó que aumentaba después de la primera década de vida sin una coherencia real. La media del diámetro anteroposterior de la calcificación de la glándula pineal fue de 4,55 ± 2,13 y la media del DIÁ- METRO derecho-izquierdo fue de 3,95 ± 1,54; estos diámetros difieren según el sexo y la edad. La calcificación del plexo coroideo tiene una prevalencia del 53,6 %. En la mayoría de los casos, la calcificación del plexo coroideo se encontró de forma bilateral (77,3%). No hubo diferencia de sexo, no obstante en el plexo coroideo se observó que la calcificación aumentaba gradualmente según la edad. Tanto la calcificación de la glándula pineal como del plexo coroideo tienen una prevalencia relativamente alta. Si bien se demostró que la formación de calcificación de la glándula pineal está relacionada con la edad y el sexo, se observó que la formación de calcificación del plexo coroideo se relaciona solo con la edad.

Degeneración valvular en pacientes con bioprótesis aórtica porcina evaluada mediante PET con 18Ffluoruro de sodio / Valve degeneration in patients with aortic porcine bioprosthesis evaluated through 18Fsodium fluoride PET / Degeneração valvular em pacientes com bioprótese aórtica suína avaliada mediante PET com fluoreto18F

Introducción: la degeneración valvular protésica es un problema clínico; los métodos de imagen convencionales permiten diagnosticarla en las últimas etapas. La tomografía por emisión de positrones (PET) con 18Ffluoruro puede detectar de manera precoz la degeneración subclínica. Objetivo: correlacionar parámetros de deterioro estructural protésico por PET con parámetros hemodinámicos ecocardiográficos al año de la sustitución valvular aórtica (SVA) por bioprótesis porcina. Métodos: estudio prospectivo ad hoc de un ensayo clínico. Se reclutaron pacientes sometidos a SVA por bioprótesis porcina en dos centros nacionales entre el 01/01/2019 y el 13/02/2020. Se realizaron controles clínicos y ecocardiográficos. Se seleccionaron aleatoriamente 19 sujetos a los que se les realizó PET 18Ffluoruro de sodio con angiotomografía al año de la SVA. Se midió la captación del trazador en la válvula (SUVavV) y aurícula derecha (SUVavA), calculando el índice SUVavV/SUVavA, que se comparó con los gradientes ecocardiográficos medio y máximo al año, mediante análisis de correlación de Spearman. Resultados: de 140 sujetos sometidos a SVA se realizó PET a 19, a los 16,3 meses (15,9-16,9) luego de la SVA. La mediana del índice SUVavV/SUVavA fue de 1,17 (1,11-1,27). Se encontró una correlación negativa moderada entre la captación de 18Ffluoruro y el gradiente medio (coeficiente de correlación -0,516, p = 0,028) y máximo (coeficiente -0,589, p = 0,010) al año. Conclusiones: en el seguimiento de los pacientes en los que se le realizó una sustitución valvular aórtica con bioprótesis, encontramos valores bajos de captación en el PET y gradientes ecocardiográficos normales con una correlación negativa moderada entre estos hallazgos

Introduction: prosthetic valve degeneration is a relevant clinical disorder; conventional imaging methods allow diagnosis in the later stages. 18Ffluoride positron emission tomography (PET) can detect subclinical degeneration earlier. Objective: correlate parameters of prosthetic structural deterioration by PET with echocardiographic hemodynamic parameters one year after aortic valve replacement (AVR) by porcine bioprosthesis. Methods: prospective ad hoc study of a clinical trial. Patients undergoing AVR by porcine bioprosthesis were recruited in two national centers between 01/01/2019 and 02/13/2020. Clinical and echocardiographic controls were carried out. 19 subjects were randomly selected and underwent 18Fsodium fluoride PET with CT angiography one year after AVR. Tracer uptake in the valve (SUVavV) and right atrium (SUVavA) was measured, creating the SUVavV/SUVavA index, which was compared with the mean and maximum gradients at one year, using Spearman's correlation analysis. Results: of a total of 140 subjects, PET was performed on 19 at 16.3 months (15.9-16.9) after the AVR. The median SUVavV/SUVavA ratio was 1.17 (1.11-1.27). A moderate negative correlation was found between. 18Ffluoride uptake and the mean gradient (correlation coefficient -0.516, p = 0.028) and maximum (coefficient of -0.589, p = 0.010) at one year. Conclusions: we found low uptake values in PET, echocardiographic gradients in normal range and no positive correlation between both parameters. It is the first national report with these imaging techniques

Introdução: a degeneração da válvula protética é um problema clínico; os métodos convencionais de imagem permitem o diagnóstico nas fases posteriores. A tomografia por emissão de pósitrons (PET) com fluoreto18F pode detectar a degeneração subclínica precocemente. Objetivo: correlacionar parâmetros de deterioração estrutural protética por PET com parâmetros hemodinâmicos ecocardiográficos após um ano da troca valvar aórtica (SVA) por bioprótese suína. Métodos: estudo ad hoc prospectivo de um ensaio clínico. Pacientes submetidos a SVA por bioprótese suína foram recrutados em dois centros nacionais entre 01/01/2019 e 13/02/2020. Foram realizados controles clínicos e ecocardiográficos. 19 indivíduos foram selecionados aleatoriamente que foram submetidos a PET com fluoreto de sódio 18F com angiotomografia um ano após AVS. A captação do traçador na válvula (SUVavV) e átrio direito (SUVavA) foi medida, criando o índice SUVavV/SUVavA, que foi comparado com os gradientes médio e máximo em um ano, usando a análise de correlação de Spearman. Resultados: de um total de 140 indivíduos submetidos a SVA, PET foi realizado em 19, em 16,3 meses (15,9-16,9) após a SVA. A proporção média de SUVavV/SUVavA foi de 1,17 (1,11-1,27). Uma correlação negativa moderada foi encontrada entre a captação de fluoreto18F e o gradiente médio (coeficiente de correlação -0,516, p = 0,028) e máximo (coeficiente de -0,589, p = 0,010) em um ano. Conclusões: encontramos valores baixos de captação na PET, gradientes ecocardiográficos dentro da normalidade, sem correlação positiva entre os dois parâmetros. É o primeiro trabalho nacional com essas técnicas de imagem