vitamin-d-2 and Necrosis

Calciphylaxis represents a dermatological emergency with a mortality of up to 80%. The disease is characterized by a triad of arteriolar medial calcification, thrombotic cutaneous ischemia and necrotic ulcerations. Recently several mechanisms of vascular calcification have been identified. This may led to preventive measures in the future. Early diagnosis is important to avoid complications such as sepsis. The dermatologist plays an important role in early diagnosis based on the recognition of clinical presentation and histopathology. Patients with end-stage renal disease are most commonly affected by calciphylaxis. The most frequent non-uremic predisposing conditions are primary hyperparathyroidism, malignancies, alcohol-induced liver disease, and autoimmune connective tissue diseases. Medical treatment aims to normalize mineral metabolism to reduce the serum concentration of sodium phosphate and thus to prevent precipitation and calcification. Newer compounds are bisphosphonates, non-sodium/non-aluminium phosphate binders, cinacalcet, paricalcitrol, and sodium thiosulfate. Among the surgical procedures parathyroidectomy did not result in a significant survival benefit. An aggressive surgical debridement of necrotic ulcerations, on the other hand, improved survival. Early diagnosis and a multidisciplinary treatment approach including re-vascularization by the vascular surgeon, repeated surgical debridement and split skin transplantation support wound healing and insure limb conservation.

Topics: Biopsy; Bone Density Conservation Agents; Calciphylaxis; Chelating Agents; Combined Modality Therapy; Debridement; Diagnosis, Differential; Diphosphonates; Ergocalciferols; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Necrosis; Negative-Pressure Wound Therapy; Prognosis; Risk Factors; Skin; Skin Diseases, Metabolic; Thiosulfates

Topics: Animals; Arrhythmias, Cardiac; Calcium; Cardiotonic Agents; Catecholamines; Cats; Culture; Death, Sudden, Cardiac; Dogs; Electrocardiography; Emotions; Ergocalciferols; Fludrocortisone; Heart Conduction System; Heart Diseases; Helplessness, Learned; Humans; Hypothalamus; Immobilization; Mice; Myocardial Reperfusion Injury; Myocardial Stunning; Myocardium; Necrosis; Parasympathetic Nervous System; Psychophysiologic Disorders; Rats; Stress, Physiological; Subarachnoid Hemorrhage; Sympathetic Nervous System; Thyroxine; Vagus Nerve

Calciphylaxis occurred in a 40-year old female patient with end-stage renal failure. The patient developed livedo racemosa ("livedo reticularis") with painful skin necrosis and ulcers involving multiple areas of the hip and legs after 22 years of hemodialysis. X-ray-examinations revealed calcinosis of peripheral arteries, especially of the pelvis, thigh and hands, while histological examinations showed a fibrosis and calcinosis of small subcutaneous arteries. A generalized cutaneous microangiopathy could be demonstrated by transcutaneous oxygen pressure measurements. Laboratory data showed a moderate secondary hyperparathyroidism with mild elevation of calcium-phosphate product. In addition to the hemodialysis an attempt was made to improve the microcirculation by vasoactive drugs. The clinical course was characterized by slow healing of the ulcers and occurrence of new areas of cutaneous necrosis. Calciphylaxis is a rare late complication in patients with advanced, often end-stage renal failure. It has characteristic histopathological features and is frequently, but not always, associated with a disturbed calcium and phosphorus metabolism and mildly elevated levels of parathyroid hormone. Calciphylaxis is classified as a special type of metastatic calcinosis.

Topics: Adult; Aluminum Hydroxide; Calciphylaxis; Calcium; Cholecalciferol; Disseminated Intravascular Coagulation; Ergocalciferols; Erythropoietin; Female; Humans; Ischemia; Kidney Failure, Chronic; Long-Term Care; Necrosis; Parathyroid Hormone; Renal Dialysis; Skin Diseases, Vascular

In 1966, Verhoeff suggested that retinoblastomas might be sensitive to vitamin D because they sometimes undergo calcification and spontaneous regression. In recent years, the antineoplastic effect of vitamin D has been established in vitro and in vivo. This study presents evidence that vitamin D2 inhibits the growth of the human retinoblastoma cell line (Y-79) grown in athymic mice. In mice treated with ergocalciferol, the subcutaneous retinoblastomas were smaller and showed increased tumor necrosis and calcification. Unfortunately, the vitamin D caused significant toxic reactions. Further studies that reduce the toxicity of vitamin D will be needed before its use in children with retinoblastomas can be advocated. To our knowledge, this is the first demonstration of the activity of ergocalciferol against a tumor in vivo and it suggests that ergocalciferol or one of its derivatives may be an effective chemotherapeutic agent against retinoblastomas in humans.

Topics: Animals; Calcinosis; Calcium; Cell Line; Dose-Response Relationship, Drug; Ergocalciferols; Eye Neoplasms; Necrosis; Neoplasm Transplantation; Retinoblastoma; Skin Neoplasms; Vitamin D

Topics: Adenosine Triphosphatases; Animals; Aorta; Aortic Diseases; Arteriosclerosis; Ergocalciferols; Esterases; Freund's Adjuvant; Glutamate Dehydrogenase; L-Lactate Dehydrogenase; Monoamine Oxidase; Necrosis; Rabbits; Succinate Dehydrogenase

Topics: Analysis of Variance; Animals; Aorta; Blood Sedimentation; Body Weight; Calcinosis; Cholesterol; Chondroitin; Coronary Vessels; Ergocalciferols; Female; Flavonoids; Hematocrit; Necrosis; Nephrocalcinosis; Rats; Rutin

Topics: Ergocalciferols; Lupus Vulgaris; Necrosis; Tuberculosis, Cutaneous; Vitamin D