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    "textoCompleto" => "<p class="elsevierStylePara">To the editor&#58; Penile necrosis is a rare entity and only a few cases have been described in patients on dialysis&#46;<span class="elsevierStyleSup">1&#44;2</span> In these patients it can be associated to diabetes mellitus &#40;DM&#41;&#44; cholesterol emboli and seldom to calciphylaxis&#46;<span class="elsevierStyleSup">1&#44;3&#44;4</span> The diagnosis relies on clinical picture&#44; history&#44; physical exam and on other investigations like skin biopsy&#46;<span class="elsevierStyleSup">1</span> We present a case of calciphylaxis in an infrequent location in a patient on hemodialysis&#46;</p><p class="elsevierStylePara">A 43 year-old male was on periodic hemodialysis because of chronic glomerulonephritis&#46; In the next three years the Ca&#47;P product was persistently higher than 70 mg2&#47;dL2&#44; he had hyperphosphatemia and severe hyperparathyroidism &#40;iPTH 1200 pg&#47;mL&#41;&#46; No control could be achieved either with calcitriol or with subtotal parathyroidectomy&#44; which was performed in January of 2005&#46; Since the intervention the PTH level was 200 pg&#47;mL&#44; and calcium and phosphorus levels were 8&#46;5 mg&#47;dL and 4 mg&#47;dL&#44; respectively&#46; In September of 2005 he was admitted because of general deterioration and progressive appearance of petechiae on the penis&#44; which evolved to necrosis &#40;fig&#46; 1&#41;&#46;</p><p class="elsevierStylePara">Laboratory findings were the following&#58; 9&#44;100 leucocytes&#47;mm3&#44; Hb 9&#46;8 g&#47;dL&#44; proteins 4&#46;4 g&#47;dL&#44; P 4&#46;32 mg&#47;dL&#44; and PTH 248 pg&#47;mL&#46; Coagulation parameters were normal and HIV serology was negative&#46; A plain X-ray film of the abdomen showed calcifications within the iliofemoral vessels&#46; Doppler ultrasound of the penis and the iliac vessels revealed a complete lack of flow in the penis and minimal flow in the iliac and femoral arteries&#44; as well as calcifications within the penis vessels&#46;</p><p class="elsevierStylePara">A decision to perform a partial penectomy was made&#46; The pathological study disclosed hyperplasia of the intimal layer&#44; calcifications in the media with necrotic areas and bleeding within the penis&#46; The postsurgical evolution was acceptable&#46;</p><p class="elsevierStylePara">Calciphylaxis is a disorder of unknown etiopathogenesis&#46; It is associated to hypercalcemia and&#47;or hyperphosphatemia due to secondary hyperparathyroidism or to intake of calcium preparations and calcitriol&#46;<span class="elsevierStyleSup">5</span> It appears in 1&#37;-4&#37; of the patients on hemodialysis&#46; It was also described in patients on peritoneal dialysis&#44; and very rarely in patients with renal transplantation or in those with end stage CRF&#44; stages III and IV&#46;<span class="elsevierStyleSup">6-8</span></p><p class="elsevierStylePara">The main approach to this condition should be the prevention&#44; through monitoring of calcium levels and appropriate frequency of dialysis sessions&#46; In experimental models it has been shown that early use of biphosphonates decreases the incidence&#46;<span class="elsevierStyleSup">9</span> Parathyroidectomy is only beneficial in case of very PTH high levels&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">In the literature review we have found 35 cases of calciphylaxis with penis involvement&#46;<span class="elsevierStyleSup">2&#44;11&#44;12</span> In 35&#37; of them the treatment was conservative&#44; in 53&#37; surgery was underwent only if complications developed and in 12&#37; surgery was early performed&#46; The mortality rate was 58&#37;&#44; 61&#37; and 25&#37;&#44; respectively&#46; Sixty-eight percent of the cases evolved to moist gangrene &#40;<span class="elsevierStyleSup">2&#44;11</span>&#41;&#46; If the penis is involved the mortality reaches 69&#37;&#46;<span class="elsevierStyleSup">2&#44;12</span></p><p class="elsevierStylePara">A high mortality of 50&#37; at 6 months has been reported when penis necrosis develops in patients with DM and endstage CRF&#46;<span class="elsevierStyleSup">13</span> DM&#44; high blood pressure&#44; end-stage CRF and dyslipidemia accelerate the atherosclerotic angiopathy&#44; and they are the main risk factors for this entity&#46;</p><p class="elsevierStylePara">Penis calciphylaxis is an infrequent systemic presentation of end-stage CRF&#46; Early diagnosis and appropriate management can be determinant for the evolution and the prognosis in these patients&#46; <br></br></p>"
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Penis necrosis as an unusual manifestation of calciphylaxis in uremia
Necrosis del pene como rara manifestación de calcifilaxis en la uremia
Faissal Tarrassa, M.. Benjellouna
a Hospital Central Hassani, Marruecos,
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    "textoCompleto" => "<p class="elsevierStylePara">To the editor&#58; Penile necrosis is a rare entity and only a few cases have been described in patients on dialysis&#46;<span class="elsevierStyleSup">1&#44;2</span> In these patients it can be associated to diabetes mellitus &#40;DM&#41;&#44; cholesterol emboli and seldom to calciphylaxis&#46;<span class="elsevierStyleSup">1&#44;3&#44;4</span> The diagnosis relies on clinical picture&#44; history&#44; physical exam and on other investigations like skin biopsy&#46;<span class="elsevierStyleSup">1</span> We present a case of calciphylaxis in an infrequent location in a patient on hemodialysis&#46;</p><p class="elsevierStylePara">A 43 year-old male was on periodic hemodialysis because of chronic glomerulonephritis&#46; In the next three years the Ca&#47;P product was persistently higher than 70 mg2&#47;dL2&#44; he had hyperphosphatemia and severe hyperparathyroidism &#40;iPTH 1200 pg&#47;mL&#41;&#46; No control could be achieved either with calcitriol or with subtotal parathyroidectomy&#44; which was performed in January of 2005&#46; Since the intervention the PTH level was 200 pg&#47;mL&#44; and calcium and phosphorus levels were 8&#46;5 mg&#47;dL and 4 mg&#47;dL&#44; respectively&#46; In September of 2005 he was admitted because of general deterioration and progressive appearance of petechiae on the penis&#44; which evolved to necrosis &#40;fig&#46; 1&#41;&#46;</p><p class="elsevierStylePara">Laboratory findings were the following&#58; 9&#44;100 leucocytes&#47;mm3&#44; Hb 9&#46;8 g&#47;dL&#44; proteins 4&#46;4 g&#47;dL&#44; P 4&#46;32 mg&#47;dL&#44; and PTH 248 pg&#47;mL&#46; Coagulation parameters were normal and HIV serology was negative&#46; A plain X-ray film of the abdomen showed calcifications within the iliofemoral vessels&#46; Doppler ultrasound of the penis and the iliac vessels revealed a complete lack of flow in the penis and minimal flow in the iliac and femoral arteries&#44; as well as calcifications within the penis vessels&#46;</p><p class="elsevierStylePara">A decision to perform a partial penectomy was made&#46; The pathological study disclosed hyperplasia of the intimal layer&#44; calcifications in the media with necrotic areas and bleeding within the penis&#46; The postsurgical evolution was acceptable&#46;</p><p class="elsevierStylePara">Calciphylaxis is a disorder of unknown etiopathogenesis&#46; It is associated to hypercalcemia and&#47;or hyperphosphatemia due to secondary hyperparathyroidism or to intake of calcium preparations and calcitriol&#46;<span class="elsevierStyleSup">5</span> It appears in 1&#37;-4&#37; of the patients on hemodialysis&#46; It was also described in patients on peritoneal dialysis&#44; and very rarely in patients with renal transplantation or in those with end stage CRF&#44; stages III and IV&#46;<span class="elsevierStyleSup">6-8</span></p><p class="elsevierStylePara">The main approach to this condition should be the prevention&#44; through monitoring of calcium levels and appropriate frequency of dialysis sessions&#46; In experimental models it has been shown that early use of biphosphonates decreases the incidence&#46;<span class="elsevierStyleSup">9</span> Parathyroidectomy is only beneficial in case of very PTH high levels&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">In the literature review we have found 35 cases of calciphylaxis with penis involvement&#46;<span class="elsevierStyleSup">2&#44;11&#44;12</span> In 35&#37; of them the treatment was conservative&#44; in 53&#37; surgery was underwent only if complications developed and in 12&#37; surgery was early performed&#46; The mortality rate was 58&#37;&#44; 61&#37; and 25&#37;&#44; respectively&#46; Sixty-eight percent of the cases evolved to moist gangrene &#40;<span class="elsevierStyleSup">2&#44;11</span>&#41;&#46; If the penis is involved the mortality reaches 69&#37;&#46;<span class="elsevierStyleSup">2&#44;12</span></p><p class="elsevierStylePara">A high mortality of 50&#37; at 6 months has been reported when penis necrosis develops in patients with DM and endstage CRF&#46;<span class="elsevierStyleSup">13</span> DM&#44; high blood pressure&#44; end-stage CRF and dyslipidemia accelerate the atherosclerotic angiopathy&#44; and they are the main risk factors for this entity&#46;</p><p class="elsevierStylePara">Penis calciphylaxis is an infrequent systemic presentation of end-stage CRF&#46; Early diagnosis and appropriate management can be determinant for the evolution and the prognosis in these patients&#46; <br></br></p>"
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Article information
ISSN: 20132514
Original language: English
DOI:
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Idiomas
Nefrología (English Edition)