Central Surgical AssociationParathyroidectomy promotes wound healing and prolongs survival in patients with calciphylaxis from secondary hyperparathyroidism*
Section snippets
Methods
Between January 1989 and May 2000, 13 patients with pathologic/clinical criteria of calciphylaxis were treated at the Johns Hopkins Bayview Medical Center. Patients were retrospectively identified through the pathology specimen database with the histologic diagnosis of calciphylaxis. Minimal pathologic criteria for biopsy diagnosis included the presence of dermal and epidermal necrosis, small and medium-sized vessel calcification and obliteration, and focal calcification in the dermis or
Demographic data
The mean age of the patients was 50.2 ± 11 years. Twelve patients were female and only 1 was male. All had significant renal disease, 12 of 13 requiring dialysis. Three had prior kidney transplants that had failed. In addition to kidney failure, patient comorbidities included obesity, hypertension, and diabetes but were not related to treatment group or outcome (Table I).Patient no. Age (y) Gender Comorbidity Dialysis type Wound location 1 37 F Obesity, HTN HD Thighs 2 36 F Obesity, HTN,
Discussion
Selye and Savoie2 coined the term calciphylaxis after a series of animal experiments. Their theory defined calciphylaxis as a systemic hypersensitivity induced by calcifying factors such as PTH, vitamin D, or phosphates, in which acute challengers induce extensive inflammation, tissue calcification, and necrosis. This experimental work remains the basis of present calciphylaxis theory. The 2 sensitizing agents frequently cited in the literature include PTH, commonly arising from the secondary
Discussion
Dr Michael J. Demeure (Milwaukee, Wis). Calciphylaxis is indeed a rare condition. One would infer from these data that surgical intervention in secondary parathyroidism patients at high risk for calciphylaxis could prevent the onset of this rather dreaded complication. However, at our institution only 1% of dialysis patients come to parathyroidectomy.
What are your indications for surgery in patients with secondary hyperparathyroidism, and what is the prevalence of calciphylaxis in your dialysis
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Cited by (117)
Uremic calciphylaxis
2022, Nephrologie et TherapeutiqueTreatment of Calciphylaxis in CKD: A Systematic Review and Meta-analysis
2019, Kidney International ReportsCalcific uremic arteriolopathy in hemodialysis patient, review of literature through five cases reports
2018, Nephrologie et TherapeutiqueChallenges and controversies in the surgical management of uremic hyperparathyroidism: A systematic review
2018, American Journal of SurgeryCitation Excerpt :Notably, this improvement in bone mineral density occurs even in the absence of renal transplantation, highlighting that patients who may not be candidates for renal transplantation may still derive significant benefit from surgical management with PTX.21 PTX has also been shown to result in enhanced wound healing, improved pain scores, and greatly decreased mortality in patients with calcific uremic arteriolopathy.22 Several studies have also shown a quality of life benefit associated with PTX.
Massive panniculectomy and bilateral subtotal mastectomy in a case of calciphylaxis: A case report and up date
2015, Annales de Chirurgie Plastique Esthetique
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Reprint requests: Herbert Chen, MD, University of Wisconsin Medical School, H4/750 Clinical Science Center, 600 Highland Ave, Madison, WI 53792.