CALCIFICATION

From Big Medical Encyclopedia

CALCIFICATION (calcinosis; calcium + - osis; synonym: calcification, calcification, limy dystrophy) — loss of salts of calcium from liquids of an organism where they are in the dissolved state, and their adjournment in fabrics.

Distinguish cellular and extracellular K. Matritsey calcifications there can be mitochondrions and lysosomes of cells, glikozaminoglikana of the main substance, collagenic and elastic fibers of connecting fabric. Sites of calcification can have an appearance of the smallest grains found only under a microscope (powdered calcification) or the centers well visible with the naked eye. The fabric inlaid with lime becomes dense and fragile, reminds a stone (petrification of fabric) and quite often contains iron. The chemical composition of salts of calcium in calciphied fabric qualitatively corresponds to the compounds of calcium which are contained in bones of a skeleton (see. Calcium ). In sites of calcification formation of a bone — ossification is possible; around deposits the reactive inflammation with proliferation of elements of connecting fabric, accumulation of colossal cells of foreign bodys and development of the fibrous capsule appears.

Calcium and its connections in fabrics reveal by means of various gistokhy, methods. Kossa's method consisting in processing of fabric cuts of 5% solution of caustic silver is most widespread; at the same time calcic salts, forming connections with silver, are painted in black color (see. Kossa ways ).

Calcium contains in an organism hl. obr. in the form of phosphate and carbonic salts which ground mass is concluded in bones where they are connected with a protein basis. In soft tissues and blood it is present at difficult connections with proteins and at the ionized state. Solubility of slabodissotsiiruyushchy salts of calcium in blood and liquids of an organism amplifies weak to-tami. Deduction of salts of calcium in solution is promoted by also proteinaceous colloids. From an organism calcium is emitted with preferential large intestine and to a lesser extent kidneys. Phosphatase and vitamin D participate in exchange of calcium enzyme. Regulation of calcic exchange and constancy of its level in blood is carried out by a nervous system and parathyroids (parathormone). Calcification — complex process, to-rogo promotes development change of proteinaceous colloids and pH of blood, disturbance of regulation of level of calcium in blood, local enzymatic (e.g., activation of phosphatases) and non-enzymatic (e.g., alkalization of fabric) factors. Calcification is preceded by increase in metabolic activity of cells, increase in synthesis of DNA and RNA, protein, hondroitinsulfat, and also activation of a row of fermental systems.

According to dominance of the general or local factors in mechanisms of development To. distinguish metastatic, dystrophic and metabolic calcification. Process can be system (widespread, or generalized, To.) or local (local To.), with dominance of deposits of lime in or out of cells.

Fig. 5. Microdrug of a muscle of heart of the person who died from sublimate poisoning (shooters specified limy metastasises).
Fig. 6. Microdrug of a mucous membrane of a stomach with a limy metastasis at basal membranes of ferruterous cells (it is specified by an arrow).

Metastatic calcification (limy metastasises) arises at hypercalcemias (see) in connection with the strengthened exit of calcium from depot lowered by its removal from an organism, disturbance of endocrine regulation of exchange of calcium (hyperproduction of parathormone, a lack of a calcitonin). This look To. develops at destruction of bones (multiple fractures, a multiple myeloma, metastasises of a tumor), osteomalacy (see) and parathyroid osteodystrophies (see), damage of a large intestine (at poisoning with corrosive sublimate, hron, dysentery) and kidneys (at a polycystosis, hron, nephrite), excess introduction to an organism of vitamin D, etc. Lime at metastatic To. drops out in different bodies and fabrics, but most often in lungs, a mucous membrane of a stomach, in a myocardium (tsvetn. fig. 5 and 6), kidneys and a wall of arteries that is explained by the feature of exchange in lungs, a stomach and kidneys connected with allocation of acid products and big alkalinity of their fabric; these features are physiological premises to calcification.

Fig. 1. Diffraction pattern of a muscle of heart: fixing of salts of calcium (1) on cristas of mitochondrions (2); x 40 000.
Fig. 2. Diffraction pattern of a kidney: fixing of salts of calcium (1) on cristas and covers of mitochondrions (2); x 40 000.

Adjournment of lime in a myocardium and a wall of arteries is promoted by washing of their fabrics rather poor in carbonic acid, an arterial blood. At limy metastasises of salt of calcium inlay cells of a parenchyma, fiber and the main substance of connecting fabric. In a myocardium and kidneys primary deposits of calcium phosphate find in mitochondrions (fig. 1 and 2) and phagolysosomes. In a wall of arteries and connecting fabric lime initially drops out on the course of membranes and fibrous structures. The condition of collagen and hondroitinsulfat is of great importance for loss of lime.

Fig. 4. Petrification of tuberculous focuses in a lung (it is specified by shooters).
Fig. 7. Microdrug of a brain of the person who died from a toxoplasmosis: calcification of nervous cells is specified by shooters.
Fig. 8. Microdrug of a skeletal muscle with a petrifitsirovanny trichinella in the center of drug

Dystrophic calcification (petrification) — adjournment of lime in the fabrics which became lifeless or being in a condition of deep dystrophy. It is local To., the main reason to-rogo — physical. - the chemical changes of fabrics causing absorption of lime from blood and an intercellular lymph. The greatest significance is attached to alkalization of the environment and strengthening of activity of the phosphatases which are released from nekrotizirovanny fabrics. At dystrophic calcification in fabrics limy conglomerates of stone density are formed the different sizes — petrifikata (see). Petrifikata are formed in the tuberculous caseous focuses (tsvetn. fig. 4), gummas, heart attacks, the died cells (tsvetn. fig. 7), focuses hron, inflammations etc. At calcification of the organized exudate on a pleura there are so-called armor-clad lungs (see. Pleura ), and on a pericardium this process comes to the end with emergence of an armored heart (see. Pericardis ). Calcification of cells of renal tubules (as a result of their death or excess release of lime) brings to to a nephrocalcinosis (see). Also cicatricial fabric, napr, valves of heart is exposed to dystrophic calcification at its defect, atherosclerotic plaques, cartilages (see. Chondrocalcinosis ), the died parasites (tsvetn. fig. 8), a transplant (calcification of a transplant), a dead fruit at an extrauterine pregnancy (see. Lithopedion ), etc. In some cases in petrifikata the bone tissue appears.

Metabolic calcification (intersticial To.) takes the intermediate place between dystrophic calcification and limy metastasises. The pathogeny it is not studied. The great value is attached to instability of buffer systems in this connection calcium does not keep in blood and an intercellular lymph even at its low concentration. Hypersensitivity of an organism to calcium can play a part, to-ruyu G. Selye designates kaltsifilaksiya (see): at the same time the local or system kaltsifilaksiya is possible. Metabolic To. can be system and limited. At system (universal) To. lime drops out in skin, a hypodermic fatty tissue, on the course of sinews, fastion and aponeuroses, in muscles, nerves and vessels; sometimes localization of deposits of lime happens same, as at limy metastasises. Assume that at system To. initially there are disturbances of lipid metabolism of connecting fabric in this connection process is suggested to be designated the term lipokaltsinogranulematoz (see). Limited (local) To., or the calcium gout, is characterized by adjournment of lime in the form of plates in skin of fingers of hands, is more rare than legs.

Children have a hypercalcemia from the subsequent patol, by calcification of internals is observed at primary parathyroidism, universal intersticial To., a kaltsifitsiruyushchy chondrodystrophia (Konradi's syndrome — Hyunermanna), the raised resorption of salts of calcium in a digestive tract: an idiopathic hypercalcemia, intoxication vitamin D, a syndrome of overconsumption of milk and alkalis (see. Burnett syndrome ); at anomaly of renal tubules — Butler's syndrome — Albright (see. Acidosis, at children ), inborn insufficiency of renal balls with a secondary hyper parathyroidism. The hypercalcemia in combination with osteoporosis can develop at insufficient load of a bone (osteoporosis from inaction), edges is observed at children with deep paresis of extremities owing to the postponed poliomyelitis or at paralyzes of other etiology.

Value K. for an organism is defined by the mechanism of development, prevalence and the nature of calcifications. So, universal intersticial To. represents the serious progressing illness, and limy metastasises usually have no wedge, manifestations. Dystrophic calcification of a wall of an artery at atherosclerosis leads to functional disturbances and can be the reason of a number of complications (e.g., fibrinferment). Along with it adjournment of lime in a caseous tuberculous focus demonstrates its healing.

Fig. 3. Calcic nodes in skin of a forearm at the patient metabolic calcification of skin.
Fig. 4. «Calcic gummas» in soft tissues of a hip and buttock. Above spontaneously opened gumma with the expiration of contents.

Calcification of skin and hypodermic fatty tissue. In skin of other forms meets metabolic more often To. The leading role in development of this look To. play local disturbances of metabolism in the skin or a hypodermic fatty tissue. Changes of connecting fabric, vessels of skin and a hypodermic fatty tissue cause physical. - chemical affinity of fabric to salts of calcium. Assume that the atsidotichesky shifts resulting at the same time the partial pressure of carbon dioxide decreases and solubility of calcium decreases that promotes its adjournment. Metabolic To. skin can be limited and widespread, or universal, with adjournment of salts not only in skin, but also in muscles, tendinous vaginas. Calcium and calcium carbonate drops out and is laid in actually skin and a hypodermic fatty tissue. At the same time skin loses the microscopic structure and it is represented as if sprinkled with the fine grains which are intensively perceiving nuclear coloring; around deposits of calcium colossal cells of foreign bodys are found. Further the changed skin becomes withdrawal pains. In cases limited To. skin firm small knots arise preferential on upper extremities (fig. 3), first of all in joints; less often the lower extremities, auricles are surprised. At a universal form of various size nodes arise on other body parts (e.g., on a back, buttocks). The skin covering nodes is accustomed to drinking with them, sometimes becomes thinner and breaks (fig. 4). At the same time from the opened node milky-white kroshkovaty or kashitseobrazny weight is allocated. These are so-called «calcic gummas» — the painless educations creating the fistulas differing in slackness of a current and extremely slow healing. Hard cases of a disease are characterized by an immovability of large joints and an atrophy of the corresponding groups of muscles; process is followed by fever, a cachexia and can lead to death. Limited and common forms To. skin and a hypodermic fatty tissue are often observed at a scleroderma (a syndrome of Tibyerzha — Veyssenbakh), dermatomyositis (see), atrofiruyushchy acrodermatitis.

Dystrophic To. — calcification of the previous defeats (abscesses, cysts, tumors) — is also observed in skin. Refer calcification of hems, fibromas, epidermal cysts to this form (e.g., a calcific epithelioma of Malerba), calciphied cysts of sebaceous glands at men (is more often on a scrotum), the calcification of nekrotizirovanny fatty segments of a hypodermic fatty tissue which is observed at elderly people, is especially frequent on the lower extremities — so-called stone tumors. Consider that skin and a hypodermic fatty tissue rather seldom become the place of deposition of limy metastasises.

To. skin comes to light slightly more often at women. Limited To. meets both in young, and at advanced age, a universal form K. mostly young people suffer. There are single descriptions of inborn solitary calcic small knots in skin of small children.

Diagnosis and differential diagnosis does not represent difficulties. The stone density of hypodermic nodes, a characteristic arrangement them on extremities correctly orient the doctor. The main diagnostic method metabolic (intersticial) To. the X-ray analysis is.

Radiological distinguish limited, universal and tumorous To. At limited intersticial To. deposits of lime are defined in skin of fingers of hands, is more often than a palmar surface, in a kosha and a hypodermic fatty tissue at a patella in the form of humbly visible masses.

Fig. 5. Roentgenogram of brushes sick universal form of calcification: shooters specified the largest sites of calcification of skin and hypodermic cellulose.
Fig. 6. Roentgenogram of area of a hip joint sick tumorous form of calcification: calcification of hypodermic cellulose is specified by shooters.

At a universal form K. in pictures sites of calcification which are located in skin, a hypodermic fatty tissue, sinews and muscles of various body parts are visible widespread kroshkovidny, linear or irregular shape. These centers can be isolated, can merge in the separate conglomerates which are located near large joints of extremities in phalanxes of fingers (fig. 5), soft tissues of hips, a stomach and back. Tumorous intersticial To. — the large limy nodes the size apprx. 10 cm, irregular shape which are localized most often near large joints (fig. 6), sometimes symmetrically on both sides. Nodes are not connected with bones, the structure of a bone tissue is, as a rule, not broken, in rare instances there is moderate osteoporosis (see). At differential diagnosis it must be kept in mind a D-hypervitaminosis which is easily distinguished according to the anamnesis, characteristic of it. In the presence of the fistulas sometimes arising at a tumorous form K., it is necessary to exclude tuberculosis, for to-rogo the changes of bones which are absent at To are characteristic. The calcium gout differs from true gout in lack of painful attacks.

By the most effective method treatments the separate large centers of calcification of skin and hypodermic fatty tissue their operational removal is. In the presence of the nodes inclined to disintegration, make their opening and emptying in the surgical way or using electrothermic coagulation and electrocaustic. At a universal form of a disease surgical intervention can bring only, partial simplification to the patient.

Patients are recommended to avoid, the uses of the food rich with calcium (milk, vegetables) and vitamin D.

Forecast for life favorable though treatment is observed extremely seldom. There are messages on spontaneous disappearance of small calcic deposits in skin and a hypodermic fatty tissue. In rare instances of the heavy current extended To. skin there can come death.



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B. Herov; Yu. Ya. Ashmarin (dermas.), V. V. Kitayev (rents.), A. V. Papayan (ped.).

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