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Colboc H, Fontaine J, Bazin D, Frochot V, Letavernier E, Daudon M, Laporte N, Rouzière S, Reby M, Galezowski A, Forasassi C, Meaume S. Calcified leg Ulcers in older patients: clinical description, morphology and chemical characterization. J Gerontol A Biol Sci Med Sci 2021; 77:27-32. [PMID: 34331540 DOI: 10.1093/gerona/glab223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Chronic wounds, including leg ulcers, constitute an important medical problem among older patients. Dystrophic calcifications (DC) are associated with a variety of disorders, including leg ulcers. The aim of this study was to report the clinical and biological characteristics of older patients with DC in leg ulcers and to determine the morphology and chemical composition of these calcifications. We conducted a prospective monocentric study in our Geriatric-Wound and Healing ward, Rothschild Hospital, Paris, from January 2018 to December 2019. Patients with leg ulcers were screened for DC by palpation. Patients' clinical, biological and radiological findings were collected. DC morphology was analyzed using field-emission scanning electron microscopy and chemical composition was analyzed using µFourier transform infra-red spectroscopy and X-ray Fluorescence. Ten (7%) of the 143 patients hospitalized for leg ulcers presented DC. Older patients with DC were more likely to have leg ulcers with venous insufficiency (P=0.015), colonized by Pseudomonas aeruginosa (P=0.026), with a longer healing evolution (P=0.0072) and hypercalcemia (P=0.041). Five DC were extracted from ulcers: two presented 500 nm lacunar spheres and intermingled fibrils of about 10 nm in diameter, consistent with bacterial and biofilm imprints. DC were always composed of Calcium-phosphate apatite and associated to the presence of Zinc. Our analyses were consistent with the involvement of microorganisms and inflammatory process in DC formation. Early management of venous insufficiency, treatment of chronic bacterial colonization and use of calcium-solubilizing drugs seem to be rational strategies for calcified leg ulcer management in older patients.
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Affiliation(s)
- Hester Colboc
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Juliette Fontaine
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | | | - Vincent Frochot
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Emmanuel Letavernier
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Michel Daudon
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Naomi Laporte
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Stéphan Rouzière
- Laboratoire de Physique des Solides, CNRS, Université Paris-Saclay, Orsay, France
| | - Michael Reby
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Agnes Galezowski
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Christine Forasassi
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Sylvie Meaume
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
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Galezowski A, Deylon J, Le Cleach L, Guegan S, Ducroux E, Alanio A, Moguelet P, Dadban A, Leccia M, Le Pelletier F, Francès C, Lebbé C, Barete S. Mycoses cutanées profondes des transplantés d’organes solides : étude observationnelle multicentrique pour le groupe peau et greffe d’organe (GPGO). Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Galezowski A, Sin C, Rothé-Thomas F, de la Bretèque MA, Bilan P, Sigal ML, Mahé E. [Subcutaneous calcinosis, a late and severe complication of radiotherapy: Three cases]. Ann Dermatol Venereol 2015; 142:761-6. [PMID: 26631443 DOI: 10.1016/j.annder.2015.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/03/2015] [Accepted: 08/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation-induced subcutaneous calcinosis is a rare and special form of potentially severe subcutaneous calcinosis of late onset. Herein, we report three cases of this disease, occurring in each instance more than 10 years after use of radiotherapy as an adjuvant treatment in breast cancer. PATIENTS AND METHODS Our report concerns 3 women aged 69-88 years consulting for pre-sternal ulcers (n=2) and/or subcutaneous nodules (n=2). These lesions developed on areas irradiated between 10 and 38 years earlier for breast cancer. In all three cases, radiological explorations showed extensive subcutaneous calcification. In one case, calcification extended into the mediastinum. In each patient, a diagnosis of radiation-induced subcutaneous calcinosis was made and symptomatic treatment was given. DISCUSSION Radiation-induced subcutaneous calcinosis is an irreversible and rare complication of high-dose radiation that usually occurs several years after radiotherapy. Its severity is related to potential ulcerations, pain and a risk for in-depth extension up to the mediastina. This complication remains unclear and treatment has not been codified. The only option seems to be "heavy" plastic surgery.
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Affiliation(s)
- A Galezowski
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - C Sin
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - F Rothé-Thomas
- Service de radiothérapie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - M Amy de la Bretèque
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - P Bilan
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - M-L Sigal
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - E Mahé
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France.
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