Home Penile calciphylaxis in a patient with end-stage renal disease: a case report and review of the literature
Article Open Access

Penile calciphylaxis in a patient with end-stage renal disease: a case report and review of the literature

  • Ti-Yuan Yang , Tao-Yeuan Wang , Marcelo Chen , Fang-Ju Sun , Allen W. Chiu and Yu-Hsin Chen EMAIL logo
Published/Copyright: May 9, 2018
Download Article (PDF)
Open Medicine
From the journal Open Medicine Volume 13 Issue 1

Abstract

Penile calciphylaxis is a rare cause of penile gangrene that presents in patients with end-stage renal disease. The rates of comorbidity and mortality of penile calciphylaxis are extremely high. Unlike other penile gangrene, such as Fournier’s gangrene, the benefit of aggressive surgical therapy is controversial. Here we present a case of penile calciphylaxis in a 43-year-old man with end-stage renal disease on hemodialysis. He received total penectomy but died due to multisystem complications 2 weeks after surgery. We review the literature on the management options and outcomes in patients with penile calciphylaxis.

Keywords: Penile calciphylaxis; Penile gangrene; Penectomy; End-stage renal disease; Microcalcification

1 Introduction

Calciphylaxis is a serious systemic disorder of smaller arteries, arterioles and capillaries seen in 1% to 4% of patients with end-stage renal disease on hemodialysis and is usually associated with elevated calcium-phosphate product [1]. It is a clinical condition with mortality rate higher than 60% [2]. Penile calciphylaxis is rare because of its rich vascular network and the prognosis is also poor, with a reported overall mortality rate of 64% and mean time to death of 2.5 months [1,3]. The benefit of penectomy is still under debate. Herein, we present a hemodialysis-dependent diabetic patient who presented with subacute distal penile dry gangrene due to penile calciphylaxis, and review the pertinent medical literature.

2 Case report

A 43-year-old man presented with fever, chills and a purulent sternotomy wound. He had a history of end-stage renal disease for which he had been treated with hemodialysis for 6 years, poorly controlled type II diabetes mellitus, hypertension, and double vessel coronary artery disease. He had undergone coronary artery bypass graft surgery 2 months before this presentation, and received debridement for a sternotomy wound infection and pectoralis major myocutaneous flap rotation 1 month before this presentation. One month after admission, he presented with dry gangrene of the distal third of the penis, including the glans and part of the shaft for 7 days (Figure 1). Dry gangrene was also present in both feet, the right ankle and thigh. Serum phosphate was 6.7 mg/dL (2.7-4.5 mg/dL), calcium was 9.8 mg/dL (8.9-10.3 mg/dL), calcium-phosphate product was 65.7 mg2/dl2 (20.6-52.5 mg2/dl2), albumin was 2.4g/dL (3.5-5.0 g/dL), HbA1c was 9.0%, and BMI was 24.8kg/m2. He did not take any anticoagulant medication, such as Warfarin. Computed tomography of his abdomen showed severe diffuse vascular calcifications, including in the branches of bilateral internal iliac arteries (Figure 2). Due to penile pain and progression of necrosis of the distal penis, penectomy was performed. The intraoperative findings after penile degloving showed extensive ischemic damage, and the spongiosal and cavernosal tissues of the pendulous part of the penis showed no signs of vitality. After incision of the cavernous bodies, only blood clots were drained, and therefore we performed total penectomy and perineal urethrostomy. Plastic surgeon consultation suggested not to resect other extragenital gangrene due to patient’s poor condition. The pathological report showed microcalcifications in the stroma and vascular wall consistent with calciphylaxis (Figure 3). Dyspnea and conscious disturbances occurred after three days antibiotics usage for post-operative fever. His overall condition deteriorated and died of respiratory failure and sepsis 2 weeks later.

Figure 1 Gangrenous penis.
Figure 1

Gangrenous penis.

Figure 2 Internal pudendal (large arrow) and penile artery (small arrow) calcification seen on computed tomography.
Figure 2

Internal pudendal (large arrow) and penile artery (small arrow) calcification seen on computed tomography.

Figure 3 Calcifications in the vascular wall within the gangrenous penile shaft.
Figure 3

Calcifications in the vascular wall within the gangrenous penile shaft.

Ethical approval: Research has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration.

Informed consent: Informed consent has been obtained from all individuals included in this study.

3 Discussion

Calciphylaxis is characterized by medial calcification and intimal fibrosis of medium and small arteries. Mottling of the skin and induration in a livedo reticularis pattern is a characteristic clinical presentation of calciphylaxis, which generally affects the distal extremities, buttocks, and thighs, and sometimes the penis. Penile calciphylaxis has an extremely poor prognosis, with a reported overall mortality rate of 64% and mean time to death of 2.5 months [3]. Cimmino et al. recommend penile biopsy is unnecessary for diagnosis of penile calciphylaxis [4].

A total of 50 cases of penile calciphylaxis have been reported in the English literature (Table 1) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. The average age was 54.5 years (range 32 to 81). Including our case, all patients had end stage renal disease, 42 patients received hemodialysis, 7 patients received peritoneal dialysis and 2 patients were in the pre-dialysis stage. Forty-one patients had diabetes mellitus. Average calcium level was 9.2 mg/dl, average phosphate level was 8.0 mg/dl and average calcium-phosphate product was 72.8 mg2/dl2. The overall mortality rate was 56.5%. Three-month mortality rate was 47.8%. Mean time to death was 97 days and median time to death was a month. There was no correlation between mortality rate and age, diabetes mellitus, calcium level, phosphate level and calcium-phosphate product level.

Table 1

Review of reported cases of penile calciphylaxis with end-stage renal disease.

AuthorsAgeCaPCaPPTHextragenital gangrenepenectomyparathyroidectomy3-month prognosis
(mg/dl)(mg/dl)(mg2/dl2)(pg/mL)
MMH439.86.765.7no datayesyesnodeath
Ivker RA[5]439.25.651.5375yesnoyesalive
Ivker RA[5]587.96.450.689yesyesyesalive
Melikoglu M[6]487.41181.4no datayesyesnodeath
Wood JC[7]568.9980.11280yesyesyesalive
Jhaveri FM[8]629.39.588.474yesnonodeath
Jhaveri FM[8]4410.57.679.81450yesnoyesalive
Jhaveri FM[8]441010.2102405yesnoyesloss
Jhaveri FM[8]4110.67.175.3746yesnonodeath
Jhaveri FM[8]5910.37.476.289yesnoyesdeath
Siami GA[9]447.98.667.9no datayesyesnodeath
Boccaletti VP[10]7210.57.891.9881nononodeath
Rich A[11]34no datano datano datano datayesyesnodeath
Jacobsohn HA[12]609.7987430yesyesnodeath
Karpman E[3]597.99.675.8379yesyesnodeath
Barthelmes L[13]48no datano datano datano datanoyesnodeath
Oikawa S[14]32no datano datano data63yesnoyes[*]death
Rifkin BS[15]61no datano datano datano datayesno datano dataloss
Woods M[16]358.47.462.238noyesnodeath
Halachmi S[17]578.58.576.5375yesnonodeath
Agarwal MM[18]528.57.563.8no datayesnonodeath
Sorensen MD[19]658.5no datano data121noyesnoalive
Ohta A[20]419.85.25118yesyesnoalive
Rizvi T[21]727.47.354315nononoalive
Bhatty TA[22]39no data7.1no data344.7yesnonoalive
Sandhu G[23]5810.210.3105.182nononoalive
Bappa A[24]729.67.370.1315.2yesnonoloss
Shah MA[25]727.96.652.1164yesnonodeath
Prematilleke I[26]6610.45.961.430.8noyesnodeath
Prematilleke I[26]389.97.776.248noyesnoalive
O’Neil B[27]728.9544.51462noyesyesalive
O’Neil B[27]59no datano datano data816yesyesyesalive
O’Neil B[27]6488.164.8516noyesyesalive
Akai A[28]36no datano data56no datayesnonoalive
Kumar V[29]738.811.8103.8633nononoalive
Barbera V[30]5012.88.6110.1615noyesnoalive
Yecies T[31]33no datano datano datano datanoyesnoalive
Cimmino CB[4]6298.475.6no datanononoalive
Cimmino CB[4]388.7no datano datano datayesnonoloss
Cimmino CB[4]497.49.671799.8nononoloss
Haider I[32]61no datano datano data260yesnonodeath
Morrison M[33]60no datano datano datano datayesnonoalive
Hanna RM[34]64913.5121.5612yesyesnoalive
Sarkis E[2]54no datano datano data94yesnonodeath
Malthouse T[35]619.18.475.9155yesnonodeath
Shiraki T[36]76no datano data42127yesnonoalive
Endly D[37]5894.139.8410yesnonodeath
Bashir SO[38]469.57.470.3600nonoyesalive
Maselli G[39]64no datano datano datano datanononoalive
Campbell RA[40]4610.7664.21096noyesnoalive
Olaoye OA[41]819.88.482.31131nononodeath

  1. Ca, calcium; P, phosphate; CaP, calcium-phosphate product; PTH, parathyroid hormone

Parathyroid hormone level was reported in 38 patients and average parathyroid hormone level was 458.9 pg/ml. Secondary hyperparathyroidism was found in 33 patients. One patient underwent parathyroidectomy before and 10 patients underwent parathyroidectomy after calciphylaxis developed. The 3-month mortality rates were 33.3% and 60% in patients undergoing parathyroidectomy after calciphylaxis and patients without parathyroidectomy, respectively (P=0.18). Mortality rate was not correlated with parathyroid hormone level and parathyroidectomy. This finding was different from that reported by Karpman et al., who suggested that parathyroidectomy may improve survival [3]. The possible reason for the difference was that they included patients without documented parathyroid hormone level in their statistics.

Extragenital gangrene was noted in 32 patients. The 3-month mortality rate was higher in patients with extragenital gangrene than in those without extragenital gangrene (60.7% vs. 27.8%, p=0.03). Extragenital gangrene involves more blood vessels and may result in worse prognosis.

Twenty-one patients received partial or total penectomy. The mortality rates were 42.9% and 52% in patients undergoing partial or total penectomy and patients who received local debridement and wound care, respectively (P=0.54). Karpman et al. also reported no statistically significant difference in survival between patients treated with penectomy and those treated with local debridement and wound care [3]. Since penectomy showed no survival benefit, we suggest that penectomy should be considered in the presence of severe pain refractory to analgesics or uncontrolled infection.

Akai A et al. reported a case of penile calciphylaxis who underwent femoral artery to deep dorsal penile vein bypass [28]. After revascularization surgery, pain subsided and the wound healed. Shiraki T et al. reported a case of penile calciphylaxis successfully treated with internal iliac artery balloon-expandable bare metal stent implantation [28]. Two cases were treated with hyperbaric oxygen therapy but both of them died within a month [12,14].

Three cases were treated with sodium thiosulfate, and 2 patients survived [2,23,33]. The possible mechanism of sodium thiosulfate is chelation of calcium ions, dissolution of insoluble calcium deposits and restoration of endothelium [2]. In a retrospective study of 27 patients with calciphylaxis in other locations, 52% resolved with sodium thiosulfate administration [2].

Penile calciphylaxis is a rare disease with poor prognosis because calciphylaxis involves smaller arteries, arterioles and capillaries systemically. Unlike other penile gangrene, such as Fournier’s gangrene, the benefit of aggressive surgical therapy is controversial. Patients with extragenital gangrene have higher rates of mortality. Due to its rarity, there is no consensus regarding the treatment of this disease. Conservative treatment, sodium thiosulfate, hyperbaric oxygen, internal iliac artery stent, revascularization surgery, penectomy and parathyroidectomy have all been described. Literature review showed that penectomy and parathyroidectomy had no significant survival benefit. However, since there is no definite curative treatment, physicians may attempt combining different treatment modalities.

  1. Conflict of interest

    Conflict of interest statement: Authors state no conflict of interest.

References

[1] Vedvyas C., Winterfield L.S., Vleugels R.A., Calciphylaxis: a systematic review of existing and emerging therapies, J Am Acad Dermatol, 2012,67(6),e253-26010.1016/j.jaad.2011.06.009Search in Google Scholar

[2] Sarkis E., Penile and generalised calciphylaxis in peritoneal dialysis, BMJ Case Rep, 201510.1136/bcr-2014-209153Search in Google Scholar

[3] Karpman E., Das S., Kurzrock E.A., Penile calciphylaxis: analysis of risk factors and mortality, J Urol, 2003,169(6),2206-220910.1097/01.ju.0000064334.85656.a1Search in Google Scholar

[4] Cimmino C.B., Costabile R.A., Biopsy is contraindicated in the management of penile calciphylaxis, J Sex Med, 2014,11(10),2611-261710.1111/jsm.12390Search in Google Scholar

[5] Ivker R.A., Woosley J., Briggaman R.A., Calciphylaxis in three patients with end-stage renal disease, Arch Dermatol, 1995,131(1),63-6810.1001/archderm.1995.01690130065013Search in Google Scholar

[6] Melikoglu M., Apaydin S., Hamuryudan V., Yurdakul S., Uygun N., Aki H., et al., Calciphylaxis: a condition mimicking necrotizing vasculitis, Clin Rheumatol, 1996,15(5),498-50010.1007/BF02229650Search in Google Scholar

[7] Wood J.C., Monga M., Hellstrom W.J., Penile calciphylaxis, Urology, 1997,50(4),622-62410.1016/S0090-4295(97)00311-7Search in Google Scholar

[8] Jhaveri F.M., Woosley J.T., Fried F.A., Penile calciphylaxis: rare necrotic lesions in chronic renal failure patients, J Urol, 1998,160(3 Pt 1),764-76710.1097/00005392-199809010-00037Search in Google Scholar

[9] Siami G.A., Siami F.S., Intensive tandem cryofiltration apheresis and hemodialysis to treat a patient with severe calciphylaxis, cryoglobulinemia, and end-stage renal disease, Asaio j, 1999,45(3),229-23310.1097/00002480-199905000-00024Search in Google Scholar PubMed

[10] Boccaletti V.P., Ricci R., Sebastio N., Cortellini P., Alinovi A., Penile necrosis, Arch Dermatol, 2000,136(2),261, 26410.1001/archderm.136.2.259-cSearch in Google Scholar PubMed

[11] Rich A., Leach A., Ellershaw J., A case of difficult pain in a patient with chronic renal failure and calciphylaxis, J Pain Symptom Manage, 2001,22(1),617-62110.1016/S0885-3924(01)00298-6Search in Google Scholar

[12] Jacobsohn H.A., Jenkins P.G., Jacobsohn K.M., Penile calciphylaxis, Urology, 2002,60(2),34410.1016/S0090-4295(02)01713-2Search in Google Scholar

[13] Barthelmes L., Chezhian C., Thomas K.J., Progression to wet gangrene in penile necrosis and calciphylaxis, Int Urol Nephrol, 2002,34(2),231-23510.1023/A:1023258127729Search in Google Scholar

[14] Oikawa S., Osajima A., Tamura M., Murata K., Yasuda H., Anai H., et al., Development of proximal calciphylaxis with penile involvement after parathyroidectomy in a patient on hemodialysis, Intern Med, 2004,43(1),63-6810.2169/internalmedicine.43.63Search in Google Scholar PubMed

[15] Rifkin B.S., Perazella M.A., Calcific uremic arteriolopathy (calciphylaxis), Mayo Clin Proc, 2006,81(1),910.4065/81.1.9Search in Google Scholar PubMed

[16] Woods M., Pattee S.F., Levine N., Penile calciphylaxis, J Am Acad Dermatol, 2006,54(4),736-73710.1016/j.jaad.2005.07.025Search in Google Scholar PubMed

[17] Halachmi S., Storch S., Penile gangrene due to severe vascular calcification, Isr Med Assoc J, 2006,8(12),888-889Search in Google Scholar

[18] Agarwal M.M., Singh S.K., Mandal A.K., Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis, Indian J Urol, 2007,23(2),208-21010.4103/0970-1591.32081Search in Google Scholar PubMed PubMed Central

[19] Sorensen M.D., Long L.O., Wessells H., Kuan J.K., Monckeberg’s calciphylaxis with necrosis of the glans penis: a case presentation, Hemodial Int, 2007,11(3),300-30210.1111/j.1542-4758.2007.00183.xSearch in Google Scholar PubMed

[20] Ohta A., Ohomori S., Mizukami T., Obi R., Tanaka Y., Penile necrosis by calciphylaxis in a diabetic patient with chronic renal failure, Intern Med, 2007,46(13),985-99010.2169/internalmedicine.46.6201Search in Google Scholar PubMed

[21] Rizvi T., Al-Nakshabandi N.A., Penile necrosis due to calciphylaxis in a patient of end stage renal disease, Saudi Med J, 2009,30(1),143-145Search in Google Scholar

[22] Bhatty T.A., Riaz K., Calciphylaxis mimicking penile gangrene: a case report, ScientificWorldJournal, 2009,9,1355-135910.1100/tsw.2009.150Search in Google Scholar PubMed PubMed Central

[23] Sandhu G., Gini M.B., Ranade A., Djebali D., Smith S., Penile calciphylaxis: a life-threatening condition successfully treated with sodium thiosulfate, Am J Ther, 2012,19(1),e66-6810.1097/MJT.0b013e3181e3b0f2Search in Google Scholar PubMed

[24] Bappa A., Hakim F., Ahmad M., Assirri A., Penile gangrene due to calcific uremic arteriopathy, Ann Afr Med, 2011,10(2),181-18410.4103/1596-3519.82064Search in Google Scholar PubMed

[25] Shah M.A., Roppolo M.W., Calciphylaxis: temporal artery calcification preceding widespread skin lesions and penile necrosis, Case Rep Nephrol, 2012,2012,30972710.1155/2012/309727Search in Google Scholar PubMed PubMed Central

[26] Prematilleke I., Espinosa O., Henderson J., Altmann P., Roberts I., Penile calciphylaxis: an unusual cause of penile necrosis, Histopathology, 2012,61(4),749-75010.1111/j.1365-2559.2011.04118.xSearch in Google Scholar PubMed

[27] O’Neil B., Southwick A.W., Three cases of penile calciphylaxis: diagnosis, treatment strategies, and the role of sodium thiosulfate, Urology, 2012,80(1),5-810.1016/j.urology.2012.04.012Search in Google Scholar PubMed

[28] Akai A., Okamoto H., Shigematsu K., Miyata T., Watanabe T., Revascularization surgery for penile calciphylaxis, J Vasc Surg, 2013,58(6),1665-166710.1016/j.jvs.2013.02.030Search in Google Scholar PubMed

[29] Kumar V., Patel N., Images in vascular medicine. Calcific uremic arteriolopathy of the penis, Vasc Med, 2013,18(4),23910.1177/1358863X13493826Search in Google Scholar PubMed

[30] Barbera V., Di Lullo L., Gorini A., Otranto G., Floccari F., Malaguti M., et al., Penile calciphylaxis in end stage renal disease, Case Rep Urol, 2013,2013,96891610.1155/2013/968916Search in Google Scholar PubMed PubMed Central

[31] Yecies T., Lee D.J., Sorbellini M., Ramasamy R., Penile Fournier’s gangrene, Urology, 2013,82(4),e3110.1016/j.urology.2013.07.025Search in Google Scholar PubMed

[32] Haider I., Siddiqui M., Naji W., Sheikh M., Waqar A., Calciphylaxis leading to penile necrosis, J Pak Med Assoc, 2014,64(6),711-713Search in Google Scholar

[33] Morrison M., Merati M., Ramirez J., Cha H.C., LaFond A., Penile calciphylaxis diagnosed with computed tomography, J Eur Acad Dermatol Venereol, 2016,30(2),352-35310.1111/jdv.12764Search in Google Scholar PubMed

[34] Hanna R.M., Nabil J.R., Lopez E.A., Corry D.B., Wilson J., Multiple sites of calciphylaxis in a patient with chronic renal failure, Saudi J Kidney Dis Transpl, 2015,26(2),344-34810.4103/1319-2442.152506Search in Google Scholar PubMed

[35] Malthouse T., Lam W., Brewin J., Watkin N., Ayres B., Nitkunan T., Penile lesion in end-stage renal failure - cancer or otherwise?: Calcific uremic arteriolopathy presenting with a penile lesion, Can Urol Assoc J, 2015,9(3-4),136-13710.5489/cuaj.2331Search in Google Scholar PubMed PubMed Central

[36] Shiraki T., lida O., Okamoto S., Ishihara T., Fujita M., Uematsu M., Usefulness of Endovascular Therapy for Penile Gangrene Secondary to Calciphylaxis: A Case Report, Ann Vasc Surg, 2015,29(7),1451.e1411-145510.1016/j.avsg.2015.04.068Search in Google Scholar PubMed

[37] Endly D., Irfan M., Piliang M., Tender, necrotic plaques of the glans penis due to calciphylaxis, Dermatol Online J, 2015,21(6)10.5070/D3216027817Search in Google Scholar

[38] Bashir S.O., Aamer M.A., Omer H.A., Morsy M.D., Penile calcific uremic arteriolopathy occurring postparathyroidectomy in a hemodialysis patient, Saudi J Kidney Dis Transpl, 2016,27(6),1265-126910.4103/1319-2442.194685Search in Google Scholar PubMed

[39] Maselli G., Cordari M., Catanzariti F., Donatelli G., DelľAtti L., Galosi A.B., Penile Gangrene by Calciphylaxis: An Unusual Clinical Presentation in a Patient with Diabetic Nephropathy on Hemodialysis, J Emerg Med, 2017,52(6),e255-e25610.1016/j.jemermed.2017.02.005Search in Google Scholar PubMed

[40] Campbell R.A., Alzweri L.M., Sopko N.A., Macura K.J., Burnett A.L., Penile Calciphylaxis: The Use of Radiological Investigations in the Management of a Rare and Challenging Condition, Urol Case Rep, 2017,13,113-11610.1016/j.eucr.2017.03.008Search in Google Scholar PubMed PubMed Central

[41] Olaoye O.A., Koratala A., Calcific uremic arteriolopathy, Oxford Medical Case Reports, 2017,2017(10), omx055-omx05510.1093/omcr/omx055Search in Google Scholar PubMed PubMed Central

Received: 2018-01-26
Accepted: 2018-03-19
Published Online: 2018-05-09

© 2018 Ti-Yuan Yang et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Articles in the same Issue

  1. Regular Articles
  2. Cleidocranial dysplasia-dental disorder treatment and audiology diagnosis
  3. A hybrid neural network – world cup optimization algorithm for melanoma detection
  4. Early administration of venovenous extracorporeal life support for status asthmaticus during anaesthetic induction: case report and literature review
  5. Assessment of maximal isometric hand grip strength in school-aged children
  6. Evaluation of a neurokinin-1 antagonist in preventing multiple-day cisplatin-induced nausea and vomiting
  7. Value of continuous video EEG and EEG responses to thermesthesia stimulation in prognosis evaluation of comatose patients after cardiopulmonary resuscitation
  8. Platelet-rich plasma protects HUVECs against oX-LDL-induced injury
  9. Pharmacoeconomics of three therapeutic schemes for anti-tuberculosis therapy induced liver injury in China
  10. Small-cell lung cancer presenting as fatal pulmonary hemorrhage
  11. Correlation of retinopathy of prematurity with bronchopulmonary dysplasia
  12. Prognosis of treatment outcomes by cognitive and physical scales
  13. The efficacy of radiofrequency hyperthermia combined with chemotherapy in the treatment of advanced ovarian cancer
  14. Arcuate Fasciculus in Autism Spectrum Disorder Toddlers with Language Regression
  15. Aesthetic dental procedures: legal and medico-legal implications
  16. Blood transfusion in children: the refusal of Jehovah’s Witness parents’
  17. Burnout among anesthetists and intensive care physicians
  18. Relationship of HS CRP and sacroiliac joint inflammation in undifferentiated spondyloarthritis
  19. Ethical and legal issues in gestational surrogacy
  20. Effects of arginine vasopressin on migration and respiratory burst activity in human leukocytes
  21. Associations of diabetic retinopathy with retinal neurodegeneration on the background of diabetes mellitus. Overview of recent medical studies with an assessment of the impact on healthcare systems
  22. Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results: A case report
  23. Effectiveness of treatment with endostatin in combination with emcitabine, carboplatin, and gemcitabine in patients with advanced non-small cell lung cancer: a retrospective study
  24. Piercing and tattoos in adolescents: legal and medico-legal implications
  25. The central importance of information in cosmetic surgery and treatments
  26. Penile calciphylaxis in a patient with end-stage renal disease: a case report and review of the literature
  27. Serum CA72-4 as a biomarker in the diagnosis of colorectal cancer: A meta-analysis
  28. Association between uric acid and metabolic syndrome in elderly women
  29. Distinct expression and prognostic value of MS4A in gastric cancer
  30. MAPK pathway involved in epidermal terminal differentiation of normal human epidermal keratinocytes
  31. Association of central obesity with sex hormonebinding globulin: a cross-sectional study of 1166 Chinese men
  32. Successful endovascular therapy in an elderly patient with severe hemorrhage caused by traumatic injury
  33. Inflammatory biomarkers and risk of atherosclerotic cardiovascular disease
  34. Related factors of early mortality in young adults with cerebral hemorrhage
  35. Growth suppression of glioma cells using HDAC6 inhibitor, tubacin
  36. Post-stroke upper limb spasticity incidence for different cerebral infarction site
  37. The esophageal manometry with gas-perfused catheters
  38. MMP-2 and TIMP-2 in patients with heart failure and chronic kidney disease
  39. Genetic testing: ethical aspects
  40. Intervention for physician burnout: A systematic review
  41. The melanin-concentrating hormone system in human, rodent and avian brain
  42. Clinical effects of piribedil in adjuvant treatment of Parkinson’s Disease: A meta-analysis
  43. Identification of a novel BRAF Thr599dup mutation in lung adenocarcinoma
  44. Adrenal incidentaloma – diagnostic and treating problem – own experience
  45. Common illnesses in tropical Asia and significance of medical volunteering
  46. Genetic risk in insurance field
  47. Genetic testing and professional responsibility: the italian experience
  48. The mechanism of mitral regurgitant jets identified by 3-dimensional transesophageal echocardiography
  49. Control of blood pressure and cardiovascular outcomes in type 2 diabetes
  50. Pseudomesotheliomatous primary squamous cell lung carcinoma: The first case reported in Turkey and a review of the literature
  51. Diagnostic efficacy of serum 1,3-β-D-glucan for invasive fungal infection: An update meta-analysis based on 37 case or cohort studies
  52. GPER was associated with hypertension in post-menopausal women
  53. Metabolic activity of sulfate-reducing bacteria from rodents with colitis
  54. Association of miRNA122 & ADAM17 with lipids among hypertensives in Nigeria
  55. The efficacy and safety of enoxaparin: a meta-analysis
  56. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis
  57. Thresholding for medical image segmentation for cancer using fuzzy entropy with level set algorithm
  58. Sleep deprivation in Intensive Care Unit – systematic review
  59. Benefits of computed tomography in reducing mortality in emergency medicine
  60. Ipragliflozin ameliorates liver damage in non-alcoholic fatty liver disease
  61. Limits of professional competency in nurses working in Nicu
  62. MDA-19 suppresses progression of melanoma via inhibiting the PI3K/Akt pathway
  63. The effect of smoking on posttraumatic pseudoarthrosis healing after internal stabilization, treated with platelet rich plasma (PRP)
  64. Partial deletion of the long arm of chromosome 7: a case report
  65. Meta-analysis of PET/CT detect lymph nodes metastases of cervical cancer
  66. High Expression of NLRC5 is associated with prognosis of gastric cancer
  67. Is monitoring mean platelet volume necessary in breast cancer patients?
  68. Resectable single hepatic epithelioid hemangioendothelioma in the left lobe of the liver: a case report
  69. Epidemiological study of carbapenem-resistant Klebsiella pneumoniae
  70. The CCR5-Delta32 genetic polymorphism and HIV-1 infection susceptibility: a meta-analysis
  71. Phenotypic and molecular characterisation of Staphylococcus aureus with reduced vancomycin susceptibility derivated in vitro
  72. Preliminary results of Highly Injectable Bi-Phasic Bone Substitute (CERAMENT) in the treatment of benign bone tumors and tumor-like lesions
  73. Analysis of patient satisfaction with emergency medical services
  74. Guillain-Barré syndrome and Low back pain: two cases and literature review
  75. HELLP syndrome complicated by pulmonary edema: a case report
  76. Pharmacokinetics of vancomycin in patients with different renal function levels
  77. Recurrent chronic subdural hematoma: Report of 13 cases
  78. Is awareness enough to bring patients to colorectal screening?
  79. Serum tumor marker carbohydrate antigen 125 levels and carotid atherosclerosis in patients with coronary artery disease
  80. Plastic treatment for giant pseudocyst after incisional hernia mesh repair: a case report and comprehensive literature review
  81. High expression levels of fascin-1 protein in human gliomas and its clinical relevance
  82. Thromboembolic complications following tissue plasminogen activator therapy in patients of acute ischemic stroke - Case report and possibility for detection of cardiac thrombi
  83. The effects of gastrointestinal function on the incidence of ventilator-associated pneumonia in critically ill patients
  84. A report of chronic intestinal pseudo-obstruction related to systemic lupus erythematosus
  85. Risk model in women with ovarian cancer without mutations
  86. Direct oral anticoagulants and travel-related venous thromboembolism
  87. How bispectral index compares to spectral entropy of the EEG and A-line ARX index in the same patient
  88. Henoch-schonlein purpura nephritis with renal interstitial lesions
  89. Cardiovascular risk estimated by UKPDS risk engine algorithm in diabetes
  90. CD5 and CD43 expression are associate with poor prognosis in DLBCL patients
  91. Combination of novoseven and feiba in hemophiliac patients with inhibitors
https://doi.org/10.1515/med-2018-0025
Keywords for this article
Penile calciphylaxis; Penile gangrene; Penectomy; End-stage renal disease; Microcalcification
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. Regular Articles
  2. Cleidocranial dysplasia-dental disorder treatment and audiology diagnosis
  3. A hybrid neural network – world cup optimization algorithm for melanoma detection
  4. Early administration of venovenous extracorporeal life support for status asthmaticus during anaesthetic induction: case report and literature review
  5. Assessment of maximal isometric hand grip strength in school-aged children
  6. Evaluation of a neurokinin-1 antagonist in preventing multiple-day cisplatin-induced nausea and vomiting
  7. Value of continuous video EEG and EEG responses to thermesthesia stimulation in prognosis evaluation of comatose patients after cardiopulmonary resuscitation
  8. Platelet-rich plasma protects HUVECs against oX-LDL-induced injury
  9. Pharmacoeconomics of three therapeutic schemes for anti-tuberculosis therapy induced liver injury in China
  10. Small-cell lung cancer presenting as fatal pulmonary hemorrhage
  11. Correlation of retinopathy of prematurity with bronchopulmonary dysplasia
  12. Prognosis of treatment outcomes by cognitive and physical scales
  13. The efficacy of radiofrequency hyperthermia combined with chemotherapy in the treatment of advanced ovarian cancer
  14. Arcuate Fasciculus in Autism Spectrum Disorder Toddlers with Language Regression
  15. Aesthetic dental procedures: legal and medico-legal implications
  16. Blood transfusion in children: the refusal of Jehovah’s Witness parents’
  17. Burnout among anesthetists and intensive care physicians
  18. Relationship of HS CRP and sacroiliac joint inflammation in undifferentiated spondyloarthritis
  19. Ethical and legal issues in gestational surrogacy
  20. Effects of arginine vasopressin on migration and respiratory burst activity in human leukocytes
  21. Associations of diabetic retinopathy with retinal neurodegeneration on the background of diabetes mellitus. Overview of recent medical studies with an assessment of the impact on healthcare systems
  22. Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results: A case report
  23. Effectiveness of treatment with endostatin in combination with emcitabine, carboplatin, and gemcitabine in patients with advanced non-small cell lung cancer: a retrospective study
  24. Piercing and tattoos in adolescents: legal and medico-legal implications
  25. The central importance of information in cosmetic surgery and treatments
  26. Penile calciphylaxis in a patient with end-stage renal disease: a case report and review of the literature
  27. Serum CA72-4 as a biomarker in the diagnosis of colorectal cancer: A meta-analysis
  28. Association between uric acid and metabolic syndrome in elderly women
  29. Distinct expression and prognostic value of MS4A in gastric cancer
  30. MAPK pathway involved in epidermal terminal differentiation of normal human epidermal keratinocytes
  31. Association of central obesity with sex hormonebinding globulin: a cross-sectional study of 1166 Chinese men
  32. Successful endovascular therapy in an elderly patient with severe hemorrhage caused by traumatic injury
  33. Inflammatory biomarkers and risk of atherosclerotic cardiovascular disease
  34. Related factors of early mortality in young adults with cerebral hemorrhage
  35. Growth suppression of glioma cells using HDAC6 inhibitor, tubacin
  36. Post-stroke upper limb spasticity incidence for different cerebral infarction site
  37. The esophageal manometry with gas-perfused catheters
  38. MMP-2 and TIMP-2 in patients with heart failure and chronic kidney disease
  39. Genetic testing: ethical aspects
  40. Intervention for physician burnout: A systematic review
  41. The melanin-concentrating hormone system in human, rodent and avian brain
  42. Clinical effects of piribedil in adjuvant treatment of Parkinson’s Disease: A meta-analysis
  43. Identification of a novel BRAF Thr599dup mutation in lung adenocarcinoma
  44. Adrenal incidentaloma – diagnostic and treating problem – own experience
  45. Common illnesses in tropical Asia and significance of medical volunteering
  46. Genetic risk in insurance field
  47. Genetic testing and professional responsibility: the italian experience
  48. The mechanism of mitral regurgitant jets identified by 3-dimensional transesophageal echocardiography
  49. Control of blood pressure and cardiovascular outcomes in type 2 diabetes
  50. Pseudomesotheliomatous primary squamous cell lung carcinoma: The first case reported in Turkey and a review of the literature
  51. Diagnostic efficacy of serum 1,3-β-D-glucan for invasive fungal infection: An update meta-analysis based on 37 case or cohort studies
  52. GPER was associated with hypertension in post-menopausal women
  53. Metabolic activity of sulfate-reducing bacteria from rodents with colitis
  54. Association of miRNA122 & ADAM17 with lipids among hypertensives in Nigeria
  55. The efficacy and safety of enoxaparin: a meta-analysis
  56. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis
  57. Thresholding for medical image segmentation for cancer using fuzzy entropy with level set algorithm
  58. Sleep deprivation in Intensive Care Unit – systematic review
  59. Benefits of computed tomography in reducing mortality in emergency medicine
  60. Ipragliflozin ameliorates liver damage in non-alcoholic fatty liver disease
  61. Limits of professional competency in nurses working in Nicu
  62. MDA-19 suppresses progression of melanoma via inhibiting the PI3K/Akt pathway
  63. The effect of smoking on posttraumatic pseudoarthrosis healing after internal stabilization, treated with platelet rich plasma (PRP)
  64. Partial deletion of the long arm of chromosome 7: a case report
  65. Meta-analysis of PET/CT detect lymph nodes metastases of cervical cancer
  66. High Expression of NLRC5 is associated with prognosis of gastric cancer
  67. Is monitoring mean platelet volume necessary in breast cancer patients?
  68. Resectable single hepatic epithelioid hemangioendothelioma in the left lobe of the liver: a case report
  69. Epidemiological study of carbapenem-resistant Klebsiella pneumoniae
  70. The CCR5-Delta32 genetic polymorphism and HIV-1 infection susceptibility: a meta-analysis
  71. Phenotypic and molecular characterisation of Staphylococcus aureus with reduced vancomycin susceptibility derivated in vitro
  72. Preliminary results of Highly Injectable Bi-Phasic Bone Substitute (CERAMENT) in the treatment of benign bone tumors and tumor-like lesions
  73. Analysis of patient satisfaction with emergency medical services
  74. Guillain-Barré syndrome and Low back pain: two cases and literature review
  75. HELLP syndrome complicated by pulmonary edema: a case report
  76. Pharmacokinetics of vancomycin in patients with different renal function levels
  77. Recurrent chronic subdural hematoma: Report of 13 cases
  78. Is awareness enough to bring patients to colorectal screening?
  79. Serum tumor marker carbohydrate antigen 125 levels and carotid atherosclerosis in patients with coronary artery disease
  80. Plastic treatment for giant pseudocyst after incisional hernia mesh repair: a case report and comprehensive literature review
  81. High expression levels of fascin-1 protein in human gliomas and its clinical relevance
  82. Thromboembolic complications following tissue plasminogen activator therapy in patients of acute ischemic stroke - Case report and possibility for detection of cardiac thrombi
  83. The effects of gastrointestinal function on the incidence of ventilator-associated pneumonia in critically ill patients
  84. A report of chronic intestinal pseudo-obstruction related to systemic lupus erythematosus
  85. Risk model in women with ovarian cancer without mutations
  86. Direct oral anticoagulants and travel-related venous thromboembolism
  87. How bispectral index compares to spectral entropy of the EEG and A-line ARX index in the same patient
  88. Henoch-schonlein purpura nephritis with renal interstitial lesions
  89. Cardiovascular risk estimated by UKPDS risk engine algorithm in diabetes
  90. CD5 and CD43 expression are associate with poor prognosis in DLBCL patients
  91. Combination of novoseven and feiba in hemophiliac patients with inhibitors
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 22.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/med-2018-0025/html?lang=en
Scroll to top button