Noguchi T, Sakamoto A, Kakehi K, Matsuda S. New method of local adjuvant therapy with bicarbonate Ringer’s solution for tumoral calcinosis: A case report. World J Orthop 2024; 15(3): 302-309 [PMID: 38596192 DOI: 10.5312/wjo.v15.i3.302]
Corresponding Author of This Article
Akio Sakamoto, MD, PhD, Associate Professor, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. akiosaka@kuhp.kyoto-u.ac.jp
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takashi Noguchi, Akio Sakamoto, Kensaku Kakehi, Shuichi Matsuda, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
Co-corresponding authors: Takashi Noguchi and Akio Sakamoto.
Author contributions: Noguchi T, Sakamoto A, Kakehi K and Matsuda S were participated in the treatment; Sakamoto A drafted the manuscript; All authors reviewed the manuscript and approved the final version of the manuscript. Noguchi T and Sakamoto A contributed equally to this work as co-corresponding authors. This invention was achieved through the cooperation of Noguchi T and Sakamoto A, they contributed efforts of equal substance throughout the research process, the designation of co-corresponding authorship accurately reflects our team's collaborative spirit and equal contributions.
Informed consent statement: The analysis used anonymous clinical data that were obtained after each patient had been notified at the Kyoto University home page that the data could be used for a clinical study.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akio Sakamoto, MD, PhD, Associate Professor, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. akiosaka@kuhp.kyoto-u.ac.jp
Received: December 3, 2023 Peer-review started: December 3, 2023 First decision: December 28, 2023 Revised: January 6, 2024 Accepted: January 24, 2024 Article in press: January 24, 2024 Published online: March 18, 2024 Processing time: 103 Days and 4.1 Hours
Abstract
BACKGROUND
Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.
CASE SUMMARY
A bicarbonate Ringer’s solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer’s solution.
CONCLUSION
The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.
Core Tip: Tumoral calcinosis, which occurs in 2%-3% of hemodialysis patients, involves calcium phosphate deposits, thus making surgical resection challenging. Hydroxyapatite, the main component of tumoral calcinosis, infiltrates tissues extensively. A bicarbonate Ringer’s solution is used post-resection. A 49-year-old hemodialysis patient with calcified shoulder, hip, and foot lesions underwent the bicarbonate dissolution method. After resection, the operative field was washed with the solution. This simple and effective treatment offers a novel approach for managing tumoral calcinosis in hemodialysis patients.
