array:24 [
  "pii" => "S1578219012000522"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.01.006"
  "estado" => "S300"
  "fechaPublicacion" => "2012-01-01"
  "aid" => "459"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "cita" => "Actas Dermosifiliogr. 2012;103:79-81"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4792
    "formatos" => array:3 [
      "EPUB" => 38
      "HTML" => 3714
      "PDF" => 1040
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731011003346"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2011.01.017"
      "estado" => "S300"
      "fechaPublicacion" => "2012-01-01"
      "aid" => "459"
      "copyright" => "Elsevier España, S.L. y AEDV"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "cor"
      "cita" => "Actas Dermosifiliogr. 2012;103:79-81"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6789
        "formatos" => array:3 [
          "EPUB" => 1
          "HTML" => 5070
          "PDF" => 1718
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "79"
            "paginaFinal" => "81"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 750
                "Ancho" => 501
                "Tamanyo" => 66969
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#218;lcera con escara necr&#243;tica rodeada por una placa purp&#250;rica de morfolog&#237;a retiforme en la cara posterior de la pierna izquierda&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; &#193;lvarez-P&#233;rez, E&#46; Guti&#233;rrez-Gonz&#225;lez, D&#46; S&#225;nchez-Aguilar, J&#46; Toribio"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "&#193;lvarez-P&#233;rez"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Guti&#233;rrez-Gonz&#225;lez"
              ]
              2 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "S&#225;nchez-Aguilar"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Toribio"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219012000522"
          "doi" => "10.1016/j.adengl.2011.01.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000522?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003346?idApp=UINPBA000044"
      "url" => "/00017310/0000010300000001/v1_201304241349/S0001731011003346/v1_201304241349/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219012000583"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.11.019"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "aid" => "511"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "prp"
    "cita" => "Actas Dermosifiliogr. 2012;103:82-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2516
      "formatos" => array:3 [
        "EPUB" => 39
        "HTML" => 1906
        "PDF" => 571
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">In Memoriam</span>"
      "titulo" => "Dr&#46; Benedicto Hern&#225;ndez Moro &#40;1933&#8211;2011&#41;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "82"
          "paginaFinal" => "83"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Dr&#46; Benedicto Hern&#225;ndez Moro &#40;1933&#8211;2011&#41;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Vidal-Asensi"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Vidal-Asensi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011004868"
        "doi" => "10.1016/j.ad.2011.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011004868?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000583?idApp=UINPBA000044"
    "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000583/v1_201304241248/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219012000601"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "aid" => "458"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2012;103:76-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5013
      "formatos" => array:3 [
        "EPUB" => 50
        "HTML" => 3841
        "PDF" => 1122
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Anogenital Granulomatosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "76"
          "paginaFinal" => "79"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Granulomatosis anogenitales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1367
              "Ancho" => 1301
              "Tamanyo" => 535322
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Lymphocytic infiltrate occupying the reticular dermis&#44; showing granulomatous structures without central necrosis &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;12&#46;5&#41;&#46; &#40;B&#41; Detail of a granuloma composed of multinucleated giant cells and epithelioid cells and surrounded by lymphocytes &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46; &#40;C&#41; Dense lymphocytic infiltrate occupying a mucous membrane &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;40&#41;&#46; &#40;D&#41; At higher magnification&#44; epithelioid cells are seen forming nonnecrotizing granulomas &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Villar, G&#46; Petiti, A&#46; Guerra, F&#46; Vanaclocha"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Villar"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Petiti"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Guerra"
            ]
            3 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Vanaclocha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011003334"
        "doi" => "10.1016/j.ad.2011.05.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003334?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000601?idApp=UINPBA000044"
    "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000601/v1_201304241248/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Editor&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "79"
        "paginaFinal" => "81"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; &#193;lvarez-P&#233;rez, E&#46; Guti&#233;rrez-Gonz&#225;lez, D&#46; S&#225;nchez-Aguilar, J&#46; Toribio"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "&#193;lvarez-P&#233;rez"
            "email" => array:1 [
              0 => "adriana&#95;alpe&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Guti&#233;rrez-Gonz&#225;lez"
          ]
          2 => array:2 [
            "nombre" => "D&#46;"
            "apellidos" => "S&#225;nchez-Aguilar"
          ]
          3 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Toribio"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Departamento de Dermatolog&#237;a&#44; Complejo Hospitalario Universitario&#44; Facultad de Medicina&#44; Santiago de Compostela&#44; Spain"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 749
            "Ancho" => 499
            "Tamanyo" => 59202
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with necrotic eschar surrounded by a reticular purpuric plaque on the back of the left leg&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calciphylaxis is a rare disease characterized by cutaneous ischemia and necrosis caused by mural calcification of small and medium-sized blood vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This condition leads to cutaneous ulceration and eschar formation&#46; It generally affects patients with end-stage renal failure and secondary hyperparathyroidism&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> and is associated with a poor prognosis&#44; high morbidity&#44; and high mortality rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> In recent years&#44; cases have been reported of calciphylaxis in patients with normal kidney function and calcium&#8211;phosphate metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> When seen in patients without abnormalities of this sort&#8212;a rather rare occurrence&#8212;the condition is called atypical calciphylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It has occasionally been reported in patients receiving oral anticoagulant therapy with coumarin derivatives&#44; such as warfarin and phenprocoumon&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 80-year-old woman who came to our hospital with purpuric skin lesions in a livedoid pattern that had appeared 2 months earlier on the back of the right leg&#46; The lesions were associated with induration and intense local pain&#46; Several weeks after the onset of the first symptoms&#44; the patient noticed the appearance of an ulcer&#44; which was quickly covered by necrotic eschar&#46; Similar intensely painful skin lesions began to appear on the left leg at the same time&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Relevant aspects of her medical history included diabetes mellitus&#44; bronchial asthma&#44; arterial hypertension&#44; and atrial fibrillation&#46; Current medication included acenocoumarol &#40;which she had been taking for 1 year&#41;&#44; acetaminophen&#44; omeprazole&#44; diltiazem&#44; metformin&#44; tiotropium bromide&#44; and a formoterol&#8211;budesonide combination&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatological examination revealed a well-defined and extremely painful ulcer on the back of the patient&#39;s left leg &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesion was covered with eschar and surrounded by a racemose erythematous-violaceous plaque&#46; Livedo reticularis was observed on the back of both legs&#46; The skin lesions and the underlying area were indurated on palpation&#46; The patient&#39;s right leg had similar lesions&#44; but without necrotic eschar&#46; The physical examination was otherwise normal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Testing revealed normal levels of urea&#44; creatinine&#44; parathyroid hormone&#44; calcium&#44; serum phosphate&#44; protein C&#44; and protein S&#46; The patient tested negative for cryoglobulins and for antinuclear and anticardiolipin antibodies&#46; Radiographs of both legs showed marked vascular calcification&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A skin biopsy of the affected area revealed superficial ulceration with necrosis of the superficial dermal collagen&#44; as well as extensive calcification and intimal proliferation in multiple arteries and arterioles &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The calcium deposits in the blood vessel walls were more visible with Von Kossa staining&#46; As there were no extravascular calcium deposits or fat necrosis&#44; the diagnosis of calciphylaxis was confirmed&#46; Because the patient had normal levels of protein C&#44; protein S&#44; parathyroid hormone&#44; calcium&#44; and serum phosphate&#44; a diagnosis of atypical calciphylaxis was established&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In this case the condition was associated with treatment with coumarin derivatives&#44; a phenomenon that has recently been described in the literature&#46; Acenocoumarol was withdrawn and the patient was prescribed enoxaparin anticoagulant therapy at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg every 12<span class="elsevierStyleHsp" style=""></span>h&#44; which led to rapid improvement in both the lesion and local pain&#46; Moreover&#44; the ulcer gradually healed and the livedo rash resolved&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Calciphylaxis is considered atypical when it occurs in patients who do not have renal failure or impaired calcium&#8211;phosphate metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In such cases&#44; we must consider that the disease may be the result of the interaction between various risk factors&#44; including obesity&#44; liver disease&#44; systemic corticosteroid therapy&#44; elevated erythrocyte sedimentation rate&#44; white race&#44; female sex&#44; warfarin therapy&#44; vitamin D supplementation&#44; protein C or protein S deficiency&#44; and diabetes mellitus&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our patient&#39;s kidney and parathyroid function were normal&#44; but other risk factors were present&#59; she was white&#44; she had diabetes mellitus&#44; and she was receiving acenocoumarol&#44; a coumarin-derived oral anticoagulant&#46; Since the anticoagulant treatment was the only risk factor that could be modified&#44; it was withdrawn and replaced with low-molecular-weight heparin&#44; the recommended anticoagulant for patients of these characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Atypical calciphylaxis has occasionally been described in association with oral coumarin-derived anticoagulants&#44; which interact with the calcification inhibitor matrix gla protein&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should consider warfarin-induced skin necrosis&#44; which normally appears 3&#8211;10 days after start of treatment and is caused by an imbalance between procoagulant and anticoagulant factors&#46; Histopathology of this condition reveals thrombotic occlusion of dermal and subcutaneous venules and veins&#44; surrounded by diffuse fat necrosis and bleeding&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but no calcification of the blood vessel walls&#44; unlike the case of our patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">None of the authors in the literature reviewed indicated an association between atypical calciphylaxis and acenocoumarol anticoagulant therapy&#46; Risk factor modification should be considered whenever possible&#46; In our case&#44; the cessation of acenocoumarol was decisive in the favorable evolution of the disease&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; &#193;lvarez-P&#233;rez A&#44; Guti&#233;rrez-Gonz&#225;lez E&#44; S&#225;nchez-Aguilar D&#44; Toribio J&#46; Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol&#46; Actas Dermosifiliogr&#46; 2012&#59;103&#58;79&#8211;81&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 749
            "Ancho" => 499
            "Tamanyo" => 59202
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with necrotic eschar surrounded by a reticular purpuric plaque on the back of the left leg&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 628
            "Ancho" => 948
            "Tamanyo" => 174422
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin biopsy showing intramural calcification and intimal hyperplasia in an arteriole of the subcutaneous tissue &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis&#8212;a topical overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Arseculeratne"
                            1 => "A&#46;T&#46; Evans"
                            2 => "S&#46;M&#46; Morley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2006.01506.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "493"
                        "paginaFinal" => "502"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16684274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;K&#46; Guldbakke"
                            1 => "A&#46; Khachemoune"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2007.03160.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "46"
                        "paginaInicial" => "231"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17343576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis&#58; natural history&#44; risk factor analysis and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;H&#46; Weenig"
                            1 => "L&#46;D&#46; Sewell"
                            2 => "M&#46;D&#46;P&#46; Davis"
                            3 => "J&#46;T&#46; McCarthy"
                            4 => "M&#46;R&#46; Pittelkow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.08.065"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2007"
                        "volumen" => "56"
                        "paginaInicial" => "569"
                        "paginaFinal" => "579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17141359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis with normal renal and parathyroid function&#58; not as rare as previously believed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;H&#46; Kalajian"
                            1 => "P&#46;S&#46; Malhotra"
                            2 => "J&#46;P&#46; Callen"
                            3 => "L&#46;P&#46; Parker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2008.602"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "451"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19380668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic calciphylaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Banky"
                            1 => "J&#46;P&#46; Dowling"
                            2 => "C&#46; Miles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Australas J Dermatol"
                        "fecha" => "2002"
                        "volumen" => "43"
                        "paginaInicial" => "190"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12121396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical calciphylaxis in a patient receiving warfarin then resolving with cessation of warfarin and application of hyperbaric oxygen therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Banerjee"
                            1 => "S&#46;C&#46; Woller"
                            2 => "J&#46;R&#46; Holm"
                            3 => "S&#46;M&#46; Stevens"
                            4 => "M&#46;J&#46; Lahey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1076029609355588"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Appl Thromb Hemost"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20019019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis in a diabetic patient provoked by warfarin therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Asobie"
                            1 => "E&#46; Wong"
                            2 => "M&#46;G&#46; Cook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2230.2007.02626.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Dermatol"
                        "fecha" => "2008"
                        "volumen" => "33"
                        "paginaInicial" => "342"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actitud ante un paciente con calcifilaxia que precisa anticoagulaci&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Ferrando"
                            1 => "J&#46;M&#46; Ricart"
                            2 => "A&#46; Vay&#225;"
                            3 => "Y&#46; Mira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2007"
                        "volumen" => "98"
                        "paginaInicial" => "721"
                        "paginaFinal" => "722"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18035037"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcific uremic arteriolopathy &#40;calciphylaxis&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;S&#46; Rifkin"
                            1 => "M&#46;A&#46; Perazella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/81.1.9"
                      "Revista" => array:5 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2006"
                        "volumen" => "81"
                        "paginaInicial" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16438472"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin-induced skin necrosis mimicking calciphylaxis&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Chacon"
                            1 => "T&#46; Nguyen"
                            2 => "A&#46; Khan"
                            3 => "A&#46; Sinha"
                            4 => "S&#46; Maddirala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "859"
                        "paginaFinal" => "863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20677545"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000522/v1_201304241248/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000001/v1_201304241248/S1578219012000522/v1_201304241248/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000522?idApp=UINPBA000044"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Case and Research Letters
Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol
Calcifilaxia atípica secundaria al tratamiento con acenocumarol
A. Álvarez-Pérez
Corresponding author
adriana_alpe@hotmail.com

Corresponding author.
, E. Gutiérrez-González, D. Sánchez-Aguilar, J. Toribio
Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain
Read
9336
Times
was read the article
2847
Total PDF
6489
Total HTML
Share statistics
 array:24 [
  "pii" => "S1578219012000522"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.01.006"
  "estado" => "S300"
  "fechaPublicacion" => "2012-01-01"
  "aid" => "459"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "cita" => "Actas Dermosifiliogr. 2012;103:79-81"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4792
    "formatos" => array:3 [
      "EPUB" => 38
      "HTML" => 3714
      "PDF" => 1040
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731011003346"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2011.01.017"
      "estado" => "S300"
      "fechaPublicacion" => "2012-01-01"
      "aid" => "459"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; y AEDV"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "cor"
      "cita" => "Actas Dermosifiliogr. 2012;103:79-81"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6789
        "formatos" => array:3 [
          "EPUB" => 1
          "HTML" => 5070
          "PDF" => 1718
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "79"
            "paginaFinal" => "81"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 750
                "Ancho" => 501
                "Tamanyo" => 66969
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#218;lcera con escara necr&#243;tica rodeada por una placa purp&#250;rica de morfolog&#237;a retiforme en la cara posterior de la pierna izquierda&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; &#193;lvarez-P&#233;rez, E&#46; Guti&#233;rrez-Gonz&#225;lez, D&#46; S&#225;nchez-Aguilar, J&#46; Toribio"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "&#193;lvarez-P&#233;rez"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Guti&#233;rrez-Gonz&#225;lez"
              ]
              2 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "S&#225;nchez-Aguilar"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Toribio"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219012000522"
          "doi" => "10.1016/j.adengl.2011.01.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000522?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003346?idApp=UINPBA000044"
      "url" => "/00017310/0000010300000001/v1_201304241349/S0001731011003346/v1_201304241349/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219012000583"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.11.019"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "aid" => "511"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "prp"
    "cita" => "Actas Dermosifiliogr. 2012;103:82-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2516
      "formatos" => array:3 [
        "EPUB" => 39
        "HTML" => 1906
        "PDF" => 571
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">In Memoriam</span>"
      "titulo" => "Dr&#46; Benedicto Hern&#225;ndez Moro &#40;1933&#8211;2011&#41;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "82"
          "paginaFinal" => "83"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Dr&#46; Benedicto Hern&#225;ndez Moro &#40;1933&#8211;2011&#41;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Vidal-Asensi"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Vidal-Asensi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011004868"
        "doi" => "10.1016/j.ad.2011.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011004868?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000583?idApp=UINPBA000044"
    "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000583/v1_201304241248/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219012000601"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2012-01-01"
    "aid" => "458"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2012;103:76-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5013
      "formatos" => array:3 [
        "EPUB" => 50
        "HTML" => 3841
        "PDF" => 1122
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Anogenital Granulomatosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "76"
          "paginaFinal" => "79"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Granulomatosis anogenitales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1367
              "Ancho" => 1301
              "Tamanyo" => 535322
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Lymphocytic infiltrate occupying the reticular dermis&#44; showing granulomatous structures without central necrosis &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;12&#46;5&#41;&#46; &#40;B&#41; Detail of a granuloma composed of multinucleated giant cells and epithelioid cells and surrounded by lymphocytes &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46; &#40;C&#41; Dense lymphocytic infiltrate occupying a mucous membrane &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;40&#41;&#46; &#40;D&#41; At higher magnification&#44; epithelioid cells are seen forming nonnecrotizing granulomas &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Villar, G&#46; Petiti, A&#46; Guerra, F&#46; Vanaclocha"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Villar"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Petiti"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Guerra"
            ]
            3 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Vanaclocha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011003334"
        "doi" => "10.1016/j.ad.2011.05.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003334?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000601?idApp=UINPBA000044"
    "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000601/v1_201304241248/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Atypical Calciphylaxis Secondary to Treatment With Acenocoumarol"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Editor&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "79"
        "paginaFinal" => "81"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; &#193;lvarez-P&#233;rez, E&#46; Guti&#233;rrez-Gonz&#225;lez, D&#46; S&#225;nchez-Aguilar, J&#46; Toribio"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "&#193;lvarez-P&#233;rez"
            "email" => array:1 [
              0 => "adriana&#95;alpe&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Guti&#233;rrez-Gonz&#225;lez"
          ]
          2 => array:2 [
            "nombre" => "D&#46;"
            "apellidos" => "S&#225;nchez-Aguilar"
          ]
          3 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Toribio"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Departamento de Dermatolog&#237;a&#44; Complejo Hospitalario Universitario&#44; Facultad de Medicina&#44; Santiago de Compostela&#44; Spain"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 749
            "Ancho" => 499
            "Tamanyo" => 59202
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with necrotic eschar surrounded by a reticular purpuric plaque on the back of the left leg&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calciphylaxis is a rare disease characterized by cutaneous ischemia and necrosis caused by mural calcification of small and medium-sized blood vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This condition leads to cutaneous ulceration and eschar formation&#46; It generally affects patients with end-stage renal failure and secondary hyperparathyroidism&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> and is associated with a poor prognosis&#44; high morbidity&#44; and high mortality rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> In recent years&#44; cases have been reported of calciphylaxis in patients with normal kidney function and calcium&#8211;phosphate metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> When seen in patients without abnormalities of this sort&#8212;a rather rare occurrence&#8212;the condition is called atypical calciphylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It has occasionally been reported in patients receiving oral anticoagulant therapy with coumarin derivatives&#44; such as warfarin and phenprocoumon&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 80-year-old woman who came to our hospital with purpuric skin lesions in a livedoid pattern that had appeared 2 months earlier on the back of the right leg&#46; The lesions were associated with induration and intense local pain&#46; Several weeks after the onset of the first symptoms&#44; the patient noticed the appearance of an ulcer&#44; which was quickly covered by necrotic eschar&#46; Similar intensely painful skin lesions began to appear on the left leg at the same time&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Relevant aspects of her medical history included diabetes mellitus&#44; bronchial asthma&#44; arterial hypertension&#44; and atrial fibrillation&#46; Current medication included acenocoumarol &#40;which she had been taking for 1 year&#41;&#44; acetaminophen&#44; omeprazole&#44; diltiazem&#44; metformin&#44; tiotropium bromide&#44; and a formoterol&#8211;budesonide combination&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatological examination revealed a well-defined and extremely painful ulcer on the back of the patient&#39;s left leg &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesion was covered with eschar and surrounded by a racemose erythematous-violaceous plaque&#46; Livedo reticularis was observed on the back of both legs&#46; The skin lesions and the underlying area were indurated on palpation&#46; The patient&#39;s right leg had similar lesions&#44; but without necrotic eschar&#46; The physical examination was otherwise normal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Testing revealed normal levels of urea&#44; creatinine&#44; parathyroid hormone&#44; calcium&#44; serum phosphate&#44; protein C&#44; and protein S&#46; The patient tested negative for cryoglobulins and for antinuclear and anticardiolipin antibodies&#46; Radiographs of both legs showed marked vascular calcification&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A skin biopsy of the affected area revealed superficial ulceration with necrosis of the superficial dermal collagen&#44; as well as extensive calcification and intimal proliferation in multiple arteries and arterioles &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The calcium deposits in the blood vessel walls were more visible with Von Kossa staining&#46; As there were no extravascular calcium deposits or fat necrosis&#44; the diagnosis of calciphylaxis was confirmed&#46; Because the patient had normal levels of protein C&#44; protein S&#44; parathyroid hormone&#44; calcium&#44; and serum phosphate&#44; a diagnosis of atypical calciphylaxis was established&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In this case the condition was associated with treatment with coumarin derivatives&#44; a phenomenon that has recently been described in the literature&#46; Acenocoumarol was withdrawn and the patient was prescribed enoxaparin anticoagulant therapy at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg every 12<span class="elsevierStyleHsp" style=""></span>h&#44; which led to rapid improvement in both the lesion and local pain&#46; Moreover&#44; the ulcer gradually healed and the livedo rash resolved&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Calciphylaxis is considered atypical when it occurs in patients who do not have renal failure or impaired calcium&#8211;phosphate metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In such cases&#44; we must consider that the disease may be the result of the interaction between various risk factors&#44; including obesity&#44; liver disease&#44; systemic corticosteroid therapy&#44; elevated erythrocyte sedimentation rate&#44; white race&#44; female sex&#44; warfarin therapy&#44; vitamin D supplementation&#44; protein C or protein S deficiency&#44; and diabetes mellitus&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our patient&#39;s kidney and parathyroid function were normal&#44; but other risk factors were present&#59; she was white&#44; she had diabetes mellitus&#44; and she was receiving acenocoumarol&#44; a coumarin-derived oral anticoagulant&#46; Since the anticoagulant treatment was the only risk factor that could be modified&#44; it was withdrawn and replaced with low-molecular-weight heparin&#44; the recommended anticoagulant for patients of these characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Atypical calciphylaxis has occasionally been described in association with oral coumarin-derived anticoagulants&#44; which interact with the calcification inhibitor matrix gla protein&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should consider warfarin-induced skin necrosis&#44; which normally appears 3&#8211;10 days after start of treatment and is caused by an imbalance between procoagulant and anticoagulant factors&#46; Histopathology of this condition reveals thrombotic occlusion of dermal and subcutaneous venules and veins&#44; surrounded by diffuse fat necrosis and bleeding&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but no calcification of the blood vessel walls&#44; unlike the case of our patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">None of the authors in the literature reviewed indicated an association between atypical calciphylaxis and acenocoumarol anticoagulant therapy&#46; Risk factor modification should be considered whenever possible&#46; In our case&#44; the cessation of acenocoumarol was decisive in the favorable evolution of the disease&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; &#193;lvarez-P&#233;rez A&#44; Guti&#233;rrez-Gonz&#225;lez E&#44; S&#225;nchez-Aguilar D&#44; Toribio J&#46; Calcifilaxia at&#237;pica secundaria al tratamiento con acenocumarol&#46; Actas Dermosifiliogr&#46; 2012&#59;103&#58;79&#8211;81&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 749
            "Ancho" => 499
            "Tamanyo" => 59202
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with necrotic eschar surrounded by a reticular purpuric plaque on the back of the left leg&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 628
            "Ancho" => 948
            "Tamanyo" => 174422
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin biopsy showing intramural calcification and intimal hyperplasia in an arteriole of the subcutaneous tissue &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;400&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis&#8212;a topical overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Arseculeratne"
                            1 => "A&#46;T&#46; Evans"
                            2 => "S&#46;M&#46; Morley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2006.01506.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "493"
                        "paginaFinal" => "502"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16684274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;K&#46; Guldbakke"
                            1 => "A&#46; Khachemoune"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2007.03160.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "46"
                        "paginaInicial" => "231"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17343576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis&#58; natural history&#44; risk factor analysis and outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;H&#46; Weenig"
                            1 => "L&#46;D&#46; Sewell"
                            2 => "M&#46;D&#46;P&#46; Davis"
                            3 => "J&#46;T&#46; McCarthy"
                            4 => "M&#46;R&#46; Pittelkow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.08.065"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2007"
                        "volumen" => "56"
                        "paginaInicial" => "569"
                        "paginaFinal" => "579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17141359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis with normal renal and parathyroid function&#58; not as rare as previously believed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;H&#46; Kalajian"
                            1 => "P&#46;S&#46; Malhotra"
                            2 => "J&#46;P&#46; Callen"
                            3 => "L&#46;P&#46; Parker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2008.602"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "451"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19380668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic calciphylaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Banky"
                            1 => "J&#46;P&#46; Dowling"
                            2 => "C&#46; Miles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Australas J Dermatol"
                        "fecha" => "2002"
                        "volumen" => "43"
                        "paginaInicial" => "190"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12121396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical calciphylaxis in a patient receiving warfarin then resolving with cessation of warfarin and application of hyperbaric oxygen therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Banerjee"
                            1 => "S&#46;C&#46; Woller"
                            2 => "J&#46;R&#46; Holm"
                            3 => "S&#46;M&#46; Stevens"
                            4 => "M&#46;J&#46; Lahey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1076029609355588"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Appl Thromb Hemost"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20019019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calciphylaxis in a diabetic patient provoked by warfarin therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Asobie"
                            1 => "E&#46; Wong"
                            2 => "M&#46;G&#46; Cook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2230.2007.02626.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Dermatol"
                        "fecha" => "2008"
                        "volumen" => "33"
                        "paginaInicial" => "342"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actitud ante un paciente con calcifilaxia que precisa anticoagulaci&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Ferrando"
                            1 => "J&#46;M&#46; Ricart"
                            2 => "A&#46; Vay&#225;"
                            3 => "Y&#46; Mira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2007"
                        "volumen" => "98"
                        "paginaInicial" => "721"
                        "paginaFinal" => "722"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18035037"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcific uremic arteriolopathy &#40;calciphylaxis&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;S&#46; Rifkin"
                            1 => "M&#46;A&#46; Perazella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/81.1.9"
                      "Revista" => array:5 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2006"
                        "volumen" => "81"
                        "paginaInicial" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16438472"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Warfarin-induced skin necrosis mimicking calciphylaxis&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Chacon"
                            1 => "T&#46; Nguyen"
                            2 => "A&#46; Khan"
                            3 => "A&#46; Sinha"
                            4 => "S&#46; Maddirala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "859"
                        "paginaFinal" => "863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20677545"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000522/v1_201304241248/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000001/v1_201304241248/S1578219012000522/v1_201304241248/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000522?idApp=UINPBA000044"
]
Article information
ISSN: 15782190
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 6 5 11
2024 October 68 54 122
2024 September 82 36 118
2024 August 109 61 170
2024 July 88 48 136
2024 June 91 54 145
2024 May 94 68 162
2024 April 71 32 103
2024 March 87 40 127
2024 February 66 36 102
2024 January 47 35 82
2023 December 55 16 71
2023 November 54 39 93
2023 October 50 23 73
2023 September 72 34 106
2023 August 41 29 70
2023 July 63 34 97
2023 June 53 25 78
2023 May 45 25 70
2023 April 40 21 61
2023 March 36 26 62
2023 February 35 22 57
2023 January 39 32 71
2022 December 55 35 90
2022 November 21 20 41
2022 October 29 20 49
2022 September 21 35 56
2022 August 16 35 51
2022 July 30 31 61
2022 June 45 27 72
2022 May 45 33 78
2022 April 84 32 116
2022 March 53 54 107
2022 February 43 29 72
2022 January 38 41 79
2021 December 37 31 68
2021 November 45 55 100
2021 October 46 59 105
2021 September 32 42 74
2021 August 37 30 67
2021 July 47 35 82
2021 June 33 39 72
2021 May 41 41 82
2021 April 78 39 117
2021 March 83 23 106
2021 February 59 28 87
2021 January 50 17 67
2020 December 27 16 43
2020 November 31 15 46
2020 October 21 15 36
2020 September 32 27 59
2020 August 33 14 47
2020 July 29 14 43
2020 June 42 26 68
2020 May 34 12 46
2020 April 35 16 51
2020 March 27 25 52
2020 February 5 1 6
2020 January 6 3 9
2019 December 4 3 7
2019 November 4 1 5
2019 October 0 5 5
2019 September 0 2 2
2019 August 4 1 5
2019 July 4 6 10
2019 June 4 36 40
2019 May 7 29 36
2019 April 2 27 29
2019 March 2 7 9
2019 February 0 3 3
2019 January 3 0 3
2018 November 1 0 1
2018 October 2 0 2
2018 September 3 2 5
2018 August 1 7 8
2018 July 0 4 4
2018 June 0 1 1
2018 May 0 3 3
2018 March 0 5 5
2018 February 50 5 55
2018 January 75 9 84
2017 December 73 11 84
2017 November 65 12 77
2017 October 46 12 58
2017 September 52 8 60
2017 August 76 10 86
2017 July 64 6 70
2017 June 75 15 90
2017 May 76 17 93
2017 April 66 9 75
2017 March 60 16 76
2017 February 54 15 69
2017 January 48 15 63
2016 December 65 19 84
2016 November 89 21 110
2016 October 124 26 150
2016 September 205 14 219
2016 August 128 27 155
2016 July 59 82 141
2016 June 14 21 35
2016 May 10 9 19
2016 April 9 3 12
2016 March 7 3 10
2016 February 14 11 25
2016 January 11 2 13
2015 December 8 1 9
2015 November 26 10 36
2015 October 41 13 54
2015 September 18 7 25
2015 August 20 1 21
2015 July 122 9 131
2015 June 97 28 125
2015 May 132 27 159
2015 April 126 16 142
2015 March 85 12 97
2015 February 72 11 83
2015 January 90 10 100
2014 December 85 17 102
2014 November 52 8 60
2014 October 77 16 93
2014 September 62 15 77
2014 August 57 14 71
2014 July 93 19 112
2014 June 103 12 115
2014 May 136 14 150
2014 April 70 15 85
2014 March 79 17 96
2014 February 67 21 88
2014 January 55 12 67
2013 December 34 10 44
2013 November 17 12 29
2013 October 13 10 23
2013 September 12 8 20
2013 August 16 23 39
2013 July 20 14 34
2013 June 14 28 42
2013 May 15 20 35
2013 April 9 8 17
2013 March 16 6 22
2013 February 21 4 25
2013 January 72 9 81
2012 December 16 5 21
2012 November 0 2 2
2012 October 2 4 6
2012 September 0 9 9
2012 August 1 0 1
Show all

Follow this link to access the full text of the article

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?