RESUMO
OBJECTIVE: To evaluate the effectiveness and safety of electrohydraulic lithotripsy of calculi of the main pancreatic duct using ultrathin SpyGlass DS endoscope. MATERIAL AND METHODS: The study included 29 patients with chronic calcifying pancreatitis and obstructive calculi of the main pancreatic duct. All surgeries were carried out between 2018 and 2023. RESULTS: Complete removal of calculi (≥5 mm) within one procedure was achieved in 25 (86%) patients. CONCLUSION: Pancreatoscopy with electrohydraulic lithotripsy using the digital SpyGlass DS system (BostonScientificCorp, Marlborough, MA) is the most effective method for calculi of the main pancreatic duct.
Assuntos
Litotripsia , Pancreatite Crônica , Humanos , Pancreatite Crônica/cirurgia , Pancreatite Crônica/diagnóstico , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Feminino , Ductos Pancreáticos/cirurgia , Adulto , Cálculos/cirurgia , Cálculos/diagnóstico , Resultado do Tratamento , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Calcinose/cirurgia , Calcinose/diagnósticoRESUMO
Diabetes mellitus type 3 refers to diabetes secondary to an existing disease or condition of the exocrine pancreas and is an uncommon cause of diabetes occurring due to pancreatogenic pathology. It accounts for 15-20% of diabetic patients in Indian and Southeast Asian continents. This is case report of a rare case of type 3 diabetes mellitus (T3DM) presenting with diabetic ketoacidosis (DKA). The patient was admitted for DKA along with complaint of hyperglycemia, blood glucose of 405 mg/dl with HbA1c level of 13.7%. Computed tomography evidence revealed chronic calcific pancreatitis with intraductal calculi and dilated pancreatic duct.
Assuntos
Calcinose , Cálculos , Cetoacidose Diabética , Ductos Pancreáticos , Pancreatite Crônica , Humanos , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/diagnóstico por imagem , Cálculos/complicações , Cálculos/diagnóstico por imagem , Cálculos/diagnóstico , Ductos Pancreáticos/patologia , Ductos Pancreáticos/diagnóstico por imagem , Calcinose/etiologia , Calcinose/diagnóstico , Calcinose/complicações , Calcinose/diagnóstico por imagem , Masculino , Adulto , Tomografia Computadorizada por Raios XRESUMO
The term dacryoliths refers to the concretions found within the lacrimal system. When the term dacryoliths is unspecified, it usually refers to the noninfectious dacryoliths commonly isolated from the lacrimal sac and the nasolacrimal duct. More often, they are diagnosed incidentally during a dacryocystorhinostomy, and the reported incidence among all dacryocystorhinostomy surgeries is 5.7% to as high as 18%. Dacryolithiasis is a complex process occurring within the lacrimal system, and current evidence suggests a multifactorial etiology. The sequence of events can be summarized broadly into 4 stages: stage of susceptibility, stage of initiation/trigger, stage of development, and stage of maintenance. The triggering event is the breach of the lacrimal sac or nasolacrimal duct epithelium, resulting in microtrauma with blood leakage. The blood clots act as a nidus for subsequent sequential laying of mucopeptides, cellular debris present locally, debris washed from the ocular surface, and extraneous agents in tears. This process is aided by altered rheology and composition of the tear film. After the formation of dacryoliths, extracellular neutrophil traps usually form on the surface, which help to maintain the dacryoliths (which do not dissolve). This review highlights and discusses the possible sequence of events during dacryolithiasis.
Assuntos
Cálculos , Dacriocistorinostomia , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologia , Dacriocistorinostomia/efeitos adversos , Cálculos/diagnóstico , Cálculos/complicações , Cálculos/cirurgia , Ducto Nasolacrimal/cirurgiaRESUMO
The progressive inflammatory nature of chronic pancreatitis and its sparse therapeutic toolbox remain obstacles in offering patients durable solutions for their symptoms. Obstruction of the main pancreatic duct by either strictures or stones represents a scenario worthy of therapeutic focus, as nearly all patients with pancreatitis eventually have intraductal stones. A more recent option for removal of main duct stones is extracorporeal shock wave lithotripsy (ESWL). In an effort to explore the role of ESWL in a Canadian setting, we evaluated our initial experience over an 8-year period (2011-2019).
Assuntos
Cálculos , Litotripsia , Pancreatopatias , Pancreatite Crônica , Humanos , Canadá , Pancreatopatias/terapia , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Cálculos/terapia , Cálculos/diagnóstico , Ductos Pancreáticos , Tecnologia , Resultado do TratamentoRESUMO
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
Assuntos
Cálculos , Litotripsia , Pancreatopatias , Humanos , Cálculos/terapia , Cálculos/complicações , Cálculos/diagnóstico , População do Leste Asiático , Pancreatopatias/terapia , Pancreatopatias/complicações , Ductos Pancreáticos , Estudos Retrospectivos , Resultado do Tratamento , Endoscopia do Sistema DigestórioRESUMO
Introduction: Tonsillolith, also known as tonsil stones or tonsil calculi, are the mineralization of the debris or bacteria within the crevices of the palatine tonsils. It is a rare condition with prominent symptoms of halitosis (bad breath), foreign body sensation, sore throat, painful swallowing, and cough. So far, Individualized Homoeopathy for tonsillolith has been rarely recorded in peer-reviewed journals. Methods: This case was recorded in the Medicine Department of Dr. D. Y. Patil Homoeopathic Medical College & Research Center, India. A 41-year-old male patient suffering from offensive breath and tonsil stones was treated on basis of Individualized Homeopathy medicine between 6th January 2021 and 30th May 2021. During the treatment the responses to therapy were assessed accordingly. To assess whether the changes were due to homoeopathic medicine, an assessment using Modified Naranjo Criteria was performed. Results: This case report demonstrated the treatment of tonsillolith exclusively using Individualized Homeopathy which complies the totality of the symptoms of the case over an observational period of five months. Recovery of this case helps us to strengthen the use of homoeopathy in treating rare and extensive medical cases.
Assuntos
Cálculos , Homeopatia , Masculino , Humanos , Adulto , Cálculos/diagnóstico , Tonsila Palatina , ÍndiaRESUMO
BACKGROUND: Treatment of broncholithiasis is complex, especially in the case of a large or transbronchial broncholith. Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy may be a useful treatment in broncholithiasis; however, as it is not yet common practice, the optimal parameters are unknown. METHODS: We performed a single-center retrospective analysis of the clinical data of 13 broncholithiasis patients who underwent Ho:YAG laser lithotripsy from May 2012 to October 2018. RESULTS: For the 13 patients (2 males and 11 females), Ho:YAG laser lithotripsy was performed 17 times, in total. All procedures were performed under general anesthesia with rigid bronchoscopy. We initially set the Ho:YAG laser to a pulse frequency of 5 Hz and a pulse energy of 0.8 J, gradually increasing these as required. The pulse frequency range we employed was 5-15 Hz, and the pulse energy range was 0.8-1.6 J. All broncholiths were successfully extracted after lithotripsy, and all symptoms improved. Hemoptysis, bronchial esophageal fistula, and pneumonia were the most common complications; however, there were no long-term complications. CONCLUSIONS: Ho:YAG laser lithotripsy is an effective and safe treatment for broncholithiasis, over a long-term follow up.
Assuntos
Alumínio , Broncopatias/terapia , Broncoscopia/métodos , Cálculos/terapia , Litotripsia a Laser/métodos , Ítrio , Idoso , Broncopatias/diagnóstico , Broncoscopia/efeitos adversos , Cálculos/diagnóstico , Estudos de Viabilidade , Feminino , Hemoptise/etiologia , Hólmio , Humanos , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The carcass of a critically endangered, juvenile female grey nurse shark (Carcharias taurus, Rafinesque 1810) was recovered from a south-eastern Australian beach and subjected to necropsy. The 1.98-m-long shark exhibited advanced cachexia with its total weight (19.0 kg) and liver weight (0.37 kg) reduced by 60% and 89%, respectively, compared with a healthy individual of the same length. Marked tissue decomposition was evident preventing histopathology and identification of a definitive cause of death. At necropsy, the abdominal organs were abnormally displaced and showed marked reductions in size compared with a healthy individual of the same size. Importantly, a hook-shaped enterolith (HSE), with a rough surface and cream in colour, was found within the spiral valve of the intestine and is to the authors' knowledge, the first description of such in any marine animal. X-ray diffractometry showed that the HSE comprised the minerals monohydrocalcite (Ca[CO3].H2O; ~70 wt%) and struvite (Mg [NH4 ] [PO4 ]. [H2 O]6 ; ~30 wt%). A CT scan showed concentric lamellate concretions around a 7/o offset J-hook that formed the nidus of the HSE. Nylon fishing line attached to the hook exited the HSE and was evident in the abdominal cavity through a perforation in the intestinal wall where the posterior intestinal artery merges. The most parsimonious reconstruction of events leading to enterolithiasis and secondary cachexia in this shark was the consumption of a hooked fish and subsequent hook migration causing perforations of the cardiac stomach wall followed by the thin, muscular wall of the apposed, sub-adjacent intestine.
Assuntos
Caquexia/diagnóstico , Cálculos/complicações , Doenças dos Peixes/diagnóstico , Tubarões , Animais , Caquexia/etiologia , Caquexia/patologia , Cálculos/diagnóstico , Cálculos/etiologia , Cálculos/patologia , Feminino , Doenças dos Peixes/etiologia , Doenças dos Peixes/patologia , New South WalesRESUMO
Vaginal stones are rare and therefore a delay in accurate diagnosis often occurs. We present a 54-year old woman with multiple sclerosis who was diagnosed with a primary vaginal stone. Initially, she presented with recurring urinary tract infections (UTI) and macroscopic haematuria to the urologist. A cystoscopy showed no abnormalities. Because of persistent bleeding, she was referred to the gynaecologist, and on gynaecological examination, a vaginal stone was revealed. Stone formation was likely to be the result of urinary pooling due to incontinence, which was caused by a neurogenic bladder. Other contributing factors were prolonged recumbency, threads of an intrauterine device and a UTI. The presence of a vesicovaginal fistula was excluded by testing with methylene blue. The stone was surgically removed and composed of 70% struvite and 30% apatite. The patient was treated for decubitus ulcerations of the vaginal wall with estriol (Synapause-E3). Follow-up was uneventful.
Assuntos
Cálculos/diagnóstico , Esclerose Múltipla/complicações , Vagina/diagnóstico por imagem , Doenças Vaginais/diagnóstico , Cálculos/etiologia , Diagnóstico Diferencial , Endossonografia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Doenças Vaginais/etiologiaRESUMO
Choledochal cysts are dilations of the biliary tree that cause a variety of clinical symptoms and can lead to several types of complications. Choledochal cysts are most commonly diagnosed in childhood and frequently present with abdominal pain, jaundice and, in infants, an abdominal mass. Although the most concerning complication is malignant transformation of the cyst epithelium, other complications such as stone formation, acute pancreatitis and stricture can also occur and lead to patient morbidity. Treatment is aimed at not only relieving patient symptoms, but also decreasing a long-term cancer risk. We present a case of a child presenting with abdominal pain and vomiting secondary to a type IVa choledochal cyst complicated by acute pancreatitis, a common bile duct stricture and cystolithiasis.
Assuntos
Cálculos/diagnóstico , Cisto do Colédoco/diagnóstico , Pancreatopatias/diagnóstico , Pancreatite/diagnóstico , Doença Aguda , Cálculos/complicações , Cisto do Colédoco/complicações , Constrição Patológica/complicações , Constrição Patológica/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Ilustração Médica , Pancreatopatias/complicações , Pancreatite/etiologiaRESUMO
Seminal Vesicle (SV) calculi are a rare pathology. Clinical presentation usually consists of nonspecific perineal pain and haematospermia. Adjuncts to aid diagnosis include US, MRI, and Vesiculography. This rare condition can be treated conservatively, however, surgical options are becoming more advanced with Vesiculoscopy now being the gold standard. Here, we present a case of a SV calculi treated conservatively.
Assuntos
Cálculos/complicações , Hemospermia/etiologia , Adulto , Cálculos/diagnóstico , Cálculos/patologia , Doenças dos Genitais Masculinos/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Dor/etiologia , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/patologiaRESUMO
INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study.
Assuntos
Cálculos/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Doenças Testiculares/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Biomarcadores Tumorais/metabolismo , Cálculos/epidemiologia , Cálculos/patologia , Estudos Transversais , Humanos , Incidência , Masculino , Metástase Neoplásica , Neoplasias Embrionárias de Células Germinativas/patologia , Prevalência , Prognóstico , Estudos Retrospectivos , Doenças Testiculares/epidemiologia , Doenças Testiculares/patologia , Neoplasias Testiculares/patologia , Ultrassonografia , Adulto Jovem , alfa-Fetoproteínas/metabolismoRESUMO
OBJECTIVE: To report our experience in the diagnosis, minimally invasive treatment, and composition of seminal vesicle calculi (SVC). PATIENTS AND METHODS: In the present study, we evaluated 20 patients who were admitted to our hospital from January 2013 to January 2018. All the patients were diagnosed with intractable haematospermia and SVC. The diagnosis was further confirmed by seminal vesiculoscopy. SVC were removed by basket extraction; with larger SVC fragmented by holmium laser before extraction. Scanning electron microscopy, X-ray diffraction, and infrared spectroscopy were used to determine the SVC composition. RESULTS: All operations were completed successfully without surgical complications. SVC were mostly composed of hydroxyapatite and protein, suggesting that they were produced by infections. CONCLUSIONS: Seminal vesiculoscopy is a simple, minimally invasive technique that can be used for diagnostic confirmation and treatment of seminal vesiculitis with SVC. This study improves our understanding of SVC and provides a theoretical basis for the prevention of postoperative recurrence of SVC.
Assuntos
Cálculos/cirurgia , Hemospermia/cirurgia , Litotripsia/métodos , Glândulas Seminais/cirurgia , Doenças Uretrais/cirurgia , Adulto , Pesquisa Biomédica , Cálculos/diagnóstico , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/cirurgia , Endoscopia , Hemospermia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Glândulas Seminais/fisiopatologia , Resultado do Tratamento , Doenças Uretrais/diagnóstico , Doenças Uretrais/fisiopatologiaRESUMO
Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further investigation, an isolated urogenital sinus anomaly with a calculus inside one of the hemivaginae was noted. She was managed expectantly with a plan to intervene at puberty. At puberty, during removal of the stone, the hemivaginal introitus was found to be stenotic. Gradually increasing sizes of Amplatz type graduated renal dilators were introduced from the introitus of the urogenital sinus into the hemivaginal stone until a size 22F Amplatz sheath could be passed easily. Size 10F cystoscope was passed through this channel, and the stone was fragmented using electrohydraulic lithotripsy. At a later date, she underwent staged anterior sagittal transvulval mobilization of the urogenital sinus.
Assuntos
Cálculos , Anormalidades Urogenitais , Vagina/fisiopatologia , Cálculos/diagnóstico , Cálculos/etiologia , Cálculos/cirurgia , Pré-Escolar , Feminino , Humanos , Litotripsia , Infecções Urinárias , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/diagnósticoRESUMO
INTRODUCTION: There are no clear recommendations on how patients with testicular microlithiasis should be followed up. The aim of our systematic review is to give clinical guidelines based on the evidence in the literature. METHODS: A web search was conducted during February 2018 based on Pubmed data, Embase and Cochrane database. The eligibility of articles was defined using the PICOS method, in concordance with the PRISMA recommendations. RESULTS: Fifty three articles were selected for our final synthesis. Our review highlighted an association between testicular microlithiasis and the already known risk factors of testicular germ cell tumor. The presence of testicular microlithiasis in patients with such risk factors increases more the risk of cancer. In the absence of risk factors, the risk to develop testicular cancer is similar to the risk in general population. CONCLUSION: In patients at risk to develop testicular cancer, observation versus testicular biopsy is debatable. We recommend an individualized approach based on the age of the patient, the presence of concurrent features of testicular dysgenesis syndrome, the fertility of the couple, the desire of paternity and the ultrasound pattern (bilateral and clustered vs. unilateral and limited).
Assuntos
Cálculos/diagnóstico , Cálculos/terapia , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia , Cálculos/epidemiologia , Árvores de Decisões , Humanos , Guias de Prática Clínica como Assunto , Prevalência , Doenças Testiculares/epidemiologiaRESUMO
OBJECTIVES: Per oral pancreatoscopy (POP) assists in the evaluation and treatment of select benign and neoplastic pancreatic disorders including main-duct intraductal papillary mucinous neoplasm (MD-IPMN). Although pancreatic duct stones are classically thought of as pathognomonic for chronic pancreatitis, its co-occurrence with MD-IPMN as identified via POP may help identify an alternative etiology for presumed idiopathic chronic pancreatitis. METHODS: This was a multicenter retrospective case series of patients found to have pancreatic duct stones with concomitant MD-IPMN by POP. RESULTS: Thirteen patients with presumed idiopathic chronic calcific pancreatitis were found on POP to have both pancreatic duct stones and MD-IPMN. All patients had a dilated pancreatic duct, and most (92.3%) were symptomatic. CONCLUSIONS: Per-oral pancreatoscopy may identify MD-IPMN as an etiology for patients with presumed idiopathic chronic calcific pancreatitis and associated dilated pancreatic duct. Larger prospective studies are needed to validate these findings.
Assuntos
Calcinose/terapia , Cálculos/terapia , Endoscopia do Sistema Digestório/métodos , Ductos Pancreáticos/patologia , Neoplasias Intraductais Pancreáticas/terapia , Pancreatite Crônica/terapia , Idoso , Calcinose/diagnóstico , Calcinose/etiologia , Cálculos/diagnóstico , Cálculos/etiologia , Feminino , Humanos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Intraductais Pancreáticas/complicações , Neoplasias Intraductais Pancreáticas/diagnóstico , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Although surgical or endoscopic treatment is effective for pain control in symptomatic calcified chronic pancreatitis, it is still unknown whether early intervention in mild symptomatic pancreatic stones would reduce the frequency of acute exacerbation and improve long-term outcomes. The aim of this randomized-controlled trial was to explore the efficacy of early endotherapy for mild symptomatic pancreatic stones in comparison with the wait-and-see policy. MATERIALS AND METHODS: Patients with mild symptoms because of pancreatic stones were assigned randomly to the endotherapy or the wait-and-see group. The wait-and-see group received endotherapy only when they developed refractory exacerbation or intractable pain. The primary outcome was the cumulative incidence of intolerable pain attacks and acute exacerbation. The secondary outcomes were the development of pancreatic insufficiency and the progression of pancreatic atrophy. RESULTS: A total of 20 patients were enrolled between March 2008 and March 2011. The study was terminated prematurely because of the poor patient enrollment. Early endotherapy tended to reduce the cumulative incidence of pain attacks and exacerbation, (P=0.17) with the composite incidence of pain attacks and exacerbation of 30% in the endotherapy group and 60% in the wait-and-see group. There were no significant differences in terms of diabetic status and the presence of steatorrhea. The thickness of the pancreas decreased significantly in the wait-and-see group (9.2-6.8 mm, P=0.041), but not in the endotherapy group (8.7-9.0 mm, P=0.60). CONCLUSION: In a small group of patients, early endotherapy in mild symptomatic chronic pancreatitis was associated with a trend toward a minor number of acute attacks and atrophy progression of the pancreas.