Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease.

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.

Sialolithiasis: mineralogical composition, crystalline structure, calculus site, and epidemiological features.

The purpose of this paper was to describe the characteristics of salivary calculi and their relationship to epidemiological factors, through a cross-sectional study. We analysed 100 calculi obtained in 2017-2021. Patient data including age, time since onset of symptoms, gland involved, and site of location in the salivary system were studied. The calculi were studied to determine their morphological features using scanning electron microscopy and energy dispersive plain radiographic analysis. Most of the calculi had formed in the submandibular gland (SG) (82%). The mean age of patients at onset was 45.83 years; patients presenting parotid gland (PG) stones were somewhat older (p = 0.031). The mean time since the onset of symptoms was longer in PG calculi (p = 0.038). The most common lithiasis site was the main duct (74%), followed by the hilum (22%). Hilar stones were the largest (p < 0.05) and heaviest (p = 0.028). Octacalcium phosphate (OCP) was the most common crystalline phase (Cp) founded, followed by hydroxyapatite (HA) and whitlockite (WH). Specifically, OCP had a higher presence in PG calculi (p = 0.029) and WH was the most common phase in SG calculi (p = 0.017). The most prevalent site of lithiasis was the main duct, and the largest and heaviest calculi were found in the SG. PG stones were associated with a longer history of symptoms and older age. OCP was the most frequent Cp of the calculi studied, and the main Cp in PG stones. WH was the predominant Cp in SG stones. The Cp of the calculi was not influenced by location, patient age, or time of symptoms.

Predictive factors for subsequent intrahepatic cholangiocarcinoma associated with hepatolithiasis: Japanese National Cohort Study for 18 years.

BACKGROUND: Predictive factors for intrahepatic cholangiocarcinoma in long-term follow-up of hepatolithiasis are unknown. We thus conducted a cohort study to investigate the predictive factors for developing intrahepatic cholangiocarcinoma in hepatolithiasis. METHODS: This cohort is comprised of 401 patients registered in a nationwide survey of hepatolithiasis for 18 years of follow-up. Cox regression analysis was used to elucidate predictive factors for developing intrahepatic cholangiocarcinoma. RESULTS: The median follow-up period of patients was 134 months. Twenty-two patients developed intrahepatic cholangiocarcinoma and all died. Identified independent significant factors were as follows: age 63 years or older (hazard ratio [HR] 3.344), residual stones at the end of treatment (HR 2.445), and biliary stricture during follow-up (HR 4.350). The incidence of intrahepatic cholangiocarcinoma in patients with three factors was significantly higher than that in patients with one or two factors. The incidence in the groups with one or two predictive factors was not different. In 88.9% of patients with both biliary stricture and intrahepatic cholangiocarcinoma, the duration between the diagnoses of biliary stricture and intrahepatic cholangiocarcinoma was ≥ 5 years. However, once intrahepatic cholangiocarcinoma developed, 77.8% of patients died within 1 year. Of 24 patients with no symptoms, no previous choledocoenterostomy, no signs of malignancy, no biliary stricture, and no treatment for hepatolithiasis during follow-up, only one developed intrahepatic cholangiocarcinoma. CONCLUSIONS: Regarding carcinogenesis, complete stone clearance and releasing biliary stricture can prevent the development of intrahepatic cholangiocarcinoma and improve the prognosis of hepatolithiasis.

The prognostic value of testicular microlithiasis as an incidental finding for the risk of testicular malignancy in children and the adult population: A systematic review. On behalf of the EAU pediatric urology guidelines panel.

INTRODUCTION: The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential association of TM with testicular malignancy in adulthood has led to controversy regarding management and follow-up. OBJECTIVE: To determine the prognostic importance of TM in children in correlation to the risk of testicular malignancy or infertility and compare the differences between the paediatric and adult population. STUDY DESIGN: We performed a literature review of the Medline, Embase and Cochrane controlled trials databases until November 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement. Twenty-six publications were included in the analysis. RESULTS: During the follow-up of 595 children with TM only one patient with TM developed a testicular malignancy during puberty. In the other 594 no testicular malignancy was found, even in the presence of risk factors. In the adult population, an increased risk for testicular malignancy in the presence of TM was found in patients with history of cryptorchidism (6% vs 0%), testicular malignancy (22% vs 2%) or sub/infertility (11-23% vs 1.7%) compared to TM-free. The difference between paediatric and adult population might be explained by the short duration of follow-up, varying between six months and three years. With an average age at inclusion of 10 years and testicular malignancies are expected to develop from puberty on, testicular malignancies might not yet have developed. CONCLUSION: TM is a common incidental finding that does not seem to be associated with testicular malignancy during childhood, but in the presence of risk factors is associated with testicular malignancy in the adult population. Routine monthly self-examination of the testes is recommended in children with contributing risk factors from puberty onwards. When TM is still present during transition to adulthood a more intensive follow-up could be considered.

Changes in tonsillolith characteristics detected in a follow-up CT study.

BACKGROUND: Tonsilloliths are related clinically to halitosis and tonsillar abscess. However, the dynamics of tonsilloliths over time are unknown. The aim of the study was to evaluate change in the characteristics of tonsilloliths in a time-dependent fashion by follow-up computed tomography (CT). METHODS: Tonsilloliths were analyzed in 326 CT scan pair sets of initial and at least two follow-up CT examinations of patients with whole palatine tonsils and various diseases of the oral and maxillofacial regions. RESULTS: Over the follow-up period, 12.1% of tonsilloliths disappeared. Approximately 26.1% of tonsilloliths changed in size during follow-up, mostly increasing in size. In tonsilloliths that showed enlargement, the mean (± standard deviation) growth rate was 0.61 ± 0.41 mm per year. Approximately 37.3% of tonsilloliths changed position during the follow-up period; of these, movement was toward the respiratory tract in 92% at a mean rate of - 1.38 ± 1.59 mm per year. The calcification levels of almost all tonsilloliths showed dynamic change: HU number increased in 84.3% and decreased in 12.7% of tonsilloliths over the follow-up period. The mean rate of HU increase was 63.8 ± 96.3 HU/year, and the mean rate of HU decrease was - 38.4 ± 66.8 HU/year. CONCLUSIONS: The calcification levels of all tonsilloliths showed dynamic fluctuation, and a tendency for excretion of tonsilloliths from the body. Their dynamics over time suggest that tonsilloliths may be in a permanently active phase which functions to remove foreign matter.

Risk factors of conversion in laparoscopic cholecystectomies for lithiasic acute cholecystitis. Results of a monocentric study and review of the literature.

INTRODUCTION: Nowadays, laparoscopic cholecystectomy has become the gold standard in the management of lithiasic acute cholecystitis. However, the rate of conversion to laparotomy remains considerable, greater than that of uncomplicated lithiasis. Some factors, related to the patient, the disease or the surgeon, are associated with a high risk of conversion. AIM: To identify the factors associated with a significant risk of conversion in laparoscopic cholecystectomy for acute cholecystitis. METHODS: Between January 2011 and December 2015, all patients operated on for acute cholecystitis at the Department of General and Digestive Surgery of Farhat Hached University Hospital of Sousse - Tunisia were divided into two groups: A for the laparoscopic approach and B for conversion. We compared the two groups. RESULTS: The conversion rate was 21.9% (43 patients). At the end of this work, we found that the conversion rate was significantly increased for males (p = 0.044), ulcerative disease (p = 0.004), smokers (p = 0.007), ASA score = II (p = 0.005), abdominal guarding (p = 0.001), fever (p = 0.001), perivesicular effusion on ultrasound (p = 0.041), ultrasound Murphy's sign (p = 0.023), delayed cholecystectomy (p = 0.038), perivascular adhesions (p <10-3) and gangrenous cholecystitis (p = 0.009). CONCLUSION: The conversion is sometimes badly perceived by the surgeon. However, it should in no way be considered a failure, but rather a change of strategy to ensure patient safety. Conversion should not be delayed, especially as risk factors have been identified.

Parecoxib in laparoscopic surgery for simple vesicular lithiasis.

AIM: To evaluate the contribution of parecoxib to the protocol of multimodal analgesia for simple vesicular lithiasis by laparoscopy. METHODS: A prospective, randomized, double-blind study was carried out at Habib Thameur Hospital (Tunis). We included 60 patients, ASA I or II, scheduled for cholecystectomy by laparoscopy. The patients were randomized to 2 groups. The parecoxib group (PG) receiving parecoxib 40 mg 30 minutes before the induction and the control group (CG) receiving physiological saline. Data were collected during hospitalization and a follow-up was done one year after the operation by a questionnaire. RESULTS: The pain scores at rest and at cough were significantly lower in the PG than in the CG during the first postoperative day (p < 10-3). Ten percent of the patients of the CG and no patient of the GP required Morphine in the recovery room (p = 0,07). The requirement of Tramadol was significantly less frequent in the PG (70 % of the PG, 16,6 % of the CG and p < 10-3). A chronic pain was found in 37,5 % and 8 %, respectively, in the GC and GP (p = 0,013). This pain was intense in 2 GC patients requiring analgesics and a work stoppage. CONCLUSIONS: The results of our study are in favor of the use of Parecoxib 40 mg 30 minutes before laparoscopic cholecystectomy for its effects on acute pain, opioid sparing and chronic pain.

Multidetector computed tomography imaging characteristics of asymptomatic palatine tonsilloliths: a retrospective study on 3886 examinations.

OBJECTIVE: This study aimed to estimate the prevalence of palatine tonsilloliths and analyze their multidetector computed tomography (CT) imaging features. STUDY DESIGN: The CT images of 3886 patients (1654 men, 2232 women; mean age, 35.8 years) were reviewed. The distribution, dimension, morphology, and location of each tonsillolith was assessed. The correlation between participant demographic characteristics and the characteristics (prevalence, number, size) of tonsilloliths was determined. RESULTS: The prevalence of palatine tonsilloliths was 30.3%; we identified significant differences in the prevalence and size between men and women. The prevalence of tonsilloliths significantly increased with age (P < .001). The mean number of tonsilloliths per participant was 2.7, and 64.7% of patients had 1 to 2 tonsilloliths. Ovoid-shaped tonsilloliths were the most common (approximately 80%). The centers of the tonsillar crypts contained the majority of the tonsilloliths, 50.3% of which had sizes of 1 to 2 mm. CONCLUSION: The results, based on a larger sample size compared with previous studies, can be applied as guidelines for the diagnosis of tonsilloliths on CT images.

Thoracolithiasis-Computed Tomography Findings of Intrapleural Loose Bodies.

Thoracoliths are rare benign intrapleural loose bodies, often containing calcification, that are mobile in the pleural cavity. The presence of these intrapleural nodules is referred to as thoracolithiasis. The exact etiology of thoracoliths is unknown, but they presumably result from a prior episode of mediastinal (epipericardial) fat necrosis. Thoracoliths are usually asymptomatic and incidentally encountered on computed tomography. However, they sometimes pose diagnostic challenges, as a thoracolith may be located within a pleural fissure, and is then indistinguishable from a pulmonary nodule. In addition, migration and rotation of thoracoliths within the pleural space observed on serial computed tomography studies has been reported to raise concern that these might be neoplastic lesions, leading to their surgical removal. Awareness of this benign condition is important in order to avoid unnecessary invasive procedures.

Risk factors for acute cholecystitis and for intraoperative complications.

BACKGROUND: Acute cholecystitis is still frequent in emergency surgical departments. As surgical technique, nowadays laparoscopy is widely used and with low complications and with low postoperative morbidity. MATERIAL AND METHODS: We perform an analytical study about the safety of laparoscopic surgery in patients with acute cholecystitis in a single Surgical Department with an experience of over 20 years in laparoscopic surgery. We included 193 patient admitted in our department during 2014 and 2015. RESULTS: Of the 193 patients, 43% were diagnosed with acute lithiasic cholecystitis (ALC) whereas 56% had chronic lithiasic cholecystitis (CLC). We assessed the comorbidities of the patient via Pearson's Chi-Square test and we found out that there is a significant relationship between acute cholecystitis and high blood tension, obesity and diabetes. Surgical techniques performed were in 95% of cases laparoscopic cholecystectomy and only in 5% we performed open surgery. DISCUSSIONS: Experienced surgeons have a lower conversion rate as compared to less experienced surgeons. For this reason, postoperative assessment criteria have been proposed, with a view to identify the risk of conversion CONCLUSION: In our study laparoscopic surgery for acute cholecystitis is a safe procedure with low intraoperative complication rate and with a reduced hospital stay. KEY WORDS: Acute cholecystitis, Intraoperative adhesion, Intraoperative bleeding, Laparoscopic cholecystectomy.

Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis.

Benign paroxysmal positional vertigo (BPPV) involving horizontal semicircular canal (HSCC) is characterized by direction-changing positional nystagmus (DCPN) in a supine roll test, and the occurrence of spontaneous nystagmus in HSCC BPPV has been reported recently. The aim of this study is to investigate the characteristics of pseudo-spontaneous nystagmus (PSN) in patients with HSCC canalolithiasis, and evaluate the effect of the presence of PSN on treatment outcome.Between April 2014 and January 2016, 75 and 59 patients with HSCC canalolithiasis and cupulolithiasis, respectively, were enrolled. Spontaneous and positional nystagmus were examined.PSN was observed in 31 of 75 patients (41%) with HSCC canalolithiasis, and 55 of 59 patients (93%) with HSCC cupulolithiasis. PSN persisted during the period of observation, which was at least 1 minute in all patients with PSN. In HSCC canalolithiasis, direction-reversing nystagmus was observed in 58 patients (25 bilateral and 33 unilateral). Nine of 25 patients with bilateral direction-reversing nystagmus, and 22 of 33 patients with unilateral direction-reversing nystagmus showed PSN. None of 17 patients without direction-reversing nystagmus showed PSN. The direction of PSN corresponded to that of direction-reversing nystagmus in all 22 patients with unilateral direction-reversing nystagmus. The proportion of patients who recovered after 1 session of repositioning maneuver was not significantly different between patients with and without PSN (P = .867).PSN was observed more commonly in HSCC cupulolithiasis than canalolithiasis. The pathophysiologic mechanism underlying PSN can be explained by natural inclination of HSCC and medial to lateral orientation of the HSCC cupular axis in cupulolithiasis, and by spontaneous reversal of initial positional nystagmus (direction-reversing nystagmus) generated by short-term adaptation of vestibulo-ocular reflex in canalolithiasis. The presence of PSN in HSCC canalolithiasis may not affect the treatment outcome.

[Prevalence of tonsilloliths and CT diagnosis].

Objective: To investigate the prevalence, gender and age distribution characteristics of tonsilloliths and its CT diagnosis, in order to improve the knowledge of clinicians. Methods: The images of 2 710 patients who underwent head and neck CT scans from November 2015 to November 2016 were retrospectively reviewed, the prevalence, gender and age distribution of tonsilloliths and CT manifestation were analyzed. SPSS 18.0 was used for statistical analysis. Results: Tonsilloliths were found in 383 (14.1%) of the 2 710 patients, including 217 men and 166 women. The prevalence was 15.1% in men and 13.1% in women, and no gender difference was seen. The age of patients with tonsilloliths ranged from 6-88 years, and the mean age was (51.1±16.8) years. The prevalence of tonsilloliths in patients 40 years and younger was significantly lower than in those who were over 40 years (χ(2)=15.201, P<0.001), and the prevalence of tonsilloliths was positively correlated with age(r=0.812, P=0.008). One hundred and twenty eight cases of tonsilloliths were located on the right side, and 157 were located on tleft side. Tonsilloliths were detected bilaterally in 98 patients. There was no significant difference between left and right sides(χ(2)=1.919, P=0.166). Most of tonsilloliths showed a single small tonsillolith, 60.6% of tonsilloliths showed only one tonsillolith, whereas 39.4% showed two or more. The size of tonsilloliths ranged from 1.0 to 10.0 mm, the mean maximum diameter was (2.3±1.2) mm, and 86.7% of tonsilloliths with a maximum diameter of no more than 3.0 mm. Tonsilloliths showed dot, round or oval hyperdense in tonsillar crypt or parenchyma. CT attenuation of majority tonsilloliths was over 120 Hu. Conclusion: Tonsilloliths are more common than previously suggested, its CT diagnosis is not difficult, and the knowledge of clinician and radiologist needs to be improved.

[Calcifications of the parotid space. A review]. / Calcifications de la loge parotidienne. Mise au point.

INTRODUCTION: Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space. MATERIAL AND METHODS: We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded. RESULTS: Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases. DISCUSSION: Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images.

OBJECTIVES: Palatine tonsilloliths incidentally detected on diagnostic imaging should be differentiated from pathologic calcifications to enable correct diagnosis and treatment. The aim of this study is to clarify the prevalence and imaging characteristics of palatine tonsilloliths on panoramic radiographs. MATERIALS AND METHODS: We retrospectively reviewed 2244 individuals who underwent pairs of consecutive panoramic radiography and computed tomography (CT) of the head and neck region. The imaging characteristics of palatine tonsilloliths on panoramic radiography were compared with the findings from CT, which was considered the gold standard. RESULTS: Tonsilloliths were detected in 300 (13.4 %) and 914 (40.7 %) of the 2244 individuals on panoramic radiographs and CT, respectively. On panoramic radiographs, tonsilloliths were superimposed over the ramus of the mandible at the level coincident with and inferior to the soft palate in 176 (7.8 %) and 90 (4.0 %) individuals, respectively. Tonsilloliths were also superimposed over the surrounding soft tissue inferior to the body of the mandible, postero-inferior to the angle of the mandible, and posterior to the ramus of the mandible in 33 (1.5 %), 26 (1.2 %), and 28 (1.3 %) individuals, respectively. A significant correlation was observed between the detectability on panoramic radiographs and the size (Spearman r = 1.000) and number (Spearman r = 0.991) of tonsilloliths, as revealed by CT images. CONCLUSIONS: The present results suggest that tonsilloliths are commonly detected on panoramic radiographs. Furthermore, they can be superimposed on both the mandible and the surrounding soft tissue. CLINICAL RELEVANCE: Clinicians should include tonsilloliths among the differential diagnoses when calcified bodies are detected on panoramic radiographs.

[Combined approach of parotid lithiasis. A technical note]. / Abord combiné des lithiases parotidiennes. Note technique.

INTRODUCTION: Sialendoscopy, extracorporeal lithotripsy and transoral removal are the usual treatments for parotid lithiasis. These techniques cannot treat all the patients. In fact, removal of lithiasis bigger than the ductal diameter and situated in the middle or posterior third of the duct may fail with such techniques. For this reason the combined approach has been developed. Our technical note describes this procedure. TECHNICAL NOTE: Preoperative check-up needs an ultrasound or a CT scan of the parotid region. The procedure is conducted under general anesthesia. It begins with the localization of the lithiasis with help of the sialendoscope light visible through the skin. A face lift approach is performed giving access to the SMAS that is opened over the lithiasis and the transilluminated area. A window is opened on the duct and the lithiasis is removed. Proximal duct permeability is assessed with the sialendoscope. The different layers are sutured and a suction drainage is left in place. DISCUSSION: Combined approach is indicated in case of failure of conservative techniques. It provides good results in removal of lithiasis located in the posterior or middle thirds of the duct. Its morbidity is low. It can avoid performing a parotidectomy and lowers the risk of facial palsy. In case of failure, botulinum toxin injection may be indicated.

Segmental cholangiectasia clinically worrisome for cholangiocarcinoma: comparison with recurrent pyogenic cholangitis.

The aim of this study was to review the clinical, radiographic, and pathologic features of cases of benign segmental cholangiectasia in non-Asian US patients with clinical concern for cholangiocarcinoma and compare these features with cases of recurrent pyogenic cholangitis (RPC) in Asian patients. A total of 10 non-Asian US patients with benign segmental cholangiectasia were included in this study. Nine of them underwent partial hepatic resection due to cholangiographic findings of segmental cholangiectasia with mural thickening and/or proximal biliary stricture. One was found to have markedly dilated and thickened intrahepatic bile ducts at the time of autopsy. Clinical and radiographic findings were reviewed. Elastin stains and immunostains for immunoglobulin G4, cluster of differentiation (CD1a), and Langerin were performed. Six comparison cases of RPC in Asian US patients were also examined. Histologic examination of resection specimens revealed markedly dilated large intrahepatic bile ducts with variable degrees of mural fibrosis, periductal gland hyperplasia, inflammation, and liver parenchymal atrophy. These changes were not associated with a ductular reaction. There was no evidence of biliary dysplasia or biliary cirrhosis in any cases. No gross or microscopic feature definitively separated the Asian from non-Asian patients. The etiology of this disorder in non-Asian US patients is unclear. It does not appear to represent a localized variant of Caroli disease or primary sclerosing cholangitis. The high degree of similarity shared by these cases and classic RPC suggests a common pathogenic mechanism, although the pathologic features tend to be less well developed in the cases from the non-Asian US patients.

Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years.

The aims of the present study are to clarify the changes in clinicopathologic features, diagnosis and treatment for hepatolithiasis, and propose an appropriate management strategy in Japan. The research group conducted nationwide surveys seven times in the past over a period of 40 years. Furthermore, a cohort was followed up in 2010. We analyzed the clinical features, diagnosis tools, treatment procedures, outcomes, and predictive factors for cholangiocarcinoma. Surgery was the primary method for hepatolithiasis up to 1998, and the frequency of its use has decreased since then. In 2011, 66.7% of hepatolithiasis patients were treated using nonsurgical approaches. In addition, endoscopic retrograde cholangiography (ERC) with stone extraction was the most frequently performed procedure (22.7%). However, the incidences of residual stone and recurrent stone after ERC with stone extraction were higher than those after percutaneous transhepatic cholangioscopic lithotomy and surgery. Bile duct stricture and dilatation during follow up were significant risk factors for stone recurrences. In the cohort study, stone removal only and age >65 years were significant factors for the development of cholangiocarcinoma. In patients without a history of cholangioenterostomy, left-lobe-type stones were a risk factor, and hepatectomy reduced the risk of the development of cholangiocarcinoma significantly. Nonsurgical treatment may be performed as the first-line treatment for hepatolithiasis. Surgery should be performed on patients who were treated incompletely after nonsurgical treatment. However, hepatectomy may be recommended for patients with left-lobe-type stones and without a history of cholangioenterostomy.

Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs.

BACKGROUND: Recent studies suggest that tonsilloliths are clinically related to halitosis and tonsillar abscess. Based on our empirical knowledge, tonsilloliths are relatively commonly encountered in daily clinical practice. It has been reported that the detection rate of tonsilloliths was under 24% in previous reports, although experience suggests otherwise. The purpose of the study was to evaluate the prevalence and characteristics of tonsilloliths using computed tomography (CT). In addition, the possible causes of low detection rates on panoramic radiographs were evaluated based on comparisons between CT images and panoramic radiographs in order to elucidate the limitations of visualizing the area around the palatine tonsils on panoramic radiographs. METHODS: 482 pairs of CT images and panoramic radiographs were retrospectively assessed with respect to the presence and characteristics of tonsilloliths. In addition, the causes in cases of disagreement between the two modalities were analyzed. RESULTS: The detection rate of tonsilloliths was 46.1% using CT scans, unlike previous reports. The characteristics of tonsillolith were dot-like figures with about 300-500 Hounsfield units within the palatine tonsil under the soft palate. The most common length of tonsilloliths was about 3 or 4 mm. As the subjects aged, the detection rate increased gradually. A significant difference in the tonsillolith detection rate was found between the over and under 40-year-old groups (p < 0.0001). However, the detection rate of tonsilloliths was only 7.3% on panoramic radiographs. A significant correlation was observed between the detection rate of tonsilloliths on panoramic radiographs and CT number (Spearman r = 0.429), size, (Spearman r = 0.318), and number of tonsilloliths (Spearman r = 0.333). CONCLUSION: The present results suggest that tonsilloliths are relatively more common than previously suggested. However, panoramic radiographs detect only a small percentage of palatine tonsilloliths. The low detection rates on panoramic radiographs might be related to the degree of calcification, size, and number of tonsilloliths.

[Vitamin D and kidney diseases]. / Vitamine D et rein.

Calcitriol and analogs inhibit renin-angiotensin system, which has a pivotal role in glomerular and tubulo-interstitial damages and proteinuria, and inhibit NF-κB activation which is known to play an important role in renal diseases by promoting inflammation and fibrogenesis. Vitamin D presents interesting pleiotropic effects for the CKD patient (reduction of mortality, antiproteinuric effect and anti-inflammatory properties). "Native" vitamin D (cholecalciferol or ergocalciferol) administration in these patients also decrease parathyroid hormone levels. Native vitamin D administration in CKD patients is safe and does not lead to increased risk of vascular calcification, despite the known hypercalcemic and hyperphosphoremic properties of the molecule in its active form. Native vitamin D administration is not associated with an increased risk of renal stones, at pharmacological doses and without important concomitant administration of calcium salts. In the field of renal transplantation, experimental studies show that vitamin D analogs have a protective role against acute rejection but clinical studies remain mainly observational.

Prevalence of palatine tonsilloliths: a retrospective study on 150 consecutive CT examinations.

OBJECTIVES: To evaluate the prevalence of palatine tonsilloliths. METHODS: 150 consecutive CT examinations (75 males and 75 females) were read. RESULTS: Tonsilloliths were found in 37 patients (24.6%; confidence interval 17.7-31.6%), of which 18 (48%) had a bilateral location. No influence of sex or age was observed (p = 0.37 and p = 0.57, respectively). 26 patients (70%) had more than 1 concretion. The largest tonsillolith was 7 mm. None of the tonsilloliths found were involved in the reason for prescribing the CT. The radiographic density of the tonsilloliths was between 216 and 2959 HU. CONCLUSIONS: Palatine tonsilloliths could affect approximately one-quarter of the population. This prevalence is likely to be underestimated in daily clinical practice because small concretions do not result in any functional impairment and are not visible on orthopantomographs.