Oral Litholysis in Patients with Chronic Calcific Pancreatitis Unresponsive to or Ineligible for Extracorporeal Shock Wave Lithotripsy and Endoscopic Therapy.

BACKGROUND/AIMS: Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy. METHODS: Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6-0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy. RESULTS: Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione. CONCLUSION: Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.

Calcium supplements: benefits and risks.

Calcium is an essential element in the diet, but there is continuing controversy regarding its optimal intake, and its role in the pathogenesis of osteoporosis. Most studies show little evidence of a relationship between calcium intake and bone density, or the rate of bone loss. Re-analysis of data from the placebo group from the Auckland Calcium Study demonstrates no relationship between dietary calcium intake and rate of bone loss over 5 years in healthy older women with intakes varying from <400 to >1500 mg day(-1) . Thus, supplements are not needed within this range of intakes to compensate for a demonstrable dietary deficiency, but might be acting as weak anti-resorptive agents via effects on parathyroid hormone and calcitonin. Consistent with this, supplements do acutely reduce bone resorption and produce small short-term effects on bone density, without evidence of a cumulative density benefit. As a result, anti-fracture efficacy remains unproven, with no evidence to support hip fracture prevention (other than in a cohort with severe vitamin D deficiency) and total fracture numbers are reduced by 0-10%, depending on which meta-analysis is considered. Five recent large studies have failed to demonstrate fracture prevention in their primary analyses. This must be balanced against an increase in gastrointestinal side effects (including a doubling of hospital admissions for these problems), a 17% increase in renal calculi and a 20-40% increase in risk of myocardial infarction. Each of these adverse events alone neutralizes any possible benefit in fracture prevention. Thus, calcium supplements appear to have a negative risk-benefit effect, and so should not be used routinely in the prevention or treatment of osteoporosis.

Development of fatty acid calcium stone ileus after initiation of human milk fortifier.

We report a case who was born with extremely low birth weight infant and had experienced abdominal operation for necrotizing enterocolitis, eventually developed ileus due to fatty acid calcium stones after giving human milk fortifier. He had developed necrotizing enterocolitis on day 30 of his age, such that we performed enterectomy and ileostomy. He could not tolerate enteral feeding fully, because intestinal fistula infection was repeated. Although we administered hindmilk, he grew up slowly and he suffered cholestasis as well. We performed end-to-end anastomosis to prevent fistula infections on day 87. After this operation, breast milk feeding volume was increased easily. However, we started to add HMF of half-strength on day 124, because his body weight gain remained very poor. And we confirmed to intensify the ratio of HMF full-strength on day 128. After that his abdomen had distended on day 131. As there is no effect of conservative therapy to occlusive ileus, we did emergency laparotomy on day 139. Intestinal calculi were impacted at anastomic portion. Although all stones were removed, he died on 144 days due to disseminated intravascular coagulation and renal failure. Calculi analysis revealed that all of them were fatty acid calcium stones. There is no report about like our case. We speculate that the construction of fatty acid calcium result from either high concentration of calcium/phosphorus or rapid increase in the fortification. We could have prevented this case happened by slower increment of fortification.

Massive enterolithiasis associated with ileal dysgenesis.

A 20-year-old man with massive ileal enterolithiasis was investigated with plain radiography, ultrasound, computed tomography, barium follow through and double contrast barium enema. Ileocecal valve agenesis was found at surgery. The enteroliths were located in the distal ileum, which communicated with the large intestine via an ileotransverse fistula.

["Sand-clock" lithiasis on prostatic transurethral resection bed]. / Litiasis en "reloj de arena" sobre celda de resección transuretral prostática.

OBJECTIVES: Although uncommon, prostatic surgical bed lithiasis may present among post-TURP complications. The present study underscores the importance of diagnosis and treatment. METHODS/RESULTS: We report on a patient with magnesium ammonium phosphate hourglass lithiasis in the prostatic surgical bed one year and a half following transurethral resection due to adenomyomatous prostatic hyperplasia that was successfully treated by intracorporeal lithotripsy with the Lithoclast. The physiopathological, clinical, diagnostic and therapeutic aspects are discussed. CONCLUSIONS: This condition should be suspected in patients with dysuric syndrome post-TURP. The importance of simple complementary diagnostic procedures as DRE and plain abdominal films in discarding lithiasis in underscored. We consider retrograde endoscopic manipulation and ultrasonic lithotripsy or penumatic lithotripsy with the Lithoclast to be the safest procedures for this type of lithiasis.

[Inflammation and subcutaneous calcification of venous origins]. / Inflammation et calcifications sous-cutanees d'origine veineuse.

There have been few descriptions up to now of calcifications in chronic venous insufficiency, other than in cases where venous insufficiency is complicated be severe trophic disorders and in particular ulcers. It was therefore felt to be of interest to assess the presence of calcifications in venous insufficiency without trophic disorders. This study was based upon 40 cases recruited in the phlebology out-patient clinic of the Notre Dame de Bon Secours Hospital. Calcifications of the lower limbs were found in 7 patients, either by palpation, routine X-rays or ultrasonography. The etiopathogenic mechanisms of this occurrence not having been elucidated, a number of hypotheses are put forward on the basis of acquired data concerning: the process of formation of ectopic calcifications, changes in subcutaneous tissue, the ultimate consequences of venous stasis and of raised venous pressure, due essentially to anoxia and inflammation. One hypothesis can thus be put forward: that of inflammation. The release of cells and mediators of inflammation, the production of free radicals, causing damage to the cells of connective tissue and to the organic framework (collagen fibres) and changes in the chemical environment could combine to result in the formation of calcifications in subcutaneous tissue. However, inflammation has not been proven to be the primary etiological factor.

[Antropyloric lithiasic obstruction. A variant of Bouveret's syndrome]. / Obstruction lithiasique antro-pylorique. Une variante du syndrome de Bouveret.

We report about one case of cholecystoduodenal fistula complicated by antropyloric lithiasic obstruction, which was treated surgically with gastrotomy and extraction of the calculus, in an 82-year-old woman. This case represents an anatomic variant of Bouveret's syndrome, which is classically defined as a duodenal lithiasic obstruction. On the basis of this case, the authors discuss the diagnostic and possibly therapeutic merits of digestive endoscopy and define the main clinical, anatomical and evolutive characteristics of this unfrequent complication of biliary lithiasis.

Phlebolithiasis associated with intramuscular hemangioma. X-ray diffractometric, X-ray microanalytical and scanning electron microscopic investigations.

Phlebolithiasis associated with intramuscular hemangioma is relatively rare. Combined crystallographic, microanalytical and morphological studies have not been done before. We investigated a case of phlebolithiasis by scanning electron microscopy, X-ray microdiffractometry and energy-dispersive X-ray microanalysis. The calculus revealed a lamellar structure with irregular distribution of radipaque and radiolucent portions. The radiopaque portions contained apatite which could be demonstrated in prismlike as well as globular granular structures. In contrast to other authors, brushite was not detected by us. The radiolucent protions adjacent to the stone surface contained sulfur and showed undefined diffraction peaks supposing the presence of organic crystals. The possible milieu factors govering calculus formation are discussed.

Gastric carcinoma with psammomatous calcification: report of a case, with reference to calculogenesis.

A case of gastric adenocarcinoma with argyrophilic property and psammomatous calcification is reported. Histologically, the psammoma bodies are found most frequently within the glandular lumina. Electron microscopy, however, reveals that calcium first appears within the cytoplasm of tumor cells. Electron probe x-ray microanalysis demonstrates calcium and phosphorus in granular or floccular osmiophilic deposits found in intracytoplasmic electronlucent zones of tumor cells. By x-ray diffractometry, the calcium component is presumed to be hydroxyappatite (Ca5(PO4)3.(OH). The findings strongly support the view of the intracytoplasmic origin of psammomatous calcification. The tumor yielded a parathyroid hormone (PTH)-like substance, and a possible relationship between this substance and psammomatous calcification is spectulated.

Lacrimal sac calculi.

Analysis of dacryoliths removed at operation showed that most consisted of calcium. One consisted of ammonium and could be directly related to the presence of bacteria. Tear samples obtained from 14 patients with dacryoliths were compared with seven normal patients with regard to calcium, phosphorus, and uric acid concentrations, tear to serum calcium ratios, and calcium-phosphate products. There was no significant difference between the two groups and thus no evidence that dacryoliths from because of abnormal tear electrolytes. We believe that dacryolith formation results from chronic obstruction and inflammation of the sac causing a build up of various electrolytes, particularly calcium. The preoperative dacryocystograms showed either a filling defect or apparent displacement of the lacrimal sac.

Meckel's stones: a case report.

The authors describe a case of Meckel's stones demonstrated by barium study of the small bowel. Preoperative diagnosis of Meckel's stones is extremely rare; but with knowledge of their existence, more cases should be encountered.