Liesegang rings in kidney diseases- A Systematic Review.

INTRODUCTION: Liesegang rings (LR) are concentric acellular lamellar structures, usually found in cystic and inflammatory tissues but can also be seen in neoplastic conditions. They have been mistakenly interpreted as various structures like psammomatous calcification, parasites, and algae. This study has aimed to systematically review and summarize the existence of LRs in both non-neoplastic and neoplastic conditions of the kidney. The systematic search in PUBMED, PUBMED CENTRAL, and EMBASE databases along with Google Scholar was performed by using Kidney, Liesegang Rings, or Liesegang structure or pseudo parasitic structure in combination with the Boolean operators ''and'' as searching terms. Data were collected for demographic characteristics and histopathology diagnosis. The search function was limited to human subjects. Two reviewers independently performed the eligibility assessment and data extraction. Eligibility inclusion criteria were all publications in the English literature worldwide related to Liesegang rings in association with kidney's non-neoplastic and neoplastic conditions, regardless of the years of publication. Also included were those cases whose full articles were unavailable, but the abstract was well-described, fulfilling our inclusive criteria. Eligibility exclusion criteria included LRs found elsewhere in the body organs apart from the kidney and availability of full text in a different language, non-human, and duplicate article/case. METHOD: After the exclusion of the articles as per the exclusion criteria, the total articles that fulfilled the inclusive criteria were reviewed. In addition, all the articles were further cross-referenced for additional articles. All published papers retrieved from this search were considered for this review. A total of 22 records (26 cases) were found with a diagnosis of LRs in the kidney to date. Some articles were published as case series. Accordingly, 26 patients were reported to have Liesegang rings associated with kidney neoplastic and non-neoplastic conditions, 12 were male and 14 were female. For one case the gender was not mentioned. LRs presented a higher frequency in individuals between the 4th and 5th decades of life. No single case was reported in infants and younger children. Regarding predisposing factors for LRs, cystic fluid contents were the most common underlying condition. RESULT: In our practice, we encountered an unusual case of a 55-year-old female with a complaint of pain in the left upper quadrant of the abdomen. The ultrasound revealed nephrolithiasis and chronic kidney disease for which a nephrectomy was performed. On the histopathological examination, there was an incidental finding of Liesegang rings and a papillary adenoma along with features of chronic pyelonephritis. Our review will provide insight into LRs in different spectrums of kidney diseases. CONCLUSION: This study represents the first available systematic review of the literature demonstrating LRs in the kidney. Although Liesegang rings have no great clinical significance, nonetheless, their presence in both tissue and cytological specimens should be kept in mind while dealing with different lesions of the kidney as they are good mimickers of many organic and inorganic substances, parasites, and malignancies.

Value of High-resolution MRI in Detecting Lymph Node Calcifications in Patients with Rectal Cancer.

RATIONALE AND OBJECTIVES: To analyze CT and high-resolution MRI findings of nodal metastasis calcifications and determine the value of high-resolution MRI in detecting nodal calcifications in rectal cancer patients. MATERIALS AND METHODS: In total, 229 rectal cancer patients were included. The CT was reviewed for the presence of nodal calcifications by two radiologists. High-resolution two-dimensional turbo spin-echo T2-weighted imaging (2D-TSE-T2WI) and fat-suppressed gadolinium-enhanced isotropic high-resolution three-dimensional gradient-echo T1-weighted imaging (3D-GRE-T1WI) were independently reviewed for nodal calcifications by the two radiologists at one-month and two-month intervals, respectively. The sensitivities, specificities and accuracies of the two high-resolution MRI in detecting nodal calcifications were calculated using CT results as a reference. RESULTS: Regional calcified metastatic lymph nodes were found in 28 patients. The node-to-node evaluation revealed that 55 (98.2%) of the 56 calcified lymph nodes were metastatic. Fifty-one (92.7%) calcified metastatic lymph nodes displayed scattered fine punctate calcifications to different degrees on CT. In both types of high-resolution MRI, the calcifications demonstrated a patchy area of markedly reduced signal intensity in corresponding areas that were larger than those on CT. The sensitivity and accuracy of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were significantly higher than those of high-resolution 2D-TSE-T2WI (76.8% vs 58.9%, P = 0.013; 98.3% vs 97.9%, P = 0.007; respectively). CONCLUSION: Metastatic nodal calcifications are characteristic imaging findings in rectal cancer. Calcifications are indicated by markedly reduced signal on high-resolution MRI, which will alert radiologists to scrutinize CT for nodal calcifications and aid in the accurate diagnosis of metastatic lymph nodes.

Vesícula en porcelana: un interesante hallazgo incidental. Presentación de un caso y revisión de la literatura / Porcelain gallbladder an interesting incidental finding. Case report and literature review / Vesícula em porcelana: um achado incidental interessante. Apresentação de caso e revisão de literatura

RESUMEN Se realizó la comunicación de un caso recientemente diagnosticado en el Hospital Docente Clínico Quirúrgico "Joaquín Albarrán" de La Habana. El caso que se presenta correspondió con un paciente masculino de 73 años de edad que en el estudio autópsico se reveló la presencia de vesícula en porcelana, la cual, según la literatura, su identificación es un diagnóstico incidental durante el estudio del paciente por otro padecimiento, en su mayoría neoplásico o en la autopsia. Su relación con el cáncer de vesícula presenta controversias. La vesícula en porcelana es una entidad caracterizada por la calcificación intramural de la vesícula, tiene una incidencia reportada de 0,06 a 0,8 % de las colecistectomías realizadas. Se realizó revisión de la literatura en bases de datos, MEDLINE, PubMed, ELSEVIER y SciELO, con un total de 26 publicaciones encontradas entre 1999 y 2018.

ABSTRACT The communication of a newly diagnosed case was carried out at the "Joaquín Albarrán" Surgical Clinical Teaching Hospital in Havana. The case presented corresponded with a 73-year-old male patient who in the autopsy study revealed the presence of a porcelain gallbladder, which, according to the literature, its identification is an incidental diagnosis during the study of the patient for another condition, mostly neoplastic or at autopsy. His relationship with gallbladder cancer is controversial. The porcelain gallbladder is an entity characterized by intramural gallbladder calcification, has a reported incidence of 0.06 to 0.8% of the cholecystectomies performed. We reviewed the literature in databases, MEDLINE, PubMed, ELSEVIER and SciELO, with a total of 26 publications found between 1999 and 2018.

RESUMO A comunicação de um caso recentemente diagnosticado foi realizada no Hospital de Ensino Clínico Cirúrgico "Joaquín Albarrán", em Havana. O caso apresentado correspondeu a um paciente do sexo masculino, 73 anos, que no estudo de autópsia revelou a presença de uma vesícula na porcelana, a qual, segundo a literatura, sua identificação é um diagnóstico incidental durante o estudo do paciente para outra condição, principalmente neoplásico ou na autópsia. Sua relação com o câncer de vesícula biliar é controversa. A vesícula biliar de porcelana é uma entidade caracterizada pela calcificação intramural da vesícula biliar, com incidência relatada de 0,06 a 0,8% das colecistectomias realizadas. Revisamos a literatura nas bases de dados MEDLINE, PubMed, ELSEVIER e SciELO, com um total de 26 publicações encontradas entre 1999 e 2018.

Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography. / Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina.

INTRODUCTION AND OBJECTIVES: Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate. METHODS: According to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner. RESULTS: The total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%. CONCLUSION: It is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies.

Frequência de calcificações em tecidos moles na região bucomaxilofacial por meio de exames de tomografia computadorizada de feixe cônico / Frequency of soft tissue calcification in the oral and maxillofacial region by the Cone-Beam Computed Tomography

A maioria das calcificações em tecido mole na região de cabeça e pescoço são achados radiográficos. Com o crescente uso da tomografia computadorizada de feixe cônico há um aumento do número desses achados, em decorrência da melhor visualização das estruturas em três dimensões e da ausência de sobreposição de imagens. O objetivo desse estudo foi avaliar a frequência de calcificações em tecidos moles na região bucomaxilofacial, visualizadas por meio de exames de tomografia computadorizada de feixe cônico. Foram avaliados 549 exames, em todas as reconstruções multiplanares, e as calcificações encontradas tabuladas para posterior análise descritiva dos dados no software SPSS 18®. Foram diagnosticadas 663 calcificações, com maior prevalência em indivíduos acima dos 40 anos e localizadas bilateralmente (67%). Muitas delas eram múltiplas, sendo possível mensurar 1367 calcificações. O tipo mais prevalente foi a calcificação do ligamento estilohioideo (42,9%), com maior prevalência bilateral (80,6%) e em mulheres (60,7%), seguido pelos tonsilolitos, ateromas de carótida, antrolitos, nódulos calcificados, acnes, sialolitos e flebólitos. O ateroma carotídeo, em sua maioria, foi encontrado no gênero feminino (60%), unilateral (67,5%) e em indivíduos acima dos 70 anos (40%). Concluiu-se que a frequência de calcificações em tecidos moles foi bastante elevada, especialmente em mulheres acima dos 40 anos, sendo a calcificação do ligamento estilohioideo o tipo mais prevalente diagnosticado. (AU)

Most soft tissue calcifications in the head and neck region are radiographic findings. With the increasing use of CT images, there is an increase in the number of these findings, due to the better visualization of the structures in three dimensions and the absence of overlapping images. The objective of this study was to evaluate the frequency of soft tissue calcifications in the buccomaxillofacial region, visualized by means of cone beam computed tomography. A total of 549 examinations were performed in all multiplanar reconstructions and the calcifications found tabulated for further descriptive analysis of the data in the SPSS 18® software. A total of 663 calcifications were diagnosed, with a higher prevalence in individuals over 40 years old and located bilaterally (67%). Many of them were multiple, and it was possible to measure 1367 calcifications. The most prevalent type was calcification of the stylohyoid ligament (42.9%), with a greater bilateral prevalence (80.6%) and in women (60.7%), followed by tonsilolites, carotid atheromas, antrolites, calcified nodules, acnes, sialolites and phlebolites. Carotid atheroma was found mostly in the female gender (60%), unilateral (67.5%) and in individuals over 70 years (40%). It was concluded that the frequency of soft tissue calcifications was quite high, especially in women over 40 years of age, with stylohyoid ligament calcification being the most prevalent type diagnosed. (AU)

Análise de propriedades biológicas do MTA em condição normal e hiperglicêmica / Analysis of biological properties of MTA in normal and hyperglycemic conditions

O objetivo deste estudo foi analisar as propriedades biológicas do MTA em condição normal e hiperglicêmica. Para tanto, esse trabalho foi dividido em duas partes, sendo que a primeira teve como objetivo avaliar o efeito do MTA no processo de reparo do Ligamento Periodontal (PDL) e na diferenciação de células mesenquimais progenitoras do PDL (PDSCs) e da Medula Óssea (BMSCc) após injuria dental. Uma perfuração na região de furca do primeiro molar superior de camundongos transgênicos (αSMACreERT2/Ai9/Col2.3GFP) foi realizada e os efeitos do MTA após 2, 17 e 30 dias de lesão, foram examinados e comparados com resina composta (AS) utilizando análise histológica e epifluorescência. Além disso, BMSCs e PDSCs desses camundongos foram isoladas, cultivadas e os efeitos do MTA na proliferação celular e diferenciação osteogênica foram avaliados. Os resultados indicaram que o MTA promoveu a regeneração do PDL e do osso alveolar na área da injuria dental. No entanto, demonstrou efeitos negativos na diferenciação osteogênica de PDSCs e BMSCc. A segunda parte, teve como objetivo avaliar a influência da Diabetes Mellitus na proliferação celular, produção de citocinas, resposta tecidual, capacidade de mineralização e na expressão local e sistêmica de marcadores ósseos. Para alcançar esses objetivos, células de linhagem fibroblásticas L929 foram cultivadas em alta concentração de glicose e a influência do MTA na proliferação celular e na produção de citocinas das IL-1ß, IL-6 e TNF-α foram observados às 6, 24, 48 e 72 horas; tubos de polietileno foram implantados no tecido subcutâneo de ratos normais e diabéticos (induzidos pelo Aloxano) e a influência do MTA na resposta tecidual, produção de citocinas e na capacidade de mineralização em condição diabética foram observadas através de técnicas histológicas e imunoistoquímicas aos 07 e 30 dias; analises bioquímicas para Cálcio, Fósforo e Fosfatase Alcalina e imunoistoquímica para osteocalcina e osteopontina, aos 07 e 30 dias, também foram realizadas com a finalidade de verificar a influência do MTA na expressão local e sistêmica de marcadores ósseos. O quadro hiperglicêmico promoveu, in vitro, um aumento da produção de IL-6 e comprometeu a proliferação celular após 72hs. Independente da condição diabética, a resposta tecidual e a capacidade de produção de IL-1ß, IL-6 e TNF-α de ambos MTA não foi alterada, embora uma redução na intensidade de fluorescência do MTA Branco foi observada aos 14 dias em animais diabéticos. Por outro lado, o quadro hiperglicêmico inibiu a produção local de osteocalcina e osteopontina na presença dos dois MTA e aumentou os níveis séricos de Fósforo e Fosfatase Alcalina. Assim, concluiu-se que, o MTA promoveu a regeneração do PDL e do osso alveolar na área da injuria dental, contudo, apresentou um efeito negativo com relação à diferenciação osteogênica e, que em condições hiperglicêmicas, o MTA Cinza melhores resultados biológicos quando comparado ao MTA Branco(AU)

The aim of this study was to analyze the biological properties of MTA in normal and hyperglycemic conditions. Therefore, this study were divided into two parts; the first part aim was to evaluate MTA effect on healing of periodontal ligament (PDL) and differentiation of mesenchymal progenitor cells in PDL (PDSCs) and bone marrow stromal cells (BMSCc) following dental injury. Perforation on the pulp floor in the furcation area in the first maxillary molars of transgenic mice (αSMACreERT2/Ai9/Col2.3GFP) were performed and the effects of MTA after 2, 17, 30 days of injury, were examined and compared to AS using histological and epifluorescence analysis. Additionally, BMSCs and PDSCs from these mice were isolated, cultured and the effects of MTA on cell proliferation and osteogenic differentiation were evaluated. The results indicated that MTA promoted regeneration of injured PDL and alveolar bone in the area of dental injury. However, it has demonstrated negative effects on the osteogenic differentiation of PDSCs and BMSCs. The aim of second part was to evaluate the influence of Diabetes Mellitus on cell proliferation, cytokine production, tissue response, mineralization ability and local and systemic expression of bone markers. To achieve these goals, L929 fibroblasts cell line were cultured under high glucose concentration and the influence of MTA on cell proliferation and production of cytokine IL-1ß, IL-6 and TNF-α were observed at 6, 24, 48 and 72 hours; polyethylene tubes were implanted in the subcutaneous tissue of normal and diabetic rats (induced by Alloxan) and the influence of MTA on tissue response, cytokines production and mineralization ability in diabetic condition were observed by histological and immunohistochemical techniques at 07 and 30 days; biochemical analysis for Calcium, Phosphorus and Alkaline Phosphatase and immunohistochemistry for osteocalcin and osteopontin were also performed, at 07 and 30 days, in order to verify the influence of MTA on the local and systemic expression of bone markers. The hyperglycemic state promoted an increase on IL-6 production and impaired L929 proliferation after 72hs. Independent of the diabetic condition, the tissue response and ability to produces IL-1ß, IL-6 and TNF-α by both MTA was not change, although a reduction on fluorescence intensity of White MTA was observed after 14 days in diabetic animals. Moreover, hyperglycemia state inhibited the local production of osteocalcin and osteopontin in the presence of both MTA and increased serum levels of Phosphorus and Alkaline Phosphatase. Thus, it was concluded that MTA promoted regeneration of PDL and alveolar bone in the area of dental injury, moreover, it had a negative effect in relation to osteogenic differentiation; and under hyperglycemic condition, Gray MTA showed better biological results when compared with White MTA(AU)

Porcelain Gallbladder: Decoding the malignant truth.

Gallbladder calcification, also referred to as porcelain gallbladder, has received significant attention in the medical literature due to its perceived role in increasing the risk of developing a gallbladder carcinoma. However, recent reports raise questions challenging this purported high risk. While previous studies reported a concomitant incidence of gallbladder cancer in porcelain gallbladder ranging from 7-60%, more recent analyses indicate the incidence to be much lower (6%). Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients. However, it is important to note that a nonoperative approach may require prolonged follow-up. A laparoscopic cholecystectomy is a feasible therapeutic option for patients with porcelain gallbladder, although some researchers have indicated a higher incidence of complications and conversion due to technical difficulties.

Las bandas de Liesegang como origen de los patrones simétricos del esmalte / Liesegang rings as origin of enamel symmetrical patterns

INTRODUCCIÓN:en los dientes existen variadas estructuras visibles que tienen formas y patrones simétricos repetitivos como los prismas, los penachos, los husillos del esmalte, las bandas de Hunter-Schreger y las líneas incrementales de Retzius. Por otro lado, los anillos de Liesegang, estudiados y aplicados desde hace más de cien años por los geólogos y otras disciplinas, son bandas simétricas repetitivas incrementales halladas en minerales naturales que se asemejan a los observados en el esmalte dental. El objetivo de este artículo es revisar los procesos, ampliamente conocidos, de formación de los anillos de Liesegang en la naturaleza y relacionarlos con la mineralización del esmalte dental y con la conformación de su anatomía característica. MÉTODOS: para este efecto se hizo una revisión bibliográfica, delimitada al período comprendido entre 1970 y 2013 en las bases de datos Science Direct, Springer, Medline y Pubmed, de donde se seleccionaron 51 referencias con información original y/o datos relevantes del tema estudiado. RESULTADOS Y CONCLUSIONES: un análisis detallado del proceso de formación de estas bandas y la similitud de los casos del mineral rocoso y del mineral dental, llevan a pensar que los procesos que se desarrollan en las rocas y en tejidos dentales duros serían los mismos.

INTRODUCTION: teeth contain various visible structures that have repeating shapes and symmetrical patterns such as prisms, crests, enamel spindles, Hunter-Schreger bands, and Retzius incremental lines. On the other hand, Liesegang rings, studied and applied for over a hundred years by geologists and other specialists, are incremental repetitive symmetrical bands found in natural minerals which are similar to those observed in tooth enamel. This article aims to review the widely known processes of formation of Liesegang rings in nature and relate them with dentin mineralization and the conformation of their characteristic anatomy. METHODS: to this end, a bibliographic review was conducted, restricted to the 1970-2013 period, in the Science Direct, Springer, Medline, and Pubmed databases, finally selecting 51 references with original information or relevant data on the subject. RESULTS AND CONCLUSIONS: a detailed analysis of the processes of formation of these rings and the similarity of rocky and dental minerals lead to think that the processes developed in rocks and hard dental tissues would be the same.