Electron microscopic features of the lacrimal sac mucopeptide concretions.

PURPOSE: The aim of this study was to examine the ultrastructural features of the mucopeptide concretions obtained from the lacrimal sac. METHODS: Mucopeptide concretions obtained from the lacrimal sacs of 10 patients during a dacryocystorhinostomy were immediately fixed for electron microscopic analysis. The surfaces were studied separately and longitudinal and transverse ultra-thin sections were obtained at different levels and all were studied using the standard protocols of scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS: Mucopeptide concretions based on their extent take the shape of the lacrimal sac and nasolacrimal duct. The external surfaces and cut sections show mostly areas of homogenous deposits with occasional intervening heterogenic areas. Two distinct types of craters were noted, mostly in the heterogeneous areas. The core of the concretions was made up of extensive networks of fibril like tangles filled predominantly with granular material and red blood cells with occasional presence of granulocytes and epithelial cells. Numerous vacuoles and fissures appear to be more of artifacts than any metabolic process. No organic fibers of fungal filaments were noted within the concretions. There was no evidence of any bacterial biofilms other than few focal areas of scattered bacteria. Possible events in the development of mucopeptide concretions have been hypothesized based on the ultrastructural findings. CONCLUSION: Ultrastructural features of mucopeptide concretions from the lacrimal sac help in better understanding of their etiopathogenesis and tissue interactions. Further exploration of different stages of a concretion is needed to understand the potential factors that trigger its genesis and evolution.

Ultrastructural analysis of an enterolith composed of deoxycholic acid.

A 67-year-old Japanese man underwent enterotomy because of enterolith ileus. Component analysis by infrared spectroscopy revealed that the enterolith was composed of a high concentration of deoxycholic acid. We further analyzed and compared the ultrastructure of the enterolith and a commercially available powdered form of deoxycholic acid by means of scanning electron microscopy and energy dispersive X-ray spectroscopy. Energy dispersive X-ray spectroscopy analysis revealed that the ratios of carbon and oxygen in the enterolith were equal to those in the deoxycholic acid powder. Scanning electron microscopy analysis showed rectangular prism-shaped particles on the surface of the enterolith. This structure was similar to that of the deoxycholic acid powder. The surgically removed enterolith had a twisted and coiled appearance. Possible mechanisms underlying the formation of this unique form are discussed.

A biological stone from a medieval cemetery in Poland.

A review of the literature shows that origination of biological stones as well as their pathogenesis mostly depend on the environmental factors. As a result, the structural spectrum of such calculi and their chemical composition are highly diversified. It is well known that biological stones are formed mostly in the digestive and urinary tracts. However, it has been demonstrated that this kind of stony structure can be also, though rarely, found in circulatory and reproductive systems, skin, mucosa, and tear ducts. Although in palaeopathology, the list of biological stones is enriched by stony tumours and/or discharges, it is very difficult to uncover the small size deposits in excavation material. In the literature such findings, originating from different countries and centuries, are few. The described stone was found among the bones of an adult individual in the medieval cemetery of Gdansk (Poland). The SEM, X-ray spectrometer and chemical evaluation revealed that it was a bladder calculus.

Lacrimal sac dacryoliths (86 samples): chemical and mineralogic analyses.

BACKGROUND: Because dacryoliths occur at low frequency, few studies have focused on their composition. We aimed to present findings from morphological, chemical, and mineralogic analysis of 86 dacryoliths. METHODS: We studied 86 dacryoliths obtained during 832 dacryocystorhinostomies (DCR) performed for postsaccal obstruction. We examined the samples with atomic infrared spectrometry (80 samples), amino acid analysis (17 samples), scanning electron microscopy, and an electron microprobe with an energy dispersive detector (seven samples). RESULTS: Dacryoliths were found in 86/832 DCRs (10.3 %), mostly in patients with primary acquired nasolacrimal duct obstruction. All the dacryoliths were soft, composed of organic material, including proteins and mucoproteins, with approximately 20 % amino acid content. There were no "hard" dacryoliths composed of calcium phosphate. The stones were composed of lobes and lobules built on an amorphous core material with small cavities, probably as a result of various chemical processes that produced a gaseous product. The most frequent elements found in inorganic inclusions were silicon, magnesium, sulfur, potassium, calcium, sodium, and chlorine. Also, some particles had high contents of bismuth, titanium, iron, and organic fibers. The fibers found in the core of dacryoliths suggested a potential origin from cotton swabs used in cosmetics. CONCLUSION: Dacryoliths are composed almost exclusively of organic material, including proteins and mucoproteins, with approximately 20 % amino acid content.

Composition and distribution of elements and ultrastructural topography of a human cardiac calculus.

Trace elements (TEs) may contribute to the formation of calculi or stones or be involved in the aetiopathogenesis of stone diseases. The compositions and spatial distribution of elements from the inner nucleus to outer crust of the cardiac calculus were investigated by energy-dispersive X-ray fluorescence (EDXRF) spectrometer. The surface topograph, distribution map of elements, elemental and chemical compositions were also determined by environmental scanning electron microscope (ESEM)-energy-dispersive X-ray (EDX) analysis. Twenty-five elements were identifiable from 18 positions on the cardiac calculus by EDXRF spectrometer, in which the highest concentrations of toxic TEs (Ni, Pt, Hg, Sn, Pb, W, Au, Al, Si) and higher levels of essential TEs (Ca, Sr, Cr, P) were detected. A moderate positive Pearson's correlation between TEs concentrations of Mg, Ca or P and location differences from centre to periphery in the cardiac calculus was observed. A positive correlation was also found for Ca/Zn and Ca/Cu, indicating the gradual increase of calcium concentration from inner nucleus to outer crust of cardiac calculus. The drop-like nodules/crystals on the surface of petrous part of cardiac calculus were observed from ESEM analysis. ESEM-EDX analysis determined the calculus to be predominantly composed of calcium hydroxyapatite and cholesterol, as indicated by the petrous surface and drop-like nodules/crystals, respectively. This composition was confirmed using a portable Raman analyser. The spatial distribution analysis indicated a gradual increase in Mg, P and Ca concentrations from the inner nucleus to the outer crust of the cardiac calculus. The major chemical compositions of calcium hydroxyapatite and cholesterol were detected on this cardiac calculus.

Prostatic stones: evidence of a specific chemistry related to infection and presence of bacterial imprints.

Prostatic stones are a common condition in older men in industrialized countries. However, aging appears not to be the unique pathogenesis of these calcifications. Our morpho-constitutional investigation of 23 stone samples suggested that infection has a significant role in the lithogenic process of prostate calcifications, even without detection of infection by clinical investigation. Most stones (83%) showed bacterial imprints and/or chemical composition, suggestive of a long-term infection process. Chronic infection may induce persistent inflammation of the tissue and secondarily, a cancerization process within a few years. Thus, the discovery of prostate calcifications by computerized tomodensitometry, for example, might warrant further investigation and management to search for chronic infection of the prostate gland.

Application of mineralogical techniques in the study of human lithiasis.

The authors review the mineralogical methods and techniques of analyzing calculi, stony concretions in the body. They discuss the main types of kidney stones (prostate, testicular, salivary, and bile) and the different diagnostic methods in mineralogy. By applying the techniques of optical microscopy and electron microscopy, they describe the different characteristics of human stones, based on extensive experience as evidenced by their numerous studies.

[Revisiting the chemical diversity in prostatic calculi: a SEM and FT-IR investigation]. / Diversité chimique des calculs prostatiques : une investigation par MEB et spectroscopie infrarouge.

OBJECTIVE: Revisiting the chemical diversity of the crystalline phases of prostatic calculi by means of SEM and FT-IR analysis. METHODS: A set of 32 prostatic calculi has been studied by FT-IR and SEM. RESULTS: FT-IR analysis has determined the chemical composition of each prostatic calculus and the SEM observation has described the morphology of the calculi surfaces and layers. Infrared analysis revealed that 90.7% of the stones were mainly composed of calcium phosphates. However, several mineral phases previously not reported in prostatic calculi were observed, as brushite or octocalcium phosphate pentahydrate. CONCLUSION: Prostatic calculi exhibited a diversity of crystalline composition and morphology. As previously reported for urinary calculi, relationships between composition and morphology of prostatic stones and étiopathogenic conditions could be of interest in clinical practice.

[Prostatic calculi: silent stones]. / Litiasis prostática: cálculos silentes.

INTRODUCTION AND OBJECTIVES: Prostate stones are frequently encountered during transurethral resection of the prostate in urology practice. We aimed to demonstrate the physical and chemical properties of prostate stones. We also aimed to determine possible relationship between inflammation of prostate gland and prostate stones. METHODS: The consecutive patients (excluding subjects with PSA>or=4ng/ml and urolithiasis), who underwent TURP operation and who were observed to have prostatic calculi during TURP, were included in the study. The prostatic stones obtained from each patient during TURP were analysed for chemical composition and observed under electron microscopy (SEM) for structure and surface morphology. The pathological specimens were assessed by the uropathologist for the final diagnosis and existence and degree of inflammation. RESULTS: Five patients were included in the study. From each patient at least three (range 3-8) samples of stones (diameter varying from 1mm up to 5mm) were obtained. The stones were made of mixed composition of calcium phosphate and calcium carbonate. The stones were found to have lobular surface made up of small spheres under SEM. Histopathological examination of the TURP specimens revealed being prostatic hyperplasia accompanied with inflammation of mild to severe degree. CONCLUSIONS: Prostatic stones are concentrically precipitated calcium stones within the prostatic ductuli with granular grape like morphology. Histopathological inflammation seems to be associated with these prostatic calculi.

Litiasis prostática: cálculos silentes / Prostatic calculi: silent stones

Introducción y objetivos: En la práctica urológica se encuentran con frecuencia cálculos prostáticos durante la resección transuretral de la próstata. Nuestro objetivo era demostrar las propiedades físicas y químicas de los cálculos prostáticos, así como determinar la posible relación entre la inflamación de la próstata y los cálculos prostáticos. Métodos: Se incluyó en el estudio a pacientes consecutivos (excluidos los sujetos con PSA≥4ng/ml y urolitiasis) sometidos a resección transuretral de la próstata (RTUP) en quienes se observaron cálculos prostáticos. Se analizó la composición química de los cálculos prostáticos obtenidos de cada paciente durante la RTUP, que se observaron también al microscopio electrónico (MEB) para determinar su estructura y morfología superficial. El uroanatomopatólogo valoró las muestras para emitir el diagnóstico definitivo y determinar la existencia y el grado de la inflamación. Resultados: Se incluyó en el estudio a cinco pacientes. Se obtuvieron de cada paciente al menos tres (de 3–8) muestras de cálculos (con un diámetro de 1–5mm). Los cálculos tenían una composición mixta de fosfato cálcico y carbonato cálcico. En la MEB se observó que los cálculos tenían una superficie lobular formada por pequeñas esferas. El examen histopatológico de las muestras de RTUP reveló hiperplasia prostática benigna acompañada de inflamación entre leve e intensa. Conclusiones: Los cálculos prostáticos son cálculos de calcio precipitados concéntricamente situados dentro de los conductillos prostáticos con una morfología granular arracimada. Estos cálculos prostáticos parecen ir acompañados de inflamación histopatológica (AU)

Introduction and Objectives: Prostate stones are frequently encountered during transurethral resection of the prostate in urology practice. We aimed to demonstrate the physical and chemical properties of prostate stones. We also aimed to determine possible relationship between inflammation of prostate gland and prostate stones. Methods: The consecutive patients (excluding subjects with PSA≥4ng/ml and urolithiasis), who underwent TURP operation and who were observed to have prostatic calculi during TURP, were included in the study. The prostatic stones obtained from each patient during TURP were analysed for chemical composition and observed under electron microscopy (SEM) for structure and surface morphology. The pathological specimens were assessed by the uropathologist for the final diagnosis and existence and degree of inflammation. Results: Five patients were included in the study. From each patient at least three (range 3–8) samples of stones (diameter varying from 1mm up to 5mm) were obtained. The stones were made of mixed composition of calcium phosphate and calcium carbonate. The stones were found to have lobular surface made up of small spheres under SEM. Histopathological examination of the TURP specimens revealed being prostatic hyperplasia accompanied with inflammation of mild to severe degree. Conclusions: Prostatic stones are concentrically precipitated calcium stones within the prostatic ductuli with granular grape like morphology. Histopathological inflammation seems to be associated with these prostatic calculi (AU)

Recurrence of renal lithiasis.

OBJECTIVE: It is well known that all renal stones are associated with a high recurrence rate. The aim of this paper is to study the different types of renal calculi recurrence. MATERIAL AND METHODS: The study included 220 patients who had produced two or more renal calculi over a period of <5 years (total 634 calculi). The procedure used to study renal calculi involved appropriate combinations of stereoscopic microscopy with infrared spectrometry and scanning electron microscopy coupled with X-ray microanalysis. RESULTS AND CONCLUSION: Recurrent stone-formers can be classified into two large groups: those who always produce the same type of calculus (the most common type of recurrence was calcium oxalate dihydrate, followed by calcium oxalate monohydrate non-papillary and calcium oxalate monohydrate papillary calculi); and those who produce different types of renal calculi (the most frequent recurrences in this group were the changes calcium oxalate dihydrate-->calcium oxalate dihydrate/hydroxyapatite and calcium oxalate monohydrate-->calcium oxalate dihydrate).

Cholesterol crystal morphology in acalculous gallbladder disease.

BACKGROUND: Biliary crystal morphology is best described in patients with gallbladder stones, but most patients undergoing bile collection for microscopy have a clinical diagnosis of acalculous gallbladder disease. We investigated the morphology of biliary crystals in such patients. STUDY: Bile was obtained for polarizing microscopy from fresh cholecystectomy specimens of patients with a clinical diagnosis of acalculous or calculous gallbladder disease. Slides for microscopy were prepared by touch contact with bile in freshly opened gallbladder specimens, and following aspiration of gallbladder bile through a 5-French cannula. RESULTS: Bile was examined from five patients with a clinical diagnosis of acalculous gallbladder disease and five patients with known gallstones. Needle-like cholesterol crystals predominated in most patients without gallstones, whereas plate-like and dot-like crystals were more common in patients with gallstones. All three crystal types were seen in most patients. Crystal morphology was not affected by aspiration of bile through a 5-French cannula. CONCLUSIONS: Birefringent needles and dots should be recognized as cholesterol crystals during bile microscopy. These crystal morphologies may predominate in some patients with a clinical diagnosis of acalculous gallbladder disease.

Pathogenesis of pigment gallstones in Western societies: the central role of bacteria.

Bacteria are traditionally accorded a greater role in pigment gallstone formation in Eastern populations. Stone color is thought to predict the presence of bacteria; that is, black stones (Western predominant) are supposedly sterile and brown stones (Eastern predominant) contain bacteria. We previously reported that, regardless of appearance, most pigment gallstones contain bacteria. This study examined, in a large Western population (370 patients), the incidence, appearance, and chemical composition of pigment stones, and the characteristics of gallstone bacteria. One hundred eighty-six pigment stones were obtained aseptically. Bacteria were detected by means of scanning electron microscopy and gallstone culture. Chemical composition was determined by infrared spectroscopy. Bacteria were tested for slime and beta-glucuronidase production. Seventy-three percent of pigment stones contained bacteria. Choledocholithiasis was associated with gallstone bacteria. Ca-bilirubinate was present in all pigment stones. Ca-palmitate was characteristic of infected stones, and more than 75% Ca-carbonate was characteristic of sterile stones. Neither chemical composition nor stone appearance predicted the presence of bacteria. Ninety-five percent and 67% of infected pigment stones contained bacteria that produced slime and beta-glucuronidase, respectively. Most pigment stones contained bacteria that produced beta-glucuronidase, slime, and phospholipase, factors that facilitate stone formation. Thus bacteria have a major role in Western pigment gallstone formation. Furthermore, gallstone color did not predict composition or bacterial presence.

Broncholithiasis and lithoptysis associated with silicosis.

A case of broncholithiasis associated with massive silicosis is reported, showing a rare aspect of parenchymal lesions generating broncholiths as well as the presence of recurrent lithoptysis, with subsequent regression of radiological lesions. Aetiological, clinical, physiopathological, and radiological aspects of the disease are discussed, demonstrating the importance of the use of computed tomography in diagnosis. The mineralogical analysis of expectorated fragments is also shown.

Electron microscopic detection of tin accumulation in biliopancreatic concrements after induction of chronic pancreatitis in rats by di-n-butyltin dichloride.

The organotin compound di-n-butyltin dichloride (DBTC) is able to induce an acute and later a chronic pancreatitis in rats. In previous papers the authors demonstrated this DBTC pancreatitis as a rat model for an interstitial pancreatitis with tendency to transduction to the chronic form. DBTC is excreted according to its lipophilic nature by liver and bile. Therefore, the bilio-pancreatic main duct is necrotized by the tin-loaded bile. The duct system is blocked by cell debris and later by epithelial proliferations. In the chronic phase, numerous rats develop concrements in the main duct. In the present paper, the authors report about bacterial growth in some bilio-pancreatic concrements. Whereas the electron microscopic detection of tin by energy-dispersive X-ray analysis (EDX) in SEM or electron energy loss spectroscopy (EELS) in TEM was negative in the parenchyma of pancreas and liver, some concrements with bacterial cells were positive for this element. Tin mapping with energy spectroscopic imaging (ESI) in TEM demonstrated the congruency of tin signals and electron-dense particles inside these bacteria and of electron-dense accumulations in the matrix of these concrements. The low content of tin in pancreatic and liver tissue and the higher quantity of tin inside the bacterial contaminated concrements were supported by atomic absorption spectrophotometry (AAS). The paper discusses the long time preservation of tin in the concrements as an action of heavy-metal- accumulating bacteria, which should be classified in the future by bacteriological methods.

Pulmonary alveolar microlithiasis. A clinicopathologic and chemical analysis of seven cases.

OBJECTIVE: To determine the clinical features and outcome of patients with pulmonary alveolar microlithiasis and to determine the chemical composition of the microliths. CASE MATERIAL: We studied seven cases of pulmonary alveolar microlithiasis. The patients were six women and one man, aged 19 to 70 years (mean age 44.5 years). Clinically, five patients were known to have suffered from this condition for 5 to 41 years. One patient presented with shortness of breath, and another had a gradual decrease in exercise tolerance. None of the patients had a previous history of disturbances in metabolism or any other relevant medical condition. Reports on radiographic studies were available in six cases, and chest radiographs were available for review in the seventh case. They all showed diffuse bilateral pulmonary infiltrates. Open lung biopsies were performed in two patients, and autopsy lung material was reviewed in five patients. RESULTS: Histologically, the lung showed the typical features of pulmonary alveolar microlithiasis, that is, presence of numerous microliths filling the alveolar spaces with either a normal or thickened fibrotic interstitium. Chemical analysis performed on the lung tissue of six of these patients revealed that the microliths consisted principally of calcium and phosphorus salts. Five of these patients died of respiratory failure; however, their deaths occurred from 5 to 41 years following the initial diagnosis. No follow-up information was obtained in two patients. CONCLUSIONS: The findings of this study confirm that pulmonary alveolar microlithiasis can be seen in any age group and that the microliths are composed principally of salts of calcium and phosphorus. Additionally, these cases confirm that the disease typically follows a protracted course.

Dissolution of artificial (natural) stones in a standard model: first results.

In studying the dissolution of stones in vitro, the advantage of artificial stones in comparison to natural stones is that one can get substance-specific standardized and reproducible results. Our investigations were performed with artificial stones composed of natural material (calcium apatite). These stones were of spherical form and consisted of layers built up around a core. They were comparable to natural stones in their physical properties. Litholysis was performed in a special apparatus with continuous exposure to Suby G solution under standard conditions. Natural stones of the same chemical composition served as a reference. Statistical measurements were performed. By hardening of the artificial stones, it was possible to reach a dissolution comparable to natural stones composed of calcium apatite depending on the Suby G concentration (artificial 2.5 resp. 4.75 mg/h; natural 2.18 resp. 4.2 mg/h). For the first time, an artificial stone model has been created with reproducible behaviour in response to chemolitholysis and with properties of dissolution comparable to those of natural stones of identical chemical composition.

Lacrimal sac dacryolith: a study wit atomic absorption spectrophotometry and scanning electron microscopy.

Dacryoliths are uncommon causes of partial or complete obstruction of the nasolacrimal drainage apparatus. We report our findings of a dacryolith that we studied by culture, light microscopy, atomic absorption spectrophotometry, and scanning electron microscopy. Although no fungi were recovered by culturing, hyphae-like structures were observed. No inorganic material was detected by atomic absorption spectrophotometry. Scanning electron microscopy of ultrastructure showed the stone was composed of lobes and lobules built on an amorphous core material.

Calcium concretions in the pineal gland of aged rats: an ultrastructural and microanalytical study of their biogenesis.

The genesis of calcium concretions in aged rats was studied by means of transmission and scanning electron microscopy. The potassium pyroantimonate method, combined with X-ray microanalysis, allowed us to study the distribution of cations and calcium. Notable accumulations of calcium (associated with phosphorus) were localized in vesicles, vacuoles, lipid droplets, lipopigments, and mitochondria of dark pinealocytes. The results obtained in the present investigation suggest that these organelles are involved in the genesis of the concretions. The presence of sulfur indicates the existence of an organic matrix. We propose that genesis takes place in dark pinealocytes, which contain more calcium than light pinealocytes. Mineralization foci are sometimes associated with cellular debris and enlarge by further apposition of material. Two types of concretions, as determined by electron microscopy and confirmed by electron diffraction, could be observed: the "amorphous" type with concentric layers and the crystalline type with needle-shaped crystals. Once formed, the concretions reach the extracellular space and the cell breaks down. Possible extracellular calcification is suggested in the extracellular calcium-rich floculent material. The mineralization process is interpreted as being an age-related phenomenon and mainly a consequence of the degeneration of pinealocytes.