Tentativa diagnóstica de la composición química de los cálculos vesiculares / Diagnostic tentative of the chemical composition gallstones

Los procedimientos no quirúrgicos intentan desplazar a la colecistectomía como tratamiento para la litiasis vesicular; son técnicas que se basan en la disolución de litos predominantemente colesterínicos con disolventes químicos o su fragmentación con ondas de choque. Por lo tanto resulta imprescindible conocer el contenido de colesterol de los mismos previo al tratamiento. Se estudiaron in vitro con radiología simple, ecografía, tomografía axial computarizada y resonancia nuclear magnética 10 cálculos vesiculares. Posteriormente se realizó el estudio bioquímico de los mismos. La radiología convencional como la ecografía no permitió conocer la estructura interna de los litos. Los partones hipertenso, hipointenso y heterogéneo, confeccionados con resonancia nuclear, mostraron un pobre correlato con el contenio químico de los cálculos. Se elaboraron los patrones tomográficos hipodenso, isodenso, heterogéneo, anular e hiperdenso, demostrando un íntimo correlato entre el contenido de colesterol y la imagen de los patrones hipodenso e isodenso.

Tentativa diagnóstica de la composición química de los cálculos vesiculares / Diagnostic tentative of the chemical composition gallstones

Los procedimientos no quirúrgicos intentan desplazar a la colecistectomía como tratamiento para la litiasis vesicular; son técnicas que se basan en la disolución de litos predominantemente colesterínicos con disolventes químicos o su fragmentación con ondas de choque. Por lo tanto resulta imprescindible conocer el contenido de colesterol de los mismos previo al tratamiento. Se estudiaron in vitro con radiología simple, ecografía, tomografía axial computarizada y resonancia nuclear magnética 10 cálculos vesiculares. Posteriormente se realizó el estudio bioquímico de los mismos. La radiología convencional como la ecografía no permitió conocer la estructura interna de los litos. Los partones hipertenso, hipointenso y heterogéneo, confeccionados con resonancia nuclear, mostraron un pobre correlato con el contenio químico de los cálculos. Se elaboraron los patrones tomográficos hipodenso, isodenso, heterogéneo, anular e hiperdenso, demostrando un íntimo correlato entre el contenido de colesterol y la imagen de los patrones hipodenso e isodenso. (AU)

Analysis of calcific deposits in calcifying tendinitis.

The precise composition of calcific deposits in calcifying tendinitis is still unknown. However, analysis of such deposits can help to elucidate the disease's pathogenesis. Twenty-five calcific deposits from various phases of the disease were analyzed by several methods. The macroscopic appearance of the specimens during the acute phase of calcifying tendinitis resembled a milky emulsion; in contrast, it resembled a granular conglomerate during the chronic phase. X-ray diffraction showed a poorly crystallized hydroxyapatite lattice (resembling that in bone) in both phases. Infrared spectroscopy revealed variable H2O, CO3, and PO4 contents in all samples, but no significant differences in these proportions were seen in the two phases of the disease. Organic molecules were seen in addition in all samples. Scanning electron microscopy showed similar morphologies of the crystalline conglomerates of both phases, with somewhat round, nongeometric structures. The macroscopic difference was not reflected in the mineralogic structure. Neither a chemical compositional change nor a change in the crystal lattice was observed. The disintegration of the conglomerates probably depends on a change in the bonding capacity of the organic molecules, which in turn initiates phagocytosis in the resorptive phase.

Identification of immunoreactive pancreatic stone protein in pancreatic stone, pancreatic tissue, and pancreatic juice.

We first examined whether pancreatic stone protein (PSP) was present in pancreatic stone and normal pancreatic tissue. By using HPLC and Western blotting, a protein of Mr 13.5 kDa that reacted with monoclonal antibody against PSP was detected as a major component in EDTA-soluble fractions of pancreatic stone. In an in vitro experiment, this protein dose-dependently suppressed CaCO3 precipitation. PSP was immunohistochemically stained in the acinar cells of normal pancreatic tissue. Based on these findings, it seemed that PSP in pancreatic stone is probably a physiological secretory protein of the pancreas. We subsequently examined immunoreactive PSP in normal pancreatic juice by the Western blotting method. In all of the specimens, the band for immunoreactive PSP in pancreatic juice was found to correspond to 13.5 kDa, which thus agreed with that of purified PSP from a stone.

Conjunctival concretions. Polarized microscopic, histopathologic, and ultrastructural studies.

To elucidate the pathophysiologic features of conjunctival concretions, we performed polarized microscopic examinations, immunocytochemical studies, histochemical stains, and electron microscopic studies of concretions obtained from five patients with chronic conjunctivitis. Electron-dense secretory granules, ranging from 0.2 to 0.5 micron in diameter and stained positively for periodic acid-Schiff and mucicarmine, were found in the superficial lining epithelial cells of the pseudogland of Henle. In view of the granular and membranous figures reflecting degenerating epithelial cells and secretory granules in the concretions, we argue that the concretions, are mostly composed of the mucinous secretion of the transformed conjunctival glands admixed with the degenerative products of the epithelial cells.

[A case of obstructive jaundice caused by incarceration of pancreatic stones in the ampulla of papilla Vater].

A very rare case of obstructive jaundice caused by the incarceration of pancreatic stones in the ampulla of papilla Vater is reported. A forty-eight-year-old man, who had been taking alcohol daily for 10 years, was admitted to our hospital because of recurrent attacks of upper abdominal pain. Biochemical analysis demonstrated typical pattern of chronic pancreatitis. US, CT and ERCP showed a markedly dilated pancreatic duct and pancreatic calcifications. Cholecystolithiasis, or dilatation of the choledochus was not noted. Conservative treatment was performed under the diagnosis of chronic calcifying pancreatitis for one month. Then, obstructive jaundice, severe epigastralgia, and high fever occurred. Obstructive jaundice with sudden onset and existence of pancreatic stones suggested incarceration of pancreatic stones in the bile duct, and cephalic pancreaticoduodenectomy was performed. The largest pancreatic stone was incarcerated into the ampulla of papilla Vater. Histopathological analysis of the pancreas showed severe chronic pancreatitis. No report of the similar case can be found in the literature. Incarceration of pancreatic stones into biliary system might be very rare, however, should not be forgotten in differential diagnoses of obstructive jaundice in chronic pancreatitis patients.

Intrahepatic cholesterol stones associated with peripheral cholangiocellular carcinoma: an autopsy case.

A rare autopsy case of intrahepatic cholesterol stones associated with peripheral intrahepatic cholangiocellular carcinoma is presented. The patient, a 60-yr-old man, was diagnosed as having peritoneal dissemination of adenocarcinoma, and died of respiratory failure 4 months later. At autopsy, intrahepatic cholangiocellular carcinoma was found at the left lateral segment of the liver. The cancer was extensively disseminated to the peritoneal cavity. In addition, the liver harbored a cholesterol stone (1.0 cm in diameter) impacted in the right peripheral bile duct, as well as tiny cholesterol stones (0.1-0.2 cm in diameter) scattered in the intrahepatic peripheral bile ducts. A few tiny cholesterol stones were also present in the cancerous bile ducts. Although the causal relationship between the intrahepatic cholesterol stones and cholangiocellular carcinoma remains speculative, clinicians should be aware of this association.

Mineralogical analysis of sputum lith from an apparently healthy subject.

The sputum lith, 1 to 3 mm in diameter, were examined by microanalyser and by the method of X-ray diffraction, which revealed that the lith was composed of calcium carbonate and calcite in crystalline style. A composition of bronchial liths is often associated with different underlying diseases so that these nondestructive analyses seem to provide useful information for differential diagnosis. The present case is the first one to expectorate bronchial lith without marked pulmonary diseases.

[Tonsillolith: clinical picture and mineralogic analysis]. / Tonsillolith: klinisches Bild und mineralogische Analyse.

We report the clinical appearance and mechanism of origin of a tonsillolith 7 g in weight, found in a 77-year-old patient and simulating a tumour of the oropharynx. Mineral analysis showed the main ingredients to be CaO and P2O5. Only trace amounts of SiO2, MgO, Na2O and K2O were found.

Microlithiasis associated with chronic bronchopneumonia in a cat.

Chronic bronchopneumonia associated with microlithiasis was diagnosed in a 9-year-old domestic shorthair cat with a 3-month history of coughing and dyspnea. Thoracic radiography revealed multifocal patchy alveolar infiltrates in all lung fields. Numerous acellular, concentrically laminated, periodic acid-Schiff-positive microliths were seen in mucus from tracheal washing. Microliths were composed primarily of calcium carbonate. A definite cause could not be identified. There was no response to treatment and the cat was euthanatized. Marked type-II alveolar cell proliferation, peribronchiolar smooth muscle proliferation, and alveolar microlithiasis were seen histologically. Microliths are rarely encountered in tracheal washings from companion animals. Their pathophysiologic properties and meaning remain to be established.

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs.

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis.

The human pancreatic stone protein.

Chronic calcifying pancreatitis (CCP) is characterized by the presence of stones in pancreatic ducts. Calcium carbonate (CaCO3) is the main constituent of stones, to which is associated an organic matrix consisting primarily of one protein of Mr 14,000, the pancreatic stone protein or PSP. PSP is not present as such in pancreatic juice, but in polymorphic forms with higher molecular weights. These secretory forms (PSP S2-5, Mr 16-19,000) are synthesized in the acinar cells of the pancreas and secreted along the same secretory pathway as the exocrine enzymes. The heterogeneity of the forms of higher Mr (PSP S2-5) is probably due to different glycosylation patterns. PSP and PSP S1 are generated by the cleavage of an Arg-Ile bond in the N-terminal part of PSP S2-5. The N-terminal sequence of PSP (40 amino acids) is identical to that of PSP S1, whose complete sequence (133 amino acids) has been determined. Yet, the two proteins differ by their pI. Pancreatic juice is normally supersaturated in CaCO3, suggesting the presence of a stabilizer preventing CaCO3 precipitation. The PSP S could play that role, since an activity inhibiting the nucleation and growth in vitro of CaCO3 crystals was found in pancreatic juice, associated with these proteins. Moreover, PSP S concentration was significantly lower in the pancreatic juice of patients with CCP than in control patients. Proteins homologous to PSP S were also found in the dog, rat, swine, monkey and ox. They constitute a new family of pancreatic secretory proteins, whose biological role would be to maintain pancreatic juice in a stable state towards CaCO3.

Pathological findings in the bulbourethral glands of bulls.

The bulbourethral glands of 323 Bos indicus or B. indicus crossbred bulls more than 1 1/2 years old were examined in an abattoir study. Bulbourethral adenitis was diagnosed grossly and confirmed by histological examination in 4 (1.2%). Unilateral chronic interstitial inflammation was seen in 2 cases; one of these was associated with a degenerative-type seminal vesiculitis. In the others adenitis was bilateral; in one case it was associated with a concretion and foreign (plant) material in the principal duct of the left bulbourethral gland; in the other bilateral case, numerous calculi were present and microscopically, a chronic active and diffuse inflammation was observed. Chemical analysis of the calculi showed calcium oxalate and tricalcium phosphate to be the most important components. Corynebacterium spp was isolated from the lesion with multiple calculi but attempts to isolate Chlamydia spp, Mycoplasma spp and Brucella abortus from the 4 adenitis cases were unsuccessful. Congenital abnormalities such as glandular fusion (2.2%) or unilateral aplasia (0.6%) were also observed. Cysts were the most common finding (19.2%), and duct dilation was frequent (7.1%). The significance of these findings in relation to fertility is considered.

[Pancreatic stone protein, a new marker for chronic pancreatitis]. / La "pancreatic stone protein", un nuovo marker di pancreatite cronica.

A CaCO3 precipitation and crystal growth inhibitor has recently been isolated from pancreatic calculi and from pancreatic juice. It is a glycoprotein with a molecular weight of 14,000, whose probable physiological role is the stabilization of exocrine pancreatic secretion which is normally supersaturated with CaCO3. It is hoped to determine a simple, but sensitive assay of this new protein on pancreatic juice and on serum, a decrease in which could be a marker for chronic pancreatitis.

Buccal hemangioma with phleboliths. Report of two cases.

Two cases of buccal hemangioma with phleboliths were reported. Angiography, angioxerography, and computerized tomography were carried out before the procedures were planned. One patient was treated by means of surgical excision of the tumor after ligation of the left external carotid artery. The second patient was treated by means of surgical excision alone. Histologic examinations suggested that the thrombi in the blood vessels of hemangiomas might become the core of the phleboliths. Analysis of the phleboliths by means of x-ray diffraction and infrared spectrometry confirmed calcium phosphate and calcium carbonate as the main components of the phleboliths.

Organic matrix of pancreatic stones associated with nutritional pancreatitis.

In recent studies performed on pancreatic stones from patients with alcoholic pancreatitis, a novel secretory protein was identified: the pancreatic stone protein (PSP Mr 14,000). This protein suppresses CaCO3 precipitation, and could therefore stabilize normally supersaturated pancreatic juice. Crystallographic analysis of stones from patients with nutritional pancreatitis (NP), as well as alcoholic pancreatitis (AP), revealed that the main constituent was calcite (CaCO3). In the present study, we investigated the organic matrix of NP stones. In the 14 cases studied, the organic matrix was rendered soluble after mineral dissolution with EDTA + citrate. Analysis of the isolated matrix revealed the presence of one major protein (Mr 14,000), and of a minor protein (Mr 30,000), which is in fact an aggregate form of the 14,000 Mr protein. Using PSP antibodies, complete immunological identity was found between PSP, the immunoreactive form of PSP present in nonactivated pancreatic juice, and the protein matrix of NP stones. Moreover, protein matrix of NP stones also inhibited the nucleation of CaCO3 crystal, and decreased their growth rate in vitro. The presence of PSP in all AP and NP stones suggests that it plays a key role in stone formation during the course of chronic pancreatitis. These results also suggest the existence of some pathophysiological links between these two apparently different etiological forms of calcifying pancreatitis.

Maxillary antrolith: report of a case.

A case of maxillary antrolith in a 60-year-old male is presented. Complaints were mucous discharge and a small amount of periodic bleeding from the right nasal cavity, of two months' duration. CT scan revealed a small calcified mass in the right maxillary sinus. By Caldwell-Luc operation an antrolith was removed from the right maxillary sinus with chronic sinusitis. This was 0.6 x 0.4 x 0.3 cm in size and 0.03 g in weight. Histopathological studies showed calcium deposition around the necrotic mass. Chemical analysis of the specimen revealed calcium phosphate (65%), calcium carbonate (8%) and albuminous material (27%).

Multiple enteroliths in a chronically obstructed duodenal loop after Roux-en-Y biliary diversion.

A case of chronic mechanical obstruction of the duodenal loop due to stricturing of the enteroenterostomy after diversion following a Polya gastrectomy for bile reflux gastritis is reported. The dilated loop contained several hundred enteroliths. The clinical and chemical evidence strongly supports the view that the enteroliths were formed in the intestinal loop. This complication of Roux-en-Y reconstruction has not previously been recognized.