Failure frequency of fixed mandibular retainers after pre-treatment of the enamel surface with pumice versus sandblasting-a randomized controlled trial

BACKGROUND/OBJECTIVES

To compare retainer survival, periodontal health, and caries implications of fixed lower retainers bonded after pre-treatment of the enamel surface with either pumice or sandblasting.

TRIAL DESIGN

Two-arm parallel-group, two-center randomized controlled clinical trial.

METHODS

One hundred sixty patients (101 females, 59 males, mean age: 17.9) requiring mandibular retainers were consecutively recruited. Patients were randomly allocated to have pre-treatment of the enamel surface with either pumice (n = 80) or sandblasting (n = 80). The primary outcome was retainer survival at 3 (T1) and 12 months (T2) control. Secondary outcomes were carious lesions and periodontal health: plaque index (PI), gingival index (GI), calculus index (CI), and probing depth (PD). The randomization sequence was generated using an online randomization and allocation concealment was secured by contacting the sequence generator for treatment assignment. Blinding was not possible at T0 due to the nature of the intervention. Statistical analyses were carried out using the t-test, Fisher's exact test, repeated measure analysis of variance, and log rank test.

RESULTS

Overall, the risk of bonding failure at T1 was 6.7 per cent and at T2 6.9 per cent. There were no statistically significant differences in failure rate between the two groups, neither at T1 (P = 1.000) nor at T2 (P = 0.360). No statistically significant differences were found for the intercanine periodontal indices GI, PI, CI, PD, and caries between the two groups at T0 and T1. At T2, significantly more gingivitis and plaque were seen in the sandblasting group (P = 0.05 and P = 0.047, respectively) compared with the pumice group. Calculus increased during the follow-up period in both groups (P ≤ 0.001) as well as plaque levels (P ≤ 0.001 and P = 0.025, respectively). No harm was reported.

CONCLUSIONS

Enamel sandblasting prior to bonding mandibular retainers is not better at preventing bonding failure.

REGISTRATION

275767 (https://www.researchweb.org/is/sverige).

Nonsurgical treatment for asymptomatic pancreatolithiasis is meaning: A case report

BACKGROUND

Many guidelines for nonsurgical treatment of pancreatolithiasis suggest little guidance for patients with pancreatolithiasis who do not have abdominal pain. Some patients with pancreatolithiasis whom we have treated nonsurgically with extracorporeal shock-wave lithotripsy did not have abdominal pain, and we describe one of them here.

METHODS AND RESULTS

A 42-year-old man complaining of an 8-kg weight loss over 6 months was admitted to a nearby hospital, where fasting blood sugar and hemoglobin A1c values were 500 mg/dL and 11.8%. Computed tomography showed stones in the head of the pancreas and dilation of the main pancreatic duct. He was referred to our hospital to be considered for nonsurgical treatment of pancreatolithiasis. His height and weight were 160 cm and 52 kg (body mass index, 20.31). No tenderness or other abdominal findings were evident. After obtaining informed consent for nonsurgical treatment despite absence of abdominal pain, we performed extracorporeal shock wave lithotripsy. Computed tomography showed disappearance of stones from the pancreatic head. At discharge, his weight had increased to 62 kg and hemoglobin A1c was 6.8%, though antidiabetic medication has since become necessary.

CONCLUSION

We believe that nonsurgical treatment of pancreatolithiasis was helpful for this patient, and could improve exocrine and endocrine function in other patients without abdominal pain.

Management of Pancreatic Duct Stones

PURPOSE OF REVIEW

Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stones.

RECENT FINDINGS

Stone fragmentation by extracorporeal shock wave lithotripsy has become first line and the mainstay of treatment for majority of patients with pancreatic duct stones. Introduction of digital video pancreatoscopy in the last few years with the capability of guided lithotripsy has provided a robust therapeutic option where extracorporeal shock wave lithotripsy is unsuccessful or unavailable. Historically, surgery has been considered a more reliable and durable option when feasible. However, it had not been compared with more effective endoscopic therapy. Lithotripsy (extracorporeal and pancreatoscopy guided) is evolving as a strong treatment modality for pancreatic stones.

Vaginal stones caused by urethrovaginal fistula: A case report

RATIONALE

Vaginal stone is a rare condition that is often misdiagnosed due to its low incidence. It can be divided into 2 types, primary vaginal and secondary vaginal, based on the etiology of the disease. Vaginal stones involve pathologic calcification. The formation of vaginal stones is mainly due to stasis and urine infection. We describe a procedure for the safe extraction of vaginal stones.

PATIENT CONCERNS

We report a case of a 25-year-old female patient with congenital genitourinary malformation and urethrovaginal fistula. A urogenital tract malformation repair operation was performed before she was 21 years old. Frequency of urination occurred before and after menstruation for 9 years, and dyspareunia occurred for 1 year.

DIAGNOSES

B ultrasound examination showed a 59 × 55 × 23 mm fusiform region of increased signal intensity in the vagina followed by a sound shadow. We performed a gynecologic examination and found that the long diameter of the vaginal opening was 20 mm. A brown substance observed in her vagina had a hard texture and felt like a stone, and a palpation hand test revealed the size was approximately 60 × 50 mm. A cystoscope was inserted into the urethra and revealed that the broken end of the urethra was connected to the vagina. The proximal broken end of the urethra was 20 mm from the distal end.

INTERVENTIONS

The purpose of this operation was to make a definite diagnosis and remove the stones. We performed vaginal stone removal surgery and cystoscopy under anesthesia.

OUTCOMES

We removed the stone successfully. The patient was discharged from the hospital after a smooth recovery without any complications. Follow-up was conducted 1 month after the operation and then every 3 months.

LESSONS

Although vaginal stones are rare, we must pay attention to this disease, especially in patients with congenital genitourinary malformations and urethrovaginal or vesicovaginal fistulas. Obstruction of urine discharge combined with repeated urinary tract infection is the main cause of vaginal stone formation. For these patients, follow-up every 3 months, including a physical examination, B-mode ultrasonography of the urinary system and cystoscopy if necessary, can avoid the occurrence of the disease.

Relapse rate and predictors of relapse in a large single center cohort of type 1 autoimmune pancreatitis: long-term follow-up results after steroid therapy with short-duration maintenance treatment

BACKGROUND

Type 1 autoimmune pancreatitis (AIP), as a pancreatic manifestation of IgG4-related disease, shows a favorable prognosis in the short term. However, disease relapse is common in long-term follow-up, despite a successful initial treatment response. This study aimed to identify the predictors of relapse and long-term outcomes in patients with type 1 AIP.

METHODS

Patients with more than 2 years of follow-up who met the International Consensus Diagnostic Criteria for type 1 AIP were included. Patients who had undergone pancreatic operations associated with AIP or who lacked sufficient clinical data were excluded.

RESULTS

All 138 patients achieved clinical remission with initial steroid therapy, and 66 (47.8%) experienced relapse during a median 60 (range 24-197) months follow-up. Among the relapsed patients, about 74% (49/66) relapsed within 3 years. About 60% (82/138) had other organ involvement (OOI), most commonly in the proximal bile duct (26.8%). At first diagnosis, OOI, and especially OOI of the proximal bile duct, was a significant independent predictor of relapse (hazard ratio 2.65; 95% confidence interval 1.44-4.89; p = 0.002), according to multivariate analysis. During the follow-up period, 16 (11.6%) patients experienced endocrine/exocrine dysfunction and 32 (23.2%) patients developed de novo pancreatic calcifications/stones. No pancreatic cancer occurred in any patients.

CONCLUSIONS

Type 1 AIP has common relapses, and patients with OOI, especially OOI of the proximal bile duct, appear to be at increased risk for relapse. Long-term sequelae, including pancreatic insufficiency and pancreatic calcifications/stones, are common in patients with relapse. To reduce the relapse, longer maintenance treatment may be needed especially for patients at high risk for relapse.

[A woman with purulent rhinorrhoea after bathing in the sea]

A 59-year-old woman was referred because of nasal discharge with stones and sand. Some months earlier, a rip current had thrown her over while bathing in the sea. CT showed bilateral stones in the maxillary sinus. A right maxillary sinus rinse was performed, which revealed six small stones.

[Advances in the studies of testicular microlithiasis]

With the increased attention to men's health and development of ultrasound imaging technology, clinicians are achieving a better understanding of testicular microlithiasis. This review presents an overview on recent studies of the etiology, pathogenesis, and imaging characteristics of testicular microlithiasis, its impact on male reproductive function, and its relation ship with testis tumors and other related diseases, as well as its treatment strategies and follow-up proposals, aiming to provide some new evidence for further understanding and management of the disease.

Pancreatic duct stones: A report on 16 cases

BACKGROUND

Pancreatolithiasis occurs in less than 1% of the general population and is mainly recognized in patients with chronic pancreatitis. Selection of the appropriate treatment method depends on the location, size and number of stones.

OBJECTIVES

The aim of the study was to analyze data concerning patients with pancreatic duct stones who were hospitalized at Wroclaw Medical University's Department of Gastroenterology and Hepatology from 2010 to 2014.

MATERIAL AND METHODS

The study presents data on 16 patients with pancreatic duct stones, who constituted 7% of all 228 patients with chronic pancreatitis hospitalized at the Department in the study period. The clinical data were compared with findings reported in the literature.

RESULTS

Epigastric pain was the most common symptom reported by patients with pancreatolithiasis. The sensitivity of imaging tests in the diagnosis of pancreatic duct stones was as follows: abdominal ultrasonography - 31%, endoscopic retrograde cholangiopancreatography (ERCP) - 67%, computed tomography - 71%, endoscopic ultrasonography - 73%. In 6 patients ERCP and sphincterotomy were performed along with stenting of the main pancreatic duct. Three other subjects were qualified for surgical treatment. In 7 selected patients conservative treatment and further observation were applied.

CONCLUSIONS

Endoscopic ultrasonography is characterized by high sensitivity in the diagnosis of pancreatic duct stones. ERCP is the first-line treatment in the case of a small number of stones with sizes below 5 mm located in the head or body of the pancreas. In the case of stones with sizes ≥ 5 mm, extracorporeal shock wave lithotripsy should be performed before endoscopic drainage during ERCP. Stenosis of the main pancreatic duct is the key risk factor for the recurrence of pancreatolithiasis.

Ureteral stent encrustation. Pathophysiology

Ureteral stents are the most commonly used urological implants. They are used for temporary as well as for long-term ureteral stenting. Amongst others, complications of ureteral stenting are encrustation and cellular adherence which, in turn, promotes urinary tract infection and can induce impaired healing in case of ureteral damage. Biofilm formation on urological implants leads to the protection of persisting bacteria from local defense mechanisms, thereby rendering persistent urinary tract infections more common. It seems clear that antibiotics cannot penetrate into biofilms adequately. Also, bacteria persist in biofilms in a state of reduced metabolism which further reduces antibiotic efficacy. Furthermore, bacteria develop resistance more quickly in biofilms. This paper tries to give an overview of the complex pathophysiological mechanisms that underlie stent encrustation as far as we know to date.

Bilateral mobile thoracolithiasis

Thoracolithiasis is the presence of one or more freely mobile pleural stones (with or without calcification) in the pleural space. They occur with a reported incidence of less than 0.1% and are benign and do not require intervention. Historically, they have led to unnecessary interventions - something unlikely in the era of multidetector computed tomography (CT). Thoracolithiasis should be included in the differential diagnosis of a single or multiple, mobile peripheral pulmonary nodules. Here, we review the imaging characteristics of a rare case of bilateral mobile thoracolithiasis.

Testicular microlithiasis: prevalence and association with primary testicular neoplasm

PURPOSE

To assess the prevalence of testicular microlithiasis and its association with primary testicular neoplasm.

METHODS

Evaluated were 6,002 patients undergoing scrotal ultrasound at our institution. Data recorded included age, ultrasound date, presence of microlithiasis, presence of testicular mass on ultrasound, and pathologic diagnosis for those who had subsequent orchiectomy.

RESULTS

Four hundred fifty-six of 6,002 patients (7.6%) demonstrated testicular microlithiasis. The prevalence increased from 4.6% for those examined before 2001 to 9.02% for those examined since 2001 (p < 0.001). The prevalence of primary testicular neoplasm in patients without microlithiasis was 1.5% (84/5,546), whereas in those with microlithiasis it was 12% (53/456) (p < 0.001). The prevalence of pure seminoma was 39% (33/84) in the nonmicrolithiasis group with tumor versus 64% (34/53) in the microlithiasis group with tumor (p < 0.001). Germ cell tumors made up 98% of neoplasms in patients with microlithiasis, but only 85% in patients without microlithiasis (p = 0.009).

CONCLUSIONS

Advances in ultrasound technology have led to an increased detection of testicular microlithiasis. We observed an eight-fold increased prevalence of primary testicular neoplasm in patients with microlithiasis than in those without as well as an increased prevalence of germ cell tumors, particularly pure seminoma. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:423-426, 2014.

Significant testicular enlargement in a 6.5-year-old boy with monorchism and testicular microlithiasis

We report a testicular enlargement that mimics precocious puberty in a boy aged 6.5 years with monorchism and testicular microlithiasis.

Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Laser lithotripsy to treat basket impaction during mechanical lithotripsy of a pancreatic duct stone

CONTEXT

Though uncommon, pancreatic duct stones can cause significant discomfort and morbidity. Endoscopic removal of pancreatic stones may decrease intraductal pressure by augmenting ductal drainage. Endoscopy is shown to be most effective when used early in the course of the disease. Endoscopic methods such as mechanical lithotripsy are often successful in removing the majority of pancreatic stones. However, its complication rate is quite high, with basket malfunction being the one most frequently encountered.

CASE REPORT

We report a case of a patient with idiopathic chronic calcific pancreatitis presenting with symptomatic pancreatic duct stones. During one attempt of basket mechanical lithotripsy, the basket wires fractured. The basket and stone thus became entrapped in the patient's pancreatic duct. Holmium laser lithotripsy was applied via the mother-baby system of the endoscope. The stone was crushed, and the basket and stone fragments were able to be removed.

CONCLUSIONS

To our knowledge, this is the first time laser lithotripsy has been employed to relieve basket impaction during attempted mechanical lithotripsy of a pancreatic duct stone. This method may be considered as a rescue technique by endoscopists encountering basket impaction in the future.

Pancreatic stone protein/regenerating protein family in pancreatic and gastrointestinal diseases

Pancreatic stone protein (PSP; reported in 1979), pancreatitis-associated protein (PAP; 1984) and regenerating protein (Reg I; 1988) were discovered independently in the fields of the exocrine (pancreatitis) and endocrine (diabetes) pancreas. Subsequent analysis revealed that PSP and Reg I are identical and PAP belongs to the same protein family. PSP/Reg I and PAP share a selective and specific trypsin cleavage site and result in insoluble fibrils (PTP, PATP). Search for a functional role of PSP had led to the idea that it might serve as an inhibitor in pancreatic stone formation and PSP was renamed lithostathine. Inhibitory effects of lithostathine in stone formation have been questioned. Evidence so far obtained can support a lithogenic role rather than a lithostatic role of PSP. PAP and its isoforms have been investigated mainly regarding responses to inflammation and stress. Reg I and its isoforms have been examined on regeneration, growth and mitogenesis in gastrointestinal neoplastic diseases as well as diabetes. Evidence obtained can be applied in the prediction of prognosis and therapy for inflammatory and neoplastic diseases.

[Clinical trial on pancreatic duct stones caused by chronic pancreatitis]

OBJECTIVE

To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones.

METHODS

A total of 172 patients with chronic pancreatitis (n=67), pancreatic duct stones (n=62), and pancreatic injury (n=43), admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby(ERCP) or computed tomography(CT), and intraoperatively confirmed by exploration and biopsy, were divided into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+.

RESULTS

The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with various stones; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05), which were more obvious in the PS group.

CONCLUSION

Decreased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic duct stones.

Vaginal calculus following severe form of female genital mutilation: a case report

We present a case of vaginal calculus formation following an initial insult of female genital mutilation (FGM) and crocodile bite to the external genital. A literature review made with regards to acute and late complication of female genital mutilation. Female genital cutting existed as early as the 5th century B.C. This ritualistic practice has affected the physical, mental, and social well being of women and undermined the basic reproductive and sexual health rights of the female population. Worldwide, 85-114 million girls and young women are subjected to this dreadful practice. It is mostly practiced in Africa and Middle East. Various authors classify female genital cutting differently. The World Health Organization classifies FGM in to FOUR types. Female genital mutilation is associated with immediate, intermediate and long-term complications (1-4). The complications are strongly related to the variant of the mutilation, especially of the third and the fourth types where introcision or vaginal scraping is performed. Vaginal calculus formation is a rare phenomenon. Our patient had a total obliteration of the introitus, vaginal calculus formation and urethra-vaginal fistula, which were surgically managed and corrected

Enterolith formation in the roux limb hepaticojejunostomy

Enterolith in the Roux limb of Roux-en-Y hepaticojejunostomy is rare. We report a case of a Roux loop enterolith presenting with recurrent cholangitis. Cholescintigraphy and magnetic resonance imaging aided in the preoperative diagnosis. Intraoperatively, a large enterolith was extracted distal to the biliodigestive anastomosis. A kink of the small bowel was also noted distal to the stone. The mechanism for enterolith formation in the Roux loop is discussed.

[Late complication of selective renal arterial embolization after percutaneous surgery: renal "colic"]

Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion.

Hypercalciuria associated with pediatric prostatic calculi

Prostatic calculi, though common in adult men, are rare in children. We report three cases of pediatric prostatic calculi seen at our clinic that were associated with hypercalciuria and elevated urinary calcium/creatinine ratios. The patients had no symptoms from their prostatic calcification, but one patient had recurrent symptomatic renal calculi. In patients with prostatic calculi, determination of spot urine calcium/creatinine ratios is recommended. If significant hypercalciuria is found, treatment to prevent upper urinary tract calculi may be considered.

Seminal vesicle calculus after transurethral resection of ejaculatory duct

We report a case of symptomatic seminal vesicle calculus following transurethral resection of ejaculatory duct. A 37-year-old male, who had previously undergone transurethral resection of ejaculatory duct, presented with perineal discomfort and graveluria. Computed tomography revealed a calculus situated within a dilated left seminal vesicle. The patient was treated with cystoscopy and litholapaxy of the seminal vesicle calculus. Although rare, our case demonstrates that seminal vesicle calculi formation can occur following treatment of ejaculatory duct obstruction, possibly secondary to urinary reflux and stasis.

Intestinal obstruction due to meckel's diverticulum: a rare presentation

Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman.

Testicular microlithiasis: what does it mean clinically?

OBJECTIVE

To review our current practice of follow-up for boys with testicular microlithiasis (TM), an uncommon condition characterized by calcification within the seminiferous tubules, detected by ultrasonography (US); TM has been associated with both benign and malignant conditions of the testes but the natural history of TM in children remains unclear.

PATIENTS AND METHODS

All boys diagnosed with TM over a 14-year period were included in this study. A search of the radiology database was carried out using the keywords 'testicular microlithiasis' and 'testicular calcification'. A retrospective case-note review was then used to determine age at diagnosis, presenting symptoms, indication for testicular US, outcome and follow-up. We also searched Medline/PubMed, using the same keywords for published data on TM from 1970 to 2006.

RESULTS

Over the study period 711 testicular scans were taken in 623 patients; seven cases (1.1%) of TM were identified. The mean (range) age at presentation was 12 (7-15) years. The presenting symptoms were testicular pain (three), undescended testes (two), hydrocele (one) and asymptomatic scrotal swelling (one). In five cases the TM was bilateral and in two a solitary kidney was identified. Only one patient had tumour markers measured (beta-human chorionic gonadotrophin and alpha-fetoprotein) and these were within normal limits. On yearly US follow-up, the TM was less prominent in one patient, unchanged in four and two were lost to follow-up. Three patients are currently on yearly US follow-up while two are under the care of adult general surgeons. The analysis of reports published to date indicated that malignancy only develops when TM is associated with other predisposing factors.

CONCLUSION

There is no convincing evidence that TM alone is premalignant. However, when it accompanies other potentially premalignant features we recommend annual US follow-up.

Expression of DPC4/Smad4 gene in stone-containing intrahepatic bile duct

BACKGROUND AND OBJECTIVES

Hepatolithiasis is etiologically related to cholangiocarcinoma. We underwent this study with an attempt to examine the expression of DPC4/Smad4 gene in stone-containing intrahepatic bile ducts (IHD) and intrahepatic cholangiocarcinoma (ICC).

PATIENTS AND METHODS

The immunohistochemical method and RT-PCR analysis were used to study the expression of DPC4/Smad4 gene in normal IHD, stone-containing IHD, and ICC. All the specimens were from hepatic resection.

RESULTS

The immunohistochemical study showed that all specimens from 24 normal IHD had marked expression of DPC4/Smad4 gene, while there was 4.4% (2/46) and 33.3% (3/9) loss of DPC4/Smad4 expression in stone-containing IHD and ICC, respectively. Among the specimens of stone-containing IHD, all the hyperplastic epithelial cells showed normal expression of DPC4/Smad4 gene while dysplastic epithelial cells showed 20% (2/10) loss expression of DPC4/Smad4. The RT-PCR analysis showed that the normal IHD had the highest content of DPC4/Smad4 mRNA, which was threefold and sixfold higher than that of stone-containing IHD and ICC, respectively.

CONCLUSION

Loss expression of DPC4/Smad4 gene was found both in stone-containing IHD and ICC. Dysplastic epithelium of stone-containing IHD had higher potential for malignant transformation.

Case report: endoscopic management of seminal vesicle stones with cutaneous fistula

Stones in the seminal vesicle are rare. Open surgery to remove either the seminal vesicle or the stone usually is required. We report a case of seminal-vesicle stones compounded by cutaneous fistula that was treated by ureteroscopy, intracorporeal lithotripsy, and fulguration of the fistulous tract.

Vesicovaginal Fistula with Secondary Vaginal Stones

PURPOSE

We report a rare case of a vesicovaginal fistula associated with secondary vaginal stones that was managed totally endoscopically.

MATERIALS AND METHODS

A 52-year-old woman presented with urinary incontinence and perineal pain. On subsequent evaluation, we found a vesicovaginal fistula associated with secondary vaginal stones caused by a retained gauze. Management involved vaginoscopy, intracorporeal shock wave lithotripsy for vaginal stones, and removing retained medical gauze. We performed cystoscopy, laparoscopic cystotomy, transabdominal Foley catheterization of the vesicovaginal fistula for traction, injection of diluted adrenaline-saline solution for better dissection, dissection of the bladder from the vagina, tension-free closure of the bladder and vaginal defects, and closure of the cystotomy.

RESULTS

Operative time was 155 minutes and blood loss was 60 mL. The patient was discharged on postoperative day 3, and catheterization time was 14 days. At 3-month follow-up, the patient was fully continent.

CONCLUSION

To our knowledge, this is the first reported case of a vesicovaginal fistula associated with secondary vaginal stones which was managed totally endoscopically. We believe that this is a feasible and efficacious approach for the management of such cases.

Giant rhinolith: a case report

A rhinolith is a stone that forms in the nose. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. It can be seen on radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that will call for more invasive surgical procedures. We present the first case of a giant rhinolith, possibly arising from aspergillosis, and discuss its clinical and radiologic features.

Infrared spectrophotometry of intraluminal meconium calculi in a neonate with imperforate anus and rectourethral fistula

BACKGROUND/PURPOSE

Intraluminal meconium calculi are a rare cause of neonatal abdominal calcifications in patients with anorectal malformations. To investigate their pathogenesis, we performed infrared spectroscopic analysis of meconium-calcified lesions.

METHODS

Meconium calculi were collected from the colostomy in a newborn patient with imperforate anus and rectourethral fistula. The potassium bromide method was employed to obtain the infrared absorption spectrum of the meconium calculi.

RESULTS

The wavelength pattern of the meconium calculi exhibited 4 specific peaks at 1570, 1390, 1105, and 1005 cm(-1) between 22% and 45% transmittance values. The unique absorption spectrum exclusively indicated ammonium hydrogen urate (C(5)N(5)O(3)H(7)), having the combined constituents of ammonium and uric acid.

CONCLUSIONS

These results suggest that the intraluminal meconium calculi were originally derived from meconium and fetal urine. The stasis of meconium passage and fetal urine mixing through the rectourethral fistula in a low-pH condition was deduced to be the main cause of this rare stone formation.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Small bowel obstruction secondary to a giant enterolith complicating Crohn's disease

BACKGROUND

Enterolith formation associated with Crohn's disease is a very uncommon clinical entity.

AIM

To describe a case of sub-acute small bowel obstruction secondary to a giant enterolith in a patient with Crohn's disease.

RESULTS

A 54-year-old male with a history of Crohn's disease presented with sub-acute small bowel obstruction secondary to a giant enterolith. The diagnosis was confirmed utilising plain film radiography and computed tomography

CONCLUSION

Plain film radiography and computed tomography play a central role in establishing the diagnosis of this rare complication of Crohn's disease and assist in planning surgical intervention.

Endourologic management of duodenal calculi in pancreas-kidney transplantation

Duodenal stones formed during pancreas-kidney transplantation are usually associated with nonabsorbable sutures or staples. We report on the delayed formation of a struvite duodenal stone not attributed to foreign material, managed successfully with intracorporeal electrohydraulic lithotripsy.

A large intrascrotal calculus

A large stone with 8.7 cm multiply 7.2 cm multiply 6.5 cm in size and 420 g in weight dropped down spontaneously from a 93-year-old man's scrotum, who had suffered from left intrascrotal mass and pain for more than 20 years. The component of the stone was magnesium ammonium phosphate. To the best of our knowledge, it is the largest intrascrotal calculus reported in the world. We hereby present the case and discuss the diagnosis and etiology of scrotal calculi.

Crohn's disease with enterolith treated laparoscopically

Symptomatic enteroliths are relatively rare. Most occur from ingestion of undigestible materials such as pits or bones. Primary enteroliths are usually from the condition of partial bowel obstruction, diverticular type diseases such as Meckel's or congenital bands. Gallstone ileus is also a more common cause of gastrointestinal stones. Enteroliths associated with Crohn's disease is an extremely rare condition with fewer than 25 cases reported in the literature. Presented herein is such a case successfully treated laparoscopically.

Migrating calcified enterolith and chronic anemia: an unusual case presentation of a Meckel's diverticulum

Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2 % of the population. The most common complications associated with a Meckel's diverticulum include obstruction, bleeding, and inflammation (7, 9, 11, 18-20). The estimated lifetime risk of developing symptoms with a Meckel's diverticulum is 4-6 % (16), with the risks of complications decreasing with age. Stones within Meckel's diverticulum are recognized as a rare complication in the adult population (13,15). However, it has not been reported in the pediatric age group. The authors describe a 19-month-old male who presented with intermittent abdominal pain and vomiting, chronic microcytic anemia and a calcified stone in the lower abdomen, who was found to have a Meckel's enterolith.

Vaginal calculus secondary to vaginal outlet obstruction

Primary vaginal stones are extremely rare and are often mistaken for bladder calculi on plain radiography. However, intravenous pyelography and sonography can help differentiate between the two. We report a case of a large vaginal stone in a 21-year-old woman referred for apareunia and difficult micturation. The clinical findings of vaginal outlet obstruction and a hard mass anterior to the rectum made us suspect a bladder calculus; however, sonography of the pelvis indicated that the mass was in the vagina. Further examination using a probe to physically define the stone's location confirmed it to be a vaginal calculus. Surgery was performed to repair the outlet obstruction and remove the stone, which permitted the woman to urinate normally and engage in normal sexual relations.

Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation

OBJECTIVES

Autoimmune pancreatitis has been characterized by irregular narrowing of the main pancreatic duct and sonolucent swelling of the parenchyma, both of which are due to lymphoplasmacytic inflammation at the active stage of the disease, and by the absence of pancreatic stone formation. The aim of the present study was to confirm or deny whether or not this disease is progressive with recurrent attacks, resulting in pancreatic stone formation like ordinary chronic pancreatitis.

METHODS

Forty-two patients, 36 of whom were treated with prednisolone, were followed up for periods longer than 12 months (median follow-up period: 54.5 months, range: 13-111 months) by regular interview and examination of their medical records for laboratory tests and image tests.

RESULTS

Eleven patients (26.2%) who were treated with prednisolone showed recurrent attacks during median follow-up periods of 22 months. Eight patients (19%) showed the formation of pancreatic stones during the follow-up periods. Because 6 of 11 patients (54.5%) who suffered relapse showed pancreatic stone formation, it is significantly associated with relapse in comparison with nonrelapse (p= 0.0019).

CONCLUSIONS

Contrary to previous reports, we observed both relapse and pancreatic stone formation in some patients with autoimmune pancreatitis, which suggests that autoimmune pancreatitis has the potential to be a progressive disease with pancreatic stones.

Pediatric Canaliculitis and Stone Formation

A 5-year-old girl with a remote history of idiopathic thrombocytopenic purpura presented with a history of partial nasolacrimal duct obstruction unresolved with standard treatments of probing, irrigation, and lacrimal system intubation. Surgical exploration revealed canaliculitis with dacryolith formation within the inferior canalicular system. After punctoplasty and removal of the dacryoliths, the patient had full resolution of symptoms. Although the diagnosis is uncommon in this age group, it should be included in the differential diagnosis of chronic or recurrent pediatric nasolacrimal obstruction.

Hepatolithiasis with biliary ascariasis--a case report

BACKGROUND

Biliary ascariasis is regarded as possible etiological factor for hepatolithiasis. Here we report one case of a patient with hepatolithiasis with biliary ascariasis who developed a liver abscess, which was treated with partial hepatectomy.

CASE PRESENTATION

A young adult female presented with epigastric pain and vomiting with repeated attacks of cholangitis. ERCP showed evidence of multiple intrahepatic calculi with the development of abscess in the left lobe of liver. The patient underwent partial hepatectomy and was found to have biliary ascariasis on histology. She was treated with antihelmenthic therapy and has had an uneventful postoperative period of 2 years.

CONCLUSION

Biliary ascariasis with hepatolithiasis, although rare, should be considered in endemic countries.