Calculus Formation Research Articles

106 Stentolith As an Uncommon Complication of Loss to Follow Up After Endoscopic Biliary Stenting

Abstract Introduction Endoscopic biliary stenting is a common procedure, with indications from malignant obstruction to benign stone disease. We discuss a patient who re-presented after endoscopic stenting having been lost to follow up, with a large ‘stentolith’ requiring open CBD exploration. Case Presentation A 56-year-old female presented in 2013 with obstructive jaundice and a 2-week history of abdominal pain. She was a smoker, but otherwise had no past medical, surgical, or relevant family history. After initial workup, ERCP with sphincterotomy and pigtail stent placement was performed with interval laparoscopic cholecystectomy in 2014. Post-operative follow up was not arranged, and the patient subsequently re-presented in 2020 with fatigue. MRCP confirmed a proximal CBD stone and linear artefact. Open exploration facilitated removal of the stone-stent complex. Discussion Complications of stenting include cholangitis, stent occlusion and migration [2]. Stenting for failed biliary stone extraction is considered a temporary measure, with removal or exchange at three months (1). However, patients may be lost to follow up and return with non-specific symptoms. A rare cause is de novo formation of a gallstone calculus encasing the stent, a phenomenon termed “stentolith” [4]. Proposed pathophysiology is through promotion of bacterial proliferation by the stent, with biofilm formation and calcium bilirubinate precipitation [6]. Variation in formation has been described, with plastic stents developing circumferential stones [12-25], due to potential space between the wall and stent. Conclusions This highlights the importance of robust inter-disciplinary working; careful patient follows up and implementation of a mandatory registry at all hospitals for stented patients.

A Systematic Review of the Potential Effects of Lippia sidoides on Dental Plaque and Periodontal Diseases.

Lippia sidoides is a typical shrub from Brazil that has been used in traditional medicine. This is a systematic review on the effect of L.sidoides for controlling dental plaque, gingivitis, and periodontitis. A database search through May 2021 in Medline/PubMed, SCOPUS, BVS, and Web of Science identified 711 reports of which 17 met our inclusion criteria. Five randomized controlled trials and three animal studies were included that compared L.sidoides-based products (toothpaste, mouthrinse, and gel) to cetylpyridinium chloride, chlorhexidine, and placebo products. Among the human studies, a significant antiplaque effect after treatment with L.sidoides-based products was observed in three studies and an antigingivitis effect in two studies, similar to chlorhexidine-based products. One study found superior dental plaque reduction compared to cetylpyridinium chloride mouthrinse. Only one study testing a L.sidoides gel found no antiplaque effect. Among the animal studies, an L.sidoides mouthrinse significantly reduced calculus in two studies, inflammatory infiltrate in one study, and plaque bacteria and gingivitis in one study. An L.sidoides gel significantly reduced alveolar bone loss and inflammatory response in one study in which mice were submitted to ligature-induced periodontal disease. In general, L.sidoides-based products were effective in reducing dental plaque and calculus formation, as well as clinical signs of gingivitis. As most studies present methodological limitations, these results should be interpreted carefully. Further clinical trials with greater methodological accuracy and control of biases are necessary for the use of L.sidoides-based products in humans to be viable in clinical practice.

The role of calcium metabolism disorders in the formation of different density calculi with calcium oxalate nephrolithiasis

Objective To investigate the relationship between calcium metabolism disorders, stone formation inhibitor levels and stone density in primary and recurrent calcium-oxalate nephrolithiasis.Material and Methods Sixty nine patients with urolithiasis were examined, their average age was 41,4 ± 9,5 years. Two main groups were distinguished: Group 1 – primary calcium-oxalate nephrolithiasis (PN), Group 2 – recurrent calcium-oxalate nephrolithiasis (RN). Then each group was divided into two subgroups – A and B according to stone density: 500–1000 HU and from 1000–1500 HU, respectively. Stone density was determined by computed tomography (CT). PTH (parathormone), PTHrP (parathyroid hormone related protein), vitamin D, total blood calcium (Ca), ionized blood Ca, total blood protein, Ca and urine pH were also examined. After the examination, patients underwent surgical removal of the stones.Results It was found that 41.9% of group 1 and 46.9% of group 2 patients had grade I obesity. Average creatinine level in group 2 was 9.7% higher than in group 1 (p < 0.05). Urea level in both groups was not statistically significantly different. Glomerular filtration rate (GFR) was comparable. Groups 2A and 2B had higher PTHrP values (77.61 and 76.98 pg/mL, respectively) combined with relatively high PTH levels (2A – 4.4 pg/mL and 2B – 5.1 pg/mL), relatively low osteopontin concentration (2A – 0.044 pg/ mL, 2B – 1.106 pg/mL), compared to those in group 1 (p < 0.05). Pairwise unidirectional differences between groups 1A and 2A, 1B and 2B were found to correlate positively with density values: for osteopontin: r = 0.992 (p < 0.05); for vitamin D: r = 0.831 (p < 0.05); for blood Ca2+ ions: r = 0.836 (p < 0.05); for urine pH: r = 0.863 (p < 0.05). There was a negative correlation with the daily concentration of urinary calcium ions with the density of concrements: r = -0.663; p < 0.05. The concentration of osteopontin was significantly higher in Group 1B and 2B patients, and it was significantly lower in patients with stones of < 1000 HU density. Higher values of osteopontin concentration were noted in groups 1B and 2B in relation to groups 1A (p < 0.05) and 2A (p < 0.05). The increase of blood Ca2+ ions in patients in groups 1B and 2B in relation to groups 1A (p < 0.05) and 2A (p < 0.05) was also accompanied by higher values of vitamin D.Conclusion Patients with denser stones showed high values of osteopontin and PTHrP in serum and low values of urinary calcium ions, which may lead to the formation of concrements on the matrix with an organic base. Determination of calcium metabolism makes it possible to predict recurrence of KSD in primary calcium oxalate nephrolithiasis and assess the severity of mineral metabolism disorders in recurrent calcium oxalate nephrolithiasis.

Bisphosphonate Use May Reduce the Risk of Urolithiasis in Astronauts on Long-Term Spaceflights.

ABSTRACTLong‐duration spaceflight is associated with an increased risk of urolithiasis, and the pain caused by urinary calculi could result in loss of human performance and mission objectives. The present study investigated the risk of urolithiasis in astronauts during 6 months on the International Space Station, and evaluated whether the suppression of bone resorption by the bisphosphonate, alendronate (ALN), can reduce the risk. A total of 17 astronauts were included into the analysis: exercise using the advanced resistive exercise device (ARED) plus weekly oral 70 mg alendronate (ARED+ALN group, n = 7) was compared to resistive exercise alone (ARED group, n = 10). Urine volume decreased in both groups during spaceflight but recovered after return. The ARED group showed increased urinary calcium excretion from the 15th to 30th day of spaceflight, whereas urinary calcium was slightly decreased in the ARED+ALN group. Urinary N‐terminal telopeptide (NTX) and helical peptide (HP) of type I collagen, as bone resorption markers, were elevated in the ARED group during and until 0 days after spaceflight, while there was no elevation in these parameters in the ARED+ALN group. Urinary oxalate and uric acid excretion tended to be higher in the ARED group than in the ARED+ALN group during spaceflight. These results demonstrate that astronauts on long‐duration spaceflights may be at high risk for the formation of urinary calcium oxalate and calcium phosphate stones through increased urinary excretion of oxalate and uric acid, from degraded type I collagen, as well as of calcium from enhanced bone resorption. Our findings suggest that increased bone resorption during spaceflight, as a risk factor for urinary calculus formation, could be effectively prevented by an inhibitor of bone resorption. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Comparison of a Vegetable-Based Dental Chew to 2 Other Chews for Oral Health Prevention.

Giving dental chews to dogs is part of the passive homecare that helps prevent the formation of plaque and tartar. The objectives of these studies were to assess the effectiveness of a vegetable-based dental chew (VF) to maintain oral health, and to compare it to 2 different reference chews (RC) with a proven effectiveness. The first study was conducted on 45 small dogs (<10 kg) and the second on 60 larger dogs (15-30 kg) who were randomly assigned to 3 different groups. During 30 days, one group received no chew (control) while the second and third group received either one RC (RC1 or RC2) or one VF per day. All dogs had their teeth scaled on Day 0. On Day 30, scores were given for plaque and calculus. Gingival parameters were also assessed. Statistical analysis (analysis of variance and Tukey tests ± Bonferroni's adjustment) were performed to compare groups with α set at .05 for significance.The 3 types of chews were found to be efficacious to reduce plaque and calculus formation and the gingival bleeding compared to control (P < .05). There was no significant difference between RCs and VF in both trials except for the gingival bleeding parameters which showed a greater improvement with VF. Therefore, daily administration of the VF is effective to reduce plaque and calculus formation and gingival bleeding and has a better efficacy on gingival bleeding than the other reference products tested. It can therefore be used with confidence at home for preventative dental care.

ИНФИЦИРОВАННАЯ КИСТА УРАХУСА У ВЗРОСЛОГО

Urachus is a tubular formation originating from the top of the urinary bladder and directed to the umbilicus between the peritoneum and the transverse fascia of the abdomen. In an embryo, it serves to divert primary urine to the amniotic fluid. In case, if obliteration of the duct does not occur until the birth, various pathological processes can develop in it. The most common abnomalies of urachus reported in adults are an infected urachal cyst and urachal carcinoma. These diagnoses are not always easy to make due to atypical symptoms of their manifestation and the rarity of these diseases - just two cases per 100,000 hospitalizations of adults. A 22-year-old man with a subcutaneous abscess and anexternal fistula located in theumbilical region with redness of the surrounding skin. 16 hours after dissection and drainaging of the abscess, the patient’s condition worsened, pain in the lower parts of the abdomen began, muscle tension of the anterior abdominal wall and inflammatory changes in blood tests were revealed. The patient was operated on for peritonitis. A two-chambered urachus cyst of the «hourglass» type, with the formation of a dense consistency calculus in one of the cavities, which perforated into the abdominal cavity This clinical case is of the great interest from the point of view of the atypical course and the treatment of a rather rare anomaly in adults. The publication will remind emergency medicine physicians about the possibility of infected urachus in patients with symptoms of acute abdomen.

Calcification‐Based Cancer Diagnosis and Therapy

In nature, calcium deposition is a common biological process in mammals that shapes mechanical structures and creates the functions of bones and teeth, and causes calculi formation. Spontaneous tumor calcification and regional lymph node calcification in colorectal cancer, lung cancer, and glioblastoma have been proven to be benign prognostic factors in the clinic. In line with this concept, we introduce the idea and lead the compound development of artificially inducing bionic calcification around the surface of cancer cells. This process is shown to have excellent effects in the inhibition of growth and metastases of cervical, breast, and lung tumors, as well as superb performance in early-stage diagnosis. Therefore, we predict that this concept may open the door for cancer targeting calcification therapy and diagnosis and provide an outlook for a new avenue in anticancer drug development.

Ligating clip migration after robot-assisted laparoscopic radical prostatectomy: a single-center experience.

BackgroundLigating clip migration (LCM) after robot-assisted laparoscopic radical prostatectomy (RARP) is a rare but troublesome complication, that may result in calculus formation, bladder neck contracture, and anastomotic stricture. Herein, we describe our experiences with LCM after RARP and explore its risk factors, potential pathogenesis, and preventive measures.MethodsWe retrospectively reviewed patients who underwent RARP at our medical center between December 2015 and June 2019, identifying individuals with LCM. Clinical and surgical data were collected from these patients.ResultsOf the 682 patients who underwent RARP at our institution, 26 (3.8%) had LCM. The duration from RARP to the identification of LCM ranged from 1 to 37 (13±10) months. Clips migrated into the urethrovesical anastomosis in 22 patients (84%), prompting cytoscopic extraction to remove the migrated clips. The length of stay after RARP was longer in LCM-positive patients than in LCM-negative patients (13.5 vs. 9.4 days, P=0.034). Additionally, the rates of urine leakage (15% vs. 6%, P=0.046) and anastomotic stenosis (54% vs. 5%, P=0.000) were higher among LCM-positive patients. More positive urethra/apex margins were found in LCM-positive patients (38% vs. 21%, P=0.039).ConclusionsThe incidence of clip migration after RARP may not be as low as previously thought. Cystoscopy is recommended in post-RARP patients with recurrent lower urinary tract symptoms (LUTS) and/or urinary retention. Prolonged length of stay after the first RARP, urine leakage, anastomotic stenosis, and positive urethra/apex margin might be predictors of LCM. We recommend reduced ligating clip usage and electrotome near the urethrovesical anastomosis to reduce clip migration incidence. Meanwhile, more researches are needed to determine the practicality of reducing the risk of clip migration after RARP.

Oral health and caries/gingivitis-associated factors of adolescents aged 12\u201315 in Shandong province, China: a cross-sectional Oral Health Survey

BackgroundWe aimed to analyse the oral health status of adolescents in Shandong province, including dental caries and gingivitis, and their associated factors.MethodsAdolescents aged 12–15-years in Shandong province were recruited. Caries and gingival status were assessed following the World Health Organisation diagnostic criteria. Information including the sociodemographic, oral hygiene knowledge, attitudes and practices were collected through the questionnaire. Chi-square test and multivariate logistic regression analysis were used to investigate the oral diseases associated factors.ResultsIn total, 3868 students (50.2% males) were enrolled. Of these, 39.9% of the participants experienced caries, and 81.7% and 31.3% had calculus and bleeding gingival, respectively. Multivariate logistic regression analysis revealed that there was an association between dental caries and toothaches, dental visits and sleeping troubles caused by oral problems (P < 0.024). A low-frequency of brushing, high sugar consumption and no flossing were more associated with calculus formation and gingival bleeding (P < 0.008).ConclusionCompared to caries, worse gingival condition was more prevalent among adolescents in Shandong province. Brushing behaviour is associated with gingivitis, while dental visits and toothaches are associated with caries. Hence, prevention-oriented dental visits and oral hygiene training are strongly recommended to improve oral health status.

Effect of magnesium ammonium phosphate on the expression of adhesion molecules in sheep renal tubular epithelial cells

Adhesion molecules play an important role in urinary calculus formation. The expressions of adhesion molecules in renal tubular has been reported in some animals. However, the role of adhesion molecules in the process of sheep urinary calculus formation is still unclear. The magnesium ammonium phosphate (MAP) is the main component of sheep urinary calculus. In this paper, the sheep renal tubular epithelial cells (RTECs) were isolated and treated with MAP, the expressions of osteopontin (OPN), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and apoptosis-related indicators caspase-3, Bcl-2 and Bax in RTECs were observed, the viability of RTECs was detected by Cell Counting Kit-8 (CCK-8).The levels of superoxide dismutase (SOD) and malondialdehyde (MDA), and the expressions of inflammatory factors Interleukin-6 (IL-6), Interleukin-1 (IL-1), Interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent (ELISA). The histopathological observation of kidney in urolithiasis sheep was made. The results showed that MAP could reduce the viability and SOD activity, enhance the activity of MDA significantly and promote the expressions of IL-1, IL-6, IL-17 and TNF-α of RTECs. By western blot and qPCR methods, the expressions of ICAM-1, VCAM-1 and OPN increased in 48 h. In addition, the expression of caspase-3 increased significantly and the ratio of Bcl-2/Bax reduced with exposure to MAP. The renal tissue structure was seriously damaged, the RTECs in urolithiasis sheep were degenerative and necrotic.

Epidemiological and clinical characteristics of stone composition: a single-center retrospective study.

The aim of the study was to investigate the epidemiological characteristics of stone components in patients with urolithiasis and analyze the associations between stone components with patients' clinical characteristics. A total of 7126 patients with urolithiasis between July 2005 and June 2020 were retrospectively analyzed. In this research, calcium oxalate stones (74.6%) accounted for the highest proportion, followed by infection stones (11.8%), uric acid (10.6%), brushite (2.0%), and others (1.1%). The change in trend in the composition of urinary stones revealed that the proportion of uric acid declined steadily, while the content of infection stones increased gradually over 15years. The results also suggested that stone composition was significantly associated with PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture (P < 0.05). However, there was no significant correlation between stone composition with smoking, WBC and NEU% (P > 0.05). Our study concluded that calcium oxalate represented the highest proportion, followed by infection stones, uric acid, brushite, and others. The proportion of uric acid declined steadily, while the infection stones increased gradually. Furthermore, the factors influencing the formation of urinary calculi are PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture. Collectively, these results may provide clues to establish effective prevention and management strategies for urinary calculi.

Treatment Characteristics of Kidney Stone Disease in Children

Kidney stone disease (KSD) is a disease caused by the formation of calculi in kidneys and other parts of the urinary tract. The rate of hospitalization of children with KSD worldwide is increasing. The adequate method of calculus extraction and further therapy according to calculus composition and metabolic disorders are crucial for effective treatment of patients with KSD and recurrence risk reduction. This review covers surgical (extracorporeal lithotripsy, percutaneous nephrolithotripsy, retrograde intrarenal surgery, ureterolithotripsy, laparoscopy, open surgery) and non-surgical (lithokinetic and litholytic) therapy. Special attention is paid to metaphylaxis, or recurrence prevention, and calculi formation. It is noted that medication of children with KSD can be aggravated by various adverse reactions, complexity in drugs dosages in children of first years of life. Moreover, all surgical methods are characterized by high risk of postoperative complications development. The relevance of KSD genetic nature in children, the role of lifestyle changes in disease development, the implementation of new drugs for metabolic disorders correction are presented in the article.

Geoenvironmental controls on the formation of human urinary calculi: a case study from Jordan

The purpose of this study is to determine the factors responsible for the prevalence of urinary stones disease among the inhabitants of selected regions in northern Jordan and to trace the extent of their link with the hydrogeochemical properties of groundwater in the area in addition to geoenvironmental factors and some certain dietary habits. By comparing the disease spread in the studied areas, results showed that the elevated areas (Irbid and Amman) are the most affected regions with the disease. One hundred and thirty water samples collected from 15 wells were distributed across the three studied regions to identify urinary stone patients among individuals. All samples were analyzed for percentages of cations and anions to assess water quality. Anions are distributed in the following order: HCO3− >Cl− >SO42− >NO3− >F− >PO43−, while the cations are distributed as follows: Ca2+ >Mg2+ >Na+ >K+ >Fe2+. The hydrogeochemical analysis results for the three regions compared using the Wilcoxon rank-sum test. The significant difference in the values of TDS, TH, Cl−, NO3−, Ca2+, and Mg2+ is p < 0.05 compared with water quality in the regions of Amman–Mafraq and Irbid–Mafraq. Depending on Gibbs’ diagram and the factor analysis, elements ratio plots strongly suggest that the source of chemical ions in the groundwater is the interaction of water with carbonate rocks. Therefore, this study confirms the strong relationship between urinary stones formation and the geochemistry of drinking water during the high calcium content and increase of the water hardness used by the residents of the study areas. The effect of temperature on the formation of urinary stones was observed through the direct correlation with the amount of water consumed by individuals. In winter, the daily water intake decreases, which leads to an increase in the concentration of Ca, Na, and P ions in the bladder. The high temperature in the summer increases the dehydration process in the body, which increases the concentration of calcium and other ions to create an opportunity for urine stones to form.

Role of Osteoprotegerin as Novel Marker in Urinary Stone Formers: A Pilot Study

Background: Urinary tract calculus formation can be prevented by identifying molecules and metabolic disturbances that affect this process. Osteoprotegerin (OPG), a cytokine of the TNF receptor superfamily, has been demonstrated to mediate vascular calcification and intimal calcification. Endothelial injury and oxidative stress are known to play a role in urolithiasis in the form of Randall’s plaques. Objectives: The present study aimed to compare 24-h urinary and serum OPG levels of patients with and without urolithiasis. Methods: In this case-control study, 24-h urinary levels of OPG (pg/mL), serum levels of OPG (pg/mL), and creatinine (mg/dL) were measured in both groups. Urinary and serum levels of OPG were determined by enzyme-linked immunosorbent assay (ELISA) using human OPG kits. Results: Mean serum creatinine was 0.86 ± 0.21 mg/dL in the case group and 0.77± 0.16 mg/dL in controls. The difference in the mean serum OPG levels between the cases (227.13 ± 98.02 pg/mL) and controls (47.28 ± 29.61 pg/mL) was highly significant (P value &lt; 0.0001). The difference in the mean 24-h urinary OPG levels between the cases (156.12 ± 174.31 pg/mL) and controls (9.32 ± 23.72 pg/mL) was highly significant (P value &lt; 0.001). Conclusions: There were significantly higher levels of OPG in serum and 24-h urine samples of cases than in controls. Hence, it requires further large studies to make OPG a diagnostic and prognostic marker.

Differential diagnosis of gallbladder opisthorchiasis and cholelithiasis in a teenager

Relevance. Parasitic invasions of the biliary tract, such as opisthorchiasis, are one of the significant causes of the formation of pigment calculi in the gallbladder, which is known in territories endemic for these diseases. However, visualization of the dynamics of the development of the pathological process using ultrasonography does not allow differentiating gall stones with a high degree of accuracy from the stages of development of the feline fluke. In the absence of an epidemiological history, this invasion can proceed under the guise of gallstone disease, which leads to an unjustified surgical intervention with the removal of a practically healthy gallbladder from a child. Before surgery, differentiation of calculi in the gallbladder from the stage of opisthorchiasis will significantly improve the quality of life of the child.The aim of the study was to demonstrate a clinical case of opisthorchiasis invasion in a child in a non-endemic territory, proceeding under the guise of cholelithiasis.Material and methods: the case history of a 17‑year-old girl with opistochiasis invasion is presented.Discussion. Parasitic invasion (opisthorchiasis) caused the formation of «calculi» of the gallbladder in the child. Not every hyperechoic formation of the gallbladder with the presence of a sound track is a «calculus». Timely diagnosis of the cause of cholelithiasis is important, as well as timely treatment of parasitic invasion to avoid relapse of the disease and errors in treatment, including surgical treatment.

Periodontal disease in sheep and cattle: Understanding dental health in past animal populations

ObjectiveTo provide a comparative baseline for future studies of oral pathology in domestic livestock and to better understand connections between lesion prevalence and biological context in past animal populations. MaterialsOver 1600 sheep and cattle mandibles recovered from archaeological sites in England between 500 and 1300 CE. MethodsA comprehensive investigation of periodontal disease was conducted based on four characteristics: dental calculus; periosteal new bone formation; alveolar recession; and ante-mortem tooth loss. The anatomical position and severity of these lesions were quantified and correlated against the age of each individual. ResultsTwo types of periosteal new bone formation were recognized: one in the growing mandibles of young animals, the other in older animals and associated with disease. The incidence of calculus and alveolar recession increase with age. Correlations exist between calculus, alveolar recession and periosteal new bone formation. Disruption caused by the eruption of the P4 is also implied as a contributory factor to the onset of periodontal disease. ConclusionsWhen interpreting periodontal disease in zooarchaeological collections it is vital to consider the effect of age as well as environmental and genetic factors. SignificanceThis is the first comprehensive zooarchaeological study to investigate the effect of age on periodontal disease. It provides a better understanding of the frequency and presentation of periodontal disease as a baseline for future studies. LimitationsCattle mandibles are under-represented due to poor survival. Ideally, radiographs of mandibles with ante-mortem tooth loss would be taken, but this was not possible. Suggestions for further researchThe role of genetic factors, diet and environment needs to be better understood.

An example of late postoperative complications in a patient with urogenital rhabdomyosarcoma after cystprostatectomy

About 20—25 % of all rhabdomyosarcomas in children are located in the urogenital zone. Due to introduction of new drug treatment protocols and the use of radiation therapy, most patients are cured by conservative methods. Only about 20 % of patients undergo surgical treatment, significant number of which are underwent organ-preserving operations. In those cases when the tumor has resistance to conservative treatment, when there is a residual tumor or relapse of the disease develops, radical organ-resecting operations are considered. Among the methods of urine derivation after cystectomy, preference is given to options that allow patients to carry out urine excretion voluntary: the formation of heterotopic reservoirs connected to the urethra or opening on the skin surfaces, which are constructed from different parts of the intestine. A clinical example of late postoperative complication is presented — a calculi formation within the pouch 7 years after radical cystprostatectomy with continent urinary diversion in a patient operated for urogenital rhabdomyosarcoma.

Alveólisis de diente primario. Reporte de caso

La alveólisis es una condición poco frecuente y asintomática. Se produce cuando la raíz del diente primario se vuelve susceptible a la presencia de placa bacteriana y a la formación de cálculos, impidiendo el proceso de cicatrización espontánea de la lesión, causando inflamación e irritación de la mucosa circundante. Las principales causas de la alveólisis son la caries dental y el trauma dentoalveolar. El tratamiento de la alveólisis, generalmente se indica la extracción inmediata. El presente casotrabajo tiene como objetivo describir un reporte de caso de una paciente de género femenino, de 5 años de edad, que presentó alveólisis en el diente primario 51, el cual fue extraído y presentó proceso de cicatrización normal con erupción del diente sucesor 11 sin alteraciones. Cabe al cirujano dentista la búsqueda por informaciones sobre esta patología, saber identificarla y tratarla precozmente, para así mejorar significativamente la calidad de vida de la paciente infantil.

Evaluation of fasting impact during Ramadan month on patients with a history of kidney stones in a military hospital

Introduction: One of the cornerstones and common causes of kidney stone formation is the volume of fluid consumed during a 24- hour that influences on forming that by several mechanisms. Since fluid intake decreases during Ramadan, one of the common questions posed is whether Ramadan fasting is associated with the precipitating of stone formation. The present study was aimed to investigate the effect of Ramadan fasting on precipitating and Inhibitors of stone formation in patients with a history of renal kidney disease. Methods: The study population included all of the patients with kidney stone diseases who were seen at the Clinic of Urology and Nephrology affiliated with Baqiyatallah hospital during the month of Ramadan in 2014 and 2015. The number of 66 patients was chosen and included in the study through randomized simple sampling. All subjects underwent blood tests like serum uric acid, serum phosphate, serum calcium, and serum sodium. Samples were tested in terms of volume, magnesium, uric acid, Calcium, Phosphate, Sodium, citrate, oxalate, Calcium oxalate supersaturation, Calcium Phosphate supersaturation, Uric acid supersaturation. Results: Sixty-six eligible patients were included that the mean age was 48.35±12.10 years. Fourteen men and 52 women were included. There were no significant differences in the mean pH of urine, urinary sodium, urinary oxalate, supersaturated levels of calcium oxalate in the urine, urinary phosphate levels, and super-saturated levels of urinary calcium phosphate between the two groups (P&gt;0.05). The average volume of urine, urinary magnesium, urinary calcium, urinary citrate, the uric acid level in the non-fasting group was higher than the fasting group (P&lt;0.05). There were no differences in the average blood calcium levels, blood sodium, blood phosphate levels, blood acidic levels between the two groups (P&gt;0.05). There was no difference in the mean super-saturated level of uric acid between the two groups (P=0.035). Conclusion: There was controversial evidence on the effect of Ramadan fasting on kidney stone formation and there is not enough evidence in the present study that Ramadan fasting precipitates risk factors associated with calculus formation.

Laparoscopic abdominal perineal rectal resection for rectal cancer with a horseshoe kidney using preoperative 3D-CT angiography: a case report

BackgroundA horseshoe kidney is a congenital malformation involving the fusion of the bilateral kidneys and is often accompanied by anomalies of the ureteropelvic and vascular systems. When performing resection of colorectal cancer in a patient with horseshoe kidney, damage to the ureter or excessive renal arteries should be avoided. To achieve this purpose, comprehensive preoperative anatomical assessments and surgical planning are important. Here, we report a case of a laparoscopic abdominal perineal rectal resection for lower rectal cancer with a horseshoe kidney.Case presentationA 79-year-old woman presented with bloody stool and was diagnosed with advanced lower rectal cancer, immediately above the rectal dentate line, without metastasis. A preoperative computed tomography (CT) scan revealed a horseshoe kidney, while a three-dimensional CT (3D-CT) angiography revealed aberrant excess renal artery from the aorta to the renal isthmus. The left ureter ran in front of the isthmus of the horseshoe kidney and presented calculus formation. Laparoscopic abdominal perineal rectal resection was performed with D3 lymph node dissection. During the operation, we mobilized the sigmoid colon mesentery via a medial approach and preserved the left ureter, the left gonadal vessels, and the hypogastric nerve plexus in the retroperitoneum in front of the horseshoe kidney.ConclusionsWe report a rare case of rectal cancer surgery in a patient with a horseshoe kidney. We discuss the anatomical peculiarities of a horseshoe kidney, such as excess renal arteries, inferior vena cava, ureter, gonadal vessels, and nerves, that should be preserved according to the literature. We suggest that preoperative 3D-CT angiography is both useful for revealing the relationship between the vascular system and a horseshoe kidney and helpful when performing laparoscopic surgery for a left-sided colon and rectal cancer to avoid intraoperative injury.