Cholesterol microlithiasis: bacteriology, gallbladder bile and stone composition

It is not known whether microcalculi possess structural differences compared with larger stones or whether they represent simply an earlier stage in stone disease. We carried out a controlled study on 10 patients affected by gallbladder cholesterol microlithiasis (CM). In all patients, samples from all parts of the stones were studied by X-ray diffraction and by infrared spectrophotometry. Bile analysis was carried out to determine cholesterol, phospholipid and total bile acid content. The cholesterol saturation indices (C.S.I.) were calculated. In all samples, bacterial bile culture was carried out. The results were compared with those of 10 patients who had undergone cholecystectomy for large cholesterol stones, and for 10 patients who had undergone abdominal surgery but without biliary pathology. Patients in these latter groups were matched with the first according to sex and age. Microcalculi proved to be layered (nucleus and external layer) in only 2 cases and larger stones in 9; cholesterol was seen to be the principal crystalline component in all cases. Traces of bilirubin were found in 7 CM and in the nuclei of 5 larger stones. These results show that the structural composition of microcalculi is similar to that of the nucleus of larger stones. No substantial differences exist, however, between the two groups of patients regarding the other parameters taken into consideration.     

Prospective evaluation of endoscopic ultrasonography in the diagnosis of biliary microlithiasis in patients with normal transabdominal ultrasonography

Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases. Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasonography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal TUS. Thirty-five patients with biliary-type abdominal pain and normal TUS results were prospectively studied. All patients underwent radial EUS by means of a GF UM-20 echoendoscope (Olympus Optical, Tokyo, Japan). Of 35 patients, 33 were revealed to have gallbladder sludge or small stones, and 21 had CBD sludge or microlithiasis. Nine patients were not available for follow-up; of the remaining patients, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 underwent cholecystectomy, and 3 underwent biliary sphincterotomy alone. In a postoperative follow-up at 9.2 months, 25 patients (96.2%) were symptom free. EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without EUS is an effective treatment modality in these settings. Presented in part as a poster at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004. This study was supported by local funds from Digestive Disease Research Center, Tehran University of Medical Sciences, and has had no external financial support.     

内镜逆行胰胆管造影在急性胆源性胰腺炎合并胆管微结石治疗中的应用

目的 探讨内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）在急性胆源性胰腺炎（acute biliary pancreatitis,ABP）合并胆管微结石治疗中的应用。方法 回顾性分析2016年1 月至2019 年2 月山东省立第三医院肝胆外科收治的21 例ABP患者经内镜超声检查（endoscopic ultrasonography,EUS）发现合并胆管微结石进而行ERCP治疗的临床资料,比较患者术前术后实验室指标变化。结果 ABP患者21 例均顺利进行ERCP治疗,20 例常规插管造影成功,1 例行预切开插管成功。其中十二指肠镜检查发现乳头憩室9 例,乳头过长7 例,乳头狭窄5 例,乳头萎缩3 例,乳头炎4 例。术中放置鼻胆管18例,球囊扩张17例,胰管支架植入15例,胆道支架植入3例。术后谷草转氨酶、谷丙转氨酶、总胆红素、直接胆红素、间接胆红素、血清淀粉酶、血清脂肪酶、胆汁淀粉酶较术前明显降低,差异均具有统计学意义（P＜0.05）。随访1～3 年,21 例患者均无胆源性胰腺炎、胆总管结石的复发。结论 ERCP是治疗ABP合并胆管微结石的有效方法。     

Testicular microlithiasis

Testicular microlithiasis is an uncommon condition that is characterized by calcifications within the lumina of seminiferous tubules. It is usually an incidental finding on high frequency scrotal sonography. Testicular microlithiasis is a benign condition but is associated with testicular malignancies. Recent reports support this association and suggest regular follow-up in these patients.     

Pulmonary alveolar microlithiasis

Pulmonary alveolar microlithiasis is a rare condition of unknown aetiology which is emerging from obscurity and being more frequently recognized. The case histories of two patients, one of whom is the oldest reported case in the literature, are described. In one case extensive fibrosis of interstitial tissue was present and many calcospherites appeared to lie outside the alveolar spaces. Calcospherites were also found in the bronchial wall of this patient, and this has not previously been reported. The lungs were analysed for calcium, phosphate, and iron, and detailed respiratory function tests were done in one patient; all results were similar to those previously reported in this condition.     

Testicular microlithiasis in Taiwanese men

Testicular microlithiasis (TM) is an unusual ultrasonographic manifestation in testicular parenchyma. Limited information is available about TM in Taiwanese men. We performed a retrospective analysis to investigate the characteristics of TM and its association with testicular cancer and infertility in Taiwan. Male patients who had received scrotal ultrasonography because of scrotal symptoms or infertility between January 2000 and December 2003 were recruited. The incidence of TM was 7.6%. Both testicular microlithiasis and testicular cancer occurred chiefly in the third decade. Patients with TM exhibit a higher chance of testicular cancer (6% vs. 0.9%). No local field effect between TM and testicular cancer was observed. Testicular microlithiasis severity is not positively correlated with sperm quality and sterility. Forty-eight patients (32%) were available at follow-up. No patient developed a testicular tumor or elevated tumor markers (AFP, beta-hCG) during follow-up. We suggest monthly self-examination, annual scrotal ultrasonography and tumor markers screening between the age of 20 and 30 years of patients with TM.     

Testicular microlithiasis in male infertility

Testicular microlithiasis was found in a 30-year-old infertile man. The literature is reviewed and the possible influence of testicular microlithiasis on male infertility is discussed.     

Significance of testicular microlithiasis

INTRODUCTION: Testicular microlithiasis is an uncommon condition characterized by calcifications within the seminiferous tubules. The true prevalence in a normal population has not been defined. METHODS: A review of the literature with emphasis on the connection between testicular microlithiasis and testicular malignancy was carried out. RESULTS: Testicular microlithiasis is associated with different testicular pathologies, including testicular cancer. However, a direct causative connection between testicular microlithiasis and testicular pathologies is not supported by the literature. CONCLUSIONS: Patients with testicular microlithiasis should be followed up regularly. Further investigations concerning the etiology of testicular microlithiasis remain to be done.     

Testicular microlithiasis occurring in postorchiopexy testis

Testicular microlithiasis occurring in a postorchiopexy testis is described. The histologic characteristics of this uncommon entity are presented, and its etiology and clinical significance are briefly reviewed.