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Obstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia.
This study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed.
Nineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2–3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up.
Sialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.
Saliva composition may affect sialolithiasis formation; thus, this study compared the salivary inorganic composition of sialolithiasis patients with that of healthy controls, and determined whether salivary inorganic composition changes after sialolithiasis surgery.
The study included 40 patients with sialolithiasis and 40 matched healthy controls. Patients were examined before and after sialolithiasis surgery; controls were examined once. Flow rate and the inorganic saliva composition in unstimulated whole saliva were assessed.
Patients’ salivary flow prior to surgery was significantly lower compared to that of healthy controls, but equalised after surgery. Prior to surgery, patients’ saliva exhibited higher concentrations of calcium, magnesium, phosphorous compared to that of healthy controls. The concentration of most ions remained high after sialolithiasis surgery.
Sialolithiasis patients had increased salivary concentrations of the ions that constitute the main inorganic phase of most sialoliths, and this may confer a risk for developing sialolithiasis.
Intraluminal contents of benign and malignant prostatic tissue are associated with varying forms of acellular structures. These include corpora amylacea, prostatic calculi, and prostatic crystalloids. There are relatively few microscopy studies about the characterization of intraluminal structures from benign and malignant prostatic glands and little is known about their chemical composition. In the present study, we used a combination of special histochemical methods, immunohistochemistry, and transmission electron microscopy to characterize intraluminal contents of benign and malignant prostate glands. The study was done on 33 radical prostatectomy and four transurethral resections of prostate specimens. Histochemical methods such as von Kossa, autometallography (AMG), as well as PSA immunohistochemistry and transmission electron microscopy were performed to characterize intraluminal contents of benign and malignant prostate glands. Von Kossa staining was observed in acellular structures, corpora amylacea, prostatic calculi, and calcified blood vessels. AMG staining was observed in the lumen of small glands, in the epithelium lining prostate glands, and corpora amylacea. PSA staining showed prostatic glands with both positive and negative corpora amylacea and epithelial cells. Ultrastructural observation revealed the presence of a variety of highly heterogeneous aggregates composed of fibrillar elements that were similar to those of amyloid.
Theories have been put forward on the etiology of sialoliths; however, a comprehensive understanding of their growth mechanisms is lacking. In an attempt to fill this gap, the current study has evaluated the internal architecture and growth patterns of a set of 30 independent specimens of sialoliths characterized at different scales by computed microtomography and electron microscopy. Tomography reconstructions showed cores in most of the sialoliths. The cores were surrounded by concentric or irregular patterns with variable degrees of mineralization. Regardless of the patterns, at finer scales the sialoliths consisted of banded and globular structures. The distribution of precipitates in the banded structures is compatible with a Liesegang–Ostwald phenomenon. On the other hand, the globular structures appear to arise from surface tension effects and to develop self-similar features as a result of a viscous fingering process. Electron diffraction patterns demonstrated that Ca- and P-based electrolytes crystallize in a structure close to that of hydroxyapatite. The organic matter contained sulfur with apparent origin from sulfated components of secretory material. These results cast new light on the mechanisms involved in the formation of sialoliths.
Dacryoliths are concretions formed in the lacrimal sac from cellular debris and proteins, which may calcify and cause further obstruction of the nasolacrimal pathway. Dacryoliths are often underlying contributors in cases of intermittent or chronic dacryocystitis (i.e. nasolacrimal sac inflammation, characterised by epiphora, pain, erythema, sac dilation and lacrimal punctum swelling).
We report an unusual case of dacryolith resulting in obstructive epiphora, managed via an endonasal endoscopic approach.
Case report and literature review pertaining to dacryolith.
A 54-year-old man attended the multidisciplinary nasolacrimal clinic due to recurrent epiphora. Obstructive epiphora secondary to chronic dacryocystitis was diagnosed. He underwent endonasal endoscopic dacryocystorhinostomy. Intra-operatively, a large dacryolith was found to be the cause of epiphora.
Dacryolith is an unusual cause of nasolacrimal duct obstruction. This case highlights this unusual cause, and the relevant diagnostic investigations. This case also illustrates successful endonasal endoscopic management, rather than an external, open approach.
Transvaginal ultrasound has improved the ability of ultrasound to interrogate the pelvic organs with less interference from intervening structures such as gas or fat. The gynaecologist may need to distinguish between the symptoms caused by pelvic inflammatory disease and those of an inflamed pelvic appendix. Appendiceal mucocele occurs when there is accumulation of mucoid material within the lumen of the appendix distal to an obstruction. Mucoceles occur more commonly in women than men. Ultrasound can show different patterns, including a cystic structure with thin walls, a cyst with septations and, the most common appearance, layered rings of mucus of different echogenicity. Ultrasound is highly sensitive in detecting calculi in the kidneys. An ureterocele can be clinically silent and without upper tract dilation. The diagnosis may be made for the first time during sonography of the pelvis.
This report documents an unusual case of buccal mucosa swelling due to a giant (25 × 13 mm), parotid duct sialolith. Review of the literature disclosed that this is the largest parotid sialolith ever reported. Diagnostic imaging and treatment are described.