Clinical application value of endoscopic ultrasound in the etiological diagnosis of idiopathic acute pancreatitis / 中华胰腺病杂志

Objective:To evaluate the clinical application value of endoscopic ultrasonography (EUS) in the etiological diagnosis of patients initially diagnosed with idiopathic acute pancreatitis (IAP).Methods:Clinical data of 128 patients who underwent further EUS and magnetic resonance cholangiopancreatography (MRCP) after initial diagnosis of IAP at the Gastrointestinal Endoscopy Center of the First Affiliated Hospital of Naval Medical University between January 2015 and February 2022 were collected and divided into a single-episode group (single-episode group, 51 cases) and a multiple-episode group (recurrent group, 77 cases) based on the number of AP episodes. The data and the diagnosis of the etiology of IAP in the two groups by EUS were analyzed and compared with the etiological diagnosis results of MRCP.Results:The differences on basic information such as gender, age, history of smoking, history of alcohol consumption, family history of pancreatic disease, history of cholecystectomy, abnormality of liver function, and severity of pancreatitis between the single-episode group and recurrent group of IAP patients were not statistically significant. The etiology was clarified in 79 (62%) IAP patients after EUS examination, of which 55 (43%) cases had biliary disease (gallstones, microlithiasis, biliary sludge) and 24 (19%) cases had pancreatic disease (chronic pancreatitis, pancreatic divisum, pancreatic interstitial or pancreatic ductal changes). The percentage of patients with biliary disease as the cause of IAP was significantly higher in the single-episode group than in the recurrent group (59% vs 32%), while the percentage of patients with pancreatic disease as the cause of IAP was higher in the recurrent group than in the single-episode group (25% vs 10%), with statistically significant differences ( P values=0.004 and 0.035, respectively). The performance of EUS in diagnosing the etiology of IAP was significantly higher than that of MRCP (62% vs 19%, P=0.032), where EUS was more accurate in detecting biliary microlithiasis or biliary sludge (43% vs 9%, P<0.01). EUS was also superior to MRCP in identifying subtle changes in chronic pancreatitis lesions (small pancreatic nodules, patchy hyperechogenicity, etc.) and intraductal papillary mucinous neoplasms(17% vs 7%, P<0.05), but was inferior to MRCP in identifying pancreatic divisum (2 cases vs 4 cases). Conclusions:In view of high diagnostic accuracy and safety of EUS in diagnosing biliary diseases, and based on the fact that most IAPs in China are due to biliary diseases, EUS based management strategy can be considered to be a reasonable approach for evaluation of IAP patients. The MRCP can be used as a supplement to the EUS to identify a controversial etiology.

Importancia del conocimiento de de la Microlitiasis testicular por el médico general / Important of knowing about testicular microlithiasis for the family physician

Introducción: Conocemos como microlitiasis testicular a la afección en la cual se da la formación de calcificaciones en el interior del testículo. Su etiología es desconocida, y presenta mayor prevalencia en la edad adulta que en la pediátrica. Esta patología muestra su diagnóstico por medio de estudios imagenológicos. Caso clínico: Paciente de 17 años, el cual acude por dolor pélvico de un mes de evolución, y al cual se le diagnostica esta entidad tras los estudios complementarios. En el siguiente estudio se realiza una revisión bibliográfica de los aspectos relevantes de la patología y tratamiento, así como, la relación que existe entra la microlitiasis testicular y la neoplasia de testículo, infertilidad y patologías de base genética, tópicos de sumo interés para el médico general de atención en nivel primario de salud, considerando el manejo de control y prevención que debe aplicarse día a día en la consulta médica. Conclusiones: El conocimiento de las complicaciones que podrían presentarse en el paciente portador de microlitiasis testicular, obligan al médico a mostrar una actitud prudente ante esta patología, considerando el aspecto preventivo de la atención primaria de salud(AU)

Introducción: Conocemos como microlitiasis testicular a la afección en la cual se da la formación de calcificaciones en el interior del testículo. Su etiología es desconocida, y presenta mayor prevalencia en la edad adulta que en la pediátrica. Esta patología muestra su diagnóstico por medio de estudios imagenológicos.m Caso clínico: Paciente de 17 años, el cual acude por dolor pélvico de un mes de evolución, y al cual se le diagnostica esta entidad tras los estudios complementarios. En el siguiente estudio se realiza una revisión bibliográfica de los aspectos relevantes de la patología y tratamiento, así como, la relación que existe entra la microlitiasis testicular y la neoplasia de testículo, infertilidad y patologías de base genética, tópicos de sumo interés para el médico general de atención en nivel primario de salud, considerando el manejo de control y prevención que debe aplicarse día a día en la consulta médica. Conclusiones: El conocimiento de las complicaciones que podrían presentarse en el paciente portador de microlitiasis testicular, obligan al médico a mostrar una actitud prudente ante esta patología, considerando el aspecto preventivo de la atención primaria de salud(AU)

Testicular microlithiasis in a boy with X-linked adrenal hypoplasia congenita

X-linked adrenal hypoplasia congenita (AHC) is a rare disorder that usually presents clinically as adrenal insufficiency in early infancy. It is caused by mutations in the NR0B1 gene which is located on the short arm of chromosome X (Xp21). The NR0B1 gene plays an important role in normal development and function of both the adrenal and gonadal axes and some patients with the disease can present in adolescence with hypogonadotropic hypogonadism. Testicular microlithiasis is an ultrasonographic finding of unknown etiology that has been associated with several benign conditions such as cryptorchidism, congenital adrenal hyperplasia, varicoceles, and testicular malignancy. We report the case of an 11-year-old boy who was diagnosed at the age of 8 months with X-linked AHC due to adrenal failure and presented testicular microlithiasis during follow-up. To the best of our knowledge, this is the first case of an X-linked AHC patient diagnosed with testicular microlithiasis in follow-up.

Genes associated with testicular germ cell tumors and testicular dysgenesis in patients with testicular microlithiasis / 亚洲男科学杂志(英文版)

Testicular microlithiasis (TM) is one of the symptoms of testicular dysgenesis syndrome (TDS). TM is particularly interesting as an informative marker of testicular germ cell tumors (TGCTs). KIT ligand gene (KITLG), BCL2 antagonist/killer 1 (BAK1), and sprouty RTK signaling antagonist 4 (SPRY4) genes are associated with a high risk of TGCTs, whereas bone morphogenetic protein 7 gene (BMP7), transforming growth factor beta receptor 3 gene (TGFBR3), and homeobox D cluster genes (HOXD) are related to TDS. Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis, we investigated allele and genotype frequencies for KITLG (rs995030, rs1508595), SPRY4 (rs4624820, rs6897876), BAK1 (rs210138), BMP7 (rs388286), TGFBR3 (rs12082710), and HOXD (rs17198432) in 142 TGCT patients, 137 TM patients, and 153 fertile men (control group). We found significant differences in the KITLG GG-rs995030 genotype in TM (P = 0.01) and TGCT patients (P = 0.0005) compared with the control. We also revealed strong associations between KITLG-rs1508595 and TM (G allele, P = 0.003; GG genotype, P = 0.01) and between KITLG-rs1508595 and TGCTs (G allele, P = 0.0001; GG genotype, P = 0.0007). Moreover, there was a significant difference in BMP7-rs388286 between the TGCT group and the control (T allele, P = 0.00004; TT genotype, P = 0.00006) and between the TM group and the control (T allele, P = 0.04). HOXD also demonstrated a strong association with TGCTs (rs17198432 A allele, P = 0.0001; AA genotype, P = 0.001). Furthermore, significant differences were found between the TGCT group and the control in the BAK1-rs210138 G allele (P = 0.03) and the GG genotype (P = 0.01). KITLG and BMP7 genes, associated with the development of TGCTs, may also be related to TM. In summary, the KITLG GG-rs995030, GG-rs1508595, BMP7 TT-rs388286, HOXD AA-rs17198432, and BAK1 GG-rs210138 genotypes were associated with a high risk of TGCT development.

Genes associated with testicular germ cell tumors and testicular dysgenesis in patients with testicular microlithiasis / 亚洲男科学杂志(英文版)

Testicular microlithiasis (TM) is one of the symptoms of testicular dysgenesis syndrome (TDS). TM is particularly interesting as an informative marker of testicular germ cell tumors (TGCTs). KIT ligand gene (KITLG), BCL2 antagonist/killer 1 (BAK1), and sprouty RTK signaling antagonist 4 (SPRY4) genes are associated with a high risk of TGCTs, whereas bone morphogenetic protein 7 gene (BMP7), transforming growth factor beta receptor 3 gene (TGFBR3), and homeobox D cluster genes (HOXD) are related to TDS. Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis, we investigated allele and genotype frequencies for KITLG (rs995030, rs1508595), SPRY4 (rs4624820, rs6897876), BAK1 (rs210138), BMP7 (rs388286), TGFBR3 (rs12082710), and HOXD (rs17198432) in 142 TGCT patients, 137 TM patients, and 153 fertile men (control group). We found significant differences in the KITLG GG_rs995030 genotype in TM (P = 0.01) and TGCT patients (P = 0.0005) compared with the control. We also revealed strong associations between KITLG_rs1508595 and TM (G allele, P = 0.003; GG genotype, P = 0.01) and between KITLG_rs1508595 and TGCTs (G allele, P = 0.0001; GG genotype, P = 0.0007). Moreover, there was a significant difference in BMP7_rs388286 between the TGCT group and the control (T allele, P = 0.00004; TT genotype, P = 0.00006) and between the TM group and the control (T allele, P = 0.04). HOXD also demonstrated a strong association with TGCTs (rs17198432 A allele, P = 0.0001; AA genotype, P = 0.001). Furthermore, significant differences were found between the TGCT group and the control in the BAK1_rs210138 G allele (P = 0.03) and the GG genotype (P = 0.01). KITLG and BMP7 genes, associated with the development of TGCTs, may also be related to TM. In summary, the KITLG GG_rs995030, GG_rs1508595, BMP7 TT_rs388286, HOXD AA_rs17198432, and BAK1 GG_rs210138 genotypes were associated with a high risk of TGCT development.

Basic and clinical research progress in pulmonary alveolar microlithiasis / 医学研究生学报

Pulmonary alveolar microlithiasis (PAM) is a rare genetic disease characterized by calcifications within the alveoli in the lung. Mutations in SLC34A2 gene, which encodes a type IIb sodiumphosphate cotransporter, are responsible for PAM, leading to the intra-alveolar accumulation of phosphate which favors the formation of microliths. A "sandstorm" appearance is the typical radiographic presentation of PAM. The hallmark of this disorder is clinical-radiological dissociation, with typical imaging findings, specific pathological findings and closely correlated specific genetic mutations. The disease has an insidious onset, runs a chronic course and the prognosis is poor. There is no effective treatment except for lung transplantation. This article summarizes the epidemiology, molecular genetics and clinical features of pulmonary alveolar calculi.

A case report of pulmonary alveolar microlithiasis / 基础医学与临床

Objective To report a case of pulmonary alveolar microlithiasis ( PAM) in Peking Union Medical Col-lege Hospital and to summarize the clinical features and genetic characters .Methods The clinical features , ima-ging results , pathology findings and SLC34 A2 gene mutation was analyzed and reported .Results The patient was a 35 years old male, presenting with cough and sputum for 10 years and worsen with short of breath for 3 weeks. Computed tomography of lung and pathology findings support the diagnose of pulmonary alveolar microlithiasis .And a heterozygous mutation c .A910 T in exon 8 of SLE34 A2 gene was discovered through genetic testing .Conclusions Since to the treatment is non-specific in this rare disease , it's significantly important to recognize this disease through early non-specific clinical features but typical imaging findings .And the finding that c .A910 T is more common in Asia population may provide us a potential target for screening and possible genetic engineering therapy .

Advances in the studies of testicular microlithiasis / 中华男科学杂志

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.

Clinical characteristics of testicular microlithiasis in children / 中华实用儿科临床杂志

Objective To improve the understanding of the implications of testicular microlithiasis(TM)in paediatric patients by summarizing the clinical characteristics of TM. Methods One hundred and eighteen boys diag-nosed as TM based on ultrasound between March 2006 and December 2014 at Shengjing Hospital Affiliated to China Medical University were retrospectively reviewed. Demographic data,imaging data,indications for ultrasound,associated inguinoscrotal pathologies and follow - up data were collected. Results There were 118 cases of patients aged from 0. 25 to 14. 00 years(averaging 7. 98 years). The indication for ultrasound included health check(22 cases),testicular discomfort(28 cases),small testes(6 cases),scrotal mass(10 cases),with history of cryptorchidism(36 cases),with history of hydrocele(15 cases). Concomitant diseases included congenital anomaly of testis in 44 cases[cryptorchidism (34 cases),testicular absence(4 cases),testicular hypoplasia(6 cases)],hydrocele of tunica vaginalis or hernia(15 cases),testicular epididymitis(12 cases),varicocele(6 cases),epididymal cyst(5 cases),testicular teratomas(2 ca-ses),adrenal cortical hyperplasia(1 case),testicular torsion(1 case),and none associated disease(32 cases). Bilateral TM was in 87 cases(the typical TM in 38 cases,limited TM in 49 cases),while unilateral TM was in 31 cases(the typi-cal TM in 8 cases,limited TM in 23 cases). Fifty - three cases were followed up for 1 month to 36 months(averaging 12. 5 months),and the condition was stable,no testicular malignancy was observed during follow - up. Conclusions The TM in children is not a rare disease. The etiology of TM is not clear and there are no special clinical symptoms. TM is often associated with testicular abnormality in pediatric patients and the correlation between children′s TM and adult testicular tumor can not be determined yet. The distribution and involving degree of TM is stable in the short term with infrequent testiculoma,but an appropriate follow - up scheme is required,especially during and after puberty.

Treatment outcomes of endoscopic pancreatic sphincterotomy combined with pancreatic duct stent for acute recurrent pancreatitis caused by biliary microlithiasis / 中华消化内镜杂志

Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.

Treatment outcomes of endoscopic pancreatic sphincterotomy combined with pancreatic duct stent for acute recurrent pancreatitis caused by biliary microlithiasis / 中华消化内镜杂志

Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.

Pulmonary Alveolar Microlithiasis in an Elderly: A Case Report with Brief Review of Literature.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by presence of widespread intraalveolar accumulation of innumerable minute calculi called microliths. It is caused by inactivating mutations in the gene “solute carrier family 34 member 2”, encoding a sodium-dependent phosphate co-transporter (SLC34A2) expressed primarily in alveolar epithelial type II cells. It is most frequently diagnosed from birth to 40 years of age with a mean age of 27-30 years at the time of diagnosis. Most of patients are asymptomatic or having mild symptoms and are usually diagnosed incidentally. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM and histopathological confirmation is required only in few cases. This disease has slow progressive course ultimately leading to death by causing pulmonary fibrosis and cor pulmonale. Currently, there is no medical or gene therapy capable of reducing disease progression. Lung transplantation remains the only possible treatment for end-stage disease. Herein,we report a case of PAM in a 60-year-old gentleman who presented with a 5-year history of shortness of breath on exertion and intermittent cough with expectoration. His sister had similar respiratory symptoms and died 10 years back of which no details are available. The rarity of this disease and late age of presentation prompted us to report this case.

Pulmonary alveolar microlithiasis / Microlitiasis alveolar pulmonar

Pulmonary alveolar microlithiasis is an uncommon disease of unknown etiology, and is characterized by the presence of multiple sub-pleural and intra-alveolar microcalcifications. We present the case of a patient with rheumatoid arthritis and chronic renal disease, but with no respiratory symptoms.

La microlitiasis pulmonar alveolar es una enfermedad infrecuente, de etiología desconocida, caracterizada por la presencia de múltiples microcalcificaciones intraalveolares y subpleurales. Presentamos el caso de un paciente asintomático respiratorio, con historia clínica de artritis reumatoide y enfermedad renal crónica.

Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? / Podem os achados na tomografia computadorizada de alta resolução do tórax ser diagnósticos de microlitíase alveolar pulmonar?

AbstractObjective:The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma.Materials and Methods:Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed.Results:Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%).Conclusion:As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.

ResumoObjetivo:Analisar, retrospectivamente, as tomografias computadorizadas de alta resolução (TCAR) de pacientes com microlitíase alveolar pulmonar, a fim de avaliar a frequência dos padrões tomográficos e sua distribuição no parênquima pulmonar.Materiais e Métodos:O estudo incluiu 13 pacientes (9 femininos e 4 masculinos) com idades variando de 9 a 59 anos (média de 34,5 anos). Os exames foram avaliados por dois observadores, de modo independente, e os casos discordantes, resolvidos por consenso. O critério de inclusão foi a presença de anormalidades na TCAR típicas de microlitíase alveolar pulmonar, o que prescinde a necessidade de exame histopatológico. Entretanto, em 6 casos foram realizadas biópsias pulmonares.Resultados:Os achados tomográficos predominantes foram opacidades em vidro fosco e pequenos nódulos parenquimatosos, presentes em 100% dos casos, seguidos de pequenos nódulos subpleurais (92,3%), cistos subpleurais (84,6%), calcificações lineares subpleurais (69,2%), padrão de pavimentação em mosaico (69,2%), fissura nodular (53,8%), calcificação ao longo dos septos interlobulares (46,2%) e consolidações densas (46,2%).Conclusão:Quanto à distribuição dos achados, houve acometimento preferencial dos terços inferiores. Não foi observado predomínio de distribuição dos sentidos axial e anteroposterior.

Análise quantitativa da ecogenicidade testicular pela técnica do histograma de ovinos da baixada ocidental maranhense / Quantitative analysis of testicular echogenicity by technical histogram in sheep of the western lowland region of Maranhão, Brazil

A ultrassonografia é um método de diagnóstico por imagem que permite a avaliação de diferentes órgãos e estruturas corpóreas de maneira não invasiva. No entanto, a avaliação subjetiva das imagens caracteriza um dos grandes entraves na utilização desta técnica de diagnóstico, havendo necessidade de mecanismos que minimizem a subjetividade do exame e a divergência na interpretação dos achados ultrassonográficos. Desta forma este trabalho objetivou caracterizar a ecogenicidade do parênquima e mediastino testicular de ovinos utilizando a técnica do histograma escala-cinza. Foram utilizados 30 animais divididos em três grupos de acordo com a faixa etária (FE): de três a seis meses (FE1), sete a 12 meses (FE2), 13 a 18 meses (FE3) e realizadas varreduras testiculares nos planos frontal, sagital e transversal, elaborando ao final um histograma a partir das imagens ultrassonográficas. Observou-se que tanto a ecogenicidade do parênquima quanto a do mediastino testicular aumentaram gradativamente com a progressão das idades dos animais, com média e desvio-padrão de 95,00±19,05 e 94,35±18,82 para a ecogenicidade do parênquima do antímero direito e esquerdo, respectivamente, e 127,95±12,97 para o mediastino direito e 126,59±11,78 para o esquerdo. A técnica do histograma escala-cinza demonstrou ser um método eficiente na determinação da ecogenicidade testicular, possibilitando o estabelecimento de padrões de normalidade que venham a auxiliar pesquisas futuras no monitoramento do desenvolvimento testicular bem como na detecção de patologias. Para a regimes exclusivos de criação extensiva, como na baixada maranhense, representa ferramenta valiosa para sua utilização em projetos sociais do Estado que atendem a agricultura familiar.

Ultrasound is a diagnostic imaging method that allows a no invasive evaluation of different organs and body structures. However, the personal evaluation of images is one of the major hampers in using this technique. In order to reduce this drawback, it is necessary to find out tools that can help diminish the divergence in the interpretation of sonographic findings. Therefore, this study aimed to identify features of the parenchyma's and mediastinum's testis of sheep echogenicity using the technique of gray scale histogram. 30 animals were divided into three groups according to age (FE): three to six months (FE1), seven to 12 months (FE2), 13 to 18 months (FE3). The testicular scans were performed in the frontal, sagital and transverse views, and the gray scale histograms were analyzed. It was observed that such parenchymal as the mediastinum testis echogenicity gradually increased with the aging of the animals, with mean and standard deviation of 95.00±19.05 and 94.35±18.82 for the echogenicity parenchyma of the right and left antimere, respectively, and 127.95±12.97 to 126.59±11.78, for the right and the left mediastinum. The technique of gray scale histogram was an efficient method for determination of testicular echogenicity, enabling the establishment of normal standards that may assist future research in monitoring testicular development as well as for detecting pathologies. For exclusive regimes of extensive farming, as the western lowland region of Maranhão, is a valuable tool for use in social projects of the State to attend the family farm.

Changes of calcific density in pediatric patients with testicular microlithiasis

PURPOSE: Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. MATERIALS AND METHODS: We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. RESULTS: The mean age at diagnosis was 11.3+/-4.6 years, and the follow-up period was 79.1+/-38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%+/-6.0% vs. 3.06%+/-4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. CONCLUSIONS: Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.

Microlitiasis alveolar pulmonar: caso clínico / Pulmonary alveolar microlithiasis: Report of one case

Pulmonary alveolar microlithiasis is an extremely rare disease characterized by intra-alveolar accumulation of calcified spherical particles (called microliths), due to a mutation of the gene encoding a membrane transport protein of the alveolar surface. Most patients are asymptomatic at diagnosis. The course of the disease is slowly progressive, with development of pulmonary fibrosis and respiratory failure. The "sandstorm" pattern is the characteristic finding of this disease. We report a 39-year-old female presenting with progressive dyspnea. A chest X ray showed ground-glass opacities and a high resolution CT scan showed numerous calcified lung micronodules. A surgical lung biopsy confirmed the diagnosis of pulmonary alveolar microlithiasis.

Testis tumor associated to microlithiasis / Tumor de testiculo asociado a la microlitiasis / Tumor de testiculo associado a microlitiase

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .

OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .

OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .

Pulmonary Alveolar Microlithiasis: A Clinicoradiological Dissociation.

Pulmonary alveolar microlithiasis (PAM) is a rare and slowly progressive disease characterized by widespread calcification within the alveoli with a paucity of symptoms in contrast to radiologic findings. We report here a case of pulmonary alveolar microlithiasis who presented to us with minimal chest complaints following chest trauma despite extensive imaging findings.