Effects of Weissella cibaria CMU on Halitosis and Calculus, Plaque, and Gingivitis Indices in Beagles.

Weissella (W.) cibaria strain Chonnam Medical University (CMU) has shown oral colonizing ability and inhibitory effects on the formation of volatile sulfur compounds (VSCs) in vitro studies. The present study was conducted to analyze the effects of the W. cibaria CMU on canine oral health. Halitosis, calculus, plaque, gingivitis, and intraoral microbiota were assessed in 3 groups: control (maltodextrin), W. cibaria CMU low concentration (CMU-L, 2 × 107 colony forming unit [CFU]), and high-concentration (CMU-H, 2 × 109 CFU). Halitosis was analyzed using both organoleptic evaluation and measurement of VSCs. Intraoral microbiota were analyzed by real-time polymerase chain reaction. From week 4, the total VSC level in the CMU-H group (4.0 ± 1.30 ng/10 mL) was significantly lower than in the control group (6.3 ± 2.28 ng/10 mL). Significant reduction in methyl mercaptan in the CMU-treated groups was also observed. In addition, the plaque index in the CMU-treated groups was significantly decreased. The CMU-treated groups showed significant decreases in Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia and demonstrated the colonizing ability of W. cibaria CMU in the oral cavity. We demonstrated that W. cibaria CMU suppresses halitosis, colonizes the oral cavity, and inhibits the proliferation of malodor-causing oral bacteria in beagles. According to these results, we expect that W. cibaria CMU could be a new oral hygiene solution by reducing VSC production and inhibiting the growth of oral harmful bacteria in companion animals.

Management and Histobacteriological Findings of Mucosal Fenestration: A Report of 2 Cases.

This article describes 2 unusual cases of mucosal fenestration associated with necrotic infected teeth, resulting in exposure of the root apex to the oral cavity. Both cases consisted of maxillary incisors with pulp necrosis and radiographic/tomographic evidence of apical periodontitis. Clinically, the root apex was exposed to the oral cavity through a fenestration in both bone and mucosa and covered with bacterial plaque and calculus. These teeth were treated by a combination of nonsurgical and surgical endodontic treatment. During surgery, the root apices were resected to within the alveolus and the fenestrated area covered by the flap. Specimens consisting of the root apex and surrounding soft tissues were subjected to histopathological and histobacteriological analyses. Histobacteriological analysis revealed extensive resorptive defects on the root apices filled with thick bacterial biofilm, irregular detachment of the cementum layers with consequent infection of the underlying spaces, and heavy infection in the apical foramina. The soft tissue specimens exhibited no or minimal inflammation. The 2 cases showed satisfactory postsurgical healing of the hard and soft tissues. Both cases of mucosal fenestration showed root apices covered with dense bacterial biofilms and associated with a bone crypt with no significant inflammatory tissue therein. The 2 cases were successfully treated by conservative approaches involving a combination of nonsurgical and surgical endodontic treatment with root-end resection.

Vertical canaliculotomy with retrograde expression of concretions for the treatment of canaliculitis.

PURPOSE: To evaluate the efficacy and safety of the technique of vertical canaliculotomy with retrograde expression of concretions for the treatment of canaliculitis. METHODS: This is a retrospective, interventional case series. Patients who underwent vertical canaliculotomy by 1 surgeon (D.R.M.) from August 2011 to December 2013 were identified. On initial diagnosis of canaliculitis, all patients were treated with a combination antibiotic/steroid eyedrop and an oral antibiotic. The procedure was performed 1 month later and consisted of a 2-mm vertical canaliculotomy with sharp-tipped scissors followed by retrograde expression of the canalicular contents by compressing the canaliculus medial to lateral with 2 cotton-tipped applicators. All concretion specimens were sent for pathologic examination. Pre- and postoperative subjective complaints and objective findings on examination, including eyelid thickening and probing/irrigation results, were recorded. RESULTS: Canalicular contents were readily expressed from all 8 patients who underwent the procedure. Pathologic analysis revealed Actinomyces species in 5 of 8 specimens and other Gram-negative and Gram-positive bacteria in the remaining specimens. All patients reported significant improvement in their symptoms and were patent to irrigation. CONCLUSIONS: Many reported surgical procedures for the treatment of canaliculitis involve the use of a curette, an instrument with sharp edges, that could potentially damage the lining of the canaliculus. Previous studies examining these procedures have reported canalicular stricture and dysfunction postoperatively. The current technique of vertical canaliculotomy with retrograde expression of canalicular contents described herein has been effective, limits iatrogenic trauma, and had a low incidence of postoperative complications in this series.

Timing of intra-lesion shaving for surgical treatment of chronic tophus.

OBJECTIVES: Gouty arthritis results from the deposition of monosodium urate crystals in synovial spaces. The literature shows that a tophus may require surgical treatment to improve cosmesis or function, to alleviate pain, to eradicate sinus drainage or to remove large urate deposits. However, forceful curettage to remove tophus particles embedded in the thin attenuated skin flap may compromise blood circulation and cause other complications. This series presents the experience of the authors in performing intra-lesion shaving during the surgical treatment of tophus patients. METHODS: This study analysed 147 surgical procedures performed in 108 patients with chronic tophus at a single hospital during November 2000 to July 2010. All patients underwent a soft-tissue shaver-assisted intra-lesion excavating technique developed by the authors. Bimanual palpation of the skin was performed to avoid trauma to the skin envelope. The shaving technique proved to be a simple and efficient method of reducing the total urate burden in the body. RESULTS: Compared to conventional surgical treatment, the shaver technique is a safer and more effective option for treating tophus lesions. In this series, wound cultures were positive in 18.4% of operations. Patients with positive wound cultures and chronic renal impairment had significantly longer hospital stays compared to patients with negative wound cultures and patients without chronic renal impairment (P=0.0019 and P=0.0045, respectively); patients with C-reactive protein (CRP)<5 mg l(-1) and white blood cell (WBC) count<10,000 µl(-1) had significantly shorter hospital stays compared to patients with CRP>5 mg l(-1) and WBC>10,000 µl(-1) (P=0.0002 and 0.006, respectively). The upper extremities group and the upper-lower extremities group had significantly shorter hospital stays compared to the lower extremities group (P=0.001 and P=0.0014, respectively). CONCLUSIONS: Medical treatment to control hyperuricaemia is important for reducing the risk of an acute attack of tophus formation. However, the data in this series show that surgery should be performed before the skin becomes ulcerated and before the tophus mass becomes infected. The proposed shaver technique markedly reduces tophus of the extremities with minimal surgical complications.

Prostatic stones: evidence of a specific chemistry related to infection and presence of bacterial imprints.

Prostatic stones are a common condition in older men in industrialized countries. However, aging appears not to be the unique pathogenesis of these calcifications. Our morpho-constitutional investigation of 23 stone samples suggested that infection has a significant role in the lithogenic process of prostate calcifications, even without detection of infection by clinical investigation. Most stones (83%) showed bacterial imprints and/or chemical composition, suggestive of a long-term infection process. Chronic infection may induce persistent inflammation of the tissue and secondarily, a cancerization process within a few years. Thus, the discovery of prostate calcifications by computerized tomodensitometry, for example, might warrant further investigation and management to search for chronic infection of the prostate gland.

Bacterial and mucopeptide concretions of the lacrimal drainage system: an analysis of 30 cases.

PURPOSE: To demonstrate the histopathologic characteristics of different types of lacrimal drainage system concretions with clinical correlations. METHODS: Thirty lacrimal drainage system concretions submitted to the Cogan Eye Pathology Laboratory at the Massachusetts Eye and Ear Infirmary over a 2-year period were reviewed. Concretions were studied in detail using their histopathologic staining features as revealed with hematoxylin and eosin, Gomori methenamine silver, periodic acid-Schiff, iron stain, and Brown-Hopps tissue gram stain. A separate retrospective chart review was conducted for each patient to identify any clinical correlations. RESULTS: Two major forms of concretions were identified histopathologically: mucopeptide (7) and bacterial (20). Mucopeptide concretions were found exclusively within the lacrimal sac, while bacterial concretions were found chiefly in the canaliculus. A third category of "mixed" concretions with substantial mucopeptide and bacterial characteristics comprised 3 specimens. Bacterial concretions consisted of large matted masses of filamentous, presumed Actinomyces organisms that were easily identified with the Grocott's methenamine silver stain; they were frequently cocolonized at their edges with coccal bacterial forms. Mucopeptide concretions were generally devoid of cellular elements and were composed of broad bland whorls of diffusely eosinophilic, acellular, periodic acid-Schiff-positive material punctuated by lacunae. They were often cocolonized by small numbers of bacterial cocci and occasional fungi. Culture results disclosed low virulence species. All 3 types of concretions predominated in women. Patients with bacterial concretions frequently had dry eye symptoms. CONCLUSIONS: The 2 major types of lacrimal system concretions differ in their primary location and histopathologic composition. Further characterization may lead to an understanding of the mechanisms for their formation. Mucopeptide concretion is more appropriate than terms such as "dacryolith" and "mucolith," and bacterial concretion is a more appropriate term than "canaliculith," because of the absence of significant calcium or stone-like density in these masses.

Tonsillolith: not just a stone but a living biofilm.

OBJECTIVE: To study the morphology and activity of tonsilloliths, demonstrating oxygen respiration, denitrification, and acidification on exposure to sucrose. STUDY DESIGN: Tonsilloliths were extracted in atraumatic conditions during tonsillectomy from 16 adults and sent to two different laboratories for histological, bacteriological, and biofilm studies under sterile conditions. SETTING: Multicenter laboratory study. SUBJECTS AND METHODS: Multiple tonsilloliths from two patients examined by confocal microscopy and microelectrodes were used to measure aerobic/anaerobic respiration and acid production (dissolved oxygen, nitrous oxide, pH) when exposed to saliva following addition of sucrose and fluoride. RESULTS: Morphologically, tonsilloliths were similar to dental biofilms, containing corncob structures, filaments, and cocci. Microelectrodes showed that the microorganisms respired oxygen and nitrate. The oxygen concentration in the center of the tonsillolith was depleted to approximately one-tenth of that of the overlying fluid. The addition of sucrose resulted in acid production within the tonsillolith, dropping the pH from 7.3 to 5.8. The data showed stratification with oxygen respiration at the outer layer of tonsillolith, denitrification toward the middle, and acidification toward the bottom. The depletion of oxygen and acid production following addition of sucrose may allow the proliferation of anaerobic/acidophilic bacteria. Fluoride suppressed acid production in the presence of sucrose. CONCLUSIONS: Tonsilloliths exhibit biofilm structure and the formation of chemical gradients through physiological activity. Although tonsillectomy is an option for treating cryptic infections, understanding the morphology and biofilm characteristics of tonsilloliths may stimulate scientists to use limited or targeted remedies in the future.

Broncholith removal using cryotherapy during flexible bronchoscopy: a case report.

Pulmonary broncholithiasis can cause a management dilemma depending on its location and the possible involvement of vascular structures. Many patients undergo rigid bronchoscopy or surgical interventions for the removal of broncholiths. In this case report, we describe a 38-year-old white man with a history of performing warehouse demolitions who presented with chronic cough, dyspnea on exertion, and recurrent pneumonia. Imaging studies revealed hilar and mediastinal calcifications, as well as a calcification in the right middle lobe bronchus. Flexible bronchoscopy revealed a mobile obstructing calcified mass in the right middle lobe bronchus. Attempts at removing the mass with forceps were unsuccessful. Instead, the mass was removed using cryotherapy with minimal bleeding and complete resolution of the obstruction. Pathologic examination confirmed that the mass was a broncholith, and stains revealed the presence of histoplasma fungal forms. Partially attached broncholiths can be removed safely using flexible bronchoscopy with the aid of cryotherapy.

Calcium stone lithoptysis in primary ciliary dyskinesia.

BACKGROUND: An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association. METHODS: We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age > or = 40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis. RESULTS: In total, 142 patients (n=28 age > or = 40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age > or = 40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures. CONCLUSION: There is an association between lithoptysis and PCD in patients age > or = 40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients.

Composition of the bacterial flora in tonsilloliths.

Tonsilloliths are a potential cause of oral malodor. In this study, microbial profiles and composition of tonsilloliths were determined using culture-independent molecular methods and scanning electron microscopy. 16S ribosomal RNA bacterial genes (16S rDNAs) isolated from tonsilloliths of 6 individuals were amplified by PCR and cloned into Escherichia coli. Partial 16S rDNA sequences of approximately 600 bases of cloned inserts were used to determine species identity by comparison with sequences of known species. Characteristics of bacteria on the surface and inside the tonsillolith were analyzed using scanning electron microscopy. Anaerobic bacteria detected in tonsilloliths belonged to the genera Eubacterium, Fusobacterium, Megasphaera, Porphyromonas, Prevotella, Selenomonas and Tannerella, all of which appear to be associated with production of volatile sulfur compounds. Electron microscopy revealed cocci and rods on the surface and rods predominating inside the tonsilloliths. These results support the tonsillolith as an origin of oral malodor.

Microorganisms and calcium oxalate stone disease.

Microorganisms may have a role in the pathogenesis and prevention of kidney stones. The subjects of this review include nanobacteria, Oxalobacter formigenes, and lactic acid bacteria. Not reviewed here is the well-described role of infections of the urinary tract with Proteus species and other urease-producing organisms associated with struvite stone formation. Nanobacteria have been proposed to be very small (0.08-0.5 nm), ubiquitous organisms that could play a role in stone formation. The theory is that nanobacteria can nucleate carbonate apatite on their surfaces and thereby provide the nidus for stone formation. However, their existence remains uncertain and many investigators are openly skeptical. Recent investigations suggest that they are artifacts, and not actually living organisms, but their proponents continue to study them. O. formigenes is an obligate anaerobe which may be important in the prevention of stone formation. Its sole substrate for generation of ATP is oxalate. It may thereby metabolize its human host's dietary oxalate and diminish intestinal absorption and subsequent urinary excretion of oxalate. There is evidence that the organism's absence, perhaps sometimes due to courses of antibiotics, may be a cause of hyperoxaluria and stone formation. In early investigations, patients not colonized with the organism can be recolonized. Urinary oxalate can be diminished by accompanying an oxalate-containing meal with the organism. One study demonstrated that a preparation of lactic acid bacteria successfully reduced urinary oxalate excretion in 6 patients with calcium oxalate stones and hyperoxaluria. The mechanism of this effect is uncertain since these bacteria lacked the gene possessed by O. formigenes which codes for that organism's oxalate uptake mechanism. The author is currently completing a small randomized controlled clinical trial with this preparation in calcium stone-forming patients with idiopathic hyperoxaluria.

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.

Electron microscopic detection of tin accumulation in biliopancreatic concrements after induction of chronic pancreatitis in rats by di-n-butyltin dichloride.

The organotin compound di-n-butyltin dichloride (DBTC) is able to induce an acute and later a chronic pancreatitis in rats. In previous papers the authors demonstrated this DBTC pancreatitis as a rat model for an interstitial pancreatitis with tendency to transduction to the chronic form. DBTC is excreted according to its lipophilic nature by liver and bile. Therefore, the bilio-pancreatic main duct is necrotized by the tin-loaded bile. The duct system is blocked by cell debris and later by epithelial proliferations. In the chronic phase, numerous rats develop concrements in the main duct. In the present paper, the authors report about bacterial growth in some bilio-pancreatic concrements. Whereas the electron microscopic detection of tin by energy-dispersive X-ray analysis (EDX) in SEM or electron energy loss spectroscopy (EELS) in TEM was negative in the parenchyma of pancreas and liver, some concrements with bacterial cells were positive for this element. Tin mapping with energy spectroscopic imaging (ESI) in TEM demonstrated the congruency of tin signals and electron-dense particles inside these bacteria and of electron-dense accumulations in the matrix of these concrements. The low content of tin in pancreatic and liver tissue and the higher quantity of tin inside the bacterial contaminated concrements were supported by atomic absorption spectrophotometry (AAS). The paper discusses the long time preservation of tin in the concrements as an action of heavy-metal- accumulating bacteria, which should be classified in the future by bacteriological methods.

Serum-soluble interleukin-2 receptor in patients with hepatolithiasis: a preliminary report.

BACKGROUND/AIMS: Hepatolithiasis is prevalent in Southeast Asia and remains a difficult problem to manage. Recent studies in immunology have provided evidence for the provocative roles of cytokines in many diseases. This study was designed to explore the possible relationship between the serum-soluble interleukin-2 receptor and the pathogenesis of hepatolithiasis. METHODOLOGY: In this pilot study, 34 patients with hepatolithiasis were included. All of the patients met the following criteria: (1) presence of hepatolithiasis; (2) no obvious clinical evidence of associated intrahepatic cholangiocarcinoma; (3) no clinical manifestation of cholangitis for at least 72 hours; (4) no intake of immunomodulatory agents in the previous 3 weeks; and (5) no blood transfusions in the previous 3 weeks. Venous blood samples were collected before surgery, and the concentrations of serum soluble interleukin-2 receptor were measured with an enzyme immunoassay method. Fifteen healthy subjects were used as the control group. Bile specimens routinely obtained during surgery were cultured for aerobes and anaerobes. The cholangiography films were reviewed in detail. RESULTS: The mean value of soluble interleukin-2 receptor in patients with hepatolithiasis was 706 +/- 294 units/ml, and that of the control group was 326 +/- 62 units/ml. The difference was significant (p < 0.01). Bacteria were present in the bile of all patients. The total number of bacterial species in the 34 patients was 119, and there was an average of 3.5 bacterial species cultured per patient. Intrahepatic bile duct strictures were present in 30 patients (88%). CONCLUSIONS: In addition to a high incidence of intrahepatic bile duct strictures and bacterial infection of the bile, significantly high levels of the serum soluble interleukin-2 receptor were also found in the patients with hepatolithiasis. The preliminary results in the present study seem to be promising, and the specific role of the soluble interleukin-2 receptor in patients with hepatolithiasis deserves further investigation and elucidation.

[Broncholithiasis secondary to active Mycobacterium avium infection]. / Broncolitiasis secundaria a infección activa por Mycobacterium avium.

The case of a 65-years-old woman with non-productive cough persisting for one year is described. The X-ray showed lower right paratracheal calcification. The diagnosis of broncholithiasis was made by fiberoptic bronchoscopy, and Mycobacterium avium was isolated after analysis of the specimen collected by bronchial biopsy. We discuss the characteristics of the case, emphasizing the association of broncholithiasis and non-tubercular mycobacterial infection. The literature is reviewed.

Circulating intercellular adhesion molecule-1 (ICAM-1) in patients with hepatolithiasis.

We evaluated the role of circulating intercellular adhesion molecule-1 in the pathogenesis of hepatolithiasis. From December 1994 to May 1995, 40 patients with hepatolithiasis were included. All the patients met the following criteria: (1) presence of hepatolithiasis, (2) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma, (3) no clinical manifestation of cholangitis for at least 72 hr, (4) no immunomodulatory agents in the last three weeks, and (5) no blood transfusion in the last three weeks. Venous blood samples were collected both before surgery and at least three months after complete clearance of the stones, and the serum concentrations of circulating intercellular adhesion molecule-1 were measured with a sandwich enzyme immunoassay method. Fifteen healthy subjects were used as a control group. Bile specimens routinely obtained during surgery were cultured for aerobes and anaerobes. The x-ray films of cholangiography were all reviewed in detail. The mean value (834 +/- 128 ng/ml) of circulating intercellular adhesion molecule-1 (ICAM-1) in the patient group before surgery was significantly higher than that (346 +/- 68 ng/ml) of the control group (P < 0.01). The mean value (677 +/- 139 ng/ml) of circulating ICAM-1 in the patient group at least three months after complete clearance of the stones was significantly lower than that (834 +/- 128 ng/ml) of the patients before surgery (P < 0.01), but this mean value (677 +/- 139 ng/ml) was still significantly higher than that (346 +/- 68 ng/ml) of the control group (P < 0.01). Bacteria was present in the bile of all patients. The total number of bacterial species was 135, and there were an average of 3.4 bacterial species cultured per patient. Intrahepatic stricture was demonstrated in cholangiography in 33 patients (82.5%). In addition to the high incidence of intrahepatic bile duct strictures and bile infection, a significant elevation in circulating intercellular adhesion molecule-1 (sICAM-1) was shown in patients with hepatolithiasis. Our preliminary results seem to be promising and the real role of sICAM-1 deserves further investigation and elucidation.

[Aeromonas hydrophila dacryocystitis. Case report]. / Aeromonas hydrophila-Dakryozystitis. Fallbericht.

The present paper reports on a case of severe dacryocystitis with a dacryolith, caused by Aeromonas hydrophila. On the basis of this case the authors show that a therapy effective in vitro does not lead to elimination of bacteria in all cases, so that further therapeutic considerations are necessary.