RESUMEN
OBJECTIVE: To study clinical and morphological characteristics of primary gall stones in the common bile duct in order to establish a differential diagnosis with migrating stones. DESIGN: To analyze a number of clinical parameters (age, parity, evolution, number of stones and diameter), qualitative parameters (sex, obesity, cholecystitis, cholangitis, liver disease or previous biliary surgery) and statistic evaluation. To show composition of stones throw stereomicroscope, electronic microscope and dispersion analysis by X-Ray. PATIENTS: We studied 56 patients who were diagnosed and operated of choledocholithiasis. RESULTS: 21 cases (37.5%) were considered as primary stones (group "a") and 35 (62.5%) were considered as migrating stones (group "b"). We have found significant statistical differences in relationship with the age of patients (p < 0.05) and diameter of stones (p < 0.01). They were both greater in primary stones, while the rest of parameters were not significant. Brown pigment stones dominate in primary stones followed by calcium palmitate and cholesterol stones. We identified bacteria or their traces (38.1%), foreign bodies (19.04%), carbonate of calcium (38.1%) and phosphate of calcium (9.5%). CONCLUSIONS: They are clinical and morphological characteristics which may differentiate between primary and migrating common duct stones. The high incidence of germs or foreign bodies found in the core layer of stones show their importance in the formation of brown pigment.
Asunto(s)
Cálculos Biliares/etiología , Cálculos Biliares/patología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The order and composition of the various elements that are present in the cholesterol stones has been analyzed and a useful model that should help in the study of already formed stones is proposed and therefore a better understanding of the lithogenesis and the physiopathological conditions in which stones develop. The existing components are described from the core up to the crust, case emphasizing the heterogeneity of the core, the calcium palmitate around it and the cholesterol disposition. The various forms of presentation of calcium carbonate are defined as well as the different types of ooliths.
Asunto(s)
Colelitiasis/química , Colelitiasis/ultraestructura , Cristalografía , Microanálisis por Sonda Electrónica , Humanos , Microscopía Electrónica de Rastreo , Microscopía de Polarización , Difracción de Rayos XRESUMEN
CaCO3 has been studied in twelve gallstones in which cholesterol predominated. Different polymorphs of CaCO3, as well as carbonate-apatite, were characterised by X-ray diffraction, polarised light microscopy and scanning electron microscopy. Crystals and rhombohedral aggregates of calcite, aggregates of small crystals and tabular crystals of vaterite and fibrous radial aggregates in the form of ooliths were found. In microscopic studies on sections of the stones, CaCO3 was localised mainly in the periphery in the form of layers or bands associated with calcium bilirubinate which was deposited in close relation to it. The phenomena contributing to the precipitation of CaCO3 are discussed, as is the importance of the latter in resistance to the pharmacologic treatment of gallstone disease.
Asunto(s)
Carbonato de Calcio/análisis , Colelitiasis/análisis , Colesterol/análisis , Adulto , Anciano , Femenino , Humanos , Masculino , Microscopía Electrónica , Microscopía de Polarización , Persona de Mediana Edad , Difracción de Rayos XRESUMEN
Perforation of the esophagus is a very serious condition which is nearly always fatal, unless it can be diagnosed and treated at the earliest possible moment. Ten thousand case histories in a Department of Internal Medicine and a Department of Surgery were reviewed, among which 12 cases of esophageal perforation were found. The overall mortality in this series was 59 percent; the mortality of the surgically treated group was 39 percent. Four of the five patients operated on within the first 24 hours survived. The prognosis was poor when the lower third of the esophagus was ruptured. Esophageal perforations are becoming increasingly more frequent because of the widespread practice of endoscopy. The clinical symptoms of the condition include subcutaneous emphysema, retrosternal pain and dispnea. X-rays often show air or fluid in the mediastinum, air and fluid in the pleural space, and evidence of rupture when opaque contrast material is employed. These signs should usually by sufficient for an early diagnosis. Surgery is the treatment of choice.