Dissolution versus surgical treatment of nephrolithiasis.
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Humans↗
Biomedical subjects
W H Boyce
Publications and source records attributed to W H Boyce.
Heterozygous cystinuria and calcium oxalate urolithiasis.
Many variables are known to be associated with the formation of calcium oxalate urolithiasis but none is essential for the initiation or growth of stones. It is likely that the predisposition to stone formation is related to multiple factors. We herein describe still another metabolic state that seems to predispose to calcium oxalate stone disease, namely heterozygosity for cystinuria. Cystine screening tests were done on 24-hour urine specimens obtained from 126 patients in whom recurrent calcium oxalate stones form and 84 controls and quantitative amino acid determinations were done on all positive specimens. Of those studied 17 of 126 stone patients and 1 of 84 controls were heterozygous cystinurics. A test of the differences between the relative frequencies of cystinuria heterozygotes in the 2 groups with Fisher's exact test revealed them to be highly significant (p less than 0.001). Our study indicates that carrier status for 1 of the cystinuria genes predisposes to calcium oxalate stone formation but, like other factors related to urolithiasis, it is not a necessary cause of stone disease.
Adolescent↗
Childhood urolithiasis.
Between 1965 and 1976, 54 children with urolithiasis were evaluated and treated. Age, sex, race distribution, patient symptomatology, stone localization and type are outlined. The relationship of stone formation to urinary infection and/or genitourinary anomalies is reviewed, and treatment and recurrence patterns are studied.
Adolescent↗
Biochemical profiles of stone-forming patients: a guide to treatment.
A formal protocol, controlled metabolic evaluation is essential to the most effective treatment of any patient with renal calculi, regardless of the crystalline composition of the stone. The design of the protocol and of the data sheets should be compatible with ease of diagnosis and selection of corrective therapeutic measures. These data also serve as a reference to monitor response to treatment. Treatment is highly individualized with the objective to reduce all potentially crystallizable ions to basal levels. If this is difficult to accomplish certain ratios of ions are brought to as near normal values as possible.
Adult↗
Results of urinary diversion in patients with myelomeningocele.
Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients. Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.
Adolescent↗
Low molecular weight urinary proteins and renal lithiasis.
Twenty-four hour urine specimens were obtained from 20 active calcium oxalate stone formers, 20 inactive calcium oxalate stone formers, 8 struvite stone formers, and 9 non-stone forming controls. Proteins with molecular weights less than 50,000 daltons were concentrated by ultrafiltration and separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Fourteen of the 17 active calcium oxalate stone formers had low molecular weight urinary proteins (less than 35,000 daltons) present in their urine whereas none of the inactive stone formers or struvite stone formers had similar patterns. Only one of the nine control patients had similar proteins present.
Calcium↗
Management of the papillae during intrarenal surgery.
The papillae are involved in renal disease and, hence, are an inextricable consideration in intrarenal surgical procedures. Guide lines for their management are newly emergent and, consequently, tentative. If divided along intra-arterial planes they appear to heal with little functional impairment. Resections of papillae, which are limited to the intracaliceal portions, involve no medullary structures and heal without apparent dysfunction.
Animals↗
Ultrasonic evaluation of the prostatic nodule.
Prostatic nodules detected on rectal examination of 50 patients were evaluated by the usual means and by prostatic ultrasonic scanning. Nodules were characterized as being either malignant, benign, inflammatory or stones. Those patients without evidence of calcification on radiography underwent prostatic biopsy and the histological findings were compared to the ultrasonic study. All histologically confirmed malignancies were diagnosed preoperatively and there were no instances of falsely negative ultrasonic studies.
Adult↗
Anatrophic nephrolithotomy in the solitary kidney.
A retrospective analysis was conducted on 30 patients who had undergone anatrophic nephrolithotomy for staghorn calculus disease in a solitary kidney. No statistically significant difference (p greater than 0.1) was found between the average preoperative and postoperative renal function values. Of 27 patients who were infected preoperatively 19 were rendered free of further urinary tract infection and 24 of 30 patients (80 per cent) had no further recurrence of renal calculi. Because of the predictable morbidity and mortality associated with the non-operative management of staghorn calculus disease these patients are managed best by the complete surgical removal of all calculi and intensive antimicrobial therapy.
Adult↗
The use of the ureteric stent.
The use and placement of ureteric stents either endoscopically or as part of an open procedure are outlined. The ureteric stent can replace the pyelostomy or nephrostomy tube and significantly reduce the postoperative morbidity.
Child↗
Human renal neuraminidase.
An assay technique for determination of renal neuraminidase (sialidase) activity is described. Consistent and reproducible results were obtained in studies of rat renal tissue. Neuraminidase activity was detected in all human renal specimens studied; however the degree of activity was not related to the presence of renal calculi or infection.
Animals↗
Spherical calcium bodies in stone-forming urine.
Twenty-four hour urine specimens from 26 active stone formers and 15 non-stone formers were passed through an ultrafilter that retained all molecules with a molecular weight greater than 50,000. Microscopic spherical bodies that laked alizarin red were observed in the urinary ultrafiltrate from 24 of 26 active stone formers. Only three of 15 non-stone-forming control urines contained these bodies. Histochemical studies showed the presence of calcium, phosphorus, and carbohydrate-protein complexes. No crystalline elements were detected.
Calcium↗
Biochemical profiles of stone-forming patients: a guide to treatment.
A formal protocol, controlled metabolic evaluation is essential to the most effective treatment of any patient with renal calculi, regardless of the crystalline composition of the stone. The design of the protocol and of the data sheets should be compatible with ease of diagnosis and selection of corrective therapeutic measures. These data also serve as a reference to monitor response to treatment. Treatment is highly individualized with the objective to reduce all potentially crystallizable ions to basal levels. If this is difficult to accomplish certain ratios of ions are brought to as near normal values as possible.
Adult↗
The localization of intrarenal calculi during surgery.
This is a summary review of past and present technology for accurate anatomical localization of calculi within the surgically exposed kidney. The methodology is applicable to reconstructive renal surgery for pathological processes other than calculi.
Fluoroscopy↗
Adjuvant antimicrobial therapy with renal calculus surgery.
A randomized prospective study was done, comparing massive penicillin dosage (60 million units) to the recommended dose of ticarcillin (200 mg. per kg.) in the treatment of complicated urinary tract infections. A total of 50 patients with staghorn or multiple calculi who underwent anatrophic nephrolithotomy was entered into the study during a period of 14 months. Bacteriologic results were comparable. No significant toxicity from either massive penicillin or ticarcillin was observed.
Adult↗
Radical prostatectomy: palliation for stage C carcinoma of the prostate.
An objective comparison is made of patients with stage C carcinoma of the prostate treated with radical prostatectomy versus more conservative measures. Morbidity from local manifestations of the tumor left in situ was markedly increased, whereas those patients afforded an extirpative operation had a much improved quality of life.
Aged↗
Cyclic adenosine monophosphate: relationship to calcium metabolism and renal lithiasis.
Recent concepts in calcium metabolism are being applied to the renal stone-forming patient. As our understanding of physiological mechanisms improves urinary cyclic nucleotide determinations are becoming useful in applied patient care. The changes in urinary cyclic adenosine monophosphate excretion as related to the different forms of hypercalciuria are reviewed.
Adenylyl Cyclases↗
Observations on the ultrastructure and genesis of urinary calculi.
Conventional and scanning electron microscopy of calcigerous renal calculi discloses typical concentric laminations, radial striations and microspherules. Random axial distribution of oxalate crystals and their coating by electron-dense matrix fibers with a definite parallel orientation and cross-linkages are evident. The biochemical relationship of uromucoid to matrix substance A is described. It is suggested that renal sialidase may convert the urinary uromucoid to matrix substance A, whose apatite-covered fibers may be responsible for epitaxial nucleation of some crystal systems. Our studies indicate that the intimate apatite-matrix relationship occurs in the human nephron, probably as an intracellular phenomenon. Subsequent extrusion of these mineralized complexes into the lumen of the nephron (intranephronic calculosis) may, in some instances, represent the initial microanatomic stage of renal calculogenesis.
Calcium Phosphates↗