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PubMed1983

Does total parenteral nutrition induce gallbladder sludge formation and lithiasis?

To assess the prevalence of sludge formation and lithiasis during total parenteral nutrition, serial biliary ultrasonographic studies were performed during and after i.v. nutrition periods in 23 selected adult gastroenterological patients. All patients were free of hepatobiliary disease before i.v. nutrition. Initial sonograms of 19 patients taken at the 12th day +/- 2 days (mean +/- SEM) of i.v. nutrition were normal. Initial studies for the 4 remaining patients, which were performed on the 39th day +/- 10 days of i.v. therapy (p less than 0.001), showed gallbladder sludge but did not demonstrate lithiasis. Serial ultrasonographic studies indicated that the percentage of sludge-positive patients during parenteral nutrition increased from 6% during the first 3 wk to 50% between the fourth and the sixth weeks and reached 100% in patients receiving i.v. nutritional therapy for greater than 6 wk. Gallstone formation was demonstrated in 6 of 14 sludge-forming patients but was not observed in patients who were sludge-negative. Three of the 6 stone-forming patients underwent cholecystectomy because of complications secondary to cholelithiasis after a mean 43-day course of parenteral nutrition. Analysis of bile from these patients revealed thick bile-containing cholesterol crystals and small stones of mixed bilirubin-cholesterol type. Ultrasonographic studies were obtained for sludge-positive patients after the parenteral nutrition period. Sludge positivity decreased from 88% during the first 3 wk of oral refeeding to 0% by the end of the fourth week. This study, therefore, strongly suggests that bowel rest and bile stasis during parenteral nutrition lead to production of sludge, which can result in eventual gallstone formation. Consequently, during parenteral nutrition exceeding 1 mo, gallbladder stasis should be palliated to prevent cholelithiasis formation.

Adolescent↗
PubMedDate not supplied

[Therapy of lithiasis of the main biliary passages].

On the basis of a total of 3692 surgical interventions performed on biliary pathways, of which 431 (11,6%) for lithiasis of the hepato-choledocus, the authors discuss the indications, the limitations and the results of surgical treatment in this affection. The postoperative death rate was 10,3% in the first 10 years of the period during which these interventions have been performed and decreased to 5,5% in the last 10 years. The late results were good and very good in 85% of the cases. In view of the continuing decrease in the death rate after surgery, and for improving late results, the authors stress the necessity of early interventions in the lithiasis of main biliary pathways. They also stress the correct exploration of the hepato-choledocus in the course of all surgical intervention upon the biliary pathways.

Adolescent↗
PubMed1983

[Xanthine lithiasis in a case of Lesch-Nyhan syndrome treated with allopurinol].

Classically it is considered that vital prognosis of Lesch-Nyhan syndrome depends on renal affectation secondary to uric nephropathy. A case of Lesch-Nyhan syndrome treated with Allopurinol is described which presented multiple and bilateral renal stones by precipitation of xanthine. Treatment with Allopurinol inhibits the formation of uric acid and qualitatively renal excretion of oxypurines modifies. In special circumstances (disminution of urinary output and pH), they can precipitate and originate a radiotransparent lithiasis with uric lithiasis. Interest of this case, lies in being alert to possible xanthine stone formation in patients with a large excretion of purinics metabolites, who are treated with Allopurinol.

Allopurinol↗
PubMed1984

Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis.

The incidence of pancreatic calculi in autopsy material was found to increase in proportion to age after 70 yr: 0% under 69 yr of age (0 of 134), 4.2% in the 70s (5 of 119), 7.7% in the 80s (9 of 117), and 16.7% in the 90s (8 of 48). Most of the stones were found scattered throughout the peripheral ducts. Pancreatic lithiasis in the aged was clinically characterized by lack of signs and symptoms, absence of alcoholism, and was unassociated with hypercalcemia. Extensive parenchymal atrophy and fibrosis were limited to the areas upstream from the calculi. The stones were found in the ducts just above the sites of obstruction where squamous metaplasia was invariably present. Immunohistologic study showed intense staining for lactoferrin in the protein plugs and in the cytoplasm of cuboidal or squamous cells of ducts containing the plugs. Ductal stenosis, either primarily caused or secondarily exacerbated by squamous metaplasia, and lactoferrin-positive cells appeared to play a role in the pathogenesis of pancreatic lithiasis in the aged.

Age Factors↗
PubMed1984

[Remarks on the metabolic evaluation of renal lithiasis].

Metabolic studies include certain routine investigations but which may be more or less limited or extended according to the individual case on the basis of its severity and the chemical nature of calculi. These studies are based upon the following data: analysis of one or more stones, aided and guided by methodical macroscopic examination; urine microscopy; study of urine pH which should be done by the patient himself on several samples during the 24-hour period; blood and urine calcium/phosphate balance, without omitting the measurement of urinary urea which provides information concerning protein intake and indicates its influence; oxalate balance studies and hyperoxaluria are correlated with cases of lithiasis when stones contain only calcium oxalate or a mixture of oxalate and calcium phosphate; uric acid balance, where once again the measurement of urinary urea is of fundamental importance and shows that all cases of hyperuricuria are related to a diet excessively rich in meat; urinary cystine levels with the need for a Brand reaction almost routinely in all lithiasis sufferers; electrolyte studies which may reveal a renal tubular acidosis syndrome, in fact rare; and, finally, in certain cases a magnesium balance may show a decreased erythrocyte magnesium.

Calcium↗
PubMed1982

[Personal experiences in the long-term treatment of cystine lithiasis with high-dose ascorbic acid].

We report on our experience with 9 cystine-lithiasis patients who were treated with large doses of ascorbic acid (5 g/day) for periods ranging from 6-27 months. We observed recidive lithogenesis in only 3 patients during this time. The influence of ascorbic acid on the excretion of cystine and oxalate in the urine is discussed. A lack of side effects and the significantly lower frequency of recidivation justify the further use of ascorbic as an alternative medication in cystine lithiasis.

Adult↗
PubMed1980

[Biliary lithiasis in patients aged over 70 years: considerations on 125 operations].

An experience with 125 over 70 aged patients, undergone surgery for biliary lithiasis, is here reported. These operations represent 17 percent on the whole performed ones for non malignant biliary tract diseases in Institute of Surgical Pathology of the University of Parma. As the age gets elder, we can see a percent increase of complications of lithiasis, and particularly of acute cholecystitis, of common bile duct diseases and generally of emergencies. Mortality rate was 5,6%. After cholecystectomy for uncomplicated gallstones mortality rate was zero. After operations for complications of cholelithiasis it was 9.3% (6,8% in elective, 18,7% in emergent surgery). According to the Authors, these results suggest that surgical elective indications in the aged patients have to be extensive, in order to reduce the risk of worse and often unavoidable complications.

Acute Disease↗
PubMed1981

[Comparative study of ultrasonography and oral cholecystography in gallbladder lithiasis detection (author's transl)].

A comparative study has been realized to test the accuracy of oral cholecystography versus real time ultrasonography in 150 patients with gallbladder lithiasis surgery. Oral cholecystography correctly diagnosed 107 cases (70%), whereas ultrasonography diagnosed gallbladder lithiasis in 145 or in 96,5% of the cases. Failure of the technique in the remaining cases was related to a scleroatrophic gall bladder with stones of less than 3 mm. These results confirm that ultrasonography must be proposed as the first examination for the diagnosis of gallstones.

Cholecystography↗
PubMedDate not supplied

[Epidemiology of reno-ureteral lithiasis in the province of Toledo].

In this paper a review is made of a total of 384 patients suffering from lithiasic illness and the authors stress the high incidence of hyperuricuria in the province of Toledo, referring to the possible effect and cause link between this type of lithiasis and an unsuitable diet. On the other hand, they find no connection between this type of lithiasis and the chemical-mineral composition of the water as a possible contributory, lithogenetic factor.

Adolescent↗
PubMed1994

[The laparoscopic treatment of common bile duct lithiasis].

Recently the indications to video laparoscopic approach in abdominal surgery are considerably increased thanks to the very good results of the video laparocholecystectomy technique. The improvement of this methodology and of the instruments employed has permitted to extend the indications also to the treatment of cholecysto-choledochal lithiasis. After considering the actual possibilities of treating this kind of pathology, authors report their experience of 28 cases of choledocholithotomies carried out laparoscopically "at the same time" from October 1991 to October 1993, out of 431 operations on biliary tract performed for benign disease, 350 of which (81.2%) treated with a laparoscopic approach. In 26 cases the treatment has been completed. In one case (3.5%) it was necessary to perform a laparotomy due to an empyema with a wedged choledochal stone, in another case it was necessary to performed a laparoscopic-endoscopic treatment for removing wedged choledochal stone, but because of the failure of this treatment, a laparotomy followed. The only complication worth mentioning out of 27 choledocholithotomies performed is an external biliary fistula (3.7%) treated with a following laparotomy operation. The 25 patients only laparoscopically treated were discharged on the postoperative day 5. Even if a long-term follow-up lacks, authors consider the laparoscopic choledocholithotomy an efficacious cure for the treatment of cholecysto-choledochal lithiasis as it is a mini-invasive technique, which clears up the disease in one time, avoids not necessary papillotomy and reduces the risk of mortality and morbidity to their lowest terms.

Aged↗
PubMed1994

[Therapeutic efficacy of ursodeoxycholic acid in persistent gallbladder lithiasis and persistent biliary sludge: preliminary results of a multicenter experience].

A prospective and multicenter study was performed to determine the efficacy and tolerance of ursodeoxycholic acid (UDCA) in the treatment of gallstones and biliary sludge. Criteria for entry into the trial were radiolucent gallbladder stones; until 20 mm of size and visualization of the gallbladder by oral cholecystography. Too were treatment the patients with persistent biliary sludge (PBS) defined by the persistence of the biliary sludge in two consecutive echography along three months. Without severe gallbladder disease. Then daily UDCA doses of 600 mg were suminstred divided in two postprandial times for a six months period. The control to the treatment were: basal ultrasonography (US) of the gallbladder and by follow-up gallbladder US for six months; clinical examination every month and cholecystography before and after the treatment. Of 110 admitted patients, 19 (17%) stopped the treatment for no-medical reasons and 91 (83%) arrived to the and point. After six months of treatment, complete dissolution was observed in 50% of the patients (46/91), partial in the 43% (39/91) and failed the treatment in 6.5% (6/91) who presented high density stones for computed tomography, CT (greater than 60 UH). According to pattern of lithiasis dissolution was complete in 100% (22/22) of the patients with PBS; 71.4% (10/14) in microlithiasis and 25% (14/55) in macrolithiasis. Minor adverse effects were acidism in the 7.7% (7/91) and diarrhea in the 1.1% (1/91). In the other hand, one patient presented acute pancreatitis (1/91; 1.1%), it must be discussed if was a complication of the lithiasis or an therapeutic effect. The UDCA was a safe and effective treatment without lethality in PBS and in microlithiasis while in case of macrolithiasis must be standardized response criterion, for example density stones for CT.

Adult↗
PubMed1995

[Uro-oxalic renal lithiasis. Certain characteristics].

In a paper published in 1974, it was reported that uro-oxalic stones are found more often in subjects with group O than with group A blood types although the proportions of these two blood types are approximately equivalent in the French population. The present work confirms these data, the ratio of group O to group A renal lithiasis being approximately 3 to 1. In a paper published in 1987, uro-oxalic stones were found to occur preferentially on the left side: 84 on the left and 39 on the right. The present work confirms this notion since in 57 cases, stones were bilateral in 2 cases, on the left in 39 and on the right in 16. Extra corporeal shock wave lithotripsy was performed in 40 of the 57 cases and showed that uro-oxalic stones are most resistant to shock-waves than the other types of stones. They are about as hard as calcium oxalate monohydrate stones or harder in certain cases: A mean of 3,865 shock-waves were required in the 40 cases of the uro-oxalic lithiasis treated with the HM3 Dornier device, while the mean number of shock-waves required for all types of stones in general varies from 2,000 to 2,500. In 4 cases, 5,000 or 6,000 high power shock-waves (7,000 in one session and 9,500 in two sessions) had to be used to obtain a satisfactory result. The calcium oxalate part of these stones is almost always composed of calcium oxalate monohydrate.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Group Antigens↗
PubMedDate not supplied

[Primary intrahepatic lithiasis: report of a case and review of the literature].

Primary intrahepatic lithiasis is an entity defined by intrahepatic stones exclusively located in the IH ducts above the emergence of the common bile duct. The disease is classified in two types: Eastern type (stones formed primarily in intrahepatic ducts; frequent in Japan) and Western type (stones formed in the extrahepatic bile system, usually in gallbladder, which migrate up to the intra-hepatic ducts). The mechanisms of lithogenesis in the entity are as yet not fully understood; multiple factors seem to operate synergistically: anatomical changes of the intrahepatic ducts, metabolic disorders, infections, idiopathic alteration. All these factors may facilitate biliary stasis leading ultimately to stone formation. We report on a case of and review the literature on primary intrahepatic lithiasis, which is a rare occurrence in the West and a disease of difficult surgical approach and high mortality.

Adult↗
PubMedDate not supplied

[Obstructive jaundice caused by residual and/or recurrent choledochal lithiasis: endoscopic and surgical treatment].

Results of surgical and endoscopic treatment in 79 patients (58 females and 21 males, age 40-89, mean 62), affected with jaundice, due to secondary choledochal lithiasis, are reported. Thirty-four patients (43%) underwent surgical operation: choledochotomy and T-tube 12, choledocho-jejunostomy 4, choledochoduodenostomy 3, papillosphincteroplasty 15. In 45 patients (57%) EST has been performed. Comparison of results has been obtained after 30 days and after 3-105 months (mean 49). Optimal results have been achieved in 94.9% of patients: 100% after surgery and 94.1% after EST. Morbidity and mortality outcomes in patients who underwent EST (11.1% and 0% after 30 days respectively, 8.1% and 8.1% after several months) are better compared to those ones after surgical treatment (17.6% and 5.8% after 30 days, 20% and 16% after several months). We conclude that EST is nowadays the therapy of choice in patients with jaundice due to choledochal lithiasis, either relapsing or residual.

Acute Disease↗
PubMedDate not supplied

[Percutaneous nephrolithotomy for coralliform lithiasis in a patient with bilateral triplicated ureters].

We report on a rare case of bilateral ureteral triplicity with a definitive urinary diversion (Brickner loop ureteroileostomy) who presented a staghorn stone in the upper calyx of the left kidney. The patient was submitted to percutaneous nephrolithotomy with direct access to the upper calyx of the anomalous kidney. We discuss the indication for this treatment, which resolved the lithiasis in a single session and with no complications. Furthermore, this treatment modality is compared with ESWL and open surgery, which we reserve for failures or those cases where the percutaneous approach is contraindicated. Percutaneous nephrolithotomy can be considered a therapeutic alternative for lithiasis in patients with congenital malformation and/or urinary diversion.

Adult↗
PubMed1994

[Uro-oxalic renal lithiasis. Special aspects].

In a paper published in 1974, it was reported that uro-oxalic stones are found more often in subjects with group O than with group A blood types although the proportions of these two blood types are approximately equivalent in the French population. The present work confirms these data, the ratio of group O to group A renal lithiasis being approximately 3 to 1. In a paper published in 1987, uro-oxalic stones were found to occur preferentially on the left side: 84 on the left and 39 on the right. The present work confirms this notion since in 57 cases, stones were bilateral in 2 cases, on the left in 39 and on the right in 16. Extra corporeal shock wave lithotripsy was performed in 40 of the 57 cases and showed that uro-oxalic stones are more resistant to shock-waves than the other types of stones. They are about as hard as calcium oxalate monohydrate stones or harder in certain cases: A mean of 3,865 shock-waves were required in the 40 cases of the uro-oxalic lithiasis treated with the HM3 Dornier device, while the mean number of shock-waves required for all types of stones in general varies from 2,000 to 2,500. In 4 cases, 5,000 or 6,000 high power shock-waves (7,000 in one session and 9,500 in two sessions) had to be used to obtain a satisfactory result. The calcium oxalate part of these stones is almost always composed of calcium oxalate monohydrate.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Group Antigens↗
PubMed1994

[Ambulatory treatment of lithiasis with Dormia extractor and intraureteral injection with xylocaine gel].

Our initial experience in ambulatory extraction of ureteral stones, with local anaesthesia and lubrication with xylocaine gel are reported in this paper. Extraction was thus simplified in all patients and there was no need for further sedation in 97.3% of cases. Overall results, considering the promptitude and simplicity of the methods and significant cost-efficacy ratio can be considered optimal, and their efficacy is not below that of the other current therapeutical alternatives for this type of lithiasis. We therefore conclude that the method, far from being relegated by the various lithotripsy techniques, may on the contrary constitute a useful complement to them, able to solve in an ambulatory fashion more than 60% of cases of ureteral lithiasis.

Adult↗