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PubMed1985

Heterozygous cystinuria and urinary lithiasis.

Cystinuria is a recessively inherited transport disorder, with at least three mutant alleles (I, II, and III) demonstrable. I/I, II/II, and III/III homozygotes and I/II, I/III, and II/III compound heterozygotes (cystinuric patients) have high urinary concentrations of cystine, lysine, arginine, and ornithine and frequently form cystine stones. +/I heterozygotes (nondetectable) are phenotypically normal, whereas +/II and +/III heterozygotes (detectable) show variable increases in urinary cystine and lysine concentration and at times increases in urinary arginine levels. The objectives of the present study were to determine the frequency of +/II heterozygotes among stone-forming and nonstone-forming individuals from the same region of Brazil and to evaluate the possible relationship between heterozygous cystinuria and urinary lithiasis. When urine samples from 5,150 individuals (5,000 nonstone-forming individuals and 150 stone-forming individuals) were screened by the qualitative cyanide-nitroprusside cystine test, by thin-layer amino acid chromatography, and by quantitative amino acid determination by ion-exchange chromatography, 32 +/II or +/III heterozygotes (26 nonstone-forming and six stone-forming individuals) were detected. The frequency of detectable heterozygotes among the stone-forming individuals (1:25) was significantly higher than that among nonstone-forming individuals (1:104), which provides additional evidence that heterozygosity for +/II and +/III cystinuria is a risk factor in the formation of urinary stones. No significant difference was detected in urinary cystine concentration or in terms of the various characteristics of urolithiasis when stone-forming heterozygotes were compared to nonstone-forming heterozygotes. These data suggest that the tendency towards stone-forming among heterozygotes is probably owing to a complex and multifactorial mechanism.

Arginine↗
PubMed1989

Anergy in patients with biliary lithiasis.

A prospective study was carried out in 428 subjects (212 controls and 216 patients) to evaluate the delayed cell-mediated immune response preoperatively in patients with biliary lithiasis. The delayed hypersensitivity response was assessed by a Multitest and subjects were classified as immunocompetent, relatively anergic or anergic. Significant differences were found between control subjects and patients with cholelithiasis compared with those with acute cholecystitis (P less than 0.01), non-icteric choledocholithiasis (P less than 0.01) and choledocholithiasis with jaundice (P less than 0.05). There were also differences between patients with icteric and non-icteric choledocholithiasis (P less than 0.02). Seven possible causative factors for anergy were evaluated: a haemoglobin concentration of less than or equal to 12 g/l and a haematocrit of less than or equal to 35 per cent were related to the appearance of anergy and relative anergy in patients with acute cholecystitis. Bilirubin levels greater than or equal to 34 mumol/l were found in 60 per cent of patients with choledocholithiasis and relative anergy and in 80 per cent of those who were anergic (P less than 0.001). These results show a high incidence of failure of the cell-mediated immune response in patients with acute cholecystitis (71 per cent) and icteric choledocholithiasis (82 per cent). In the latter, jaundice appears to be associated with this failure. A close correlation between relatively anergic and anergic state and the development of postoperative septic complications was found.

Adult↗
PubMed1992

Role of citric acid in primary hyperparathyroidism with renal lithiasis.

Nephrolithiasis is presented in 18-40% of patients with primary hyperparathyroidism. Our work suggests that citrate, an inhibitor of calcium salts, could be involved in the presence of renal lithiasis because hyperparathyroid stone formers show less citrate elimination than nonstone formers.

Citrates↗
PubMed1982

[Carcinoma of the gallbladder unexpectedly diagnosed after cholecystectomy for lithiasis (author's transl)].

Patients with clinically apparent carcinoma of the gallbladder seldom survive 5 years. This is only seen in about 20% of the patients whose gallbladder carcinoma is unexpectedly first discovered by the pathologist after a routine cholecystectomy for lithiasis. The prognosis of this seldom seen early stage of carcinoma of the gallbladder, which is applicable to only 10-23% of all gallbladder carcinomas, is strongly dependent on the penetration of the tumor in the wall of the gallbladder. Of the patients with a carcinoma infiltrating only the mucosa of the gallbladder, 60% can be cured for 5 years by a simple cholecystectomy, whereas for more advanced cancers this procedure seem to be inadequate. In these stages a relaparotomy should be considered with an addition wedge resection of the liver and a regional lymphadenectomy.

Aged↗
PubMed1982

Intrahepatic periductal glands and their significance in primary intrahepatic lithiasis.

Resected hepatic tissues of 24 patients with primary intrahepatic lithiasis were examined histo-pathologically. Calcium bilirubinate stones, cellular debris and mucinous substances occupied the lumen of large dilated intrahepatic bile ducts. Numerous mucin secreting glands were seen within or around the wall of these bile ducts. Similar structures were demonstrated in two patients with non calculous congenital dilatation of the intrahepatic bile ducts. Cholestasis was often absent in the hepatic parenchyma. Production of intrahepatic gallstones may be caused by not only biliary stasis and infection, but also by intraductal mucin and slow flowing bile in combination with cellular debris, bile pigment and other bile components.

Adult↗
PubMed1992

Lasertripsy in the treatment of ureteral lithiasis.

UNLABELLED: We submit our experience with laser treatment for ureteral lithiasis. We used the laser Candela MDL 2000 for the treatment of 62 lithiases (40 at the pelvic ureter, 16 at the iliac ureter and 6 at the lumbar ureter) in 58 patients. A semi-rigid Dretler or Gautier multiscope were used. Of the 62 calculi complete fragmentation was not achieved in 4 and they were ascended to the renal pelvis for subsequent ESWL. In 51% of the patients the ureteral catheter was left for 24 hours, and a double-J stent was used in two cases. COMPLICATIONS: 2 simple perforations of the ureter that were solved by means of a double-J stent; occasionally petechiae on the ureteral wall and two cases of rupture of the laser fibre tip that was easily removed with a forceps.

Humans↗
PubMed1985

Lithiasic complications of renal transplantation: the donor graft lithiasis concept.

Lithiasis is usually a late complication of renal transplantation reported in approximately 1% of all renal allografts. Underlying predisposing conditions for the formation of calculi are present in almost all cases. Preexisting stones in the donor kidney have been reported once previously. The authors have observed 2 such cases, detected by routine sonography. In 1 case, stone migration into the ureter led to acute postoperative transplant failure; this complication has been reported previously.

Adult↗
PubMed2005

An experimental study on residual lithiasis after shock wave lithotripsy.

The main objective of this paper was to study residual lithiasis after extracorporeal shock wave lithotripsy (post-ESWL), with the aim of contributing to the development of effective prophylactic measures. In vivo regrown calcium oxalate monohydrate (COM) post-ESWL residual fragments were studied by stereoscopic microscopy, infrared spectroscopy and scanning electron microscopy with an energy dispersive X-ray analyzer. An in vitro system was also used to study the regrowth of post-ESWL fragments of COM calculi. The regrowth was evaluated as the relative increase in the weight of the fragments. The effects of a calcium oxalate crystallization inhibitor (phytate) were also evaluated. All of the in vivo regrown COM real residual post-ESWL fragments exhibited practically the same internal structural features. The in vitro studies demonstrated that the regrowth of post-ESWL residual fragments, in the absence of crystallization inhibitors, occurred even using normocalciuric/normooxaluric urine and could be detected at 24 h. At 144-240 h, the formation of new COM columnar zones was observed. The presence of 1.5 mg/l of phytate totally blocked the growth process. When hypercalciuric/normooxaluric urine was used, significant amounts of disorganized calcium oxalate dihydrate (COD) crystals were formed. The in vitro regrowth of post-ESWL COM fragments was clearly influenced by the presence of crystallization inhibitors. These data also demonstrate the importance that effective prophylactic therapies could exert on preventing recurrence.

Calcium Oxalate↗
PubMed2000

Intrahepatic lithiasis: a Western experience.

Intrahepatic lithiasis (IHL) is a very rare disease in Europe and no gold-standard treatment has yet been codified. The aim of our study is to report our personal experience of IHL detected in 20 patients (6 males [30%] and 14 females [70%]) between January 1982 and December 1991. Eleven (55%) of these cases presented with only IHL, 7 cases (35%) had IHL associated with gallbladder or common bile duct stones, while 2 (10%) were affected by secondary IHL caused by previous biliodigestive anastomosis-induced stricture. The diagnosis was determined by cholangiography in all patients, by ultrasound in 94.7%, and by computed tomography in 70%. The surgical procedures used were as follows: liver resection in 12 patients (60%); various types of biliodigestive anastomosis in 6 cases (30%); choledocholithotomy with a simultaneous removal of stones from the hepatic duct in 2 patients (10%). The intraoperative mortality rate was nil. Complications consisted of 2 subphrenic abscesses, 1 septicemia, and 1 bowel occlusion. Two patients (10%) dropped out of the follow-up, 2 (10%) died 2 years after surgery for reasons not connected with the disease, 1 (5%) died from suppurative cholangitis 6 months after surgery, 2 (10%) had recurrent stones and were treated by extracorporeal lithotripsy and endoscopic stone removal, while the remaining 13 patients (65%) are symptom-free at follow-up which varied between 6 months and 11 years. Liver resection is the treatment of choice when IHL is confined to one lobe of the liver. When IHL affects the entire liver, a resection of the main involved area should be performed whenever possible. Other options include hepatoduodenal anastomosis using the interposed jejunal loop to enable endoscopic or combined treatment of recurrent stones.

Adult↗
PubMed1983

Choledochotomy for biliary lithiasis: T-tube drainage or primary closure. Effects on postoperative bacteremia and T-tube bile infection.

To compare the incidence of postoperative bacteremia in patients with biliary lithiasis after choledochotomy supplemented by either T-tube drainage or primary common bile duct closure, 117 patients who underwent surgery are presented in this clinical trial. It has been shown that primary common bile duct closure is associated with a lower incidence of postoperative bacteremia (3.3 percent), a lower mortality rate (0 percent), and a lower early morbidity rate (13.3 percent) than T-tube drainage (31.5, 3.5, and 36.1 percent, respectively). The above evidence supports the view that T-tube drainage might well provoke the exogenous acquisition of environmental microorganisms and thus promote further infection.

Bile↗
PubMed1986

2,8-Dihydroxyadenine lithiasis.

2,8-Dihydroxyadenine (2,8-DHA) lithiasis is a form of kidney stone previously mistaken for uric acid because of identical reactivity in non-specific tests used routinely in stone analysis. Unlike uric acid, the stones crush easily and do not react with uricase. The biochemical basis for the defect is a deficiency of the enzyme adenine phosphoribosyltransferase (APRT). A complete deficiency has been reported in 29 patients from 11 countries. The number of stone formers reported in Japan (10 homozygotes, 16 heterozygotes) Austria (3), and Switzerland (2) suggests more efficient diagnosis in those countries. The defective enzyme in heterozygotes in Japan is a kinetic mutant demonstrable in intact not lysed cells. 20% of APRT-deficient subjects have been asymptomatic. An equal number have presented in acute renal failure, three of whom are now on dialysis. Formation of the nephrotoxic 2,8-DHA can be prevented by allopurinol. This underlines the importance of early diagnosis, since such severe renal damage should be avoidable.

Adenine↗
PubMed1991

The effect of artificial feeding on cholestasis, gallbladder sludge and lithiasis in infants: correlation with plasma cholecystokinin levels.

The occurrence of hepatic cholestatis (judged by fasting serum bile acid levels), gallbladder sludge formation and lithiasis (ultrasonography) and their correlation with plasma cholecystokinin (CCK) levels was studied in a group of children on continuous total parenteral nutrition (TPN) (n = 95), and later in 40 of these children on cyclic TPN (cTPN). After resumption of oral feeding, 75 were studied on partial oral feeding (2-4 meals) and 40 on constant rate enteral nutrition (CREN) then 45 on total oral feeding (4-6 meals). Gallbladder sludge occurred in 23% of the children on TPN for 1 month and 32% of those on cTPN for 3 months. On CREN, the sludge rate was unchanged, but dropped significantly (17%) on partial oral feeding, and disappeared in children on total oral feeding. Serum bile acids were abnormal in 80% of children on TPN or cTPN and diminished significantly on total oral feeding only. Plasma CCK levels on TPN, cTPN and CREN were identical to fasting levels of children on total oral feeding. Plasma CCK levels increased significantly 1 h post-prandially during both partial (p < 0.02) and total oral feeding (p < 0.001). There was a significant negative correlation between the gallbladder sludge rate and CCK levels for all methods of feeding. This study demonstrates the frequent occurrence of hepatic cholestasis in infants, and the much lower frequency of gallbladder sludge in children compared to adults on TPN. Plasma CCK levels obtained during the different methods of feeding could explain the reduction and eventual disappearance of sludge following stimulation of CCK secretion by discontinuous feeding.

Journal Article↗
PubMed1996

Peritoneal lithiasis and cliptomas following laparoscopic cholecystectomy.

A review was made of five patients with post-laparoscopic cholecystectomy peritoneal soiling with clips and/or stone. Three patients were symptomatic with recurrent abdominal pain or back pain. One of these had clips alone, one had clips and stone and the third had stones alone. The location of the stones in the pelvis and right iliac fossa created confusion in the diagnosis, simulating ureteric calculi and appendicitis, respectively. Surgical operation revealed granulomas around the stones. The consequences of peritoneal clips is not yet known. However, peritoneal lithiasis and potential complications should be considered as a differential of abdominal and pelvic calculi.

Abdominal Pain↗
PubMed1996

[Neonatal cholestatic lithiasis associated with E. coli infection].

BACKGROUND: Cholestasis associated with gallbladder lithiasis is quite uncommon in the neonate. We report such a case possibly due to a bacterial infection. CASE REPORT: A 25 day-old neonate was admitted because he suffered from cholestatic jaundice associated with biological findings of inflammation. Hepatic cellular function and transaminases were normal. Ultrasonography showed hepatomegaly and a 10 mm diameter gallstone with sludge into the gallbladder. The patient was given cefotaxime plus netilmicine. Soluble antigenes for E coli were positive in the urine. Jaundice and inflammatory findings returned to normal within 10 days and ultrasonography was normal at the age of 20 months. CONCLUSION: Neonatal E coli infection could be responsible for gallstone formation since E coli endotoxin may induce biliary stasis and favours lithogenous action of bacterial glycoproteins.

Cholelithiasis↗
PubMed2006

[Imaging of urinary lithiasis: "all in one"].

Urinary lithiasis is very common among the general population, with a high prevalence level. In rich countries it is mainly located inside the upper urinary tract. Helical CToperated with newer devices is the most accurate modality to provide all needed information: diagnosis of stone without contrast medium injection, morphology (size, number) and localization, diagnosis of urinary obstruction, urinary tract aspect and all kind of differential diagnosis in emergency. It must be used during follow up to diagnose residual fragments. Multiplanar reconstructions are essential for the clinicians; but diagnosis is interpreted by scrolling axial views with dynamic analysis on computer screen. Low-dose helical CT is today available. Helical CT provides an "all-in-one" examination. It should soon replace combined plain film-ultrasonography performed in an emergency context of renal colic and intravenous urography for pre- and post-treatment assessments.

Decision Trees↗
PubMed2004

Clinical correlation of prostatic lithiasis with chronic pelvic pain syndromes in young adults.

OBJECTIVE: To investigate the incidence, morphology and clinical presentation of prostatic calculi in a selected population of young adults and to examine any possible correlation with chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS). METHODS: A population of 1374 young adults was screened with ultrasound imaging of the prostate and 101 cases with prostatic lithiasis were selected. Patients were divided in two groups, according to the type of prostatic calculi (type A: small, multiple or type B: larger, coarser calculi). Further evaluation included history and physical examination, recording of lower urinary tract symptoms and the Meares-Stamey test. RESULTS: Calculi were type A in 71.3% and type B in 28.7% of cases. Localization (central/periurethral) was not correlated with other parameters. Age was closely related to calculus burden ( p =0.034 ). Type B calculi were more often associated with symptoms and chronic prostatitis/CPPS (chi(2)-test, p=0.007 and 0.018 respectively). CONCLUSIONS: Small, multiple calcifications are a normal, often incidental ultrasonographic finding in the prostate and represent a result of age rather than a pathologic entity. However, larger prostatic calculi may be related to underlying inflammation and require further evaluation and possibly, treatment.

Adult↗
PubMed2006

Stressful life events and painful recurrent colic of renal lithiasis.

PURPOSE: There is strong evidence concerning the influence of life event stress on the onset and course of painful acute episodes in primary care. However, few studies have analyzed stressful life events in painful recurrent episodes of renal stone disease. We evaluated the association between painful recurrent colic of renal lithiasis and stressful life events. MATERIALS AND METHODS: We performed this case-control study in a primary care setting. Study participants were 194 subjects (97 cases and 97 controls) matched according to age and gender. Cases were outpatients with a confirmed diagnosis of nephrolithiasis. The control group consisted of patients seen at the Ophthalmology Outpatient Clinic of the University Hospital, reporting only refraction symptoms and presenting no chronic or acute pathology. Main outcome measures reported were stressful life events as measured by the Social Readjustment Rating Scale. RESULTS: The mean Social Readjustment Rating Scale of cases was significantly higher than controls at 257.56 (+/-193.81) vs 144 (+/-131.24), respectively. Logistic regression revealed that belonging to the case group increased the chances of showing positive results on the scale greater than or equal to 100 (OR 3.02, 95% CI 1.64-5.59) and the chance of presenting results of 200 or greater was 2.87 (OR 2.87, 95% CI 1.58-5.22). CONCLUSIONS: Stressful life events were significantly greater among cases than controls.

Adolescent↗
PubMed2005

Lithiasis of minor salivary glands: current data.

Sialolithiasis is the main pathology of major salivary glands. Sialolithiasis of minor salivary glands is, however, generally considered to be extremely rare. Lithiasis of accessory salivary glands apparently occurs more frequently than alleged and therefore should be included in differential diagnosis of tumors of the oral mucous membrane. The elementary lesion consists of a firm nodule located under the mucosal membrane on the upper lip or cheek. Nodules should be excised and examined by histopathology.

Humans↗