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PubMed1975

[Therapy of cholesterol lithiasis with chenodeoxycholic acid (Chenoxyl)].

Chenodesoxycholic acid (500-750 mg/day Chenoxyl) was employed over a period of 9 months in the treatment of 40 patients with radiotransparent calculi in a functioning gallbladder and 8 with choledochal lithiasis. Radiological examination and complete hepatological exploration were carried out before and after the treatment in all cases. Complete dissolution was obtained in 6 and 2 cases respectively, with reduction of size in 13 and 2, and no change in 21 and 4. No significant variations were notes in the blood lipid picture or in liver function. There were no cases of diarrhoea.

Adult↗
PubMed2001

Prevalence of biliary lithiasis in a Sicilian population of hemodialysis patients.

Studies performed to date on the prevalence of biliary lithiasis (BL) in chronic renal failure patients on hemodialysis (HD) have given contradictory results. The aims of the present study were to evaluate the prevalence of BL and its main associated risk factors in a population of hemodialysis patients, and to compare the results with those we had obtained previously in an overt population of the same zone. The study included 171 patients (83 M, 88 F), mean age 62.5 years and mean duration of dialysis 66.7 months. The screening protocol also included body mass index (BMI), a number of biochemical parameters and an ultrasound scan of the gallbladder and biliary tract. The general prevalence of BL was 33.3% (30.1% in men and 36.4% in women), and this figure was significantly higher than that found in our previous study. Prevalence increased with age in both sexes (Mantel-Haenszel Chi-squared = 5.4, p < 0.03), but not with duration of dialysis. The main risk factors, evaluated with multiple logisstic regression, were the presence of diabetes mellitus and high serum phosphorus levels. Specific symptoms were also significantly associated in BL patients. No association was found with parity, BMI or serum lipid alterations. In conclusion, the prevalence of BL in a Sicilian population of HD patients was higher than that found in an overt population of the same area and the associated main risk factors were not coincident. Further studies are needed to establish the role played by the phase of end-stage renal disease before HD and to correct the metabolic disturbances to limit a high percentage of morbidity in a disease already in itself sufficiently disabling.

Chi-Square Distribution↗
PubMed2001

[Vesical uric acid lithiasis in a child with renal hypouricemia].

We report a 12-month-old boy with renal hypouricemia who presented with crying due to obstructing vesicourethral uric acid stones. Metabolic study revealed persistent acidic urine with normal blood pH, and hypouricemia (1.4-1.7 mg/dl) with an increased ratio of uric acid clearance to creatinine clearance (24-32 %). Pyrazinamide produced no response but the patient showed a positive response to benzbromarone. These findings were consistent with a presecretory defect. No other tubular dysfunctions, such as renal glycosuria, aminoaciduria or phosphaturia were found. The patient underwent surgical treatment and was subsequently treated with potassium citrate. After a 2-year follow-up, he remains asymptomatic, despite persistent hyperuricosuria. To our knowledge, this is the youngest reported case of renal hypouricemia and lithiasis.

Humans↗
PubMed2001

[Renal lithiasis as a manifestation of primary hyperparathyroidism].

Primary hyperparathyroidism is an infrequent condition in infancy and is usually due to adenoma. It may be asymptomatic and is suspected when isolated hypercalcemia is detected in routine investigations. We describe the case of a 13-year-old boy with hypercalcemia presenting as renal lithiasis. Cervical magnetic resonance revealed a 13 x 8 x 5 mm-node in the right parathyroid. Gammagraphy with Cardiolite-Technetium 99 suggested an adenoma in the inferior right portion of the parathyroid. Right inferior parathyroidectomy was performed and ectopic tissue, as well as hyperplasia of the parathyroids, was removed. The histopathological diagnosis was adenoma of the parathyroid gland. After surgery blood calcium levels returned to normal. In conclusion, cervical magnetic resonance and gammography with Cardiolite-Technetium 99 should be performed in children presenting hypercalcemia and laboratory results suggestive of primary hyperparathyroidism. Subsequently, parathyroidectomy should be performed.

Adolescent↗
PubMed2001

[Role of phosphate in recurrent calcium lithiasis. A current view].

OBJECTIVE: To analyze the biochemical impact of treatment with phosphates in patients with recurrent calcium lithiasis and hypercalciuria. METHODS: 20 patients were selected according to the following criteria: normal renal function, recurrent calcium nephrolithiasis, hypercalciuria, hypophosphatemia, normal calcium and low tubular phosphate reabsorption (TPR). The mean duration of treatment was 7.5 +/- 3.8 months. The pre and post-treatment phosphatemia, calciuria, phosphaturia and TPR were analyzed. The results were analyzed by the Wilcoxon statistical method. RESULTS: We found a moderate but significant decrease of calciuria (326.5 +/- 52-4 to 266.4 +/- 31.7 mg/24 h), while phosphatemia (2.21 +/- 0.09 to 2.52 +/- 0.30 mg/24 h) and TPR (65.7 +/- 6.3 to 71.3 +/- 4.1) increased significantly. Overall treatment was well-tolerated and no patient abandoned treatment. CONCLUSIONS: The short-term biochemical results obtained are similar to those reported in the literature. However, definitive conclusions cannot be made since treatment application is not standardized and studies that demonstrate its clinical efficacy are scanty.

Calcium↗
PubMed2001

[Effect of potassium citrate in the prophylaxis of urinary lithiasis].

OBJECTIVE: The physiologic effects of potassium citrate on urinary solubility have led to their use to facilitate stone passage after lithotripsy. The aim of our study is to evaluate the foregoing effects and the efficacy of long-term treatment with potassium citrate to prevent stone recurrence in patients undergoing extracorporeal shock wave lithotripsy. METHODS: A prospective study was conducted on 100 patients with calcium oxalate or calcium phosphate nephrolithiasis that had undergone treatment by extracorporeal shock wave lithotripsy (ESWL). The patients were divided into 4 groups: patients that were stone-free treated with potassium phosphate (25 cases) or fluid diet (25 cases) and patients with persistent residual lithiasis treated with potassium citrate (25 cases) or fluid diet (25 cases). Calculi were classified according to the changes observed during the study compared with the pre-study status as stable (no changes from the pre-study status, with or without residual stone), increased (increase in number or size of the residual stone or recurrence), and decreased (decrease in number or size or passage of the residual stone). RESULTS: Of the 50 patients treated with potassium citrate, 35 (70%) remained stable, 10 cases (20%) showed a decrease and 5 (10%) showed an increase. Of the 50 patients on fluid diet, 19 (38%) remained stable throughout the study, 4 (8%) showed a decrease and 27 (54%) showed an increase in stone size or number. The number of stone recurrence throughout the study in the 100 patients was 25 (25%); of these, 8 were in patients treated with potassium citrate and 17 of those that did not receive potassium citrate. CONCLUSIONS: Potassium citrate therapy has been found to be statistically significantly effective in the control of post-lithotripsy residual stone and stone recurrence.

Adolescent↗
PubMed2001

[Usefulness of endourologic catheters in the treatment of urinary lithiasis].

OBJECTIVE: To review the indications and complications of the use of endourological catheters in the treatment of urinary lithiasis and choice of catheter based on its physical and hydrodynamic characteristics and biocompatibility. METHODS: Data from our experimental and clinical studies, as well as those published in the literature are summarized. RESULTS: Polyurethane, C-flex and Percuflex catheters have the highest retaining capacity, while the silicone, Urosoft and Wiruthan catheters have the lowest. The tensile strength of polyurethane and copolymers is superior to that of silicone. The friction coefficient, which varies within the same material, influences the facility of catheter insertion. The number and size of the side vents are essential to catheter hydrodynamic behavior. Silicone is the most biocompatible material, followed by Urosoft. The polyurethanes and C-flex catheters cause important urothelial hyperplasia and edema of the lamina propia. CONCLUSIONS: The choice of endourological catheter should be individualized and based on the clinical indication. For prevention of obstruction from steinstrasse post-lithotripsy, a catheter with a high extraluminal flow and high retaining capacity is indicated to facilitate passage of stone fragments and to avoid catheter migration.

Biocompatible Materials↗
PubMed2001

[Infective lithiasis. Treatment and complications].

OBJECTIVE: To establish the criteria for treatment of staghorn stones according to stone surface and distribution in cadaver kidneys. METHODS: Retrospective study of 344 cases treated from 1985 to 1992 and classified into two groups according to treatment by extracorporeal lithotripsy or by percutaneous nephrolithotomy (PNL). RESULTS: Mean age 48.69 years, prevalence of females and positive urinary culture in almost 70%, mainly Proteus. Stone composition was varied, but mainly magnesium ammonium phosphate. Treatment was by extracorporeal lithotripsy in 80.81% and by PNL in 19.9%. CONCLUSIONS: Treatment of this type of lithiasis should be by combined surgical removal and medical treatment. Lithotripsy is advocated for large caliceal calculi and PNL for large pyelic calculi.

Adolescent↗
PubMed2001

[Oriental biliary lithiasis. Retrospective study of 690 patients treated surgically over 8 years at Hospital 108 in Hanoi (Vietnam)].

The purpose of this study was to review the unique features distinguishing Oriental from Western gallbladder disease based on a series of 690 patient who underwent surgical treatment at hospital 108 in Hanoi. Oriental cholangiohepatitis often affects in young patients with no gender predilection. The disease originates mainly in canaliculi and leads to blockage or obstruction of the main bile duct inside and outside the liver. Onset has been related to nutritional, infectious, and parasitic factors. Ascariasis may play a determinant role. Because of these unique features, surgical treatment is usually focused on the main bile duct and depends on the size, number, and effects of gallstones. The authors recall that excision of liver tissue may be unavoidable in some cases due to the severity and consequences of lithiasis.

Adolescent↗
PubMedDate not supplied

[Intrahepatic biliary lithiasis: experience in 20 years].

In confirming that intrahepatic gallstones don't represent a frequent disease in western countries, Authors specify how this incidence is going to grow up slowly, but in a progressive way. In reporting their experience since 1980 to nowadays they point out how different diagnostic procedures and therapy way of acting were in the first and in the second deca. After having explained actual therapeutic direction that is described in literature, they finish by stating how this is often conditioned by complex anatomicopathological picture and by seriousness of hepatic damage that often comes with intrahepatic lithiasis.

Bile Ducts, Intrahepatic↗
PubMedDate not supplied

[Intraoperative ultrasonography, dissection with ultra-shears and trans-cystic choledochoscopy during laparoscopic approach in obstructive lithiasis icterus case].

The authors present the case of a 48 years old male with lithiasis obstructive icterus who was operated by laparoscopic transcystic approach with choledochoscopy. This minimally invasive technique was very spectacular trough the using of laparoscopic ultrasonography, dissection with Ultra-Shears device and transcystic choledochoscopy. Careful watching of abdominal laparoscopic view and transcystic choledochoscopic view is the particularity of laparoscopic transcystic management of choledocholithiasis. This metod don't let us to explore the biliary tract before the junction between common bile duct and cystic duct.

Cholecystectomy, Laparoscopic↗
PubMed2003

[Meta-analysis on curative effects of surgical procedures for intrahepatic bile duct lithiasis].

OBJECTIVE: To compare curative effects of various surgical procedures of bile duct stones. METHODS: Two thousand nine hundred and fifty-five patients with intrahepatic bile duct lithiasis who had undergone various surgical procedures were analysed with Meta-analysis. Some of these cases were reported in Chinese Medical Journals from January 1990 to March 2001 and others were from Tongji Hospital. RESULTS: There was a significant difference between curative effects of non-hepatectomy and that of hepatectomy (chi(2) = 62.945, P < 0.01), and the outcomes of hepatectomy were much better than those of non-hepatectomy with OR(S) equalled to 0.303 (0.222 - 0.413). There was not a significant difference between curative effect of interposed jejunum and that of hepatectomy (95% CI of RR from 0.98 to 1.04). All the other operation, effects were worse than hepatectomy (upper limit of 95% CI of RR < 1). CONCLUSIONS: Hepatectomy is the most ideal surgery for intrahepatic bile duct stones and operation methods should be diversified since good effect could also be obtained when other operations are performed on suitable cases.

Bile Duct Diseases↗
PubMed1992

[One hundred and twenty-five consecutive choledochotomies for suspected lithiasis without mortality. Current state of complications from common bile duct surgery].

The postoperative courses of 125 consecutive surgical common bile duct explorations performed between 1983 and 1990 were analysed. All cases of common bile duct lithiasis, but three, were operated on. Intraoperative cholangiography was performed in 98 percent and cholangioscopy in 92 percent of patients; common bile duct stones were found in 95 patients (76 percent); the common bile duct was sutured without drainage in 78 patients (58 percent). There were no deaths. Morbidity was 14 percent, of which 10 percent were serious. Four percent of common bile ducts retained stones. The specific morbidity was 4 percent. These results confirm the reliability of surgical management of common bile duct stones and therefore should be considered for the evaluation of new procedures, such as laparoscopic treatment of common duct stones, or combined laparoscopic cholecystectomy and endoscopic sphincterotomy.

Aged↗
PubMed1992

[Primary intrahepatic lithiasis].

Isolated intrahepatic lithiasis is a very rare condition in western countries; the reported case has to be added to the 29 cases described to date in the literature. The pathogenesis of this disease is unknown; physical and chemical bile alterations favouring lithogenesis is the most reliable hypothesis. In this case the Roux-en-Y hepaticojejunostomy with cutaneous stoma allowed us to perform periodic cleaning of intrahepatic bile ducts until complete elimination of all stones.

Bile Ducts, Intrahepatic↗
PubMed1992

[Laser lithotripsy in the treatment of ureteral lithiasis].

Laser lithotripsy constitutes a safe method with a success rate of 95% in the treatment of ureteral calculi. The photoacoustic properties of the laser permit stone fragmentation without injury to tissue. The major disadvantage of this technique is its cost. The availability of increasingly smaller electrohydraulic systems that are less costly questions the routine use of the laser system. Another aspect that must be considered is the rapid development of endourologic techniques and instruments in recent years. The use of laser-induced shock waves is not exclusive to the field of Urology. In other surgical specialties where electrohydraulic energy is difficult to use, it constitutes a necessary technique. Such is the case of endoscopy of the bile ducts, fragmentation of pancreatic calculi and lithiasis of the salivary glands. Another possible field of application of laser-induced shock waves is coronary angioplasty.

Humans↗
PubMed1992

Anuria due to lithiasis associated with septic shock.

During 18 months 38 patients with anuria due to lithiasis were admitted in our department, 8 of them developed septic shock. Twenty eight patients were cured using different procedures and were released from the hospital with normal urinary output. Ten patients died, 6 of them from septic shock, which has a high mortality rate. Emergency restoration of urinary flow, correction of fluid and electrolyte imbalance, massive antibiotherapy may improve results.

Anuria↗
PubMed1992

A pseudotumoral edema of the urinary bladder secondary to an intramural impacted ureteral lithiasis.

A case of pseudotumor of the urinary bladder secondary to intramural lithiasis is reported. Computer tomography, cystoscopy of the mass and cytology suggested a malignant tumor. A transurethral biopsy from the tumor was therefore performed, but it showed tissue covered with normal transitional cell epithelium but no signs of malignancy. Pseudotumoral edema of the bladder is easily mistaken for a malignant neoplasm (1, 2, 3).

Aged↗
PubMedDate not supplied

[The place of polar nephrectomy in the surgical treatment of renal lithiasis].

Out of a total of 475 interventions for renal lithiasis, the author has performed only 15 partial nephrectomies, as compared with 118 total nephrectomies and 342 conservatory pyelotomies and nephrotomies. The type of intervention described should be limited to cases where the polar parenchyma is jeopardised--partial tactical nephrectomy should be abandoned.

Humans↗