SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Pernasal catheter perfusion with MTBE and subsequent endoscopic lithotripsy is an effective treatment of complicated common bile duct lithiasis in which a first endoscopic attempt has failed. The authors analyzed their experience in 1990.
Presentation of 9 cases of calyceal diverticulum symptomatic lithiasis, 6 of which have been treated up to the present time. Of the remaining 3, one patients, in spite of its evolutive character (increased cavity) and moderate pain, prefers to abstain from therapeutic therapy, but undergoes follow-up controls every 6 months; the other 2 cases are waiting endourological treatment. Out of 6 patients who underwent surgery, two cases, who had previously experienced shockwave extracorporeal lithotripsy (SWEL), were advised to have endourological procedures due to persistence of pain and gallstones debris.
Urinary lithiasis is a millenary disease for which different classifications have been developed: clinical, etiopathogenic, crystallographic, etc. The introduction of endoscopic surgery and extracorporeal lithotripsy in the last decade has created the need for a clinicotherapeutic classification as manifested by Rocco, Griffith, Tisselius, and other authors. We have developed the CEP/LTS-X classification, which evaluates the stone characteristics (C) [location and form (L), size (T), consistency (S) and number (X)], the excretory tract (E) and the renal parenchyma (P), and permits classifying the urinary calculus as LTS renal calculus types I, II, III, IV; LTS ureteral calculus types I, II, III; and LTS vesical and ureteral calculi types I and II, with related general characteristics that permit indicating treatment for each type: in situ ESWL or complementary endourological techniques, endoscopic or open surgery, alone or in combination.
OBJECTIVES: We evaluated the efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of pediatric urolithiasis, analyzing results and complications in our series. METHODS/RESULTS: 20 patients (16 males and 4 females) with ages from 2 to 17 years were evaluated. Twelve patients presented left side lithiasis (60%). The size of the stone was measured in cm2 areas. 6 cases (30%) presented with lower calyx stones and 5 cases (25.9%) with stones in the pelvic ureter. 2 patients required JJ catheter insertion. Mean number of shock waves per session was 2,650 (range: 1,000-3,800). The Dornier Lithotripter S and Dornier MFL-5000 lithotripsy machines were used in the range of 10-120 Kv and 14-23 Kv respectively. Follow-up evaluation was performed at one week and three months from treatment, including abdomen x-ray to obtain fragmentation and elimination percentages. In our series total fragmentation was achieved in 100% of the cases, without any patient with partial fragmentation (fragments > 5 mm). Elimination percentages were satisfactory, with a 65% total elimination and 30% partial elimination (residual fragments < 5 mm) within one week. One patient had no elimination at all. CONCLUSIONS: After the results obtained in our series, we consider external shock wave lithotripsy the first treatment option in cases of pediatric urolithiasis.
OBJECTIVES: Obesity is considered a significant risk factor for diseases such as hypertension, diabetes, coronary artery disease, and metabolic diseases, increasing considerably the risk for surgery. We have treated with ESWL a significant number of patients with the aim of avoiding operations which could be long and have associated complications due to the patient's condition. METHODS: From April 2000 to May 2002 we treated 150 obese patients with kidney and/or ureteral stones using a Nova Ultima lithotripter. 94% of the patients were treated with a neuroleptoanalgesic drug, and 6% of the cases required narcotic-neuroleptoanalgesia. 85% of the cases were admitted for 24 hours, and 15% were outpatient. 94 males and 56 females who weighted more than 90 kg (91-141 kg) and more than 80 kg (80-127 kg) respectively were treated. Mean age was 41 years (range 20-72). 134 stones were located in the kidney, 27 in the pelvis and 16 in the ureter (25 patients presented bilateral lithiasis and 2 one ureteral stone and one homolateral kidney stone). Mean stone size was 12 mm. Stone track down was easy in 64% of the cases and difficult in 36%, mainly ureteral and pelvic stones. All patients received 3,000 shock waves at 21-22 KV and high energy with an average time per session of 35 minutes. Ultrasound tracking was preferred in 80% of the patients. RESULTS: Results at three months were: 72% stone-free, 9% < 4 mm, 14% > = 4 mm, and 5% failures. Best results were obtained in pelvic and lumbar ureter stones (88%). Mean retreatment was 1.6, with one additional session in 34 patients, two sessions in 8, and three sessions in 5. CONCLUSIONS: In the treatment of urolithiasis in obese patients, lithotriptor machine characteristics and operator experience are very important. The knowledge and the application of stone tracking systems allow the urologist to obtain a higher percentage of stone free patients. These techniques are important in these patients because positioning is key to obtain a good result. The indication of ESWL in obese patients is a good choice but selection criteria should be respected. The percentage of stone free patients at three months has been satisfactory and complications are similar to those published by other authors.
Urinary stones continue to be an interesting and major problem for both urologists and radiologists. The authors try to present the imaging diagnosis possibilities for this pathology according to the expectations of the urologists who have to deal with urinary tract lithiasis with the new methods (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy). Helical CT has certain advantages and in different centers in Europe appear to be less expensive than intravenous urography (IVU), but unfortunately, is not available in our medical center. So, for us, IVU remains the basic investigation for urinary stones. Echography helps a lot for correct strategy, but together with KUB cannot replace IVU if we want to avoid mistakes.
Diffusely-infiltrating mucinous adenocarcinoma of the renal pelvis associated with lithiasis and chronic gout is reported in a 61-year-old Malay man. The patient underwent left nephrectomy and vesiculo-lithotomy. This tumour is postulated to arise in response to chronic irritation of the urothelium.
The paper reports the authors' experience in the treatment of biliary lithiasis in elderly patients. The indications for surgery are examined taking into account the possibilities offered by the introduction of new technologies, and in particular preoperative EPST.
Ambroise Paré, founder of surgery, by his research and books concerning urology, made an enormous contribution to the foundation of this discipline. The treatment of urinary tract's lithiasis in the Works of Paré.
We report a rare case of lithiasis of the minor salivary glands (LMSG) of the upper lip, with a very atypical clinical presentation, firstly as a left hemifacial cellulitis and later, after antibiotic therapy, as a solid, firm and hard intramural nodule of the retrocommissural side of the upper lip; the needs of a wide spectrum of clinical differential diagnosis with calcified angiomas, salivary tumors, soft tissue tumors, phlogistic and neoplastic pathology of the local lymphnode, foreign body lesions, is underlined. The histological aspects of the lesion are described.
AIM: Endoscopic sphincterotomy is a well-established procedure for treating choledocolithiasis and particularly residual lithiasis. The aim of this study is to expose our experience with this method and to evaluate his safety and efficacy. METHODOLOGY: It is a retrospectively collected series of 661 patients with residual choledocolithiasis. RESULTS: Endoscopic retrograde cholangio-pancreatographies were performed in 651 patients (98.5%). Standard sphincterotomy was realized in 633 patients (95%) and a pre-cut technique was done in 15 (2%). Bile duct clearance was achieved in 583 cases (91%). Overall, the complication rate of sphincterotomy was about 8.4%. CONCLUSION: Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis.
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.
The function of DL alpha-lipoic acid (6,8-thioctic acid) as a prosthetic group in the oxidative decarboxylation of alpha-keto acids, pyruvate and alpha-ketoglutarate in mitochondria is well known. Its role is well extended to certain reactions in lipid biosynthesis. In addition, lipoic acid has been shown to prevent the induced precipitation of calcium oxalate crystals in the renal tissues of laboratory animals. Here, the effect of alpha-lipoic acid was studied, on altered tissue lipid levels manifested during experimental renal lithiasis. Raised tissue cholesterol, triglyceride and low phospholipid levels were some of the striking significant observations made in calculogenic rats. Lipoic acid treatment reduced tissue cholesterol and triglyceride levels significantly and raised phospholipids. The alterations may have a bearing in relation to calcium oxalate stone formation.
Presentation of a case of Sjögren syndrome associated to urinary lithiasis. This is a very rare association, of which only 4 cases have been described worldwide, ours being the second report in Spain. Discussion of the pathogenic mechanisms responsible for the urolithiasis, including distal renal tubular acidosis, hypercalciuria and hypocitraturia, as well as therapy followed in this case. Finally, a review is made of the scarce literature available on this rare association, and renal involvement of the syndrome is discussed.
Presentation of one case of lithiasis as complication of female urethra diverticulum. Etiopathogenic factors, signs and symptoms, diagnosis, complications and therapy options are commented.
BACKGROUND: The aim of this study is to clarify the prevalence of gallbladder benign neoplasms, their ultrasonographic appearance and their relationship with gallbladder lithiasis and cancer. METHODS: This study was carried out on 9000 consecutive patients having ultrasound of upper abdomen. Only adenomas and papillomas are considered as true benign neoplasms of the gallbladder. Adenomiomatosis and cholesterol polyps, often erroneously labelled as benign neoplasms, were excluded. Patients were followed-up by ultrasound every three months up to two years. RESULTS: The prevalence of benign neoplasms was 1.19%. Papillomas were found more frequently than adenomas both in males (68.51%) and in females (94.33%). Gallstones were not concomitant with benign neoplasms in any case. Neither stones nor growth of gallbladder benign neoplasms were recorded within the two-year follow-up period. CONCLUSIONS: Papillomas were more frequent than adenomas. No gallstone was concurrent with gallbladder benign neoplasms in our series. However, when gallstones are evidenced at ultrasound, further attention is recommended to discover probable concomitant neoplasms. Papillomas and adenomas more than 1 cm in diameter should be quarterly followed-up, while smaller masses could be six-monthly controlled. Surgery should be indicated for large-sized or rapidly growing masses because of the risk for cancer development.
Pregnancy complicated with gallbladder disease stone has an incidence of 2-14%, and more than 30% of patients do not respond to medical treatment; therefore, in order to reduce the morbidity and mortality in fetus and mother, surgical management would be required. The current use of ultrasound of high resolution has facilitated the diagnosis and also, in the present clinical case, this imaging modality allowed us to suspect the unusual diagnosis reported, that corresponds to a female of 34 years old with 33 weeks of pregnancy, complicated with symptomatic gallbladder disease stone, whose pain was intractable at the expectant management. The clinical diagnosis was corroborated by ultrasound and the report was: lithiasis, biliary sludge and an intragallbladder image of bilobular polypoid. The patient was submitted to cholecystectomy by laparotomy, whose histopathologic findings were: cholelithiasis and in situ gallbladder adenocarcinoma with an exophytic growing variety. The purposes of this article are to report a case and to review the literature.
With the aim of assessing if biochemical changes occur in the follow up of patients with renal lithiasis, 237 patients were studied (115 women and 122 men, mean age 39 +/- 8 and 42 +/- 7 years, respectively) and controlled during 27.3 +/- 19.3 months. All of them had previously undergone metabolic evaluations at baseline and one or more than one control studies afterwards. Patients with a diagnosis of sponge kidney, renal tubular acidosis, primary hyperparathyroidism, anatomical malformations of the urinary tract, or urinary infections were not included. Two populations were identified: those who presented changes in the baseline diagnosis (139 patients, Group I) and those who presented no changes (98 patients, Group II). In these groups, no differences were observed in baseline metabolic diagnoses or in the follow-up period. Hypocitraturia was the additional diagnosis most frequently observed (43.1%), followed by Idiopatic hypercalciuria (20.8%) and abnormalities of uric acid (16.5%). In the group of 110 patients followed up for more than 3 years, 37 patients recurred (33%). Among the latter, 25 (23%) changed the baseline metabolic diagnosis vs. 12 (11%) that maintained the same diagnosis (p < 0.002). Changes in metabolic disorders were frequently observed in the follow up of patients with nephrolithiasis. These changes are not necessarily associated with the diet indicated or drug treatment. Hypocitraturia was the additional metabolic disorder most frequently found. In general, there is a higher recurrence rate in those patients who present changes in their biochemical parameters and undergo no treatment.