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A series of 172 lithiasis of the common bile duct has been analysed. Priority has always been given to the external drainage by a T tube. It seems to be the simplest method, with the lowest morbidity. 6 patients, as 3.48% are deceased precociously after the intervention in keeping with the gravity of the lesions and the general state.
The authors report one case of renal hydatid disease, with lithiasis and rupture into the renal pelvis. Pre-operative diagnostic investigation included ultrasound and CT scan imaging. Serologic test was negative. Treatment was surgical: removal of the hydatid and resection of the protruding part of the cyst. The fistula is closed with a drainage into the pelvis.
Unusual features in a case of dilatation of ampulla of Vater were in the existence of biliary calculi in the diverticulum and lithiasis complicated by a revealing acute pancreatitis. Diagnosis was suggested from barium meal followed through images and confirmed by perioperative cholangiography. Surgical treatment of such cases is simple, allows recovery without sequelae and avoids risks of recurrence.
Fifteen cases of intrahepatic lithiasis are reported, on 1798 operations for non malignant diseases of the biliary tract (0.8%), carried out by the Authors in the last 11 years. Two cases were described separately, consisting respectively of an "eastern" hepatolithiasis, and a secondary form, due to stenosis of a choledochoduodenostomy, which had been performed after surgical injury of the common bile duct. The other 13 patients had a "mixed" form. Jaundice was present in 8 of these cases, cholangitis in 4. Intrahepatic stones were diagnosed preoperatively in 3 cases and intraoperatively in 10. A bilioenteric anastomosis was carried out in 9 cases, a sphincteroplasty in 3, and a T-tube drainage in a patient with suppurative cholangitis. Two patients died postoperatively, both from sepsis: the first in the early postoperative phase, after emergency operation for cholangitis; the other, with "primitive" hepatolithiasis, 3 months after the operation. Clinical results are satisfactory after 1-11 years. On the basis of data from current literature, diagnostic and therapeutic aspects are set forth, with specific reference to the mixed and secondary forms: the bilioenteric anastomoses seem to give better chances of success, but the need to have access to lobar ducts may sometimes impose hilar derivations. Spincteroplasty may have a few indications, solely in selected patients.
An uncommon case of a 42-year-old man with hilar renal symphysis in association with lithiasis and 'tubular precalyceal ectasia' is described.
We report the cases of 4 patients with renal pelvis tumor associated with renal calculi. Sonography was correlated with gross pathology in three cases. The pre operative diagnostic can be made by sonography. The carcinogenic role of the lithiasis and infection is quite possible.
Personal experience of 58 portal hypertension patients monitored for a period of 30 months is presented. Biliary lithiasis was encountered in 34.4% of these patients. The almost symptom-free course of the biliary pathology is highlighted and the surgical problems arising including those related to portal by-pass operations are examined.
A recent publication noted the apparent lack of serious complications of dilatation of salivary canals, based on a review of 16 cases. This is contested by the report of three cases of dilatation of Stensen's duct complicated by lithiasis and stenosis, with associated canalar pseudo-cysts. Surgical excision was required and allowed study of histopathology of this affection.
Hepatic lithiasis is a major disease in Asia, especially East Asia. Its clinical aspect and incidence have been reviewed. The radionuclide methods ranging from sequential scintigraphy through hepatic retention ratio determination to retention ratio image would be simple and innocuous techniques for screening and detecting this disease.
A lithotriptor delivering ultrashort shockwaves and designed for use under ultrasonographic guidance has recently been developed. Immersion in water is unnecessary. The device was experimented in renal lithiasis in dogs. Twenty-two animals were treated. In seven, who served as controls, the safety of shots delivered in particular to the lungs, liver, bones and kidneys was demonstrated. Furthermore, no cardiac rhythm disorders were recorded. A human stone was implanted in 15 animals. The stone was successfully broken up in 12. Gross and microscopic examinations done 2 to 30 days after the treatment indicate that the shots initially produce lesions similar to a limited contusion. Healing of the contusion, already underway on the 8th day, is complete by the 4th week. Elimination of the fragments is gradual. The quality of fragmentation can be evaluated during the treatment session using mode A ultrasonography. These experimental data are evidence of the effectiveness of this second generation lithotriptor.
One hundred and sixty-seven choledoco-duodenostomies for lithiasis of the common bile duct (CBD) were performed. The mean age of the patients was 74 +/- 1 years. Sixty p. 100 of the patients presented with at least one operative risk factor, usually related to their general condition. An anastomosis of at least 20 mm in diameter was possible as the diameter of the CBC was always larger than 10 mm. Immediate postoperative complications (within one month) were observed in 29 cases (17 p. 100). In 14 cases (8 p. 100), these complications were directly related to the operative procedure and, in 15 cases (9 p. 100), bronchopulmonary or cardiovascular complications occurred. Operative mortality was 4 p. 100 (7 cases); in 2 cases, death was directly related to the operative procedure, and in 5 cases, death was not directly due to surgery. Operative complications were significantly higher in the case of emergency procedures, impaction of the CBD by multiple stones, and associated acute cholecystitis. One hundred and thirty-four of the 160 survivors (84 p. 100) have been followed for a mean duration of 5 years (63 +/- 7 months); 115 (86 p. 100) have remained asymptomatic. Eleven patients had non specific findings; 8 (6 p. 100) had cholangitis, half of them having suffered from only one episode. The first (or only) episode occurred during the first postoperative year in 7 out of 8 patients. No cholangitis developed after the second postoperative year in patients still asymptomatic. No anastomotic stenosis was found in any of these cases. One case of stump syndrome was observed. These results suggest that choledocoduodenostomy is a reliable procedure for treatment of choledocolithiasis and related late complications are rare.
We report a case of intrahepatic lithiasis associated with intestinal malrotation, which showed some bile duct abnormalities, such as cystic dilatation accompanied with stenosis in its distal portion. The resected hepatic tissue was examined histopathologically. Cellular debris due to desquamation of the epithelium, hypersecretion of mucopolysaccharides from the proliferated intrahepatic glands, and periductal laminar or band-like fibrosis were present. The mixture of desquamated epithelium, mucopolysaccharides and bile juice occupied the bile duct lumen, suggesting intrahepatic immature gallstones. The timing of formation of the intrahepatic bile duct is nearly coincident with that of the rotation of the intestine. Intestinal malrotation is sometimes associated with the congenital biliary duct anomaly and therefore the present patient might were well be the case.
The high incidence of renal lithiasis in hyperparathyroidism (55 p. 100) suggests that PTH plays a causal role in stone production. It also motivates a systematic search for primary hyperparathyroidism in all patients with renal stones although it is only found in about 7 p. 100 of cases. PTH acts through the stimulation of 1.25(OH)2 vitamin D production and therefore, the absorption of calcium from the intestine, which in turn increases the filtrable calcium, hence the calciuria. In renal stones, in general, hypercalciuria represents one of the major metabolic disturbances, besides the hyperoxaluria, hyperuricosuria and the reduction of the inhibitors of crystallization. However, hypercalciuria is rarely the indirect result of excess PTH. It is usually caused by increased dietary ingestion of NaCl, meat, calcium and possibly carbohydrates.
In the kidney removed for nephrolithiasis and excretory function failure the authors found lithiasis, xanthogranulomatous pyelonephritis and squamous cell carcinoma. Brief clinical data and results of pathomorphological study are presented.
The charts of 92 children with urinary calculi were reviewed. There were 69 boys (75%) and 23 girls (25%), 20 (22%) were infants. Calculi were in kidney (74 times but were often multifocal. Fourteen children (15%) presented with a lithogenic metabolic disorder, 28 (30%) had a malformation of the urinary tract, in 4 (4.3%) a permanent urinary derivation had been performed for the treatment of a malformation or a neurologic bladder. The other children presented with apparently idiopathic lithiasis. However, urinary tract infection was found in 70%. Predisposing factors, whether stasis, urinary tract infection or some urinary malformations, were often intricate. The spontaneous elimination of calculi was rare. Even when difficult, the extraction of calculi had generally moderate functional consequences. There was one secondary renal atrophy. Relapse occurred in 11 patients. Etiologic inquiry, bacteriologic monitoring of urines and ultrasonography supervision over years are the essential means to a better evaluation of the risk of relapse.
Pure calcium oxalate monohydrate lithiasis is rare--about 5 to 10% of total renal lithiases. The proportion is the same in men and women. Pure calcium oxalate stones are a polished dark brown color, and are very hard. They are visualized radiologically as regular and homogeneous. From a biological standpoint, this type of stone is frequently associated with normal calciuria and oxaluria. Pure calcium oxalate monohydrate stones rarely evolve.
Piridoxilate (P) is given in cases of angina pectoris or arteritis. It is an intramolecular association of glyoxylic hemiacetal salts of pyridoxine. Glyoxylate has a membranous protective action; pyridoxine is used for the theoretical purpose of preventing oxidation of glyoxylic acid to oxalic acid. We have observed 12 patients with an active calcium oxalate lithiasis who had been taking P for many years. Hyperoxaluria was present in all patients and decreased significantly when the drug was interrupted. Significant hyperoxaluria was also observed in volunteers after ingestion of P (600 mg per day) or i.v. (200 mg). We have obtained experimental calcium oxalate urinary stones after intraperitoneal injection of P to Wistar rats. Piridoxilate represents an important lithogenic factor.
Determining metabolic activity in urolithiasis may avoid excessive laboratory tests and unnecessary treatment. A simple regimen such as increased oral fluids is often effective therapy in metabolically inactive disease. Most cases of renal lithiasis are idiopathic, but a complete examination and laboratory work-up will usually establish an accurate etiologic diagnosis.