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PubMed1995

[The dissolution of cystine lithiasis with n-acetylcysteine].

OBJECTIVE: The results of in situ dissolution of a cystine calculus is described. This approach was attempted in a female patient for whom surgery was not considered to be the best therapeutic option. METHODS: An obstructive cystine calculus was treated by in situ litholysis using N-acetylcysteine applied locally via two percutaneous nephrostomies and adjuvant oral metaphylaxis. The patient had a long clinical history of lithiasis that had also required surgery and a family history of cystinuria. RESULTS: In situ litholysis completely dissolved the cystine calculus and avoided the need for a complex surgery. The procedure and a pharmacological analysis are presented. CONCLUSIONS: In our view, this procedure is practical, carries minimal morbidity and should be considered in the management of cystine calculus.

Acetylcysteine↗
PubMed1995

[Role of ultrasound lithotripsy in the treatment of lithiasis of the lower urinary tract. Apropos of 38 cases].

Between February 1989 and February 1994, 38 patients with lower urinary tract lithiasis were treated by ultrasonic lithotripsy. Mean size of the stone was 23 x 19 mm, extreme being 5 mm-50 mm (over 20 mm in 27 patients). Transurethral lithotripsy has been performed in 36 patients, and percutaneous cystolithotripsy in 2 patients. Some desintegration was complete in 37 cases, and the only failure was a case in which the stone was too hard. Morbidity was zero. Ultrasonic lithotripsy for urethral and bladder stones appears to be a safe, effective and simple method of treatment.

Adolescent↗
PubMed1995

[Epidemiology of urinary lithiasis in la Ribera de Navarra (I)].

An epidemiological study on the lithiatic disease (LD) was conducted in 'La Ribera de Navarra' over a two year-period, based on the series from the Reina Sofia Hospital in Tudela. Between May 1988 and May 1990 we gathered 785 cases. This paper analyzes the hospitalization incidence, risk factors such as age, sex, familial and personal background of lithiasis, consumption of drugs., etc. A description is made of the geographical, geological, climatic conditions, composition of water, and other characteristics, as well as the clinical features. Incidence of LE in this Area V of Navarra is high, 5.1 per thousand inhabitants/year, being uncommon in children but frequent in adults: 7.92 per thousand men/year and 4.97 per thousand women/year, with a male/female ratio of 1.52. There is a predominance of women over the early decades of life, the M/F ratio being 0.40 for the 15-24 years range. 19.61% of patients have a familial background of LE, the father being the most affected relation. Around 53.79% have been affected by LE. The factor most commonly correlated to frequency is the distance to the hospital and the rate of admission to the emergency service by area. No correction was noted to water hardness or weather differences. The greater incidence takes place during the summer and the lowest in the autumn.

Adolescent↗
PubMed1996

[Lithiasis of the common bile duct: the role of cholangiography and magnetic resonance].

The aim of our study was to evaluate the sensitivity, specificity and diagnostic accuracy of Magnetic Resonance Cholangiography (MR-CP) in patients with suspected choledocholithiasis. Sixty-two patients (mean age: 56.3 years) previously submitted to US, were examined with MRCP. MR exams were performed with an 0.5 T superconductive magnet (Gyroscan T5-II; Philips, Medical System, Best, NL) and a body coil. 3D-TSE sequences (TR/TE/ETL = 5.000/244/45 ms) were acquired, with 14 min 10 sec acquisition time. In the last 21 patients, acquisition time was reduced down to 3 min, by optimizing the parameters as follows: TR/TE/ETL = 3.000/700/128 ms. The images, obtained on the coronal plane, were then reconstructed with the MIP algorithm. MRCP images were studied both as MIP reconstructions and as single slices. The diagnosis was always compared with endoscopic or percutaneous findings. MRCP images were of diagnostic quality in all cases, with 91.7% sensitivity, 100% specificity and 96.8% diagnostic accuracy. MRCP had 100% positive predictive value and 95% negative predictive value. In conclusion, this technique is extremely useful to examine the patients with obstructive jaundice secondary to lithiasis.

Adult↗
PubMed1996

[Treatment of common bile duct lithiasis under laparoscopy. A prospective multicenter study in 189 patients].

OBJECTIVES: The aim of this study was to assess the feasibility and results of common bile duct laparoscopic treatment and exploration in patients with choledocholithiasis. PATIENTS AND METHODS: From November 1991 to December 1994, 189 consecutive malades (120 females; mean age 68 years, range: 21-92) with choledocholithiasis identified during routine intraoperative cholangiogram underwent surgical exploration of common bile duct in 5 surgical centers. Twenty patients were referred to surgery after unsuccessful endoscopic sphincterotomy. RESULTS: Following laparoscopic exploration and intraoperative cholangiography, common bile duct stone extraction by laparoscopy was not attempted in 11 patients (5.8%). The common bile duct was successfully cleared of all stones in 153 patients (81% of the overall population and 86% of laparoscopic attempts), either via the transcystic route (n = 97) or through choledocotomy (n = 56). Eighteen patients required conversion to open surgery, 16 for unsuccessful stone extraction and 2 despite successful stone extraction. Postoperative endoscopic sphincterotomy was required in 7 patients (4.4%) for retained stones after laparoscopic treatment. There were no postoperative deaths (95% confidence interval 0-1.6%), and follow-up, ranging from 3 to 42 months, has shown no further clinical evidence of retained stones. CONCLUSION: Diagnosis and treatment of common bile duct stones is feasible by laparoscopy, and the results in this series compare favorably with those of conventional surgical treatment. Complete treatment of biliary lithiasis, in one operation, avoids the pitfalls of patient selection for preoperative endoscopic retrograde cholangiography and the risks of endoscopic sphincterotomy.

Adult↗
PubMed1996

[Ureteroscopy with pseudoanalgesia in the treatment of ureteral lithiasis].

Presentation of the results obtained in 35 patients with ureteral lithiasis treated over a two-year interval by means of ureteroscopy with pseudoanalgesia at the Hospital Insular, with a 89% success rate. We conclude that in selected cases, the use of peg ureteroscopy or pneumatic lithotrite is a valid therapeutical option since it is well-tolerated and has the benefit of a short or null hospitalization.

Adult↗
PubMedDate not supplied

[Lithiasis in renal transplantation].

Lithiasis as a post-renal transplantation complication is rare and of delayed appearance. After having revised 320 transplantations performed at the Fundación Puigvert 8 cases were found, which implies a two-fold increased incidence over other series studied and greater than the prevalence in the normal population. We confirmed the existence of lithogenous factors in 7 of the 8 cases, and found that in 50% of them the calculus composition was urate, what explained the differences versus normal population in terms of treatment with cyclosporin and the personal background. Two therapeutic schemes may be outlined based on the chemical composition of the calculus, and thus ultrasound-guided ESWL is chosen as chronic therapy when calculi have a calcic origin whereas medical management is used when their nature is uric, even though we understand that treatment must be individualized in each case. We have obtained good results in all 8 cases without compromising neither the renal function nor the graft viability.

Adult↗
PubMed1996

Unilobar intrahepatic lithiasis 22 years after cholecystectomy.

Complaints of right upper quadrant pain, jaundice, and fever in the postcholecystectomy patient provide the physician with a challenging diagnosis. This case concerns a patient with intrahepatic lithiasis and fibrotic atrophy of the right lobe 22 years after open cholecystectomy.

Bile Ducts, Intrahepatic↗
PubMed1995

Biliary lithiasis: retrospective analysis of a case series.

The paper analyses a series of biliary lithiasis cases encountered in 1983-92 in which cholelithiasis accounted for 79.3%, cholecystocholedochic calculosis for 16.6%, chronic stenotic papillitis for 2.1%, residual/recurring calculosis of the main biliary way after cholecystectomy for 1.7% and intrahepatic calculosis for 0.3%. Among the cases involving the main biliary way, the highest percentage (35/50 cases or 70%) of transduodenal papillosphincterostomies was performed in the first five years, while endoscopic papillosphincterotomy prevailed (28/42 or 66.7%) in the second five years. The endoscopic technique was initially considered elective for residual/recurring biliary calculosis after cholecystectomy and for cholecystocholedochic calculosis in patients who were elderly and/or at risk. Thereafter its use was gradually extended as technological developments allowed its use as a complementary technique in cases of giant stones. The advent of minimally invasive surgery has given a further boost to the use of endoscopic clean-up procedures in cases of biliary calculosis prior to laparoscopic cholecystectomy. The laparoscopic treatment of gallstones is a more recent development.

Adolescent↗
PubMed1996

Extracorporeal shock wave lithotripsy in the treatment of ureteral lithiasis: methodological controversies and therapeutic efficacy.

The treatment of ureteral stones has undergone a radical change in the last 15 years. First, the increased use of endoscopic procedures and then the introduction of extracorporeal lithotripsy relegated traditional surgery to a marginal role for this type of disorder. The best available treatment modality for ureteral lithiasis, particularly distal ureteral stones, is still a matter of great controversy among urologist. With the introduction in clinical use of second- and third generation lithotripters, which are even less invasive and require no anesthesia, interest has increased in treating patients by extracorporeal lithotripsy, reducing endoscopic monoeuvres to a minimum. The absolute contraindications to extracorporeal lithotripsy for ureteral stones are the same as those for renal stones: intractable hemostatic alterations, pregnancy, physical structure that limits positioning and altered patency of the urinary tract. From June 1990 to December 1994, 270 patients with ureteral stones were treated by extracorporeal lithotripsy at our center. The Dornier MPL 9000 lithotripter was used in 68 cases (25%) and the modified HM3 Dornier in 202 (75%). Pretreatment manoeuvres were performed in 130 patients (48%). Endoscopic manoeuvres were not performed in 140 patients treated in situ. 18 patients (13%) treated initially in situ subsequently underwent post-treatment manoeuvres which were required only in 3 patients who had undergone pretreatment. All patients were examined as outpatients 3 months after the treatment. A total of 241 patients (89%) were stone free, 121 who had undergone pretreatment manoeuvres and 119 who had been treated in situ. 29 patients (11%) were not stone free: 23 patients subsequently underwent endoscopic lithotripsy, 2 surgery and 4 stone removal by Dormia probe. The possibility of performing treatment without anesthesia, the absence of complications and the high proportion of successes make extracorporeal lithotripsy, particularly the in situ procedure, the treatment of choice for ureteral stones. Ureterorenoscopy has been proposed by some authors as the first treatment for mid and pelvic ureteral stones which are difficult to localize with the lithotripter. However, although this method is very efficacious and less expensive, the percentage of complications is greater and patient compliance is less.

Evaluation Studies as Topic↗
PubMed1996

[Duodenal obstruction by biliary lithiasis (Bouveret's syndrome)].

The case of an 81-year-old woman admitted for abdominal pain, nausea and vomiting diagnosed with Bouveret syndrome is presented. This rare disease, consisting in obstruction of gastric emptying by gallstones located in the pylorus or the duodenal bulb predominates in elderly women and represents 2% of the cases of biliary ileum. Diagnosis is based on the clinical manifestations, the existence of aerobilia, visualization of lithiasis by radiography, echography or fiber gastroscopy and the demonstration of duodenal obstruction. The treatment of choice is surgery consisting in gastrotomy or enterotomy and extraction of the stone. The importance of diagnosis and early treatment is emphasized to improve prognosis.

Aged↗
PubMed1997

[Minor salivary gland lithiasis simulating a mucocele. Apropos of a case].

Lithiasis of minor salivary glands is often considered to be extremely rare. However, recent publications reveal that minor salivary gland calculi are not so rare. Clinical features are not always typical, so clinical misdiagnosis is possible. Clinicians have to be aware to make a correct diagnosis. A case of sialolithiasis of minor salivary gland mimicking a mucous cyst is reported.

Adult↗
PubMed1997

[Infrequent association: massive inguinoscrotal bladder hernia, multiple scrotal lithiasis, and bilateral obstructive uropathy].

Vesical hernias occur in a significant number of patients with inguinal hernia, though massive inguinoscrotal vesical hernias are uncommon. This paper presents a case report of a male patient where massive inguinoscrotal vesical hernia, and scrotum-located multiple vesical lithiasis was associated to a large amount of lithiasic mass and bilateral ureterohydronephrosis. We consider this association of urinary conditions extremely rare, since to our knowledge bilateral ureterohydronephrosis has only been formerly documented in one case.

Aged↗
PubMed1998

[Vesicular and pronuclear glycoproteins in the pathogenesis of cholesterol lithiasis].

BACKGROUND: Several biliary proteins have been known to accelerate fusion of cholesterol rich phospholipid vesicles. Some of them are present in vesicular membrane, localisation of other proteins is unknown. Biliary glycoprotein has not been studied in consequence with pathogenesis of cholesterol lithiasis. METHODS AND RESULTS: Low molecular extravesicular proteins were separated from vesicles by gel filtration on a 1200mm column of Sephacryl S-300 HR. Immunoglobulins IgM, IgA, haptoglobin, biliary glycoprotein I (BGP I) and nonspecific crossreactive antigen were eluted along with vesicles. Albumin and alpha 1-acid glycoprotein were eluted later and must be extravesicular. CONCLUSIONS: Fact that BGP I (85 kDa membrane glycoprotein) eluted along with vesicles and not in albumin fraction suggests that it might be bound in vesicular membrane. As a known adhesion molecule it could thus play an important role in pathogenesis of cholesterol cholelithiasis.

Bile↗
PubMed1997

[Intra-corporeal shockwave lithotripsy in the treatment of complex lithiasis of the bile ducts. Comparison of endoscopic techniques and long-term results].

OBJECTIVES: About 2% of common bile duct stones and most intra-hepatic stones cannot be removed by conventional endoscopy. Intra-corporeal lithotripsy is an alternative technique for these patients. Contact lithotripsy can be obtained by a pulsed dye laser or by electro-hydraulic shockwaves. We compared and assessed the results of these two methods. METHODS: Thirty-seven patients (79 +/- 9.8 years, 25 women and 12 men) underwent laser lithotripsy (n = 21), electro-hydraulic lithotripsy (n = 9) or both methods consecutively (n = 7) for common bile duct stones (n = 31), intra-hepatic stones (n = 3) or diffuse lithiasis (n = 3). The mean diameter of the largest stone was 23 +/- 12 mm. Lithotripsy was performed by a retrograde approach in 35 cases and a combined, retrograde and transhepatic approach in 2 cases. RESULTS: The mean number of lithotripsy sessions was 1.5 +/- 0.65. The overall success rate (free bile ducts with patent drainage) was 95%. In 2 patients, stones were not fully extracted: one underwent surgery, the other one was treated conservatively with antibiotics. The duration of the hospital stay was 9.3 +/- 4.5 days. Morbidity at 30 days was 27% and only one case of major morbidity (hemorrhage after sphincterotomy, 2.7%) was observed. There were no procedure-related mortality. Electro-hydraulic and laser groups did not differ significantly for success rate, morbidity and time spent at hospital. Follow-up information was obtained in 34 patients (91.8%) a median of 17 months after lithotripsy (range: 4.52 months). Ten patients died of non-biliary diseases. Two patients (5.8%) developed biliary symptoms 24 and 34 months after lithotripsy, one after unsuccessful lithotripsy. CONCLUSION: Intra-corporeal lithotripsy is a valuable tool for the most complex cases of duct stones, and with an acceptable morbidity. The results of the two techniques are similar. Late biliary complications after intra-corporeal lithotripsy appear to be rare.

Aged↗
PubMed1998

[Symptomatic common bile duct lithiasis: endoscopic treatment or surgical treatment?].

Since 1974, endoscopic sphincterotomy (ES) has been considered by most practitioners as the gold standard for the treatment of symptomatic common bile duct lithiasis (CBDL). Results of the seven prospectives randomized controlled trials comparing ES to surgery in the treatment of CBDL, acute pancreatitis and angiocholitis excluded, demonstrated that: 1) the rate of feasibility of ES ranged from 90 to 100%; 2) the rate of residual stones after first extraction attempt ranged from 4 to 23% and after second extraction attempt from 6 to 25%. After surgery, rate of residual stone ranged from 2 to 14%; 3) major complications were more frequent after ES than after surgery; on the opposite, minor complications were more frequent after surgery than after ES; 4) immediate mortality was higher after ES than after surgery; 5) cost of ES with or without de principle cholecystectomy was higher than surgery. In conclusion ES should not be the first treatment of symptomatic CBDL.

Cholecystectomy↗
PubMed1998

[The diagnosis of lithiasis of the extrahepatic biliary tract].

The diagnostic approach to 227 patients presenting lithiasis of the extrahepatic biliary ducts is discussed. All patients are diagnosed in the second surgical department of the University Aleksandrovska Hospital over an eleven-year period on the ground of complex examinations, including: clinical, laboratory and instrumental (echography, endoscopic retrograde cholangiopancreatography, cholangiography, computerized tomography) study. As shown by the clinical data analysis, the basic symptoms are pain--in 221 cases (97.35%), jaundice--128 (56.38%), accompanied in most of them by dyspeptic complaints, and in a minor part--by cholangitis manifestations. Of the laboratory data, the most commonly met with are the abnormally increased values of serum bilirubin, alkaline phosphatase, liver tests etc. Of the instrumental methods echography is first and foremost used in the preoperative period, supplemented in certain cases with other methods. Intraoperatively, cholangiography is routinely used for concrement detection.

Adult↗
PubMed1998

[The surgical treatment of extrahepatic bile duct lithiasis].

Data concerning operative treatment of 227 patients with lithiasis of the extrahepatic biliary ducts, covering an eleven-year period (1985 to 1995 inclusive), are presented. In all cases diagnosis and operation are done in the Second Surgical Clinic at the Medical University--State University Hospital "Alexandrovska"--Sofia. By type the surgical interventions are distributed as follows: external drainage of hepaticocholedochus--122 cases (53.74 per cent), choledochoduodenostomy 69 (30.39 per cent) and transduodenal papillosphincterotomy 36 (15.85 per cent). Fifteen patients develop postoperative complications (6.60 per cent), and in five patients the outcome is fatal with postoperative lethality amounting to 2.20 per cent. The basic indications for the various types of surgical interventions are established.

Adult↗