Long-term urinary acidification in phosphatic urolithiasis.
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We measured the mineral content of urinary tract stones by dual photon absorptiometry, which is widely used for the analysis of bone mineral content, and compared the values of the stones by dual photon absorptiometry (DPA values) with the results of an in vitro fracture study as well as those of an in vivo extracorporeal shock wave lithotripsy treatment study. The results of a preliminary experiment showed that the DPA values of 20 urinary tract stones reflected actual stone mineral content. As a result of the in vitro fracture study, the DPA value calculated by volume of a struvite stone, which was the most easily disintegrated, was the lowest (0.53 g/cm3). The DPA values of calcium oxalate monohydrate and apatite stones, which poorly disintegrated, were the highest (0.98, 1.01 g/cm3). The DPA value of calcium oxalate dihydrate, which moderately disintegrated, was 0.86 g/cm3. By the in vivo extracorporeal shock wave lithotripsy treatment study, the total DPA values of stones measured before extracorporeal shock wave lithotripsy treatment in 12 patients were 0.73 +/- 0.34 g in successful cases and 1.92 +/- 0.43 g in unsuccessful cases with a significant difference between the two (p less than 0.05). These results showed that the measurement of stone mineral content by dual photon absorptiometry was useful in predicting the fragility of stones against shock waves before performing extracorporeal shock wave lithotripsy treatment for patients with urinary tract stones.
In a prospective, double-blind, placebo-controlled study, the efficacy and safety of acetohydroxamic acid (AHA) in preventing urinary calculogenesis was evaluated in 94 patients with chronic urinary infection. Stone growth occurred in 17% of the AHA group and in 46% of the placebo group (p less than 0.005). Completely reversible side effects consisting predominantly of psychoneurologic and musculo-integumentary symptoms were more prevalent in the AHA group (p less than 0.01). Side effects which were judged 'intolerable' were experienced by 10 (22.2%) of patients in the AHA group and 2 (4.1%) in the placebo group. It is concluded that AHA treatment is effective, relatively safe, and clinically useful in preventing infection-induced urinary calculogenesis.
Based on the analysis of magnesium (Mg), ammonium (NH4), phosphate (P), urine pH, and urine volume (V), a simplified estimate (AP[MAP] index) of the ion-activity product of magnesium ammonium phosphate (AP MAP) was derived: (Formula: see text). The factor A varies according to the collection period. In 4-hour urine samples more than half of the patients with staghorn calculi had values above 5 in contrast to normal subjects and calcium oxalate stone formers in whom lower values apparently were the rule. The AP(MAP) index might be of value in the evaluation and follow-up of patients with staghorn calculous disease.
After 24 h incubation of human urine experimentally inoculated with Corynebacterium group D2, struvite crystals appeared with an increase in pH and ammonium concentration as well as a decrease in the urea concentration. These changes were prevented by the addition of variable concentrations of acetohydroxamic acid. From these results it seems that the prevention of such crystal formation by Corynebacterium group D2 could be due to the inhibition of its urease activity besides acetohydroxamic acid having a significant antimicrobial activity, principally when tested in human urine. These effects were dose-related.
Experimental irrigation of 15 infectious renal stones with hemiacidrin resulted in complete dissolution of 11 stones within 5 days. Three of the undissolved stones had a calcium oxalate (CaOx) content of more than 10%. Stones containing calcium phosphate (CaP) and magnesium ammonium phosphate (MAP) and weighing less than 500 mg were most easily dissolved. Twenty-five stones placed in 10 ml of hemiacidrin resulted in complete dissolution of 13 and partial dissolution of 11. Even this experiment showed that the CaOx content was of importance for the outcome of hemiacidrin treatment. After treatment the MAP and CaP fractions had decreased and CaOx increased. In 36 clinical irrigations of residual concrements of known chemical composition, 5 resulted in total stone dissolution and 21 in a reduced stone volume, whereas the result was inconclusive in 3. Seven stones were not affected by the treatment, these stones were usually composed of CaP and CaOx. There was a good correlation between the dissolution test and the clinical response to hemiacidrin treatment. Based on these findings it is suggested that hemiacidrin might be a useful complement to the modern techniques of stone fragmentation such as extracorporeal shock wave lithotripsy and percutaneous surgery, at least for infectious stones with a CaOx content of less than 10%.
Six high operative risk patients with urinary retention caused by benign prostatic hyperplasia were managed with an intraprostatic spiral at our hospital. Three of them had severe coronary artery disease, 1 had uremia, 1 had cerebral stroke and 1 had poorly controlled diabetes mellitus. The urinary retention was successfully relieved by the intraprostatic spiral in all patients. No operative mortality or severe complication was encountered. One patient experienced a repeat attack of urinary retention due to proximal migration of the spiral. Four patients complained of urgency, which was relieved by anticholinergic agents. Stone incrustation was found on 2 out of 3 spirals removed (66%), and the stone turned out to be calcium phosphate and struvite by scanning electron microscopy and infrared spectrophotometry. In 1 patient, stone formation was so abundant that it almost obstructed the lumen of the redundant tip of the spiral. From our preliminary results, the intraprostatic spiral seems to be a good alternative to an indwelling catheter for patients awaiting prostatectomy. Nevertheless, the potential complication of stone incrustation should be anticipated and it is suggested to remove the device as soon as possible or to replace it at regular intervals.
Well-defined polyacrylamide-polystyrene copolymers were grafted from the fibrillar clay, attapulgite, by a four-step self-assembly process: (i) the gamma-aminopropyltriethoxyl silane was self-assembled onto the surfaces of the attapulgite; (ii) the surface amino groups were amidated with bromoacetylbromide; (iii) the bromo-acetamide modified attapulgite was used as macro-initiator for the surface-initiated atom transfer radical polymerization of styrene with the catalyst of the complex of 1,10-phenanthroline and Cu(I)Br; (iv) the polystyrene grafted attapulgite was then used as macroinitiator for the polymerization of acrylamide. The two steps of the surface-initiated atom transfer radical polymerizations were all conducted under ultrasonic irradiation at room temperature. The product, polyacrylamide-polystyrene copolymers grafted attapulgite, had been characterized with elemental analysis, Fourier transform infrared spectroscopy, Thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy, X-ray diffractometry, and transmission electron microscopy.
About 5% of American women and 12% of men will develop a kidney stone at some time in their life, and prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP); 10% of struvite (magnesium ammonium phosphate produced during infection with bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stones. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. Here we focus on the mechanisms of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including recent developments in our understanding of related changes in human kidney tissue and of underlying genetic causes, in addition to current therapeutics.
Using a pin-on-disc sliding-wear test apparatus, the wear behavior of a typical composite restorative vs. styli fashioned from human enamel, sintered alumina, and magnesium fluoride was examined. The rates of restorative wear were found to be identical, within the experimental error of the measurements, for tests using either human enamel pins or styli fabricated from sintered alumina. Moreover, these two pin materials generated morphologically similar wear-tracks in the restorative disc. Thus, styli of sintered alumina produce restorative wear that is both qualitatively and quantitatively analogous to that observed in tests using human enamel pins.
Previous studies have shown that rat incisor dentin contains a considerable amount of magnesium that is distributed heterogeneously. The cementum-related dentin, especially its incisal portion, is richest in magnesium. It was the purpose of the present study to investigate the changes that occur in the magnesium content during dentin maturation. Cross-sections were prepared from rat incisors at the apical, middle, and incisal levels. By means of an electron microprobe, tracings were made of the Ca-, Mg-, and P- signal frequencies. Comparison of corresponding dentin layers within and between the cross-sections showed that the Mg/P molar ratio was always higher in the cementum-related dentin (CRD) than in the enamel-related dentin (ERD) and increased from the apex toward the incisal edge. Especially in the incisal cross-section, an increase in Mg/P was found from the older (peripheral) toward the younger (central) dentin layers. As the Mg/P ratio varied from 0.07 to 0.33, the Ca/P ratio was found to fluctuate from 1.48 to 1.15. The two ratios appeared to be highly correlated (r = -0.97; p less than 0.001), suggesting that Mg replaces Ca and is bound to phosphate.
This study was conducted to compare the value of an older formulation of potassium-magnesium citrate (K4MgCit2) with newer formulations (K3MgHCit2 and K5MgCit2Cl) with respect to the correction of thiazide-induced hypokalemia and magnesium loss, alkalinizing effect, and citraturic action. Sixty-two healthy volunteers first took hydrochlorothiazide 50 mg/day. After 3 weeks of thiazide treatment (or earlier if hypokalemia developed), they were randomized to take one of three drugs for 3 weeks while continuing thiazide: K4MgCit2 (49 mEq K, 25 mEq Mg, and 74 mEq citrate/day), K3MgHCit2 (49 mEq K, 33 mEq Mg, and 98 mEq citrate/day), and K5MgCit2Cl (49 mEq K, 20 mEq Mg, 10 mEq Cl and 59 mEq citrate/day). Outcome measures were changes in serum potassium and magnesium, and urinary potassium, magnesium, pH, and citrate. The three drugs were equally effective in correcting thiazide-induced hypokalemia. K3MgHCit2 and K4MgCit2 produced a small but significant increase in serum magnesium concentration, whereas K5MgCit2Cl did not. Although all three supplements significantly increased urinary pH and citrate, these effects were more marked with K3MgHCit2 and K4MgCit2 than with K5MgCit2. All three supplements were generally well tolerated, with the lowest side effect profile obtained with K4MgCit2. The new formulation of K3MgHCit2 exerts similar correction of thiazide-induced hypokalemia and magnesium loss, and enhancement of urinary pH and citrate, compared with the older K4MgCit2. However, it is less well tolerated. The new formulation of K5MgCit2Cl does not avert magnesium loss, and has less prominent alkalinizing and citraturic effects than the older preparation.
Microscopic evidence of multifocal mineralizations (psammoma bodies) were seen in brains of 33/53 (62%) raccoons (Procyon lotor) necropsied on Parramore Island, Virginia. Most mineralized foci had concentric laminations and were present in small capillaries of meninges of the brain (15/33), in choroid plexus (3/33), or at both these sites (13/33). In 2 raccoons, the lesions were confined to the meninges of the proximal cervical spinal cord. In most cases, the affected vessels appeared to have been completely occluded. However, no evidence of ischemic changes in the brain parenchyma was seen, and none of the raccoons had abnormal neurologic signs prior to euthanasia. The condition appears to be a common incidental histopathologic finding in raccoons from the eastern United States. Although the exact cause of this condition is not known, a primary vascular insult with resultant dystrophic mineralization of the affected vessels is suspected.