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PubMed1995

[Metabolic evaluation at the time of the first renal lithiasis episode].

There are little doubts about the need of studying thoroughly every patient with recurrent renal lithiasis. However, the behavior to be followed after the first renal calculi remains controversial. For that reason, we decided to answer a series of questions after which, we formulate our own criteria: Which is the recurrence rate after the first calculi? Has a patient with recurrent lithiasis, the same metabolic disarrangement as a patient who has his first episode? Is the family history of both kidney stone patients the same? Which is the morbility of both groups? We answered these questions with data drawn from 200 of our patients (100 with first episode and 100 with recurrent lithiasis) and a review of the medical literature. The patients with their first episode of lithiasis correspond to the same population of patients with recurrent episodes, but they are detected at different moments of their stone disease. This was concluded since both groups of patients had the same metabolic disarrangement with predominance of hypercalciuria and alteration in uric acid metabolism. Furthermore, the family history was practically the same in both groups (39% in first episode, 41% in recurrent lithiasis) and so was the morbility. Therefore, we propose the following conduct: 1. every patient with renal lithiasis should be studied starting at the first episode, from the urological and metabolic point of view; 2. the initial metabolic studies have to be as extensive as possible in order to aim for specific treatment from the start in order to prevent a recurrence, and in the case of hypercalciuric patients to prevent secondary osteopenia.

Female↗

PubMed1998

Endoscopic electrohydraulic lithotripsy in the management of pancreatobiliary lithiasis.

BACKGROUND: Clinical evaluation of intraoperative endoscopy with electrohydraulic lithotripsy (EHL) in the management of 13 patients with pancreatobiliary lithiasis was undertaken. METHODS: Ten patients with chronic pancreatitis with intraductal lithiasis in the head and three with biliary lithiasis (one choledochal, one cystic, one right intrahepatic) underwent intraoperative endoscopy with EHL. Shock waves were applied by visual contact with a 3-Fr gauge EHL probe until all stones were fragmented and irrigated free. All pancreatitis patients had failed ERCP attempts to stent their pancreatic ducts secondary to ductal lithiasis. Patients with pancreatic stones underwent lateral pancreatojejunostomy. Biliary stone patients underwent laparoscopic cholecystectomy with common duct exploration (two cases) and open cholecystectomy with choledochoduodenostomy (one case). RESULTS: Intraductal stone eradication was successful in all patients. Transampullary visualization of the duodenum was achieved in eight cases. Average EHL time was 65 min. There was no evidence of postoperative pancreatitis, cholangitis, or retained common duct stones. CONCLUSION: Intraoperative pancreatobiliary endoscopy with EHL is safe and effective in the eradication of pancreatic and bile duct stones. This novel technique represents a valuable adjunct in the management of chronic fibrocalcific pancreatitis with ductal lithiasis in the head region and in the open and laparoscopic management of intra- and extrahepatic bile duct stones.

Adult↗

PubMed1999

[Percutaneous treatment of common bile duct lithiasis].

STUDY AIM: Biliary lithiasis in the main bile duct (particularly retained stones) may be treated percutaneously obviating reoperation or endoscopic sphincterotomy. The aim of this study was to determine risks and pitfalls of this approach. PATIENTS AND METHODS: Forty-two cases of biliary stones treated percutaneously between 1980 and 1998 were reported. Among them, 28 patients had already a biliary drainage and in 14, a drain was placed into the bile duct by transhepatic way or by punction of the intestinal loop of a bilio-jejunal anastomosis. The means to clear the bile ducts included percutaneous endoscopy and contact lithotripsy. Thirty patients had residual lithiasis (after a surgical intervention), 11 a new lithiasis above a bile duct stenosis and in 1 a bile duct lithiasis with a gallbladder lithiasis. RESULTS: Morbidity included four complications (9.5%--one severe) and no mortality. After 2.3 +/- 1 courses, desobstruction was complete in 33 cases (78.5%) and partial in one case (2.5%) allowing to optimize the patient for endoscopic sphincterotomy. Desobstruction failed in eight cases (19%), six patients were successfully treated by surgery and 2 by endoscopic sphincterotomy. CONCLUSIONS: Percutaneous desobstruction of the bile ducts may be proposed as a priority in patients with a biliary drain in place and when endoscopic sphincterotomy is impossible or contraindicated. These manoeuvres have a definitive place in hepato-biliary surgery.

Adult↗

PubMed2006

[The role of thiazides in the prophylaxis of recurrent calcium lithiasis].

OBJECTIVE: To show the prolonged efficacy of thiazides in the prophylaxis and treatment of recurrences in patients with calcium oxalate and phosphate lithiasis. METHODS: A randomised prospective study is conducted, with a three-year follow-up, in 150 patients diagnosed with recurrent calcium lithiasis. The patients are divided into three groups: A) 50 cases subject to observation with no treatment, B) 50 cases treated with 50 mg/day of hydrochlorothiazide, and C) 50 cases treated with 50 mg of hydrochlorothiazide and 20 mlEq of potassium citrate/day. Each group is subject to a renal study with imaging techniques and a urinary metabolic study at baseline, 12, 24 and 36 months. RESULTS: The patients treated with thiazides (Groups B and C) obtain a significant reduction in lithiasis recurrence compared with the control group (Group A). The most common abnormality found in the metabolic study was hypercalciuria, 52% of cases; 16% present a mixed lithogenic pattern. The number of recurrences and need for new sessions of extracorporeal lithotripsy in patients with hypercalciuria treated with thiazides is significantly smaller than in Group A (p=0.003). CONCLUSIONS: We observe a significant relation between lithogenic pattern and lithiasis recurrence. Thiazides help us to control lithogenic factors and recurrences in patients with calcium lithiasis. This effect is prolonged and significant in patients with hypercalciuria.

Adolescent↗

PubMed2006

[Imaging of salivary lithiasis].

Lithiasis is the most common disease of salivary glands after mumps. The purpose of this review is to analyze the respective role of the different available imaging techniques for the diagnosis of lithiasis and related complications since the treatment of salivary lithiasis has evolved with the emergence of minimally invasive and non surgical techniques. In spite of its limitations, US represents an excellent first line imaging technique because it is non-invasive and widely available. Non contrast helical CT with multiplanar reconstructions seems to be the gold standard for the diagnosis of lithiasis, especially when small and poorly calcified since these may not be visible on standard radiographs. CT allows accurate characterization of the number and position of lithiasis. MR Sialography is increasingly replacing the more invasive conventional sialography for the non invasive visualization of the ductal system of major salivary glands even though conventional sialography has a higher spatial resolution.

Diagnostic Imaging↗

PubMed1995

Is biliary lithiasis associated with pancreatographic changes?

The aetiological role of biliary lithiasis for chronic pancreatitis remains controversial. Previous studies based on pancreatographic studies reported changes in the pancreatic duct system caused by biliary lithiasis. This study analysed retrospectively the endoscopic retrograde cholangiopancreatography of 165 patients presenting with biliary lithiasis and of 53 controls. Among the 165 patients, 113 had choledochal stones (53 with gall bladder stones, 50 had had a cholecystectomy, 10 with a normal gall bladder), 35 had gall bladder stones without choledochal stones, 17 had cholecystectomy for gall bladder stones. Pancreatograms were analysed by measuring the diameter of the pancreatic duct in the head, the body, and the tail of the pancreas, and evaluating the regularity of the main pancreatic duct and the presence of stenosis, the regularity or the dilatation of secondary ducts, and the presence of cysts. In addition, we established a score, based on the above parameters, by which pancreatograms were classified as normal or with mild, intermediate, moderate or severe abnormalities. A multivariate analysis (stepwise multiple discriminant analysis) was performed for age, sex, presence of gall stones, presence of choledochal stones. Patients were comparable with controls for sex, alcohol consumption but were younger (55 v 68 years, p < 0.01). In patients and in controls, the frequency of pancreatographic abnormalities increased significantly with age. The pancreatographic features of patients and controls were not significantly different. In the multivariate analysis, age was the only factor with significant predicting value for pancreatographic abnormalities. In conclusion, biliary lithiasis in itself is not an aetiological factor for chronic pancreatitis, older age being responsible for the abnormalities seen by pancreatography of patients with biliary lithiasis.

Bile Duct Diseases↗

PubMed2006

[Papillary and cavitary monohydrate calcium oxalate lithiasis: comparative study of etiological factors].

OBJECTIVES: The monohydrate calcium oxalate lithiasis (MCO) is divided in two groups depending on the morphologic-crystal structure: papillary (anchorage point on a renal papilla lesion) and cavity (formed in a cavity with low urodynamic capacity). The minimal differences between urinary biochemistry of MCO makers in comparison with healthy population suggests that other factors different than urine biochemistry (professional activity, dietetic habits, systemic diseases) may be related with lithogenesis. The objective of this work is to study such factors, and compare them in both groups of MCO lithiasis (papillary and cavity). METHODS: We study 40 patients with MCO lithiasis (20 patients papillary and 20 patients cavitary). Medical history was performed (family history of lithiasis; associated diseases such as high blood pressure, diabetes, hyperuricemia, hypercholesterolemia, peptic ulcer disease; dietetic survey to evaluate phytate consumption; professions with high-risk of exposure to toxic agents); 24-hour urine biochemical tests, two-hour urine (pH), and serum biochemical profile were performed. Statistical analysis was performed using student's t test and chi-square. RESULTS: There is a high prevalence of family history of renal lithiasis (45%) without differences between groups. There are not differences in urine or blood biochemical tests. There is a low consumption of phytate-containing foods in both groups, without significant differences. There is a trend to a greater exposure to cytotoxic agents in the papillary group (45%) vs. the cavity group (25%). Hypertension and hyperuricemia are more prevalent in the cavity MCO group (alpha = 0.025 and alpha = 0.010, respectively). Peptic ulcer disease is more prevalent in the papillary MCO group (alpha = 2.025). There are no significant differences in prevalence of hypercholesterolemia or diabetes mellitus between groups. CONCLUSIONS: Papillary MCO calculi are associated with a deficit of crystallization inhibitors (phytates), and disorders of the epithelium covering the renal papilla (cytotoxic agents exposure, peptic ulcer disease). Cavity MCO calculi are associated with a deficit of crystallization inhibitors (phytates) and a greater amount of heterogeneous nucleants (organic material induced by diseases such as hypertension, hyperuricemia, hyperglycemia, and hypercholesterolemia).

Calcium Oxalate↗

PubMedDate not supplied

[Neoplasms and dysplasias of the gallbladder and their relationship with lithiasis. A case-control clinicopathological study].

BACKGROUND: A strong association has been reported between gallbladder carcinoma, premalignant epithelial or metaplasic inflammatory lesions and cholelithiasis, varying the incidence among different ethnic groups. PURPOSE: To determine the frequency of association between such lesions and gallbladder lithiasis. MATERIAL AND METHODS: We examined histopathologic changes in 1,367 cholecystectomy specimens with (1,096) or without (271) lithiasis and established its frequency of association, correlating with main clinical data. RESULTS: Overall, 80% had lithiasis. In this group, pseudopyloric metaplasia (50%), intestinal metaplasia (16%), low grade dysplasia (40%), high grade dysplasia (16%), carcinoma in situ (1.5%) and invasive carcinoma (2.6%) were observed compared to 25%, 2%, 17%, 2%, 0%, and 0% in the control group. The findings of 80% with lithiasis, 65% with carcinoma in situ and 90% of invasive carcinoma, all were in women. Median age of patients with low and high grade dysplasia, carcinoma in situ and invasive carcinoma was 42, 48, 53 and 61 years, respectively. CONCLUSIONS: Acute and xanthogranulomatous cholecystitis, adenomyomatosis, pseudopyloric and intestinal metaplasia, hyperplastic polyps, low and high grade dysplasia, tubular adenomas, carcinoma in situ and invasive carcinoma were more frequent when cholelithiasis was present (p < .05) than in cases without lithiasis.

Acute Disease↗

PubMed2000

[Transient biliary lithiasis associated with the use of ceftriaxone].

Up to 40% of ceftriaxone is excreted unchanged into the bile and, due to its high calcium-binding affinity, it may form a salt that can provoke biliary lithiasis. Echography revealed that biliary lithiasis was present in 12-45% of patients treated with ceftriaxone as early as the second day of treatment. Lithiasis is usually asymptomatic and disappears in less than 2 months. Symptomatic cases and patients requiring cholecystectomy have been described in the literature. We present four children, evaluated in 1999, who presented asymptomatic cholelithiasis between the second and fourth day of ceftriaxone treatment. Biliary lithiasis was found after 2-4 days of treatment, with resolution of the lithiasis between 1-4 months after the end of therapy.

Ceftriaxone↗

PubMed2000

[Partial nephrectomy in lithiasis].

OBJECTIVE: To analyze our series of patients with renal lithiasis who underwent partial nephrectomy from 1980-1999. METHODS: 28 patients who underwent partial nephrectomy were analyzed (22 females; mean age 48.09 years, and 6 males; mean age 60 years). Surgery for lithiasis had been previously performed in 5 renal units. Nine patients had previously undergone ESWL (more than 3 sessions), all of whom subsequently developed multiple residual calculi. Twelve patients had a microbiologically confirmed positive urine culture. The renal lithiasis amenable to treatment by partial nephrectomy was frequently localized in the lower calyces (17 cases). RESULTS: Histopathological analysis of the nephrectomy specimen showed a prevalence of signs of chronic parenchymal atrophy (25 cases). Three cases showed segmental renal dysplasia (those in whom a superior heminephrectomy was performed for duplex excretory system). Fifty percent of the stone fragments analyzed showed calcium phosphocarbonate. Eight patients had postoperative complications; the most important were two cases of renal cutaneous fistula and one subphrenic abscess. At 9 1/2 years' mean follow-up, renal function is normal in 25 patients. Lithiasis developed in the contralateral unit in 6 cases and in the same renal unit in one case. CONCLUSIONS: Partial nephrectomy continues to be a therapeutic option for lithiasis. Its indication depends on the morphological and functional characteristics of the compromised renal unit, especially in those cases in whom renal preservation can be obviated due to its scanty significance.

Adolescent↗

PubMed1992

[Ureteral lithiasis. Analysis of 3 series].

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.

Endoscopy↗

PubMed2006

Renal lithiasis: addressing the risks of austere desert deployments.

INTRODUCTION: Renal lithiasis affects approximately 5% of the general population, with higher risks for men and increasing risks with increasing age. The forward deployment of the Air Force into austere desert environments with integration of the active duty, Reserves, and Guard presents increasing risks to mission accomplishment with the increased risk of developing renal lithiasis. METHODS: This paper describes seven cases of presumed renal lithiasis in a deployed desert setting in Air Force personnel on flying status. Their status and the location of the base acted as a focus for a review of the literature on kidney stone causation, prevention, diagnosis, and management. RESULTS/DISCUSSION: A review of the literature revealed that current military recommendations to hydrate in the field may not be sufficient for the primary prevention of kidney stones. Beverage choice may prove more useful for prevention. Situations precipitating voluntary dehydration need to be prevented. Although there are superior ways to diagnose renal lithiasis, in the deployed setting patient history and physical examination are usually the only available means. Ultrasound is a viable diagnostic option for use in the deployed setting based on its portability, affordability, and ease of use. Additions to the standard management of renal lithiasis, such as subcutaneous Lidocaine and heat may have value in the deployed setting if the supply of narcotics is limited. CONCLUSION: In the deployed setting, hydration choices, the addition of portable ultrasound to the diagnostic process, and pain management with nontraditional therapies need to be explored.

Adult↗

PubMedDate not supplied

[Endoscopic treatment of ureteral lithiasis. Results of our second series of 100 cases].

The combined utilization of transurethral ureterorenoscopy (TUR) and extracorporeal shock wave lithotripsy (ESWL) have caused a revolution in the treatment of ureteral lithiasis. We present a total 113 TUR due to ureteral lithiasis performed in period of 20 months, from March 1988 to November 1989. In the last ten months of the study we used TUR an ESWL for the treatment of ureteral lithiasis. Results show success in 92.93% of the treatments; 8 cases of open surgery (7.07%), five of these were performed during the first 10 months of the study, when ESWL was not available, with only 2 serious complications (1.75%) and one death due to massive pulmonary embolism. TUR is an unsubstitutable technique for the treatment of ureteral lithiasis and when combined with ESWL obtains optimum results. It is our technique of choice in all cases non susceptible to treatment with in situ ESWL due to the impossibility of locating the lithiasis without auxiliary endourological manoeuvres.

Adult↗

PubMedDate not supplied

[So-called biliary lithiasis after vagotomy].

Reconsidering the problem of biliary lithiasis in the patient operated for gastroduodenal ulcers, and carrying out an analysis of 1 200 vagotomized patients, biliary lithiasis was noted in 11 of them. The authors make a review of the pathologic physiology of this association. The fact is stressed that biliary lithiasis following vagotomy is more likely a case of biliary lithiasis that has not been known to exist before surgery and that was not recognized during the surgical intervention. A larger statistical analysis could demonstrate that the incidence overlaps the general frequency of biliary lithiasis in a randomly investigated population.

Adolescent↗

PubMedDate not supplied

[Intrahepatic lithiasis (considerations on 20 cases)].

The authors present an analysis of 20 cases with intrahepatic lithiasis, stressing the possibility of the development of lithiasis inside the liver as a result of either metabolic disturbances (one case), or secondary to congenital obstacles (2 cases), or following surgery (3 cases). In the remaining 12 cases intrahepatic lithiasis was secondary to lithiasis in the hepato-choledocus canal through a mechanism of ascending obstruction - identified in 5 cases -,or it was due to ascending migration of calculi (in 7 cases). The diagnosis is made with the aid of good quality intra-surgery cholangiographia. There are various possibilities for surgical solution, but the authors have preferred the bilio-digestive anastomosis that was performed in 15 of the patients. The hepatic duct-jejunal anastomosis on a "Y" loop is considered to be the method that responds most satisfactorily to operatory objectives. Various conditions are discussed, that may render the solution of the condition more difficult from the surgical viewpoint, such as the presence of congenital intrahepatic septa, or the development of intrahepatic lithiasis in a patient with a narrow hepato-choledocus duct. The mortality rate was of 20% (4 patients). Death occurred through acute hepator-renal failure.

Adult↗

PubMed1980

[Hereditary deficiency in adenine phosphoribosyltransferase: a metabolic cause of urinary lithiasis in children (author's transl)].

Complete lack of adenine phosphoribosyltransferase (APRT) is a not uncommon cause of urinary lithiasis in young children. The calculi are made up of a very poorly soluble substance, 2,8-dihydroxyadenine, which results from the oxidation of adenine by xanthinoxidase. A study of the 7 cases of APRT deficiency hitherto published (including 5 cases with lithiasis) shows that the diagnosis is rarely made, since the conventional methods of urinary stone analysis are unable to distinguish dihydroxyadenine from uric acid. This form of lithiasis can be prevented by inhibiting xanthinoxidase with allopurinol. The remarkable efficacy of this treatment and the frequent severity of the disease should raise the possibility of 2,8-dihydroxyadenine lithiasis in very case of alleged uric acid lithiasis in young children.

Adenine↗

PubMed1981

[Primary lithiasis of the bile ducts].

An analysis is made of 24 cases of primitive lithiasis of the biliary tracts, viz; 10 of diffuse intrahepatic lithiasis, 9 of intrahepatic lithiasis localized in one of the ducts; and 5 of extrahepatic lithiasis. The most common cause were stenosis (14 cases) generally of idiopathic or congenital nature, followed by those of iatrogenic or tumoral origin. There were also cases of isolated or diffuse anomalus dilatation of the biliary ducts. A lithogenetic bile as well as infectious processes are rather considered secondary factors. The diagnosis of the real nature of the condiction was usually established in the postoperative period, this being an explanation why repeated surgery was so common (75%). There was a high postoperative mortality in the diffuse forms owing to severe manifestations of biliary sepsis perpetuated by the stones. Depending upon the individual cases the following procedures are proposed: 1) Biliodigestive anastomosis 2) Sphinteropapilloplasty 3) Dilatation and calibration of the stenosis 4) Postoperative instrumental extraction of calculi. The last-named procedure was carried out in 58% of the cases and result in an improvement in the serious prognosis. Primitive lithiasis should always be borne in mind when undertaking surgery of the biliary tracts in order to avoid additional surgery.

Adolescent↗

PubMed1994

[Intrahepatic lithiasis].

From 1982 to 1993 9 patients with primary intrahepatic lithiasis and 49 with secondary intrahepatic lithiasis were treated. Out of the first group of patients, 2 underwent right hepatectomy, 2 left hepatectomy and 1 lithotomy + hepatico-jejunostomy. No death occurred within thirty days from operation: morbidity occurred as a consequence of wound infection in one case and bronchopulmonary complications in two cases. At follow-up (6 months-11 years) 1 cholangitis and 1 relapse were found. Secondary intrahepatic lithiasis was treated as follows: in 15 cases we performed lithotomy + cholangio-jejunostomy + 9 postoperative percutaneous transhepatic cholangio-jejunostomy + 9 postoperative percutaneous transhepatic cholangioscopies (PTCS) + 2 cutaneous jejunostomies; in 5 cases lithotomy + papillosphincteroplasty (PSP) + Kehr + 1 trans-Kehr fiber cholangioscopy (PTKCS); in 1 case lithotomy + choledochoduodenostomy (CDS); in 3 cases right hepatectomy and in 4 cases left hepatectomy; in 14 cases lithotomy + hepatico-jejunostomy; in 5 cases PTKCS alone and in 2 cases PTCS alone. Overall mortality summed up to one case only. Overall morbidity occurred in the shape of two biliary fistulas, 3 subhepatic abscesses, 8 bronchopulmonary complications, 4 wound infections, 1 ileal perforation. Follow-up (6 months-11 years) revealed 2 stenosis of the biliodigestive anastomosis, 3 cholangitis relapses and 2 relapsing lithiasis. Since 18 cases were successfully treated through postoperative fiber cholangioscopy, the authors come to the conclusion that in all cases not requiring hepatectomy due to monolateral lithiasis, it is always advisable to leave open an access to the biliary tract, which might allow further improving maneuvers after surgery.

Bile Ducts, Intrahepatic↗