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PubMedDate not supplied

[Resection therapy in the treatment of intrahepatic biliary lithiasis].

The authors report a case of intrahepatic lithiasis in a patient already operated of cholecystectomy and without lithiasis of the common bile duct. The lithiasis was present in the left lateral bile duct, was multiple and trapped behind a very narrow stricture. The stones were associated with a marked dilatation of the involved biliary ducts, cholangitis, fibrosis and atrophy of surrounding hepatic parenchyma. It was performed a resection of the II and III hepatic segments and the patient recovered completely and is well and disease free after one year. The authors believe, also on the base of the data reported by others, that in the intrahepatic lithiasis with strictures of the bile intrahepatic ducts the hepatic resection is the treatment of choice, especially when the lithiasis is present in a sectorial or segmental bile duct, preventing any stone recurrence.

Adult↗
PubMed1997

[Treatment of common bile duct lithiasis: first-line endoscopic sphincterotomy and celioscopic cholecystectomy].

The aim of this study was to assess retrograd cholangiogram findings and first-line endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the treatment of main bile duct lithiasis. Clinical, biological and echographic criteria predictive of main bile duct lithiasis were observed in 125 patients (32 men, 93 women, mean age 44.2 years) who underwent retrograde cholangiography. Results suggested lithiasis of the main bile duct in 105 case (87.5%) and were confirmed at endoscopic sphincterotomy in 99. There were no deaths; four complications occurred (3 moderate cases of pancreatitis, 1 cholecystitis). Conversion was required in 11.6%, usually because of difficulties in dissecting. No residual lithiasis was observed. Mean duration of hospitalization was 11.4 days. This sequential treatment scheme for main bile duct lithiasis appears to be effective, minimally invasive and safe.

Adult↗
PubMed1998

Ureteroscopic treatment of ureteric lithiasis. Analysis of 354 urs procedures in a community hospital.

INTRODUCTION: The optimal treatment of ureteric lithiasis continues to be a point of discussion, as there are different treatment modalities. Conservative treatment, EWSL, ureteroscopy (URS), percutaneous litholapaxy, and (laparoscopic) ureterolithotomy, all have there place in the treatment of ureteric lithiasis. In order to evaluate if ureteroscopy is a valuable alternative to ESWL in the treatment of ureteric lithiasis, an analysis of all the ureteroscopies performed in our institution was made and these results were compared with results (both ESWL and URS) described in literature. PATIENTS AND METHODS: During the period 1990 till 1997, 292 patients underwent in our institution in total 354 ureteroscopies for ureteric lithiasis. In all procedures a rigid 9 Fr. ureteroscope was used, together with laser lithotripsy or pneumatic lithotripsy as fragmentation device. RESULTS: Overall success rate in our series was 90.1%, with distal and middle ureteric stone location being more favorable (94% and 95%) than proximal location (73%). Overall complication rate was 7.6% (including minor complications, such as ureteral mucosal tear), for which open surgical intervention had to be performed in 2.3% of cases. CONCLUSIONS: Although invasive, ureteroscopy proved to be a very competitive alternative to ESWL, when treating ureteric lithiasis. Success rates are equal, if not better, using ureteroscopy when compared to ESWL. Complications of ureteroscopy are infrequent, but do exist. Therefore ureteroscopy should be performed by experienced urologists.

Adolescent↗
PubMed1990

Bilateral intrahepatic lithiasis without extrahepatic bile duct stones.

Bilateral intrahepatic lithiasis is a rare condition, and for this reason a nationwide survey was conducted. Reports on 675 patients with bilateral intrahepatic lithiasis over a 10-year-period were collected. Among these, 258 patients with bilateral intrahepatic lithiasis having no extrahepatic bile duct stones were analyzed. The peak incidence was seen in the fourth to sixth decades. Males and females were equally effected. The stones removed were mainly calcium bilirubinate stones (75.6%). The main clinical symptoms were abdominal pain, fever and jaundice. Charcot's triad was seen in 29.7%, while 12.4% of the patients had no symptoms. Visualization of each segmental duct of the liver by direct cholangiography was excellent in this survey and ranged from 88 to 97.3% of the patients. The most frequent site of stones was the left hepatic duct (60.1%). The site of bile duct dilatation coincided with the location of stones. The most common sites of stenosis were the central part of the lateral segmental duct (32.5%) and the left hepatic duct (37.6%). Hepatic resection was employed in 49.2% of the patients, and drainage procedures were added in 95.6%. Follow-up studies of 236 patients treated by surgery revealed good results in 67.4%, fair in 13.6%, and poor in 7.6%. In these patients, however, endoscopic lithotomy was often employed intra- and/or post-operatively. Conducting hepatic resection, with adequate biliary drainage procedure and cholangiofiberscopic lithotomy may help to improve the therapeutic results of bilateral intrahepatic lithiasis.

Adult↗
PubMed1979

Intrahepatic lithiasis. Study of thirty-six cases and review of the literature.

In 2,700 operations for biliary tract stones, intrahepatic lithiasis (stones located proximal to the confluence of the main hepatic ducts) was discovered in 36 patients (1.3 per cent). The diagnosis of intrahepatic lithiasis was determined only via intraoperative chalangiography in thirty-two cases (88.9 er cent); in 23 per cent of our cases of intrahepatic lithiasis, jaundice was never observed. This confirms that intraoperative cholangiography should be performed routinely in every case of biliary lithiasis. The removal of stones was generally performed by an indirect approach (papillostomy and/or choledochotomy). In 16.7 per cent of our cases, a direct approach was indicated. It is extremely important, after removal of calculi, to assure ample bilioenteric flow. Our surgical approach was therefore based mostly on the caliber of the biliary tract. When the tract was dilated less that 2 cm (in 20 cases), choledochohepaticotomy with papillostomy was most often performed (12 cases, 60 per cent). When the dilatation was more that 2 cm (12 cases), Roux-en-Y hepaticojejunostomy was performed in all. There was no operative mortality, although the long-term follow-up results were poor in 9.6 per cent of the cases.

Adolescent↗
PubMed1995

Donor-gifted allograft lithiasis: extracorporeal shockwave lithotripsy with over table module using the Lithostar Plus.

Allograft lithiasis is usually secondary. Donor-graft lithiasis is a rare cause and only 5 cases have been reported. We report 2 such cases which are the first in the live-related transplantation programme. The pressing need to increase the donor pool in developing countries, safety of therapy in graft lithiasis coupled with minimal estimated risk of lithiasis recurrence in the donor are the main justifications for accepting calculi bearing kidney for transplantation. The 2 cases underwent extracorporeal shockwave lithotripsy using the overhead table module of the Lithostar Plus. The technical ease of lithotripsy using an on-line ultrasound module in these 'ectopically' placed kidneys is discussed. The effect of shockwaves on allograft function was studied by a pre- and post-renal scan (99Tc-DTPA) and serum creatinine. No adverse effect of shockwave on allograft function was noted both on short- and long-term follow-up.

Adult↗
PubMedDate not supplied

Effect of short-term octreotide therapy and total parenteral nutrition on the development of biliary sludge and lithiasis.

BACKGROUND/AIMS: Both total parenteral nutrition and long-term octreotide treatment (> 2 months) may induce biliary sludge and lithiasis. However, the lithogenic capacity of the combination of the two treatments in the short-term is unknown. This study was undertaken to evaluate the lithogenic capacity of short-term octreotide treatment (< 1 month) in patients with acute pancreatitis who are also receiving total parenteral nutrition, and to determine the evolution of patients who develop biliary sludge and/or lithiasis. METHODOLOGY: Thirty patients with acute pancreatitis were studied (21 males, 9 females; average age: 38). All patients received total parenteral nutrition and analgesics. In a double-blind random manner, 15 patients were treated with a continuous subcutaneous administration of octreotide (200 micrograms/8 h) and a further 15 patients received placebo. Biliary sludge and/or lithiasis were examined by ultrasonography. An echographic examination of the gallbladder was performed every seven days while the patients were in hospital. They were followed up every month, when another ultrasound of the gallbladder was carried out. RESULTS: Sixteen patients (53%) developed sludge: ten (67%) from the octreotide group and six (33%) from the placebo group (P = 0.29). Two of the patients from the octreotide group had microlithiasis (P = 0.34) and a cholecystectomy was required. In the other 14 patients, sludge had disappeared by the time of the check-up performed one month after discharge. CONCLUSIONS: Short-term octreotide treatment does not increase the risk of developing biliary sludge and/or lithiasis in patients also receiving total parenteral nutrition. Biliary sludge formed during total parenteral nutrition and short-term octreotide therapy may disappear when patients begin oral intake. Therefore, preventive measures are not required.

Acute Disease↗
PubMed2003

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the Monarch. Chronic renal lithiasis (II)].

OBJECTIVES: To review all known data about the endocrinopathy and renal disease suffered by Henry IV of Castile according to contemporary chronicles and manuscripts, comparing the clinical diagnosis made by Gregorio Marañon 70 years ago in his work "Biological essay about Henry IV and his time" (Madrid 1930) with present concepts, because we consider, as other medical authors, that his endocrinopathy is not well determined. Regarding his chronic renal lithiasis, it could have played an important role as negative factor in the Monarch's quality of life, and have been related to his endocrinopathy, so that it should also be reviewed. METHODS: We reviewed a total of 10 chronicles and 5 contemporary manuscripts treating the look and diseases of Henry IV to obtain the most important data about both diseases and be able to characterize the kind of endocrine disease suffered by the Monarch, and all aspects regarding his lithiasis, and compare them with our current knowledge. RESULTS: From the review of those chronicles and manuscripts, it is my opinion that Henry IV suffered acromegaly secondary to a GH and prolactine producing hypophyseal tumor from childhood, which might justify the impotence he suffered from his youth and other symptoms clearly referred in the chronicles. Chronic renal lithiasis (flank pain, lumbar illness, and hematuria) finally led to acute obstructive uropathy, main cause of his death. This fact has not been emphasized by historians. The renal lithiasis benign part of a multiple endocrine neoplasia syndrome (MEN I) can not be ruled out.

Acromegaly↗
PubMedDate not supplied

[Problems in the diagnosis and treatment of intrahepatic lithiasis].

Following the study of 44 cases of intra-hepatic lithiasis the authors have reached these conclusions:--intra-hepatic lithiasis (both primary and secondary) represents 3% of the biliary lithiases;--the characteristic element of the evolution of biliary lithiasis is the so-called "ageing phenomenon" leading to the formation of multiple stones, progressively obstructing the biliary pathways and finally involving the intra-hepatic segments. These are the so-called biliary panlithiases representing 50% of the cases with intra-hepatic lithiasis in the author's statistics;--cholangiography (both intravenous and intra-canalicular) should be considered as completed only when it provides a representation of the entire biliary system;--one cannot speak at present of a "remaining" or "forgotten" hepato-choledocus stone before the exclusion of the intra-hepatic "forgotten" stone;--the significant reduction of "post-cholecystectomy disturbances" depends on the correct diagnosis and treatment of all stones, indifferent of their site of occurrence (extra- and intra-hepatic).

Ampulla of Vater↗
PubMed1992

[Description of a new disease: pancreatic lithiasis with radiolucent calculi].

118 patients presenting with pancreatic lithiasis were consecutively observed in our service. They underwent both an endoscopic pancreatography and god plain films of the abdomen. Calculi were classified in 3 groups: 1) Radiolucent calculi (17 cases, 5 females; 4 hereditary cases) are build up of amorphous residues of lithostathine S. They are not related to either alcohol, diet or tobacco. 2) Target calculi (27 cases, 4 females; 3 hereditary cases) have a radiolucent core as in 1 and a peripheral calcification. They are a late evolutionary stage of radiolucent lithiasis. The frequency of females and of hereditary cases is significantly greater in form 1 + 2 than in form 3. These two forms are a newly described disease without relationship with nutrition, alcohol or tobacco but the peripheral calcification of radiolucent calculi is favoured by alcohol and tobacco. This disease could be hereditary. 3) Calcic lithiasis (74 cases, 8 females, 2 hereditary cases) is the most frequent form of pancreatic lithiasis. Its cause is nutritional.

Alcohol Drinking↗
PubMedDate not supplied

[Lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Report of one case and therapeutic management].

OBJECTIVES: To report the case of a 28-year-old female patient carrying a lithiasis of soft appearance located within a calyceal diverticulum in the right kidney which presented clinically during pregnancy, and to comment on therapeutic management, as well as the outcome one year after conservative treatment. METHODS AND RESULTS: 28-year-old female patient with history of renal colic during pregnancy, who presents at our clinics in the postpartum period with a recurrent abdominal and lumbar pain. Kidney-ureter-bladder (KUB) x-ray and intravenous urography (IVP) detected a lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Treatment was conservative with potassium citrate/citric acid and follow-up controls with urine culture (every 3 months) and ultrasounds (every 8 months). Currently she is asymptomatic but the lithiasis persists on KUB and urine culture is positive (Escherichia coli) and receives treatment with cefuroxime 250 mg every 12 hours for 6 days and nitrofurantoin 100 mg every night for three months. CONCLUSIONS: Most urinary stones located within calyceal diverticula have an asymptomatic course, treatment not being necessary. The most frequent clinical presentations of these stones are flank pain, urinary infection demonstrated by positive urine culture, and incidental finding. IVU is an effective method for diagnosis. ESWL is not an effective treatment for them, being percutaneous techniques the most suitable for a single-surgical procedure resolution of both lithiasis and pyelocalyceal diverticulum.

Adult↗
PubMed1992

[Percutaneous treatment of bile duct lithiasis. Personal experience in the first 150 cases].

Since 1983 we have percutaneously treated 150 cases of bile duct lithiasis in which previous endoscopic maneuvers had been incomplete or unfeasible. Complete resolution of lithiasis was obtained in 139 of 150 patients. In 6 cases only partial success was obtained but symptoms subsided. In 2 cases the treatment failed and the patients underwent surgery. Minor complications were observed in 12.6% of patients and resolved either spontaneously or by percutaneous maneuvers. Mortality rate was 2%. After a follow-up period of 6-12 months, 9 patients had a recurrence, completely resolved with further percutaneous treatment. These cases never required surgery. We obtained the best results in patients with stones residual after cholecystectomy or a iatrogenic stricture of the biliary tree. We obtained good results in massive lithiasis with combined endoscopic, surgical and radiological procedures. Morbidity and mortality rates were lower than in surgical series and similar to the endoscopic ones. The short hospitalization, the low cost and the possibility of treatment on an outpatient basis should promote the spreading of percutaneous techniques in the treatment of bile duct lithiasis.

Adolescent↗
PubMed1992

[Description of a new disease, pancreatic lithiasis with radiotransparent calculi].

118 patients presenting with pancreatic lithiasis were consecutively observed in our service. They underwent both an endoscopic pancreatography and good plain films of the abdomen. Calculi were classified in 3 groups: 1) Radiolucent calculi (17 cases, 5 females; 4 hereditary cases) are build up of amorphous residues of lithostathine S. This disease is not related to either alcohol, diet or tobacco. 2) Taget calculi (27 cases, 4 females; 3 hereditary cases) have a radiolucent core as in 1 and a peripheral calcification. They are a late evolutionary stage of radiolucent lithiasis. The frequency of females and of hereditary cases is significantly greater in form 1 + 2 than in form 3. These two forms are a newly described disease without relationship with nutrition, alcohol or tobacco but the peripheral calcification of radiolucent calculi is favoured by alcohol and tobacco. This disease could be hereditary. 3) Calcic lithiasis (74 cases, 8 females, 2 hereditary cases) is the most frequent form of pancreatic lithiasis. Its cause is nutritional.

Adult↗
PubMedDate not supplied

[New therapeutic alternative for complex renal lithiasis].

The combination of percutaneous nephrolitotomy and renal extracorporeal litothricy, is currently considered to be the best choice for the treatment of complex renal lithiasis. This procedure, however, quite frequently needs the use of adjuvant maneouvers (urethroscopy, catheterization, large number of sessions, etc.), and there is a considerable proportion of residual lithiasis. We present here our series using a new therapeutic sequence: first, we perform extracorporeal litothricy (ESWL) of calices not accessible to the nephroscope, followed by percutaneous nephrolitotomy which has revealed to be a simplification of the percutaneous surgical technique since it decreases the movements of the nephroscope and the use of ultrasounds. Calyceal lithiasis previously fragmented are then extracted through the nephrostomic channel and so no lithiatic paths are induced, the percentage of residual lithiasis being also lower.

Adult↗
PubMed1989

[Treatment of ureteral lithiasis using rigid ureteroscopy].

The authors report 46 cases of rigid ureteroscopy for ureteral stone removal. Ureteroscopy procedures for extraction of lithiasis are the next-ones: stone forceps, stone basket, ultrasonic lithotripsy and electrohydraulic lithotripsy. Manipulation of calculi is done under direct vision. A success rate of ureteroscopy was of 89% (41 patients). All of the patients with stone removal failure underwent immediate operative intervention (open ureterolithotomy in 4 patients and ureteral reimplantation in 1). The best results were obtained for distal calculi (pelvic lithiasis): success rate of 91.4%. The success rate of lumbar lithiasis was of 87.5% and of iliac lithiasis of 66.7%. Complications did not preclude a successful stone manipulation. These results are compared with other series and procedures for stone extraction are discussed.

Adult↗
PubMed1986

[Extracorporeal lithotripsy in the treatment of renal lithiasis. 5 years' experience].

The historical background to extracorporeal lithotripsy using shock waves is described and indications for use of this treatment discussed in relation to other types of therapy for reno-ureteral lithiasis: percutaneous or trans-ureteral endoscopy. The reduction in invasive surgical procedures is emphasized. The first human use of extracorporeal lithotripsy by shock waves dates back to 1980. Since then, more than 30,000 calculi have been treated in this way, either exclusively or in combination with other therapy. For simple small calculi (less than 1 cm in diameter and situated in the pelvis or a calyx) the incidence of complications is minimal: renal colic (15%), fever (13%), need for complementary therapy (7%). With extension of use of extracorporeal lithotripsy to complex calculi (multiple calculi, staghorn calculi) these figures increased to 30, 5 and 12% respectively. Patients with obstructive and infected lithiasis were treated by percutaneous drainage nephrostomy with intensive antibiotic therapy prior to extracorporeal treatment. Extending indications also provided data on contraindications: coagulation disorders, major vascular problems, abnormal size or weight of patient, pregnancy and finally difficulty in localizing calculi. Of interest is the almost total lack of efficacy of shock waves for treating staghorn calculi. Treatment in these cases should be by an initial percutaneous approach to reduce size of calculus followed by extracorporeal lithotripsy under nephrostomy cover. Surgery for lithiasis should therefore be reserved for complex lithiasis cases with large caliceal calculi proximal to a long narrow infundibulum and to calculi proximal to a stenosis of pyelo-ureteral junction. Whenever possible, lumbar ureter calculi should be raised towards the pelvis by endoscopic manipulation before extracorporeal lithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1983

Treatment of renal lithiasis associated with renal tubular acidosis.

In order to determine the incidence of renal lithiasis in patients with renal tubular acidosis and the effect of therapy on further stone formation, we reviewed the clinical and laboratory manifestations, X-ray findings, and treatment of 48 patients with renal tubular acidosis who were seen at the Mayo Clinic during the years 1970-1980. Thirty-four patients (70%) had radiological evidence of renal lithiasis which was the presenting symptom in 23 (48%) patients. In every instance the calculi were multiple and, with one exception, bilateral. While receiving therapy, 19 patients with renal lithiasis were followed for longer than one year with sequential uroradiographic studies. Fifteen of these patients were treated with oral base alone and thirteen had no evidence of new stone formation or continued growth of existing stones during therapy. The two patients with X-ray evidence of continued stone formation admitted to poor compliance. Four patients received initial treatment with an oral phosphorus supplement. Three of these four patients had radiographic evidence of continued renal stone formation during three, five and eight years of phosphate therapy. We conclude renal lithiasis is a frequent complication of renal tubular acidosis, and adequate base replacement is effective therapy to stop continued stone formation while oral phosphate therapy alone is often ineffective.

Acidosis, Renal Tubular↗
PubMed1984

[Value of the measurement of urinary calcium in calcium lithiasis].

The author reports certain data from the literature and based upon his own experience. The urinary excretion of calcium is dependent upon diet and in particular sodium intake. Urinary calcium decreases when sodium intake is reduced. The administration of rapidly absorbed sugars and protein rich diets cause an increase in urinary calcium. It is thus of fundamental importance to be aware of the nature of the diet in patients in whom 24 hour urinary calcium is measured. In particular, such measurements are of no value during the immediate postoperative period. Is the existence of hypercalciuria (defined by a urinary calcium greater than 0.1 mmol/kg/day) truly responsible for an increase in the frequency of recurrences of lithiasis? In two groups of patients, one with progressive lithiasis and the other with non-progressive lithiasis, the mean urinary calcium for each of the two groups was the same. In addition, patients with a high daily calcium excretion were not necessarily those with progressive lithiasis. Three groups of patients were also compared, according to whether they had a high fluid intake, a fluid intake associated with a hydrochlorothiazide or a fluid intake associated with a neutral phosphorus salt. Phosphate therapy was a failure. In comparison with their previous state, patients receiving merely a high fluid intake or in combination with thiazides had less recurrences than before such treatment. The group treated with thiazides had significantly less recurrences than the group treated by simple high fluid intake. However urinary calcium was not lowered by thiazides. Thus the role of thiazides probably does not lie in hypocalciuria but merely in an increase in urine output.

Calcium↗