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PubMed1992

Prevalence of biliary lithiasis in the elderly people of a small town in Sicily.

The aim of the present study was to determine the prevalence of biliary lithiasis (BL) and its major associated factors in the elderly people of a small town in Sicily. All inhabitants over the age of 65 were interviewed and underwent a general physical examination, blood tests and ultrasonography of the gallbladder and biliary tracts. The final group included 328 subjects (162 men and 166 women), representing 63.1% of the population asked to participate, with a mean age of 74.3 +/- 6.8 years (range 65-95). The prevalence of BL (lithiasis in progress + subjects cholecystectomized for previous calculosis) was 18.6%. No male subject had been cholecystectomized. Prevalence was higher in women than in men, but there was no progressive increase with age. There was no significant correlation between number of pregnancies and BL and there was no statistically significant difference between subjects with and without lithiasis for total cholesterol, triglycerides, HDL-cholesterol, A-I and B apoprotein values; a significant difference was found only for body weight values (p less than 0.01). Stones were more often multiple and more radiopaque than in younger subjects; specific symptoms and positive family histories were found in 22% and 18% of the study group, respectively.

Aged↗
PubMed1998

Study of renal metabolic disturbances related to renal lithiasis at school age in very-low-birth-weight children.

We studied 34 asymptomatic children who were born with a very-low-birth-weight (VLBW) and had no perinatal history of acute renal failure nor treatment with furosemide. The study was done at preschool or school age, looking for echographic changes and renal tubular disturbances which are known to predispose to renal lithiasis. The results were compared with those of a control group of 18 children who had been born at term with a body weight >2,500 g. One or more renal tubular disturbances were found in 64.70% of the VLBW children. Most frequently found were decreased ammonium excretion in response to furosemide (38.23%), enhanced N-acetylglucosaminidase excretion (35.29%), hypercalciuria (26.47%), and hypocitraturia (23.53%). Echography revealed renal cortical hyperechogenicity (17.65%) and renal lithiasis (8.82 %) in some of the VLBW children. We found a significant positive correlation (r = 0.7) between the perinatal level of plasma phosphate and the total amount of H+ excreted in response to furosemide at preschool or school age. Because these renal tubular anomalies may be precursors of future lithiasis, and the renal function and echography tests are not invasive, we suggest that renal tubular function be measured and followed up in every VLBW child, particularly when perinatal hypophosphatemia has occurred.

Calcium↗
PubMed1991

Piezoelectric lithotripsy monotherapy for partial or total staghorn lithiasis and calculi larger than thirty millimeters.

Thirty patients with partial or total staghorn lithiasis or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had a pelvic stone; the other 11 had partial (nine) or total (two) staghorn lithiasis. All patients first underwent an initial lithotripsy session. No anesthesia or intravenous sedation was required in any case. If stone fracturization was achieved after this first session, a double J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had a sterile urine culture; 12 of 30 presented major distention of the excretory tract. Results were analyzed to determine those factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stone had completely disappeared on abdominal plain films (14/30 = 46%). In seven patients (23.3%), fracturization had occurred but residual fragments remained (1-3 fragments less than or equal to 4 mm). No fracturization was obtained after the first session in nine patients (30.7%) (one total staghorn lithiasis, eight pelvic stones). The mean number of treatment sessions was five (range 1-15). Complications occurred in only 10% of patients (3/30): two steinstrasse and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distention and 55% of patients whose initial urine culture was sterile, achieved a stone-free state.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

[Epidemiology of urinary lithiasis in our Unit. Clinical course in time and predictive factors].

OBJECTIVES: To analyze the incidence of lithiasis and stone composition in our setting. The trend is compared with the results of the majority of studies on urinary calculi reported in the literature based on the number and composition of stones. METHODS: The study comprised patients referred to the Urolithiasis Unit of our hospital over the last 21 years. Stone composition was analyzed by infra-red spectroscopy. The study period was divided into 4 time intervals: 1977-1979, 1977-1980, 1977-1987 and 1977-1998 in order to determine the trends of the incidence of lithiasis in our setting. RESULTS: A total of 5516 patients were reviewed; of these, 766 had recurrence. The distribution was 385, 995, 3378 and 5516, respectively. Calcium oxalate calculi showed an incidence of 61.3%, calcium phosphate 18.5%, uric acid 11.2%, infectious calculi (ammonium urate and ammonium magnesium phosphate) 6.6%, and finally the incidence of cysteine calculi was 0.77%. Concerning the distribution according to sex, 62% of the males had calcium oxalate stones, 68% uric acid, 42.5% phosphate and 45% infectious lithiasis. The trends for uric acid, infectious, oxalate and phosphate calculi changed over time. CONCLUSIONS: There is a clear trend of calculi prevalence in the male, particularly oxalate and uric acid calculi. There is a trend for cysteine calculi to remain the same, calcium phosphate and oxalate calculi to increase, and uric and infectious calculi to decrease. The changes observed may be due to dietary changes and improvement in the quality of life.

Female↗
PubMedDate not supplied

[Value of tissue harmonic imaging in biliary lithiasis].

AIM OF THE STUDY: To define the role of harmonic imaging in the study of biliary lithiasis. SUBJECTS AND METHODS: We included 50 consecutive patients with suspected biliary lithiasis. Three independent observers compared results of harmonic imaging and conventional ultrasonography. RESULTS: This study showed a better interobserver agreement with harmonic imaging for acoustic shadow (kappa=0.87 vs 0.68) and intra-hepatic biliary stones (kappa=0.79 vs 0.49). More stones and more lithiasic gallbladders were seen with harmonic imaging (27 vs 24) and visualization of gallbladder sludge and the acoustic shadow from stones (P=0.01) was better. Ultrasound examination appears to be easier and faster and the diagnosis is more certain with harmonic imaging than with conventional ultrasonography (P=0.005). CONCLUSION: Harmonic imaging provides more information on biliary lithiasis and a more certain diagnosis.

Acute Disease↗
PubMed2001

[Treatment of ureteral lithiasis with shock waves].

OBJECTIVE: To present our results with ESWL in situ in the treatment of ureteral lithiasis. Distal ureter calculi can be managed by ESWL or URS. For complex ureteral calculi associated with ureteral malformations, failed ESWL or complications other procedures are utilized (URS) and open surgery has its indications. METHODS: From October 1990 to December 2000 the Lithiasis-Lithotripsy Unit of the FJD has performed 2,500 ESWL in situ for ureteral calculi without endoscopic or percutaneous procedures (double-J or PN). The calculus was located in the lumbar ureter in 45%, sacro-iliac in 11% and renal pelvis in 44%. 67% were males and 33% females (mean age 48 and 42 years, respectively). Stone size was 5-20 mm in 88% of the cases; 1.5% had bilateral involvement, 1.7% multiple and 1.5% had a solitary kidney. 15% had renal colic when the procedure was performed. IVP was performed during ESWL for ureteral uric acid stones. RESULTS: The overall success rate was 95%; 97% for stones in the lumbar ureter and 89% for stones in the distal ureter. Repeat-ESWL rate was 1.10. Renal colic resolved during ESWL, although stone fragmentation was partial. Hematuria is common post-ESWL and irritative voiding symptoms on passage of stone fragments. Post-ESWL colic was observed in 20% of the cases but were managed without difficulty with medication. There were 3 cases of severe complications (0.12%), colon perforation, severe renal hematoma and peritonitis. Septic obstruction was found in 1.5% that required catheterization or nephrostomy. Radiologic and asymptomatic Steinstrasse was observed in 10% of the cases. CONCLUSIONS: ESWL in situ is the treatment of choice in ureteral lithiasis and has been demonstrated by many groups. The size and degree of stone impaction have a negative influence on the results. Resistance to fragmentation, which is basically determined by stone chemical composition, influence the results. Monohydrate calcium oxalate stones have been found to be the most resistant. Previous insertion of a catheter (double-J or nephrostomy) does not enhance the results. It appears to be useful during an episode of renal colic. Distal ureteral calculi can be treated by ESWL and URS. If a lithotriptor is available, ESWL without endoscopic procedures is the first choice.

Adolescent↗
PubMed2001

[Radiotransparent lithiasis. Diagnosis and treatment].

OBJECTIVE: To analyze current clinical, diagnostic and therapeutic aspects of uric acid lithiasis. The role of helical CT in its diagnosis, ESWL and alkalinization in its treatment, and metabolic and crystalographic analyses are discussed. METHODS: The incidence of uric acid calculi is estimated to be from 5% to 7% in the Lithiasis-Lithotripsy Unit of the Jiménez Díaz Foundation. The diagnostic and therapeutic possibilities of helical CT and ESWL are illustrated in a case of complex bilateral renal uric acid staghorn stone. RESULTS: Ultrasound and endoscopic uroradiology are fundamental in the diagnosis of radiotransparent obstructive bilateral renal stone. Ureteral catheterization was warranted due to the anuresis that resulted from bilateral obstructive renal failure. Stone dissolution combined with ESWL achieved rapid resolution of the large calculi. CONCLUSIONS: Helical CT without contrast enhancement should be performed along with the conventional urological diagnostic tests for ureteral lithiasis, especially in patients with renal colic. Although urinary alkalinization is the conventional treatment for uric acid stones, ESWL permits faster resolution in large, obstructive or ureteral stones in patients with renal colic. Complete assessment of patients with uric acid calculi includes metabolic and crystalographic analyses.

Aged↗
PubMed2003

[The videolaparoscopic treatment of cholecystic common bile duct lithiasis: review of 827 cases].

BACKGROUND: The aim of this retrospective study is to verify the progress of the results in 827 patients submitted to videolaparoscopic treatment for cholecysto-choledochus lithiasis during the period >March 1994 - September 2000. METHODS: All the patients had recurring biliary colic, dyspepsia and pain in the upper abdominal quadrants. All clinical forms of cholecystitis were treated. RESULTS: The laparotomic conversions in the case of lithiasis of the gallbladder alone were 8 (0.9%) and 13 (1.5%) as it occured simultaneously with lithiasis of the common bile duct. Mortality was null and morbidity was found in 4 cases, equal to 0.4%. CONCLUSIONS: On the basis of the results obtained cholecystectomy can be implemented on a large scale to include patients of all ages and those in the high risk groups provided that the operating team include expert and skilled surgeons in the laparoscopic method as well as the conventional methods.

Adolescent↗
PubMed1992

[Tumor of the urinary tract and renal lithiasis. Apropos of 4 cases].

The authors present four observation of renal lithiasis associated with a tumor of the upper urinary tract. The rarity of this association and the facility to only consider lithiasis often conceal the tumor. They define the "high risk lithiasis" for which CT-scan is mandatory. Tumor of the urinary tract has to be treated and the prognosis becomes less favorable.

Aged↗
PubMed1992

[Contribution of surgical endoscopy and extrahydraulic lithotripsy in complex biliopancreatic lithiasis].

Surgical endoscopy combined with electro-hydraulic lithotripsy was done on 17 patients selected for complex multiple bilio-pancreatic lithiasis. In the biliary tract (7 patients), per operatory lithotripsy was performed on 3 patients (impacted main duct stones n = 2, impacted left hepatic stones n = 1); it was done through a T-tube in 1 young patient with an impacted stone in the ampulla and percutaneously in 3 patients (1 gall bladder and 2 intra hepatic lithiasis, one of them with biliary cirrhosis and portal hypertension). Four of this patients had had iterative surgery, extracorporeal lithotripsy or retrograde endoscopy. Complete desobstruction was obtained in all patients with minimal morbidity (minor hemobilia n = 2, hemorrhage from oesophageal varicose n = 1). In the pancreas, the technique was performed on 10 patients with impacted stones in the Wirsung duct and cephalic obstruction. Mean duct diameter was 7 mm. Complete desobstruction was obtained in 9 cases and endoscopic maneuvers were associated with "double stream" operation: sphincterotomy and cephalic desobstruction plus latero-lateral wirsungo-jejunostomy. Morbidity was small (minor hemorrhage n = 3). To conclude, endoluminal electro-hydraulic lithotripsy is an interesting adjuvant technique for the treatment of obstruction from stones in complex bilio-pancreatic lithiasis, either during open surgery or trans-cutaneously.

Adult↗
PubMed1992

[Definition of asymptomatic biliary lithiasis].

Asymptomatic biliary lithiasis can be defined as biliary lithiasis having determined no complication and no episode of biliary pain. Biliary pain is a consequence of acute increase of pressure inside the biliary tract. The increased pressure is induced by a stone transiently obstructing the cystic duct or the Oddi sphincter. In most patients, the site of the pain is epigastric. The level of the pain is high. The duration of the episode of biliary pain is usually less than 5 hours. Abdominal pain having other characteristics, dyspepsia, and headache are not related to biliary lithiasis.

Cholelithiasis↗
PubMedDate not supplied

[Simon's posterior vertical lombotomy in the conservative treatment of upper lumbar renal and ureteral lithiasis].

The authors present their experience accumulated in the treatment of 107 cases in which they have applied posterior vertical lombotomies as a conservative method of renal lithiasis and of the upper lumbal urether, and they re-actualize ore of the less used approaches. From the very beginning it is evident that vertical posterior lombotomy can be used as a narrow approach and, at the same time it can be created or it may be widended, just as a classical lombotomy. A secure technique, that of intra-sinusal pyelotomy, will determine, together with the type of the lithiasis, a choice of posterior lombotomy, with a sufficiently wide access pathway, which only in exceptional conditions will necessitate a cranial or caudal extension. This type of lombotomy, without fatalities, intra-surgical hemorrhagic accidents, severe complications after surgery, and especially, lacking the risk of lithiasis relapse, allows for an in situ kidney surgery and will protect the tissues to the utmost.

Adolescent↗
PubMedDate not supplied

Liver resection for intrahepatic lithiasis. Report of a case.

Intrahepatic primary lithiasis is extremely rare in the Western world. The development of endoscopic technique permitted a conservative treatment for this disease. Because of the high recurrence rate after conservative treatment due to the remaining biliary stricture and the risk of incidental cholangiocarcinoma, we believe that hepatic resection is the treatment of choice of unilateral liver intrahepatic primary lithiasis. Herein we present a case affected with intrahepatic primary lithiasis localized into the left biliary system that successfully underwent left hepatic lobectomy.

Bile Ducts, Intrahepatic↗
PubMedDate not supplied

[Treatment of biliary lithiasis with the advent of new technologies in Italy in the Lazio and Abruzzo regions over the past 15 years. Comparison between the patient series in a Roman university hospital and in a number of hospitals in the Abruzzo region].

Biliary lithiasis is a disease with a high incidence in the western world and a high social cost. To evaluate the impact of new technologies--mainly laparoscopic cholecystectomy and radiological and endoscopic techniques--in the treatment of biliary lithiasis, a statistical study was conducted on the surgical interventions performed over the past 15 years in Italy in the Lazio and Abruzzo regions. From 1985 to 1999, 150,000 cases of hepatobiliary lithiasis were hospitalized every year in Italy with a mean hospital stay of 7.8 days (13,000 in Lazio and 6,000 in Abruzzo). 100,000 cholecystectomies were performed every year in Italy in public hospitals, 30% of which by conventional laparotomy and 70% laparoscopically. Ten percent of these operations on average were performed in the Lazio region and 3% in the Abruzzo region. 10,615 cases of main bile duct stones were treated in 1999, 6,502 of which by ERCP and the others with open procedures and radiologically. The mortality was 0-0.1% for laparoscopic cholecystectomy as against 0-0.5% in open procedures.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Endo-Lap method in the management of biliary lithiasis (gallbladder and common bile duct)].

AIM: To present the results of the biliary endoscopic approach (ERCP) followed by laparoscopic cholecystectomy (LC) in the management of biliary lithiasis (gallbladder and common bile duct--CBD). PATIENTS AND METHOD: From 1997 to March 2003 37 patients with biliary lithiasis were treated by endoscopic sphincterotomy (ES) with stone extraction, followed after 24-48 hours by LC. The indications for ERCP were presence of an obstructive jaundice (n=32) and a dilated CBD at the ultrasound examination (n=5). RESULTS: Selective biliary cannulation was obtained in 35 (94.6%) cases, in all of them with successful papillotomy. Stones were found in all patients. CBD clearances for calculi (from 1 to 8) was obtained in 33 of 35 patients (94.3%), the rest of 2 being managed by open laparotomy. Antibiotics were administrated in all patients. Laparoscopic cholecystectomy was performed after 24-48 hours, with one conversion (3%). Postoperative morbidity was 12.1%: 2 transitory pancreatic reactions and 2 wound infections. CONCLUSION: Endo-Lap method is a useful management alternative for combined gallbladder and CBD lithiasis. It has all the advantages of the two mini-invasive procedures (fast recovery, short hospitalization, low costs) and a less postoperative morbidity in patients with high risk.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Conjugated linoleic acid lowers hypercholesterolemia but increases the risk for biliary lithiasis].

The term conjugated linoleic acid (CLA) refers to a series of linoleic acid isomers present in meat and diary products from ruminants that have their double bonds in a conjugated position. The aim of the present work was to study the effects of a CLA isomer, trans-10,cis-12, on cholesterolemia and biliary lithiasis risk in an animal model of diet-induced hypercholesterolemia. For that, two groups of hamsters were fed with a hypercholesterolemic diet supplemented with 0.5% linoleic acid or with the trans-10,cis-12 CLA isomer, respectively. Daily food intake and weight were determined and, 6 weeks later, serum and bile samples were obtained, and livers and spleens were dissected and weighted. Cholesterolemia, hepatic and splenic cholesterol content, and biliary cholesterol phosnolipid and bileacid concentrations were determined; Biliary Lithogenic Index was calculated, and presence of gallstones was assessed. CLA did not modify energetic intake or final body weight, spleen size or spleen cholesterol content, but it did significantly reduce total serum cholesterol (-18%) at the expense of c-LDL (-66%), and it also significantly reduced hepatic content of free cholesterol (-26%), without changes in esterified cholesterol. Besides, CLA produced a 32% increase in biliary cholesterol concentration, a 28% increase in Lithogenic Index, and a higher incidence of biliary lithiasis. Therefore, the present study shows that the CLA trans-10,cis-12 isomer is hypercholesterolemic since it increases, at least in part, cholesterol secretion to the bile. As a consequence, this effect increases the risk for biliary lithiasis.

Animals↗
PubMed1992

[Asymptomatic lithiasis of the common bile duct: diagnostic difficulty and essentiality of intraoperative cholangiography].

Biliary lithiasis is a widespread pathology the diagnosis of which, following the introduction of ultrasonography, is increasingly easy. The frequent possibility of association between gallstones and choledocholithiasis, demands pre- or intraoperative recognition. The inadequacy of ultrasonography in excluding lithiasis of the common biliary tract with certainty, notwithstanding its other unquestionable advantages, and the disproportionate costs and risks of other investigations (cholangiography, ERCP, ecc.) which are such as to discourage routine use, confirm the role of operative cholangiography in the diagnosis of asymptomatic choledocholithiasis, so permetting its treatment. Personal experience of 100 consecutive cases of gallstones which showed fully 10 of them to be negative to preoperative investigation were found to have lithiasis of the common biliary tract.

Adult↗
PubMed2005

[Giant bladder lithiasis in children].

OBJECTIVE: [corrected] To inform a case and the handling of the vesical giant lithiasis in the boy. RESULTS: Presentation of a case of a 5 year-old boy had urinary infections, and who was diagnosed giant vesical lithiasis, was made the cistolithotomy. CONCLUSIONS: The giant vesical lithiasis is not very common, and it is usually associated with nutrition factors.

Child, Preschool↗