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PubMed1993

Movement of intrapancreatic calcium in dogs with experimental pancreatic lithiasis. With special reference to the process of pancreatic calculus formation.

This study was performed to clarify the movement of calcium in the pancreas of dogs with chronic pancreatitis, using scanning and transmission electron microscopes (SEM, TEM) equipped with X-ray elemental microanalyzers. Eleven adult mongrel dogs underwent incomplete ligation of the pancreatic duct. After the procedure, the levels of pancreatic enzymes in the serum did not change for 9 mo, but the endocrine function was reduced gradually. Of all dogs, 5 revealed pancreatic sclerosis, and 2 at 9 mo had calculi, 2-4 mm in size, in the small pancreatic duct. SEM examination revealed the intralobular fibrosis and irregularity of the pancreatic duct wall, and TEM examination revealed the intralobular fibrosis and irregularity of the pancreatic duct wall, and TEM examination demonstrated the amorphous or crystalloid substances and secreted granules in the acinar lumen or ductule. In elemental analysis spectra using SEM, a high calcium peak was seen in the pancreatic duct wall. In elemental analysis spectra using TEM, a high calcium peak was observed in the amorphous or crystalloid substances, and a high ratio of Ca/K was seen in these substances. Calcium was also detected in the secreted granules or microvilli. These results suggest that there is a process of calculus formation based on the congregation of the intraductular substances containing a large quantity of calcium.

Animals↗
PubMed2005

Ureteroscopic treatment of ureteral lithiasis with pneumatic lithotripsy: analysis of 287 procedures in a public hospital.

Ureteroscopes and different lithotripsy methods have greatly improved the urologist's ability to treat ureteral stones, regardless of their location in the ureter. We retrospectively reviewed our experience with ureteroscopic pneumatic lithotriptor in 287 patients with ureteral calculi. Ureteroscopic stone treatment was performed between October 1999 and May 2004. Of 221 patients with distal ureteral calculi, 209 (group 1), and 58 of 66 patients with upper ureteral calculi (group 2) were treated successfully by ureteroscopy alone. In group 1, seven migrated stones (to the upper urinary tract) were successfully treated by ESWL later. There were five-treatment failures due to ureteral perforation which consequently required open ureterolithotomy. In group 2, there were five patients with migrated stones; two of them were sent to a percutaneous nephrolithotomy center because of previously unsuccessful ESWL attempts. Three of these with migrated stones were treated by ESWL later. In three patients, we switched to open ureterolithotomy because of ureteral rupture that required surgical repair. Ureteroscopic pneumatic lithotripsy is a safe and effective treatment modality for ureteral calculi.

Adult↗
PubMed2006

Role of magnetic resonance cholangiography in the diagnosis of bile duct lithiasis.

AIM: The aim of our study was to assess diagnostic value of magnetic resonance cholangiography (MRC) in patients with suspected common bile duct (CBD) stones focusing on the capability of this noninvasive method to replace invasive diagnostic procedures in these patients and to limit the use of endoscopic retrograde cholangiography (ERC) to the patients who need simultaneous therapeutic intervention. MATERIALS AND METHODS: Single-shot fast-spin-echo rapid-acquisition thick-section MRC images were obtained in 310 patients recruited into this prospective study. There were 136 male and 174 female patients aged 21-95 years [mean +/- standard deviation (SD) 64.9 +/- 13.6 years]. Patients were subsequently classified into different risk groups (high, moderate, low) according to biochemical abnormalities or morphological features on abdominal ultrasonography and computed tomography. Direct cholangiography was the reference method of CBD evaluation. RESULTS: CBD stones were diagnosed in 115 (37%) patients; 86 of 175 patients in the high-risk group, 24 of 83 patients in the moderate-risk group, and 5 of 50 patients in the low-risk group. In dependent risk groups, the mean CBD caliber was 9.7 +/- 4.5, 7.1 +/- 2.0, and 4.8 +/- 1.2 mm, respectively. The difference was significant between all three groups (P < 0.05). The median size of CBD stones was 7 mm (range 3-21 mm). MRC achieved accuracy and positive and negative predictive values of 97%, 94%, and 98%, respectively. CONCLUSIONS: MRC has a potential to substitute diagnostic ERC in all patients with suspected choledocholithiasis due to its high accuracy, reducing invasive direct cholangiography to patients who require therapeutic intervention.

Adult↗
PubMed2002

Septic lithiasis of the pelvis.

Laparoscopic cholecystectomy has become a standard technique for the treatment of symptomatic cholelithiasis. Despite a significant reduction in the complication rate with increasing experience, bile duct injury and gallstone spillage still occur more frequently with this approach than with the open procedure. Unretrieved gallstones, in particular, have been associated with late infection and the formation of abscesses in virtually every area of the abdominal cavity. We present a rare case of an isolated pelvic abscess that developed in a postmenopausal woman 5 months after laparoscopic cholecystectomy for recurrent cholecystitis. The preoperative differential diagnosis of this case is also discussed.

Abdominal Pain↗
PubMed2000

Choledochal stenosis and lithiasis caused by penetration and migration of surgical metal clips.

A 71-year-old woman, who had undergone laparoscopic cholecystectomy 1 year previously at our hospital, presented with abdominal pain, high fever, and jaundice. She was diagnosed with choledochal stenosis caused by migration of the clips that were used at the previous operation. At reoperation, the common bile duct was successfully dissected, including the stenotic site, where a metal clip was found to be penetrating the duct wall. The stenotic site was sufficiently resected, when a black-brown gallstone was found proximally to the stenosis. Interestingly, the stone was found to contain two metal clips, which were considered to have migrated into the bile duct and to have acted as a nidus for stone formation. The common bile duct was reconstructed by direct end-to-end anastomosis. Surgeons must exercise caution in the use of metal clips, keeping in mind the potential risk of clip migration.

Aged↗