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PubMed1984

Renal papillary changes in patient with calcium oxalate lithiasis.

We report the case of a white woman with bilateral renal calculi that were removed by bilateral nephrolithotomies. The morphology of renal tubular stones and the changes in papillary tissue were studied by light microscopy and scanning and transmission electron microscopy. The stones were made of calcium oxalate and were intratubular. Large calcium phosphate deposits were present in the interstitium. There was a marked interstitial fibrosis and tubular epithelial hyperplasia.

Calcium Oxalate↗
PubMed2006

Giant lithiasis in a female urethral diverticulum.

The formation of gallstones in a urethral diverticulum is a rare clinical entity and is usually seen in males. The case of a 50 year old woman is presented, who consults for hard vaginal mass and dispareunia associated with repeated urinary infections, with radiological images and an interesting photoendoscopic vision of the upper dome of the gallstone. The diverticulum was approached via vaginal way and the local extraction was successful.

Diverticulum↗
PubMed1999

[Hepatectomy in intrahepatic lithiasis].

STUDY AIM: The aim of this study was to report the immediate results of a series of 65 hepatic resections for hepatolithiasis performed in Vietnam. PATIENTS AND METHOD: From 1986 to 1998, 44 men and 21 women (mean age: 40 years) underwent hepatic resection for hepatolithiasis. Fourty patients had previously undergone one or several operations for hepatolithiasis. The procedure was performed on emergency in 25 patients. Indications for hepatic resection were: angiocholitis and liver abscess in 22 cases, stones closely inserted in the biliary duct in 20 cases, hemobilia in 12 cases, stones located above a biliary stricture in 8 cases and stones associated with a postoperative biliary fistula in 3 cases. Liver resections (minor in 61 patients, including 55 left lobectomies, and major in 4 patients) were performed through transhepatic approach according to the Ton That Tung technique and followed by an external biliary drainage with a Kehr tube. RESULTS: There were 6 postoperative deaths (9%), 3 due to septic shock, 2 to cachexia, and 1 to liver failure. The 15 patients with complications recovered with conservative therapy. Bile infection was present in 93%, mostly with Escherichia coli and Enterobacter. Pigmented stones were usually found. CONCLUSION: Vietnam is a country with high incidence of hepatolithlasis. Hepatic resection is an adequate treatment for localized intrahepatic bile duct stones when the involved segment including biliary strictures and calculi can be completely removed. The procedure may be performed on emergency for liver abscess, or hemobilia.

Adult↗
PubMed1981

Biliary lithiasis and helminthiasis.

The syndrome of Oriental cholangiohepatitis is characterized by helminthiasis, choledocholithiasis often without cholecystolithiasis, biliary duct stricture and hepatic abscess. The common duct stones are usually multiple, black and friable. Fourteen cases have been seen in recent immigrants to the United States. Thirteen patients had choledocholithiasis, and 1 had viable flukes in the ducts. Choledochoenterostomy is usually required because of multiple stones, including intrahepatic stones, or proven or presumed infestation with Clonorchis sinensis. The latter, the Chinese liver fluke, is an infestation for which medical therapy does not exist. Resection, particularly of the lateral segment of the left hepatic lobe, may be required in cases of abscess and stones associated with stricture of the left hepatic duct.

Adult↗
PubMed2002

[Ureteral lithiasis, what treatment?].

Extracorporeal shock wave lithotripsy and ureteroscopy are minimal invasive techniques, both of which have definitively become essential for the treatment of ureteral stones resistant to conservative treatment. At the time of evidence-based medicine, no study makes it possible to recommend one of these methods rather than the other. For stones of identical size and location, this review of the literature shows that extracorporeal shock wave lithotripsy and ureteroscopy prove of comparable effectiveness and innocuousness. The urologist thus has two alternatives of which the technical control, the availability of the endoscopes or lithotriptors as well as the desire and comfort of the patients are the factors which condition his choice of the method for the treatment of ureteral stones.

Decision Making↗
PubMed1976

Uric acid lithiasis associated with altered kinetics of hypoxanthine-guanine phosphoribosyltranferase.

1. A patient is described who had uric acid calculi which obstructed both kidneys. Serum uric acid was 34 mg/100 ml upon admission to hospital, and evidence of precipitation of uric acid in joints was obtained. 2. Total activity of hypoxanthine-guanine phosphoribosyltransferase in erythrocytes lysates from this patient was 44% of normal. Kinetic studies revealed that the apparent Michaelis constant of this enzyme for phosphoribosyl pyrophosphate was elevated 15-fold, while these values for hypoxanthine and guanine were in the normal range.

Adult↗
PubMed1989

Does hyperuricosuria play a role in calcium oxalate lithiasis?

This review evaluates the epidemiologic, clinical and experimental evidence for an etiological link between urinary uric acid and the propensity to develop calcium oxalate calculi. While epidemiologic and laboratory studies provide only equivocal support for a synergistic relationship, several clinical trials with allopurinol have demonstrated a reduction in calculus recurrence. These beneficial effects are observed only when allopurinol is given to subjects with calcium oxalate calculi who have isolated hyperuricosuria. The specificity of this effect suggests that there is an important interaction between uric acid and calcium oxalate but the mechanism(s) remain to be elucidated.

Allopurinol↗
PubMed1987

Urinary lithiasis in the black population: an epidemiological study and review of the literature.

A retrospective review of 199 black patients with urinary calculi and review of the census figures of the index hospitals revealed that white patients had urinary calculi 3 to 4 times as often as black subjects. The black male-to-female ratio was 1 to 1.55 compared to a ratio for white patients of 2.3 to 1. Calculi in black male subjects occur at a younger age than in black or white female or white male patients. The most common organisms cultured in black patients with stones were Escherichia coli and Proteus mirabilis. In contrast to the white population the most common type of stone formed in black patients was struvite/carbonate apatite. Stones of this type accounted for a third of all stones in male and 44 per cent in female subjects. We conclude that nephrolithiasis is an uncommon but not rare disease in the American black population.

Adult↗
PubMed1981

A review of 171 consecutive patients with urinary lithiasis.

During a 3-year interval 171 patients with urinary tract calculi were seen and studied: 98 had kidney, 52 had ureteral and 21 had bladder calculi. In 54 of the 98 patients with kidney stones (55 per cent) abnormal elevations of the blood and/or urine calcium, uric acid or creatinine were noted. Of these 98 patients 54 (55 per cent) were treated with observation only, 42 (43 per cent) were treated surgically (with an operative mortality of 2.4 per cent) and in 2 the renal stones passed spontaneously. Sixty-two per cent of the patients with renal calculi had a history of stones. It is believed that asymptomatic renal stones located in a calix or calices and not associated with infection are best managed nonoperatively. The average age of the 52 patients presenting with ureteral calculi was 12 years younger than that of patients presenting with renal calculi (36 versus 48 years). In 46 per cent of these cases the ureteral calculi ultimately passed spontaneously. Conservative therapy of ureteral calculi with long-term expectant observation (weeks and even months) often is indicated in the obstructed and uninfected patient. Twenty-nine per cent of the patients with ureteral calculi had a history of stones.

Adult↗
PubMed1981

Renal lithiasis and hyperparathyroidism: diagnosis, management and prognosis.

From 1969 to 1979, 448 patients underwent parathyroid exploration for presumed hyperparathyroidism. Of these patients 184 had associated renal calculus disease, 72 of whom (16 per cent) had metabolically active stone disease. Of these 72 patients 48 had adenomas, 18 had hyperplasia and 6 had normal glands. Of those patients with assessable disease none with adenomas has had recurrent calculi, whereas calculi continued to form in 45 per cent of the patients with hyperplastic glands and in 50 per cent of those with normal glands. Although most patients with adenomas had persistent calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone served to confirm the presence of parathyroid pathology. Urinary calcium levels were of no diagnostic benefit.

Adenoma↗