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Treatment of intrahepatic lithiasis using the choledochofiberscope.

Our experience with choledochoscopic extraction of intrahepatic calculi in eleven cases is presented. In three cases, the intrahepatic bile duct containing multiple stones was punctured under the guidance of ultrasonography, and the stones were removed choledochoscopically through the percutaneous transhepatic cholangial drainage (PTCD) tract which was dilated with catheters of increasing diameter. In nine cases, the removal of intrahepatic stones was attempted choledochoscopically through the T-tube tract or the jejunostomy. This procedure was successful in six of the nine cases. The advantage of the choledochoscopic removal through the PTCD tract compared with that through the T-tube tract is discussed, and an illustrative case is presented.

Adult↗

[Meckel lithiasis. A rare complication of a Meckel's diverticulum].

HISTORY AND CLINICAL FINDINGS: Acute abdominal pain, radiating to the right and left lower abdomen with pain on abdominal pressure developed in a 67-year-old man. There were questionable signs of peritonitis. INVESTIGATIONS: Leukocytosis (20,000/microliter) and a high level of C-reactive protein (177 mg/l) were found. Ultrasound and computed tomography were suggestive of a stone in a Meckel's diverticulum. TREATMENT AND COURSE: This diagnosis was confirmed at surgery and there were no other abnormalities. The diverticulum with stone was resected and the patient made an uneventful recovery. CONCLUSIONS: A stone in a Meckel's diverticulum, although rare, should be included in the differential diagnosis of acute abdomen with radiological evidence of calcification in the lower abdomen. The possibility of this rare complication raises the question of prophylactic resection of Meckel's diverticulum, even when it is merely an incidental finding.

Abdomen, Acute↗

Structural examination of tryptase-, and VIP-positive mast cells in the common bile duct of patients with lithiasis.

The morphology of tryptase-, and vasoactive intestinal polypeptide (VIP)-positive mast cells was examined immunohistochemically in 38 common bile ducts collected from patients with secondary chronic cholangitis and varying degrees of inflammatory activity. Mast cells numbers in chronic exacerbated and chronic sclerotic cholangitis were significantly higher as compared with those in controls (72.4 cells/mm2 and 25.2 cells/mm2 vs. 5.9 cells/mm2; p < 0.0001, Student's t test). The increased number of tryptase-positive mast cells in chronic exacerbated cholangitis correlated with the severeness of inflammatory infiltration. In cases of chronic exacerbated cholangitis, the increased number of mast cells was detected in conjunction with active fibroplasia. In chronic sclerotic cholangitis mast cells were lower in number as compared with exacerbated cholangitis and were observed in relation with inactive fibrosis. Numerous VIP-positive mast cells were found in all patients with cholangitis. Ultrastructural immunocytochemistry showed tryptase positivity to be localized over either electron-dense or particulate granules with a mean diameter of 0.261+/-0.073 microm or 0.171+/-0.053 microm, respectively. VIP positivity was formed as a finely or coarsely granular pattern over larger electron-dense granules of 0.475+/-0.14 microm in diameter. Tryptase-positive mast cells were located mainly in and around surface and glandular epithelium. The involvement of tryptase- and VIP-positive mast cells in inflammation, fibrosis and epithelial reactions in the common bile duct is discussed.

Adult↗

Recurrence of renal lithiasis.

OBJECTIVE: It is well known that all renal stones are associated with a high recurrence rate. The aim of this paper is to study the different types of renal calculi recurrence. MATERIAL AND METHODS: The study included 220 patients who had produced two or more renal calculi over a period of <5 years (total 634 calculi). The procedure used to study renal calculi involved appropriate combinations of stereoscopic microscopy with infrared spectrometry and scanning electron microscopy coupled with X-ray microanalysis. RESULTS AND CONCLUSION: Recurrent stone-formers can be classified into two large groups: those who always produce the same type of calculus (the most common type of recurrence was calcium oxalate dihydrate, followed by calcium oxalate monohydrate non-papillary and calcium oxalate monohydrate papillary calculi); and those who produce different types of renal calculi (the most frequent recurrences in this group were the changes calcium oxalate dihydrate-->calcium oxalate dihydrate/hydroxyapatite and calcium oxalate monohydrate-->calcium oxalate dihydrate).

Calcium Oxalate↗

Mice with adenine phosphoribosyltransferase deficiency develop fatal 2,8-dihydroxyadenine lithiasis.

Deficiencies in different steps of purine metabolism give rise to a number of human inherited disorders. Lesch-Nyhan syndrome is a severe neurological disorder, caused by a deficiency in the purine salvage enzyme hypoxanthine phosphoribosyltransferase (HPRT). HPRT-deficient mice have been generated, but have proved to be an unsuccessful model of the human disease. We have suggested that this may be due to a greater dependency in rodents on the other purine salvage enzyme, adenine phosphoribosyltransferase (APRT). We have generated an APRT-deficient mouse line by gene targeting, with a phenotype that closely resembled the symptoms of APRT deficiency in man. APRT null mice were viable, but 90% died prematurely before 6 months of age, displaying highly abnormal kidney morphology, with pathology characteristic of tubule obstruction. These mice have elevated urinary levels of adenine and 2,8-dihydroxyadenine, a highly insoluble adenine derivative, plus birefringent crystalline deposits and calculi within tubules throughout the kidney. A standard therapy for APRT-deficient human patients is the administration of the xanthine oxidase inhibitor, allopurinol. This has proved an effective therapy for APRT null mice, preventing accumulation of 2,8-dihydroxyadenine and much of the resultant renal obstruction, allowing us to establish a breeding line. We believe that these mice should provide a useful model for further study of APRT deficiency in humans. Furthermore, by generating APRT and HPRT double mutants, we will be able to test our hypothesis that both genes must be inactivated in mice before a model for Lesch-Nyhan syndrome can be obtained.

Adenine↗

Lithiasis in a heterotopic pancreas of the stomach.

A heterotopic pancreas is a relatively uncommon abnormality and usually of no clinical importance. A heterotopic pancreas is subject to various pathologic changes occurring in the pancreas, however, such as acute pancreatitis, cyst or abscess formation, pancreatic cancer, and islet cell tumor. We describe a rare case of a heterotopic pancreas presenting as a gastric submucosal mass with punctate calcifications occurring in a 43-year-old man.

Adult↗

Molecular basis of inherited renal lithiasis.

Idiopathic calcium oxalate stone formation results from an interaction between genetic and environmental factors. Clearly identifiable risk factors for the disease that have a significant genetic influence are the excretions of calcium, oxalate and citrate. Candidate genes that may be responsible for these effects have been proposed. With the large-scale sequencing of the human genome and the identification of genetic polymorphisms, it is only a matter of time before these genes and the sequence differences within them that are associated with susceptibility to the disease are conclusively identified.

Journal Article↗