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PubMed1999

[Results of the treatment of renal lithiasis by percutaneous nephrolithotomy: apropos of 115 cases].

OBJECTIVES: The objective of this study was to analyse the results of percutaneous nephrolithotomy (PCNL), which was recently introduced into Tunisia, in order to determine its place among the treatment options for renal stones. MATERIAL AND METHODS: Our retrospective study was based on 115 consecutive PCNL procedures performed between April 1994 and November 1997. The stone was a single pelvic stone in 13 cases, lower caliceal in 15 cases, lower pyelocaliceal in 28 cases, partial staghorn in 20 cases, total staghorn in 16 cases and multiple pyelocaliceal in 23 cases. In our series, ultrasound lithotripsy constitutes the procedure of choice for renal stone fragmentation. RESULTS: A good result was obtained immediately in 67% of cases. This figure is lower than that published in the literature because of the complexity of the stones and the high failure rate due to the learning curve, involving 6 members of the team. In the case of failure, the procedure was converted to conventional surgery under the same anaesthetic in 20 patients. Residual stones, observed in 23 patients, were successfully treated by extracorporeal shock-wave lithotripsy (ESWL) in 79% of cases. By combining PCNL and ESWL, the good result rate was 80%. The mortality rate of this series was 0.8% and the morbidity rate was 7.5%. Complications were generally rare and often minor. CONCLUSION: PCNL occupies an important place in the treatment of renal stones. The results depend on the site, size and number of stones and on the operator's experience.

Adolescent↗
PubMedDate not supplied

[Gallbladder lithiasis in the era of laparoscopic cholecystectomy].

Gallstones are a very common disease, present in at least 10% of the adult population. In the 70% of the cases gallstones remain silent and in these patients any therapeutical option should be undertaken, nor a periodic biological surveillance. In the remaining cases the insurgence of biliary pain is the typical symptom: pain is usually epigastric, or diffuse to the right upper quadrant or to the back. Indication for therapy should be placed only for symptomatic patients. Nowadays laparoscopic cholecystectomy must be considered as the golden standard for symptomatic patients carrying non complicated gallstones.

Adult↗
PubMed1999

[Dissolution of ammonium-magnesium phosphate lithiasis with medical systemic treatment. Report of a case].

Presentation of one case of ammonium-magnesium phosphate calculi breakdown using systemic medical treatment with oral Acetohydroxamine acid dosed at 125 mg/8 h and antibiotic therapy based on the antibiogram results. This type of treatment is generally used in an attempt to eradicate the infection, and as prophylaxis of relapse following surgical treatment or SWEL in these difficult to eradicate calculi due to their high tendency to recur.

Aged↗
PubMedDate not supplied

[The remaining indications for open surgery in common bile duct lithiasis].

Once with the continuous development of mini-invasive procedures, the open surgery indications in the treatment of CBD stones are decreasing. Between January 1986 and December 1987, 514 patients with average age 60 years old (18-94) were treated for suspected or confirmed CBDS. Three distinctive periods were studied function of how the conventional surgery were either exclusive (group I), either together with the beginning era of laparoscopy (group II), or together with institutionalised laparoscopy (group III). Group I had 110 cases, group II--207 cases and group III--197 cases. The conventional surgery were 100% performed in group I, 26% (52 cases) performed in group II, 14% (28 cases) performed in group III. If the laparotomy was the only therapeutical option in patients with CBDS from group I, the therapeutical procedures become more various after 1990. It was done endoscopic sphincterotomy in 59% (124 cases) in group II and in 64% (126 cases) in group III. The laparoscopic extraction of CBDS was 12% (cases) in group II and 19% (37 cases) in group III. The overall mortality in conventional surgery was 1.5% with 1.8% in group I and 0% in group II and III. The complications rate was 13% with 8% in group II and 21% in group III. The postoperative hospitalisation time average was 16 days for laparotomy of the 3 groups. The conventional surgery is main indicated when laparoscopic surgery for CBDS extractions or endoscopic sphincterotomy is contraindicated or failed; also it is useful in some complicated forms of CBDS.

Adolescent↗
PubMedDate not supplied

[Urinary lithiasis].

The introduction of extracorporeal shock wave lithotripsy (ESWL) and the development of "minimally invasive" endourological procedures have completely changed the management of urinary calculi. Nevertheless, some aspects in this field still remain controversial. Conservative management is the first option, when the stone can pass spontaneously. The majority of the patients can be successfully treated with ESWL without anaesthesia and in an ambulatory setting or with a 24 H admission. ESWL failures (1 to 2%) and some difficult calculi (cystine calculi, staghorn calculus, stones of great volume and some ureteral stones) can benefit with endourological or percutaneous procedures alone or in association with ESWL. The classical indication for open surgery has changed significantly and surgery is now considered only in some difficult cases and with the failure of minimally invasive procedures. Uric acid calculi, that usually respond to medical treatment, must be treated with alkalinization therapy as the first option.

Humans↗
PubMed1999

[Percutaneous extraction of renal lithiasis without radiological assistance].

OBJECTIVE: To describe the utility of posterior lumbotomy with a 3-4 cm incision through which the finger is inserted to palpate the kidney and perform percutaneous nephrolithotomy when radiological guidance is not available. METHODS: 24 selected patients underwent percutaneous nephrolithotomy. Stone size ranged from 1-4 cm. The calculi were located in the renal pelvis (17 cases), lower calyx (6 cases), inferior pyelocalyceal level (2 cases) inferior and mid-calyceal level (1 case). RESULTS: Calculi less than 1.5 cm were completely removed and ultrasonic lithotripsy and stone extraction with forceps were effective in the remaining cases. Twenty-four kidneys required a single stage procedure. Complications were observed in 12.5% of the cases. CONCLUSIONS: Posterior lumbotomy with a 3-4 cm incision to palpate the kidney and perform percutaneous nephrolithotomy, is useful when radiological guidance is not available.

Adult↗
PubMed1999

[Lithiasis of a minor salivary gland. Apropos a case].

Sialolithiasis of minor salivary glands is generally considered to be extremely rare, particularly in younger persons. In addition, the symptomatology of this entity is not always typical and, for this reason, clinical misdiagnosis is possible. A case of sialolithiasis of minor salivary glands of the cheek in a 20 year-old woman is reported. The clinical diagnosis is verified by the histopathological examination after surgical excision of the lesion.

Adult↗
PubMed1999

[Idiopathic calcium oxalate urinary lithiasis: new physiopathological approaches].

Nephrolithiasis effects 1% to 5% of the general population in industrialized countries. The majority of stones is made of calcium oxalate. The formation of calcium oxalate nephrolithiasis depends on several factors: hypercalciuria, hyperoxaluria, adhesion of crystals on the surface of renal epithelial cells, quantitative or qualitative deficit of inhibitors of crystallization in urine, intervention of promotors of crystallization. In this review we report the new insights into calcium oxalate stone formation.

Calcium↗