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PubMed1991

[Lithotripsy for pelvic lithiasis with the Dornier system with radiological location].

The authors report their results with 58 patients presenting with pelvic lithiasis who were treated by extracorporeal lithotrity with the Dornier HM3 system. They describe the appropriate procedure of analgesia and emphasize the difficulties to locate the pelvic calculi, which sometimes requires resorting to urography during the treatment. Out of the 58 cases, success was total in 55 (94.83%), after one session of lithotrity in 52 of them and after two sessions in 3. In 2 of the 3 cases of failure, the calculi were monohydrated calcium oxalate stones located very high in the ischiadic incisure. Five cases of presacral lithiasis were treated in the ventral position, successfully in 3 cases and without success in 2. Thus it appears that shock wave lithotrity with the Dornier HM3 system with radiological location is highly effective for the treatment of pelvic lithiasis.

Adolescent↗
PubMed1990

[Useful investigations for the prevention of recurring lithiasis (in the absence of anomalies of the urinary tract)].

The prevalence of renal lithiasis and the rate of recurrences in affected patients raises the problem of the minimum number of investigations really needed to arrive at an accurate diagnosis and establish a potentially effective treatment. Stone recuperation is very important as it allows to carry out an accurate analysis of its constituent(s) (frequently heterogenous). Such analysis already brings forth accurate indications as to the etiology. Other biological investigations should be limited after a first episode of kidney stone disease, but recurring lithiasis will necessitate a much more thorough work-up. Recurrences in certain lithiases, such as those caused by urate calculi, are readily prevented by conventional therapy (uricosuric agents, alkalinization of urine). Withdrawal of certain medicines is paramount in iatrogenic lithiasis. Regarding calcium stones associated with hypercalciuria, results from dynamic tests and their pertinence for differentiating between hypercalciuria due to abnormally high digestive absorption and that due to excessive elimination are currently strongly contested. The role of alimentary factors seems extremely important and prescription of adapted diets appears to be quite effective in view of the present lack of crystal formation inhibitors.

Adenoma↗
PubMed1990

[Intravenous cholangiography is not indicated before cholecystectomy for uncomplicated lithiasis].

The purpose of this prospective study was to assess the usefulness of intravenous cholangiograms before elective cholecystectomy for lithiasis. The accuracy of preoperative intravenous cholangiography to detect choledocolithiasis was compared with that of routine operative cholangiography. All patients had preoperative intravenous cholangiography provided that they did not have known common bile duct gallstones or a previous history of adverse reaction to iodine. As well, patients presenting with cholestasis, cholecystitis or cholangitis were excluded. A choledocotomy was performed when the operative cholangiography disclosed choledocolithiasis; the preoperative intravenous cholangiograms were shown to the surgeon only after the operation. One hundred patients were selected among 206 consecutive operations for biliary lithiasis. A choledocolithiasis was detected in 3 preoperative and in 9 operative cholangiographies. Twelve choledocotomies were performed: one or more stones (1 to 12) were found in 9 patients; operative cholangiography was accurate in all these cases whereas preoperative cholangiography was accurate in only 2 (sensitivity = 22 percent). We conclude that preoperative cholangiography is useless before elective cholecystectomy for lithiasis and is unreliable to select patients in which operative cholangiography could be omitted.

Cholangiography↗
PubMed1989

[Extracorporeal lithotripsy of biliary lithiasis. 160 patients treated with an EDAP apparatus].

Since February 1987, we have been using extracorporeal lithotripsy for certain cases of chronic biliary lithiasis, using an EDAP lithotripter. The technique is reserved for patients with less than four radiotransparent, or partially calcified calculi, less than 25 mm in size, within the context of a functioning gall bladder with no evidence of lithiasis in the C.B.D. Dissolution of the fragments after lithotripsy is ensured by bile salts, this treatment being continued for at least 3 months after the gall bladder has been completely cleared. 160 patients were treated using a total of 181 treatment sessions. Hospitalisation lasted on average 3 days, 1/5th of the patients suffered right hypochondrial pain and nausea for 24 hours. 17% of patients showed a transient elevation in alkaline phosphatase and 12% an elevation in amylase after the procedure. The rate of gall bladder clearance was 24% at 1 month, 40.7% at 3 months ans 50% at 1 year. 11 cholecystectomies were carried out (6.8%), 8 of which were essential. Bile duct migration occurred in 2 cases and produced oedematous pancreatitis in one case. Recurrent lithiasis was noted in 4 cases between 6 and 18 months after gall bladder clearance. 75% of cured patients had a single, radiotransparent stone less than 20 mm in diameter.

Adult↗
PubMed1989

[Biliary lithiasis].

We have reviewed our experience with 2,430 cases of lithiasis of the biliary tract, 500 of them located in the common bile duct and 104 corresponding to residual lithiasis. We have made a general reflexion on the problems aroused by this very common al condition, which has an imprevisible, some times severe, outcome. The recent acquisition of new conservative methods, as disolvents and lithotrix, and the diagnostic and therapeutic role of endoscopy have revolutionated the state of the art and have introduced controversial points still unsolved. As it is common in clinical practice, biliary lithiasis should be approached in a multidisciplinary fashion, employing the most convenient diagnostic procedure for the clinical situation of the patient; a priori no accredited procedure should be disregarded.

Bile Duct Diseases↗
PubMedDate not supplied

[Is vesicular cholesterolosis a particular anatomo-clinical form of cholesterol lithiasis? Apropos of a case of cholesterol polyp manifested by an acute complication].

A case of cholesterolic polyp, revealed by the formation of an infundibulo-cystic enclave, is reported, the polyp having the appearance of a cholesterolic calculus, but a pediculated one, and one acting as a calculus. The extreme rarity of this complication is emphasized. Despite the frequency of associated lithiasis, the cholesterolosis are included in a different framework from lithiasis, that of the cholecystoses that on histology show typical pure parietal lesions without inflammation. Findings in this atypical case suggest possible common pathogenic factors for the two affections, and raise a proposal for inclusion of cholesterolosis within the nosologic framework of lithiasis.

Aged↗
PubMed1979

[Clinicopathological profile of pancreatic lithiasis (author's transl)].

Clinical, radiological and histopathological features of 31 duodenopancreatectomies for chronic pancreatitis with lithiasis are analysed in relation to whether or not there was dilatation of the duct of Wirsung. Two groups of patients may be defined in the basis of this criterion: -- the first, without dilatation of the duct of Wirsung, with lithiasis predominantly affecting the head of the pancreas and irregular fibrosis, corresponding patients aged approximately 30 years, suffering from the disease for about 10 years, often already operated upon for pancreatitis; gastrointestinal bleeding is common; -- the second, with dilatation of the duct of Wirsung, with disseminated lithiasis, and very marked fibrosis, affecting patients aged over 50 years, suffering from the disease for less than 5 years and not yet operated upon for their pancreatitis. The problem of the independance of the two groups or of the possibility of progression of forms without dilatation of the duct of Wirsung to dilated forms remains.

Adult↗
PubMedDate not supplied

[Monotopic coralliform calculus and simultaneous contralateral lithiasis].

A study is made of 15 patients with monotopic coralliform stones, suffering from simultaneous, contralateral, renoureteral lithiasis. There are certain special features in these patients which we consider to be sufficient to distinguish them as a separate group amond cases of lithiasis in general and coralliform stones in particular. The high percentage of septic complications observed in these patients demand special treatment within the field of urinary lithiasis.

Adult↗
PubMed1984

[Results of long-term treatment of cystine lithiasis with D-penicillamine].

Eight patients with cystine stones (7 adults, 1 children) are treated by D-penicillamine since at least 5 years and at the most 9 years. The goal of the treatment is to obtain free cystinuria concentration less than 200 mg/l by the conjunction of a high urine flow and D-penicillamine. Cystinuria is measured by automatic analyser chromatography. In 2 patients, lithiasis got worse and cystinuria remained highly pathologic because bad compliance. In the 6 other cases, no lithiasis recurrence was noted; 5 patients had renal unilateral or bilateral lithiasis before treatment. A partial stone dissolution was obtained in 3 patients and total stone dissolution in 1 patient. Despite important posology often used, D-penicillamine has been remarkably well tolered since the only side effect observed was erythrodermia in 1 case at the beginning of the treatment.

Adult↗
PubMed1983

[Salivary lithiasis as a complication of surgically treated Robin syndrome].

A 15-year-old girl, operated upon (surgical ankyloglossia) at birth for glossoptosis due to Pierre Robin's syndrome provoking respiratory distress, presented with lithiasis of Wharton's duct. The pathogenesis of the lithiasis is considered to be related to the wounds and scars following the sublingual surgery, findings in this case also strongly suggesting the role of mechanical and inflammatory factors in the etiology of salivary gland lithiasis in general.

Adolescent↗
PubMed1983

[Lithiasis of the upper urinary tract and pregnancy].

The authors report 17 personal cases of lithiasis of the upper urinary tract discovered in the course of pregnancy. They discuss the diagnostic and therapeutic problems, taking into account the double risk of mother and foetus. The essential diagnostic sign is renal colic, with or without fever. Spontaneous excretion of these calculi is possible, but in 8 of the 17 cases, a ureteric catheter had to be passed or an operation was required. Neither the delivery nor the health of the infants delivered seemed to be harmed by this renal calculi disease. The authors recall that the most common cause of non-obstetrical abdominal pain in the course of pregnancy is in fact urinary calculi. The incidence is about 1 cases of lithiasis per 1,000 pregnancies. It appear that a physiological hyperparathyroidism of pregnancy is responsible for a hypercalciuria which could be a factor favouring the development of lithiasis during pregnancy. The important point is to know how to distinguish those forms of pyelonephritis of pregnancy which are due to a stone obstructing the upper urinary tract, as any purulent retention in the upper tract can lead to a pyonephrosis, a bacteraemia or even a septicaemia. The presence of the foetus makes interpretation of a plain abdominal film difficult. In any case, its indication is questionable, whenever the urine is septic, particularly with Proteus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[Personal experience of urate lithiasis (author's transl)].

In Alsace, urate lithiasis accounts for 32.7% of cases of lithiasis requiring hospitalisation. Fifty nine per cent of patients are hyperuricaemic, and only 10% have typical gout. 14.6% are hyperuricosuric but all have isoaciduria. A male disorder in 3/4 cases, it occurs above all after the age of 50. The relatively late onset, combined with marked obesity (mean weight 81.5 kg) is considered by the authors to be an argument proving the role of dietary excesses in the aetiology of this lithiasis. Excessive protein would seem to be the essential feature.

Adult↗
PubMed1995

[Influence of age and biliary lithiasis on the diameter of the common bile duct].

OBJECTIVE: To determine the influence of age and biliary lithiasis in the dilatation of the biliary ducts, a retrospective analysis was performed of the cholangiograms obtained by endoscopic retrograde cholangiopancreatography in patients presenting or with a past-history of biliary lithiasis and in controls. METHODS: Among 165 patients, 113 had choledocolithiasis (53 had gallstones, 50 had been cholecystectomized and 10 had no gallstones), 35 had gallstones and 17 had been cholecystectomized for gallstones. RESULTS: The diameter of the main biliary duct was significantly increased in the presence of common bile duct stones (14.0 +/- 4.9 mm), in cholecystectomized patients (11.7 +/- 4.3 mm), in presence of gallstones (9.2 +/- 2.4 mm). The diameter of the biliary ducts was significantly correlated with age in patients (r = 0.27; P = 0.001) and in controls (r = 0.31; P = 0.02). The different factors related to the dilatation of the main biliary duct were classified using a stepwise discriminant analysis: 1: choledocolithiasis, 2: age, 3: cholecystectomy, 4: gallstones. CONCLUSION: There is a moderate but significant statistical correlation between age and the dilatation of the common bile duct, independent of the presence of biliary lithiasis.

Adult↗
PubMed1994

[Does vitamin E protect against experimental lithiasis?].

We have recently suggested that vitamin A could protect against experimental lithiasis by repairing tubular membrane cells or protection against membrane damage caused by free radicals generated during experimental lithiasis. Although vitamin E treatment demonstrated no beneficial effect on stone formation, it promoted the repair mechanism by vitamin A during experimental lithiasis and by supported the hypothesis that oxalate crystals may be destructive to renal epithelium because they are large and irregular.

Animals↗
PubMed1995

[Common bile duct lithiasis. Analysis of surgical treatment of 130 consecutive cases].

OBJECTIVES: Common bile duct lithiasis can be treated either surgically or endoscopically. Generally, morbidity and mortality is thought to be greater for surgery. The aim of this work was to evaluate the results of surgical cure in 130 consecutive patients treated from 1983 to 1993. METHODS: Transcytic extraction was performed in 16 cases, ideal choledocotomy in 25, choledocotomy with external biliary drainage in 45, choledocojuodenal anastomosis in 14 and transduodenal sphincterotomy in 32. RESULTS: There were 3 deaths. Morbidity was 11.5%. The postoperative hospitalization time was 9.86 +/- 8.9 days for patients without drainage and 15.13 +/- 3.09 days with drainage. Stone extraction was unsuccessful in 2 cases. CONCLUSIONS: Morbidity and mortality for surgical cure of common duct lithiasis are comparable or lower than for endoscopic sphincterotomy. It is much more adapted for stone desobstruction via the choledoscopy. Supra-duodenal choledocotomy without external drainage was performed in most cases with a small incision and without touching the Oddi sphincter thus allowing a hospital stay equivalent to that for endoscopic sphincterotomy. Associating surgery with laparoscopic cholecystectomy would allow simple benign treatment in most cases of common bile duct lithiasis.

Adult↗
PubMedDate not supplied

[Orange juice in the prevention of calcium oxalate lithiasis].

From the assumption that prophylaxis of oxalocalcium lithiasis is feasible with an the intake of citrate-rich food, this paper presents a prospective, medium-term research in two groups of patients with a background of this type of lithiasis; the first group was treated with diet and increased fluid intake exclusively, while the second group had to follow similar dietetic measures and take also one litre of orange juice daily. Orange juice raises citraturia and pH, decreasing the rate of lithiasis formation and crystallization risk indicators for calcium phosphate. No significant differences are obtained in the number of relapse ratio reductions for the second group as compared to controls.

Adolescent↗
PubMed1994

[Laparoscopic management of complex lithiasis in horseshoe kidneys].

Based on the fact that the results obtained with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are uncertain in cases of complex lithiasis in horseshoe kidney, and counting on a wide laparoscopic experience as the most suitable solution in these cases, the authors present their initial experience in two cases of double lithiasis in right hemikidney. Approach was done through transperitoneal laparoscopy, after placement of a stent catheter and under the support of a radiological C-arc. After removal of the stones, the renal pelvis was closed with loose 4 zero reabsorbable suture with kots done intracorporeally. The post-operative had no complications with the exception of a transient leak of urine (5 days) that cause no further complications or subsequent sequelae. Monitoring at 6 months showed absence of residual lithiasis and good morphology and renal function of the sides operated.

Aged↗
PubMed1995

[Extracorporeal lithotripsy in the treatment of upper urinary tract lithiasis].

The advent of extra-corporal shock-wave lithotripsy in the eighties totally changed management strategies for renal and ureteral lithiasis of the upper urinary tract. Currently, approximately 80% of all patients can benefit from lithotripsy with an overall success rate of about 75%. Although classical surgery has a higher success rate of about 90%, extra-corporal shock-wave lithotripsy has many advantages. First there is a very low risk of morbidity (pain, immobilization, complications) for this outpatient treatment. Second, the overall cost, including that of preventive treatment, is low as illustrated by the major reduction in the number of cases of pyonephritis on stones and of corraliform lithiasis. The apparent safety of shock-wave therapy should not mask the risk of unacceptable indications: small stones which may resolve spontaneously or inversely very large stones carrying the risk of residual fragments and renal damage. Long-term morbidity remains to be evaluated, but the management of upper urinary tract lithiasis now relies heavily on shock-wave therapy alongside conventional surgery and percutaneous or endoscopic methods.

Female↗