Biomedical subjects
Publications and source records attributed to G Brien.
An analysis is made of the frequency distribution of calcium oxalate calculi in children according to age, the occurrence of both hydrate forms and the four basic texture types. With the exception of the first year of age, weddellite is found more frequently than whewellite. In contrast to a general survey, children show a greater share of weddellite texture types versus the concentric texture of whewellite.
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The course of urogenital tuberculosis is complicated by unspecific bacterial infections of the urinary tract and nephrolithiasis. Among 605 patients with bacteriological or histological verified urogenital tuberculosis, 122 patients (20%) developed unspecific bacterial urinary infection--commonly caused by E. coli, proteus and pseudomonas--and 57 patients (9.4%) showed nephrolithiasis. In 42% of the lithiasis patients an urinary tract infection simultaneously occurred. 22 calculi are analyzed by the combined crystal-optical and x-ray-diffraction method with following results: 9 X struvite/carbonate apatite, 6 X calcium phosphate, 7 X calcium oxalate. The texture of 12 calculi was investigated on thin sections by polarization microscopy and a high concentration of organic material was found in both calcium oxalate and struvite/carbonate apatite calculi.
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Due to a hypercalcaemia and changeably appearing hypercalciuria 13 patients with relapsing urolithiasis were under suspicion of a primary hyperparathyroidism. After selective sounding and withdrawal of blood from the cervical veins in all cases the determination of parathormones was performed and always an increased activity of parathormones was found. The exploration of the cervical region carried out could in 11 performed operations in 8 cases prove an adenoma and in 3 cases a hyperplasia as cause of hyperparathyroidism. A localization of the suspected adenoma was in 5 cases possible in combination with the angiography of the thyroid gland. By equally high activity in 3 cases no clear evidence was possible. An improvement of the diagnostics of localization might be achieved by supraselective sounding of the veins. On principle the authors recommend to perform a selective determination of parathormones before operation, which in case of need is to be supplemented by a selective angiography of the thyroid gland.
With the regression of tuberculosis of the respiratory tract a marked reduction of urogenital tuberculosis caused by the known late manifestations resulted, too. In 1981 152 new cases of urogenital tuberculosis were registered in GDR being an incidence rate of 0.91 per 100,000 inhabitants. The total duration of antibiotic therapy could be reduced from previously two years to 9 months. Inspite of using highly effective aggressive antituberculotic drugs the portion of persons with nephrectomy in our hospital amounted to 27%. Superinfection with nonspecific germs and by formation of stones in the urinary tract complicated the later course of disease. 18% among 567 patients showed a nonspecific mixed infection and additional 8% had stones in the urinary tract. Complications occurred in 50% of the cases with residual kidneys. Cases of delayed diagnosis have become more frequent in the last 8 years. The prognosis of the illness is decisively determined by early diagnosis, by adequate therapy and intensive urological-nephrological dispensairic care.
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Texture examinations were made on 416 thin section and on 1,000 grain preparations of calcium oxalate calculi. The frequency of occurrence of four basic texture types in relation to pathological urine parameters, age and sex of the patients as well as types of stone removal are discussed. Percentage share of texture type I that correlates to hyperuricosuria shows a steady increase with increasing age. The proportions of types III and IV that are linked to hypercalciuria decrease with increasing age. The examinations show the feasibility of texture-type determinations within routine stone analysis and create the precondition for texture types to be included in metaphylaxis of calcium oxalate lithiasis.
Separate core and shell examinations were made on 10,000 urinary stones using a combined crystal-optical X-ray diffractometric method of analysis. 29.5% of these concrements showed differences in qualitative phases between central and peripheral stone parts. All the more frequent stone components were found in core and shell to the same extent. Only weddellite and uric acid dihydrate show a clear preference of the shell. Our method of analysis showed cores to be mostly monomineralic and peripheral stone parts mostly bimineralic. Consequences of this topographic stone analysis for metaphylaxis of urolithiasis are pointed out.
Reference is made to the significance of hypercalciuria in the aetiology of calcium oxalate lithiasis. Differentiation between the various forms of hypercalciuria allows the therapy to be suited to the respective causes. In order to measure intestinal calcium absorption the authors examined serum samples from 22 patients after oral administration of Ca47; in 13 cases absorptive calciuria was diagnosed.
In a series of 264 inpatients with nephrolithiasis and chronic renal insufficiency, 159 received follow-up care between 1 and 14 years (4.3 years on the average) after primary hospitalization. 59 of these 159 patients had to undergo nephrectomy in the course of calculus disease. Follow-up examinations showed no deterioration in 60 patients and a further 64 showed clear symptoms of improved renal function. In 23 patients renal function deteriorated and 11 of them had to be accepted in chronic dialysis. Special emphasis is placed on the relevance of thorough metaprophylaxis after calculus removal. Stone analyses of patients with renal insufficiency showed a high share of infectious stones (struvite and carbonic apatite) as well as of uric acid calculi. For that reason especially these patients require an intensive follow-up treatment.
To make qualitative as well as semiquantitative analyses of 10,000 urinary calculi of large city population, a combined crystal-optical X-ray diffractometric method proved to be very useful. This combination goes to complement the advantages of polarization microscopy (with its minimal substance requirements, its proof limits of less than 1%, and its insight into stone texture) with those of X-ray diffraction (with its fast semiquantitative analysis and simple differentiation of all the stone components). About 30% of the calculi were found to have a monomineral composition. The most frequent types of calculi in our examination were: 33.2% whewellite/weddellite, 24.9% whewellite, 13.5% whewellite/weddellite/apatite, 7.0% struvite/apatite, and 3.9% uric acid/uric acid dihydrate.
The main indication for the application of Disalunil in the convalescent care of recidive calcium-lithiasis patients is renal hypercalciuria. Treatment with 50 mg Disalunil/d reduced the rate of recidivation by two thirds. Even during long-term application of this therapy over 3-7 years, side effects were slight and did not require any cessation of therapy.
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Urolithiasis is a rare complication following kidney transplantation. Experience with this complication in 6 of 426 transplantations performed from 1968 to 1979 is reviewed. The clinical symptoms are different from the disease in non-transplant patients. Three major predisposing causes for the development of calculi after kidney transplantation were found in our patients--urodynamic disorders following complications of the ureterovesical anastomosis, persistent bacteriuria and renal tubular acidosis and, less importantly, the presence of hypercalcemia and hypercalciuria as a result of secondary hyperparathyroidism. Crystal-optical and x-ray-diffraction studies contributed to the interpretation of the constituents and texture of the calculi and of the aetiological factors concerned.
Depending on degree and size of the changes the function of the tuberculous kidney is disturbed with different strength. With the help of the quantitative function scintigraphy by means of 131 J hippuran (sequence scintigraphy, ROI nephrography and side-separated clearance) 33 patients with urotuberculosis were examined and their course of the disease was observed. The greatest value has the function scintigraphy in progressed renal tuberculosis in the differential therapy (nephrectomy, organ-maintaining operation or conservative therapy) and control of the course.
The distal form of the renal tubular acidosis is a causal factor of the formation of phosphate calculi which is not tao be neglected. Pathophysiology, diagnostics and therapy of the renal tubular acidosis are described under the point of view of the metaphylaxis of urinary calculi. The paraclinical findings of 7 patients with distal renal tubular acidosis and nephrolithiasis and nephrocalcinosis, respectively, are discussed.
In a survey is described the inpatients suffering from urolithiasis of the urological clinic Berlin-Friedrichshain of the last three years from 1 April 1975 to 31 March 1978. Especially the cast calculi of the renal calyx were analysed and the therapeutic approach was discussed. For the complete removal of coral calculi in our clinic preoperatively made tomographies and adequate graphs of the cast concrement in its relation to the hollow system at two levels also stood the test as the intraoperative use of the X-ray device "Renodor". The two methods were described in detail. Also in multiple and movable concrements in the system of the renal calyx the Renodor stood the test. Here we could make good experiences also with the fibrin pyelolithothomy--the indications and results of these methods are represented.