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At least 19 recordsLinked to original sources
PubMed1990

Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis.

Some differences between gallbladder lithiasis and primary common bile duct lithiasis are described. Microbiological cultures and biochemical analyses were carried out on the bile of two groups of patients: 27 suffering from gallbladder and 5 from primary common duct lithiasis. The microstructure and composition of gallstones were also examined by polarized light microscopy and X-ray diffraction. Women predominated in gallbladder lithiasis but not in primary common duct lithiasis group (P less than 0.05) and body weight was higher in the former group (P less than 0.02). Primary common duct lithiasis patients had a higher, although not significant, incidence of duodenal diverticulosis (P = 0.15), and a higher incidence of E. coli-positive cultures in bile (P less than 0.001). No significant difference in the biochemical composition of the bile was found between the groups. Brown pigment stones predominated in primary common duct lithiasis, while cholesterol stones did in gallbladder and secondary common duct lithiasis (P less than 0.0001). Stones formed in the gallbladder generally show linear, radial growths of cholesterol crystals, while those from the common duct present a polystratified, concentric deposition of microgranules composed mainly of pigmentary salts. These differences should be taken into account as additional criteria in the differential diagnosis between primary and secondary common duct lithiasis, as the classical criteria for diagnosing of the former greatly underestimate its actual incidence. The distinction between primary and secondary common duct lithiasis is of practical significance, since each entity requires different treatment.

Adult↗
PubMedDate not supplied

[Intrahepatic lithiasis. Apropos of 36 cases of "regional" intraheptic lithiasis].

Out of 2,700 operations for cholelithiasis and its sequelae (1960-1976), 36 cases (1.3%) of intrahepatic lithiasis (i.l.), namely proximal to the origin of the common hepatic, were observed. The prime objective of treatment namely removal of calculi, was achieved indirectly (hepatocholedochus and/or papilla) in 84% of cases, directly (hilar) in 16%. The second objective, that of ensuring optimal bilio-enteric drainage, was achieved by papillostomy or hepaticojejunostomy depending on the lumen of the bile way (respectively less or more than 2 cm.). Operative mortality was nil, while long-term results have proved poor in 9.6% of cases. The i.l. problematic is dealt with in detail on the basis of this series.

Adolescent↗
PubMed1989

[Antilithogenic action of dehydroxymaleic, ketomalonic (mesoxalic) and tartronic acids in relation to experimental lithiasis in rats].

The authors study the effects of three acids, one with four carbon atoms, dihydroxymaleic acid, the two others with three carbon considered atoms, ketomalonic acid and tartronic acid. A first study considered the effects of these products on experimental lithiasis induced by oxalic acid, glyoxylic acid and ethylene-glycol. Dihydroxymaleic acid. Monohydrate calcium oxalate stones can be easily induced in the male rat, with in 24 hours, by an intraperitoneal injection of oxalic acid, at the rate of 8 mg per 100 g of body weight. If 25 mg of dihydroxymaleic acid are injected simultaneously via the intraperitoneal route, to a rat weighing 150 g, the lithiasis observed after 24 hours is just as severe. Experimental monohydrate calcium oxalate lithiasis is also induced by intraperitoneal injection of 8 to 9 mg of glyoxylic acid in a 100 mg rat. Dihydroxymaleic acid, injected at the same time as glyoxylic acid, also via the intraperitoneal route, at the rate of 50 mg for a rat weighing 150 g, results in total suppression of the lithiasis. Dihydroxymaleic acid also prevents lithiasis induced by the absorption by the rat, for several weeks, of a 1% ethylene-glycol solution if it is mixed to this solution at the rate of 5 mg per ml. A 12% ethylene-glycol solution given to the rat at the rate of 0.55 ml for 100 g of body weight induces the next day a comatose state and a diffuse parenchymatous monohydrate calcium oxalate lithiasis: coma and lithiasis are prevented by the simultaneous absorption of dihydroxymaleic acid at the rate of 65 to 70 mg. The ketomalonic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[2,8-dihydroxyadenine lithiasis. 2 new pediatric cases of an unknown metabolic deficit. The use of extracorporal lithotripsy].

Inherited adenine phosphoribosyltransferase (APRT) has a recessive transmission. When it is very important, adenine can't be restored into nucleic acids pool and will changed into 2,8-dihydroxyadenine (2,8-DHA) by xanthine oxidase. To date in all countries but Japan, 2,8-DHA urolithiasis is observed only into homozygotic subjects with complete APRT deficiency Commonly, its onset is observed in childhood often dramatically. The authors report two new pediatric cases into new french families. First a 8 years old boy with spontaneous elimination of two lithiasis after right lumbar pain. Secondly an infant (nineteen months) who has presented an acute renal failure with anuria. Bilateral lithiasis included into pyelourectal junctions have been pulled out by bilateral surgical pyelotomy. In each case, lithiasis were radiolucent and diagnosis made by ultrasonography. The uric acid metabolism was normal and it is the infra red spectrophotometric study of stones that had recognised the 2,8-DHA component. In the second case, bilateral residual lithiasis have been broken by piezoelectric extra-corporeal lithotripsy with good tolerance and favorable result. The two children received preventive treatment. After 36 and 19 months they have no recurrence. In the literature, the frequency of 2,8-DHA lithiasis is very more low than the theoretical of homozygotics in population (1/100,000). The common confusion with uric lithiasis is one possible explanation. So spectrophotometric study of radiolucent stones was meant to be realised when uric metabolism is not disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine↗
PubMedDate not supplied

[Cystine-lysinuric lithiasis].

Cistin-lisinuria is not a unfrequent etiology of lithiasis in children. Six patients have been studied as well as their families, being a total of 45 patients. Lithiasis was present in ten of our patients, and hyperaminoaciduria, without lithiasis in ten, affecting in both cases (with or without litiasis) either all the four amynoacide (cystine, lysine, arginine and ornithine) or only one or two of them. Authors have not found any correlation between clearance of cystine and the presence or absence of lithiasis; on the other hand the best index to correlate the presence of lithiasis is to reach a value, equal or superior to 300 mgr of cystine excreted in the urine per 1 gr of creatinine excreted in urine. The correct treatment in cystinuric patients with lithiasis is to alcalize the urine maintaining a constant urinary pH between 7-8, giving a sufficient dose of sodium bicarbonate per os. In case of resistance to this treatment or if a great calculi is present, D-penicillamine would be an efficient treatment to disolve the calculi. These treatment when carried out under analytical control presents no problems or complications in their experience.

Adolescent↗
PubMed1992

[Ureteral lithiasis. Analysis of 3 series].

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.

Endoscopy↗
PubMedDate not supplied

[Endoscopic treatment of ureteral lithiasis. Results of our second series of 100 cases].

The combined utilization of transurethral ureterorenoscopy (TUR) and extracorporeal shock wave lithotripsy (ESWL) have caused a revolution in the treatment of ureteral lithiasis. We present a total 113 TUR due to ureteral lithiasis performed in period of 20 months, from March 1988 to November 1989. In the last ten months of the study we used TUR an ESWL for the treatment of ureteral lithiasis. Results show success in 92.93% of the treatments; 8 cases of open surgery (7.07%), five of these were performed during the first 10 months of the study, when ESWL was not available, with only 2 serious complications (1.75%) and one death due to massive pulmonary embolism. TUR is an unsubstitutable technique for the treatment of ureteral lithiasis and when combined with ESWL obtains optimum results. It is our technique of choice in all cases non susceptible to treatment with in situ ESWL due to the impossibility of locating the lithiasis without auxiliary endourological manoeuvres.

Adult↗
PubMedDate not supplied

[So-called biliary lithiasis after vagotomy].

Reconsidering the problem of biliary lithiasis in the patient operated for gastroduodenal ulcers, and carrying out an analysis of 1 200 vagotomized patients, biliary lithiasis was noted in 11 of them. The authors make a review of the pathologic physiology of this association. The fact is stressed that biliary lithiasis following vagotomy is more likely a case of biliary lithiasis that has not been known to exist before surgery and that was not recognized during the surgical intervention. A larger statistical analysis could demonstrate that the incidence overlaps the general frequency of biliary lithiasis in a randomly investigated population.

Adolescent↗
PubMed1990

Bilateral intrahepatic lithiasis without extrahepatic bile duct stones.

Bilateral intrahepatic lithiasis is a rare condition, and for this reason a nationwide survey was conducted. Reports on 675 patients with bilateral intrahepatic lithiasis over a 10-year-period were collected. Among these, 258 patients with bilateral intrahepatic lithiasis having no extrahepatic bile duct stones were analyzed. The peak incidence was seen in the fourth to sixth decades. Males and females were equally effected. The stones removed were mainly calcium bilirubinate stones (75.6%). The main clinical symptoms were abdominal pain, fever and jaundice. Charcot's triad was seen in 29.7%, while 12.4% of the patients had no symptoms. Visualization of each segmental duct of the liver by direct cholangiography was excellent in this survey and ranged from 88 to 97.3% of the patients. The most frequent site of stones was the left hepatic duct (60.1%). The site of bile duct dilatation coincided with the location of stones. The most common sites of stenosis were the central part of the lateral segmental duct (32.5%) and the left hepatic duct (37.6%). Hepatic resection was employed in 49.2% of the patients, and drainage procedures were added in 95.6%. Follow-up studies of 236 patients treated by surgery revealed good results in 67.4%, fair in 13.6%, and poor in 7.6%. In these patients, however, endoscopic lithotomy was often employed intra- and/or post-operatively. Conducting hepatic resection, with adequate biliary drainage procedure and cholangiofiberscopic lithotomy may help to improve the therapeutic results of bilateral intrahepatic lithiasis.

Adult↗
PubMed1979

Intrahepatic lithiasis. Study of thirty-six cases and review of the literature.

In 2,700 operations for biliary tract stones, intrahepatic lithiasis (stones located proximal to the confluence of the main hepatic ducts) was discovered in 36 patients (1.3 per cent). The diagnosis of intrahepatic lithiasis was determined only via intraoperative chalangiography in thirty-two cases (88.9 er cent); in 23 per cent of our cases of intrahepatic lithiasis, jaundice was never observed. This confirms that intraoperative cholangiography should be performed routinely in every case of biliary lithiasis. The removal of stones was generally performed by an indirect approach (papillostomy and/or choledochotomy). In 16.7 per cent of our cases, a direct approach was indicated. It is extremely important, after removal of calculi, to assure ample bilioenteric flow. Our surgical approach was therefore based mostly on the caliber of the biliary tract. When the tract was dilated less that 2 cm (in 20 cases), choledochohepaticotomy with papillostomy was most often performed (12 cases, 60 per cent). When the dilatation was more that 2 cm (12 cases), Roux-en-Y hepaticojejunostomy was performed in all. There was no operative mortality, although the long-term follow-up results were poor in 9.6 per cent of the cases.

Adolescent↗
PubMedDate not supplied

[Problems in the diagnosis and treatment of intrahepatic lithiasis].

Following the study of 44 cases of intra-hepatic lithiasis the authors have reached these conclusions:--intra-hepatic lithiasis (both primary and secondary) represents 3% of the biliary lithiases;--the characteristic element of the evolution of biliary lithiasis is the so-called "ageing phenomenon" leading to the formation of multiple stones, progressively obstructing the biliary pathways and finally involving the intra-hepatic segments. These are the so-called biliary panlithiases representing 50% of the cases with intra-hepatic lithiasis in the author's statistics;--cholangiography (both intravenous and intra-canalicular) should be considered as completed only when it provides a representation of the entire biliary system;--one cannot speak at present of a "remaining" or "forgotten" hepato-choledocus stone before the exclusion of the intra-hepatic "forgotten" stone;--the significant reduction of "post-cholecystectomy disturbances" depends on the correct diagnosis and treatment of all stones, indifferent of their site of occurrence (extra- and intra-hepatic).

Ampulla of Vater↗
PubMed1992

[Description of a new disease: pancreatic lithiasis with radiolucent calculi].

118 patients presenting with pancreatic lithiasis were consecutively observed in our service. They underwent both an endoscopic pancreatography and god plain films of the abdomen. Calculi were classified in 3 groups: 1) Radiolucent calculi (17 cases, 5 females; 4 hereditary cases) are build up of amorphous residues of lithostathine S. They are not related to either alcohol, diet or tobacco. 2) Target calculi (27 cases, 4 females; 3 hereditary cases) have a radiolucent core as in 1 and a peripheral calcification. They are a late evolutionary stage of radiolucent lithiasis. The frequency of females and of hereditary cases is significantly greater in form 1 + 2 than in form 3. These two forms are a newly described disease without relationship with nutrition, alcohol or tobacco but the peripheral calcification of radiolucent calculi is favoured by alcohol and tobacco. This disease could be hereditary. 3) Calcic lithiasis (74 cases, 8 females, 2 hereditary cases) is the most frequent form of pancreatic lithiasis. Its cause is nutritional.

Alcohol Drinking↗
PubMed1992

[Percutaneous treatment of bile duct lithiasis. Personal experience in the first 150 cases].

Since 1983 we have percutaneously treated 150 cases of bile duct lithiasis in which previous endoscopic maneuvers had been incomplete or unfeasible. Complete resolution of lithiasis was obtained in 139 of 150 patients. In 6 cases only partial success was obtained but symptoms subsided. In 2 cases the treatment failed and the patients underwent surgery. Minor complications were observed in 12.6% of patients and resolved either spontaneously or by percutaneous maneuvers. Mortality rate was 2%. After a follow-up period of 6-12 months, 9 patients had a recurrence, completely resolved with further percutaneous treatment. These cases never required surgery. We obtained the best results in patients with stones residual after cholecystectomy or a iatrogenic stricture of the biliary tree. We obtained good results in massive lithiasis with combined endoscopic, surgical and radiological procedures. Morbidity and mortality rates were lower than in surgical series and similar to the endoscopic ones. The short hospitalization, the low cost and the possibility of treatment on an outpatient basis should promote the spreading of percutaneous techniques in the treatment of bile duct lithiasis.

Adolescent↗
PubMed1992

[Description of a new disease, pancreatic lithiasis with radiotransparent calculi].

118 patients presenting with pancreatic lithiasis were consecutively observed in our service. They underwent both an endoscopic pancreatography and good plain films of the abdomen. Calculi were classified in 3 groups: 1) Radiolucent calculi (17 cases, 5 females; 4 hereditary cases) are build up of amorphous residues of lithostathine S. This disease is not related to either alcohol, diet or tobacco. 2) Taget calculi (27 cases, 4 females; 3 hereditary cases) have a radiolucent core as in 1 and a peripheral calcification. They are a late evolutionary stage of radiolucent lithiasis. The frequency of females and of hereditary cases is significantly greater in form 1 + 2 than in form 3. These two forms are a newly described disease without relationship with nutrition, alcohol or tobacco but the peripheral calcification of radiolucent calculi is favoured by alcohol and tobacco. This disease could be hereditary. 3) Calcic lithiasis (74 cases, 8 females, 2 hereditary cases) is the most frequent form of pancreatic lithiasis. Its cause is nutritional.

Adult↗
PubMedDate not supplied

[New therapeutic alternative for complex renal lithiasis].

The combination of percutaneous nephrolitotomy and renal extracorporeal litothricy, is currently considered to be the best choice for the treatment of complex renal lithiasis. This procedure, however, quite frequently needs the use of adjuvant maneouvers (urethroscopy, catheterization, large number of sessions, etc.), and there is a considerable proportion of residual lithiasis. We present here our series using a new therapeutic sequence: first, we perform extracorporeal litothricy (ESWL) of calices not accessible to the nephroscope, followed by percutaneous nephrolitotomy which has revealed to be a simplification of the percutaneous surgical technique since it decreases the movements of the nephroscope and the use of ultrasounds. Calyceal lithiasis previously fragmented are then extracted through the nephrostomic channel and so no lithiatic paths are induced, the percentage of residual lithiasis being also lower.

Adult↗