The efficiency and radiation dose of a low-dose dual-energy (DE) CT protocol for the evaluation of urinary calculus disease were evaluated. A low-dose dual-source DE-CT renal calculi protocol (140 kV, 46 mAs; 80 kV, 210 mAs) was derived from the single-energy (SE) CT protocol used in our institution for the detection of renal calculi (120 kV, 75 mAs). An Alderson-Rando phantom was equipped with thermoluminescence dosimeters and examined by CT with both protocols. The effective doses were calculated. Fifty-one patients with suspected or known urinary calculus disease underwent DE-CT. DE analysis was performed if calculi were detected using a dedicated software tool. Results were compared to chemical analysis after invasive calculus extraction. An effective dose of 3.43 mSv (male) and 5.30 mSv (female) was measured in the phantom for the DE protocol (vs. 3.17/4.57 mSv for the SE protocol). Urinary calculi were found in 34 patients; in 28 patients, calculi were removed and analyzed (23 patients with calcified calculi, three with uric acid calculi, one with 2,8-dihyxdroxyadenine-calculi, one patient with a mixed struvite calculus). DE analysis was able to distinguish between calcified and non-calcified calculi in all cases. In conclusion, dual-energy urinary calculus analysis is effective also with a low-dose protocol. The protocol tested in this study reliably identified calcified urinary calculi in vivo. (orig.)

Due to the increase in the number of urinary calculi disease cases in Jordan, stone samples were collected from patients from various Jordanian hospitals (Princes Basma (PBH), King Abdullah University (KAUH), Al-Basheer (ABH) and Al-Mafraq (AMH)). This study concentrates on the effect of trace metals in patients of urinary calculi. Trace metals were detected in 110 urinary calculi samples using X-ray fluorescence (XRF) and atomic absorption spectroscopy (AAS) techniques. Of the calculi examined, 21 were pure calcium oxalate (CaOax), 29 were mixed calcium oxalate/uric acid, 23 were mixed calcium oxalate/phosphate (apatite), 25 were phosphate calculi (apatite/struvite), five were mixed calcium oxalate monohydrate/struvite, four were urate calculi (mixed ammonium acid urate/sodium acid urate)...

PURPOSE: To determine the usefulness of reversed display of soft-copy abdominal radiographs for urinary calculi detection. MATERIAL AND METHODS: Sixty radiographs with a single urinary calculus less than 5 mm in the long diameter (15 in the kidney; 15 in the proximal ureter; 15 in the mid-ureter, 15 in the distal ureter) and 15 radiographs without calculi were evaluated. Four readers blinded to the presence or absence of urinary calculi on each radiograph reviewed the radiographs in the conventional display, reversed display, and combination of conventional and reversed displays at 1-week intervals. All images were evaluated in random order and the presence or absence of urinary calculi was interpreted using the confidence score from 1 to 5. RESULTS: Multireader analysis for calculi in all locations showed a greater area under the receiver operating curve for combination of the two displays (0.764) than for the conventional display alone (0.655) (P=0.031). In the single-reader analysis for calculi in all locations, the third reader showed a greater area under the receiver operating curve for the reversed display (0.784) than for the conventional display (0.622) (P=0.027). Multireader analysis of the calculi in the kidney showed a greater area under the receiver operating curve for combination of the two displays (0.824) than for the conventional display alone (0.703) (P=0.043). CONCLUSION: The reversed display of soft-copy abdominal radiographs may be useful for urinary calculi detection.

To evaluate the diagnostic value of combined KUB and ultrasound in patients with ureteral calculi. We retrospectively reviewed the KUB and ultrasound findings in 71 cases of clinically,radiologically, and surgically confirmed ureteral calculi. We evaluated the diagnostic sensitivity of each method respectively, and then compared the sensitivity of each method with that of combined studies. The overall diagnostic sensitivities in detection of the ureteral calculi were 92.9% for KUB and 78.8% for ultrasound.The sensitivities in detection of the upper ureteral calculi were 95.1 (39 / 41) and 82.9% (34 / 41), and those in detection of the lower ureteral calculi were 90.0 (27 / 30) and 73.3% (22 / 30), respectively. On the ultrasonography, the false negative rate in detection of ureteral calculi was 21.1%. The sensitivity of ultrasound in detection of acute urinary obstruction by ureteral calculi was 87.3%. When both studies were combined, the diagnostic sensitivities were 92.9 (66 / 71), 97.5 (40 / 41) and 86.6% (26 / 30) for overall, upper and lower ureteral calculi, respectively. Combined KUB and ultrasound was a sensitive method for detection of ureteral calculi and for determination of acute urinary obstruction by reducing the number of false negative ultrasound results in patients with ureteral calculi

This book contains 10 chapters. Some of the chapter titles are: Radiologic considerations; Physiochemistry of urinary stone formations; Nutritional aspects of stone disease; Prevention of recurrent nephrolithiasis; Struvite stones; and Contemporary approaches to removal of renal and ureteral calculi.

Extracorporeal shock wave lithotripsy is the treatment of choice for the majority of upper urinary calculi in adults. Technical limitations, including patient size and concerns over post-treatment stone fragment passage, have made the application of extracorporeal shock wave lithotripsy in children less clearly defined. We report the successful application of the Dornier lithotriptor in the management of 18 children (22 kidneys) with upper urinary calculi.

Heavy metals are incorporated in human urinary calculi during a complex pathological process. The trace metals cadmium, lead, chromium, nickel and mercury are determined with regard to significance in pathogenesis and therapy. The amounts of cadmium, lead and chomium were determined as well directly in the solid sample as after chemical digestion by Zeeman-GFAAS. Both analyzing techniques show corresponding results. Nickel could be determined after chemical digestion only, while mercury was determined by a solid sampling technique. The evaluation of the results of trace metal analysis in the pilot study of 11 urinary calculi showed increased amounts of lead and cadmium compared to the results of tartar and salivary calculi. (orig.).

Background: Non-contrast thin-section helical CT has gained acceptance for the diagnosis of urinary tract calculi in adults, but experience with the technique in children is limited. Purpose: To evaluate the utility of non-contrast thin section helical CT for the diagnosis of urinary tract calculi in children. Materials and methods: Radiology databases at three pediatric institutions were searched to identify all pediatric patients evaluated by ''renal stone'' protocol CT scans (no oral or intravenous contrast, scans covering the entire urinary tract obtained in helical mode with narrow collimation (< 5 mm)). CT scans were reviewed for the primary finding of urinary tract calculi, for secondary signs of acute urinary tract obstruction and for evidence of alternative diagnoses. Medical records were reviewed to determine clinical presentation and to confirm the eventual diagnosis. Results: One hundred thirty-seven scans of 113 children (mean age: 11.2 years) were studied. Thirty-eight of 94 examinations (40%) performed on 82 children for acute pain and/or hematuria showed ureteral calculi. Alternative diagnoses were suggested by CT on 16 scans (17%). Twenty-eight scans were performed on 10 asymptomatic children with known calculus disease confirming renal stone burden on 21 scans (75%) and persistent ureteral calculi on 6 scans (21%). Upper tract calculi were demonstrated on 10 of 15 scans (67%) performed to evaluate for calculi in patients with known non-calculus genitourinary tract abnormalities. Conclusions: Non-contrast thin section helical CT is a useful method to diagnose urinary tract calculi in children. Radiation dose in this retrospective study may exceed the lowest possible radiation dose for diagnostic accuracy. Further research is needed to optimize CT imaging parameters, while maintaining diagnostic accuracy and minimizing radiation dose. (orig.)

A retrospective survey was made of 305 patients with proved urinary calculi. When those patients with a solitary stone were compared with those with multiple stones no diagnostically helpful difference was noted in the prevalence of abnormal serum or urine biochemistry, urinary infection, or anatomi...

To determine, when extracorporeal shockwave lithotripsy is contraindicated, the usefulness and safety of percutaneous management in the removal from the upper urinary tract of foreign bodies and calculi, or small remnants of these, retained after percutaneous nephrolithotomy. Between January 1996 and May 2001, We attempted to retrieve foreign bodies or calculi from the upper urinary tract of 20 patients, using various percutaneous technique. There were eleven foreign bodies, namely fragmented nephrostomy catheters (n=2), migrated ureteric stents inaccessible to retrograde ureteroscopic management (n=8), and one metallic radiopaque marker which was separated from the pusher of the internal ureteral stent. Nine urinary tract calculi were present. These ranged in radiographically measured size from 4 to 8 mm in their largest diameter, and were found in the renal pelvis or calyx (n=5) and ureter (n=4). After percutaneous nephrostomy, all procedures involved the use of a 7-F to 14-F sheath, inserted under fluoroscopic guidance. Devices used for the retrieval of these objects include a stone basket retriever, loop snare, grasping forceps, and balloon catheter. In all cases except one, it was possible to retrieve calculi or other items from the upper urinary tract. No surgical procedure was required and no significant complications were encountered in any of the cases during or after the procedures. The percutaneous technique can be useful and safe in the management of foreign bodies or calculi present in the upper urinary tract.

OBJECTIVE: To report use of transendoscopic electrohydraulic shockwave lithotripsy for fragmentation of urinary calculi in horses. STUDY DESIGN: Case series. ANIMALS: Male horses (n = 21). METHODS: Fragmentation of cystic calculi (median, 6 cm diameter; range, 4-11 cm diameter) was achieved by transurethral endoscopy in standing sedated horses using an electrohydraulic shockwave fiber introduced through the biopsy channel of an endoscope. The fiber was advanced until it contacted the calculus. Repeated activation of the fiber was used to disrupt the calculus into fragments bladder was maintained by repeated lavage with saline solution. RESULTS: Complete calculus removal was achieved in 20 horses (95%) with mean total surgical time of 168.6 minutes (range, 45-450). In the 20 horses with single calculi, 1-6 sessions were required to completely fragment the calculus. Except for 1 horse, in which perineal urethrotomy was eventually performed for complete fragment removal, fragments calculi were excreted via the urethra. Postoperative complications included hematuria because of severe mucosal erosion (n = 2), dysuria because of a trapped urethral fragment (2), small amount of urinary debris (1). One horse was euthanatized because of bladder rupture. Complete clearance of calculi and urinary debris was confirmed endoscopically 20 (3-45) days after the last session. Telephone follow-up (mean, 18.8 months; range, 7-24 months) revealed that horses had returned to previous activity levels without recurrence of clinical signs. CONCLUSIONS: Transendoscopic electrohydraulic lithotripsy appears to be an effective method for fragmentation of low-density calcium carbonate cystic calculi in male horses. PMID:22463076

Nephrogenic adenoma is a rare metaplastic benign lesion of urothelium in response to genitourinary tract procedures, chronic infection, trauma, urinary calculi and immunosuppressive therapy after renal transplantation. It has been reported to occur throughout the urinary tract especially, in the urinary bladder. We report a case of nephrogenic adenoma arising from the lower end of the right ureter with clinical and radiological features suspicious of carcinoma.

A new chemometric method, which uses artificial neural networks (ANN), is presented for determination of the composition of urinary calculi. The selected constituents were whewellite, weddellite, and uric acid from which approximately 40% of the urinary calculi obtained from Macedonia patients are composed. The results for the synthetic mixtures were better then those obtained by partial least squares (PLS) regression or by the principal component regression (PCR), because neural networks have better prediction capacity. The generalization abilities of the optimized neural networks were checked using the standard addition method on carefully selected real natural samples. PMID:11569876

Two hundred patients were evaluated to determine the sensitivity of tomography in detecting calculous disease of the upper urinary tract. In all cases, patients had routine scout radiographs of the abdomen and five precontrast tomograms of the kidneys. Of the 200 patients, 28 (14%) had renal calculi. Of these, 11 (39%) had either unsuspected or more calculi detected on tomography than seen on abdominal radiographs. Patients with symptoms suggestive of calculous disease should be evaluated with tomography in addition to plain films in order to optimize the detection and the extent of calculous disease involving the urinary tract.

Abstract Background and Purpose: CT has become a well-established modality in the evaluation of urinary calculi. The advent of multidetector CT (MDCT) scanners and submillimeter thick slice acquisitions has yielded CT images with even greater resolution. MDCT scanners allow for source data slice acquisition with submillimeter slice thickness. These source images can then be reconstructed to thicker slices for more convenient interpretation of the CT scan. Previous authors have looked at the effect of slice thickness on detection of urinary calculi. We investigated whether the thin slice source images yielded detection of additional stones and the potential significance of detecting these additional stones. Patients and Methods: Ninety-five consecutive patients who were referred to our outpatient imaging center for CT, with a clinical history placing them at risk for urinary calculi, were included in the study. Results: In 49 (52%) of the 95 patients, more calculi were visualized using the 0.625-mm thick images than with the 5-mm thick images. In 34 (69%) of these 49 patients, the additional findings were thought to be "clinically significant," while in the remaining 15 (31%) patients, the additional findings were not thought to be clinically significant. In 46 (48%) of the 95 patients, there were no additional urinary calculi identified on the 0.625-mm thick images compared with that observed on 5-mm thick images. Conclusion: The results from this study encourage reviewing the thin slice source images of MDCTs in patients at risk for urinary calculi, because important clinical decisions may hinge on the additional findings made on these images. PMID:22849789

Supervised self-organizing maps were used for classification of 160 infrared spectra of urinary calculi composed of calcium oxalates (whewellite and weddellite), pure or in binary or ternary mixtures with carbonate apatite, struvite or uric acid. The study was focused to such calculi since more than 80% of the samples analyzed contained some or all of the above-mentioned constituents. The classification was done on the basis of the infrared spectra in the 1450 450 cm-1 region. Two procedures were used in order to find the most suitable size and for optimizing the self-organizing map of which that using the genetic algorithms gave better results. Using this procedure several sets of solutions with zero misclassifications were obtained. Thus, the self-organizing maps may be considered as a promising tool for qualitative analysis of urinary calculi.

Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E.

Urinary tract calculi presenting during pregnancy are rare, with less than 0.1% of pregnancies being associated with stones, the vast majority being asymptomatic and a chance finding. We outline six cases treated over an 8-year period. They presented with combinations of pain, sepsis and obstruction...

Proton induced X-ray analysis (PIXE) and scanning electron microscopy together with X-ray microanalysis have been used to examine biliary and urinary calculi. Particular attention has been given to the centre or nuclear region of the stones and several interesting and unexpected trace elements have been found in these regions. Detailed analyses have indicated distinct mechanisms of formation and growth.

We report the case of a 30-year-old man who presented with obstructive renal failure and urosepsis due to bladder outlet–obstructing bladder calculi that formed around 3 copper wires that were self-inserted into his urinary bladder 15 years previously. We present the evaluation, imaging and manageme...

Abstract in english Objective: To evaluate the prevalence of metabolic disorders in patients with staghorn calculi treated at the Regional Center of Lithiasis Metabolic Studies in central region of São Paulo State, Brazil. Materials and methods: Between February 2000 and February 2008, 630 patients with urinary calculi were evaluated in the lithiasis outpatient clinic. Thirty-seven of them had staghorn calculi (35 women and 2 men). The inclusion criteria for the metabolic investigation incl (more) uded the absence of urological manipulation 30 days before the examination, negative urine culture and creatinine clearance > 60 mL/min. The protocol for metabolic investigation consisted of qualitative search for cystinuria. Two non-consecutive 24-hour urine samples collected to measure calcium, phosphorus, uric acid, sodium, potassium, magnesium, oxalate and citrate, and serum calcium levels , phosphorus, uric acid, sodium, potassium, magnesium, chloride, parathormone and urine pH. Results: Among patients with lithiasis, 5.9% (37/ 630) had staghorn calculus and in 48.6% (18/37) were diagnosed with urinary infection. The females were predominant for 94.5% of cases. The calculi were unilateral in 31 of cases and bilateral in six. Metabolic abnormalities were found in 68.2% of patients with hypercalciuria (64.2%) and hypocitraturia (53.3%) being the most common disorders. Conclusions: The presence of metabolic disorders in nearly 70% of patients with staghorn calculus reinforces the necessity for evaluation of these patients. The diagnosis and treatment of identified metabolic abnormalities can contribute to the prevention of recurrent staghorn calculi.

The review is dedicated to ultrasonography of the upper urinary tract in patients with nephrolithiasis. Ultrasonographic semiotics of urolithiasis, the ability of unlrasonography to detect nephrolithiasis, and methods of the optimization of these diagnostic techniques in patients with upper urinary tract calculi are covered. The author discusses difficulties that may be faced while differentiating between nephrolithiasis and such conditions as spongious kidney, nephrocalcinosis, calcification of renal papillae, cysts, tumors, and vascular walls, as well as other kinds of renal calcification, associated with ultrasonographic acoustic path phenomenon. The advantages and disadvantages of ultrasonography in cases of X-ray urolithiasis are evaluated in the paper. The article describes hardships in ultrasound visualization of ureteral calculi causing acute upper urinary tract obstruction, and the ways of getting over them. PMID:16758927

Abstract in english OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals) or sham operation (15 animals) and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sa (more) crifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p

FT-Raman spectroscopy is the most useful tool for the purpose of bio-medical diagnostics. In the present study, FT-Raman spectral method is used to investigate the chemical composition of urinary calculi. Urinary calculi multi-components such as calcium oxalate, hydroxyl apatite, struvite and uric acid are studied. FT-Raman spectrum has been recorded in the range of 3500-400cm(-1). Chemical compounds are identified by Raman spectroscopic technique. The quantitative estimations of calcium oxalate monohydrate (COM) 1463cm(-1), calcium oxalate dehydrate (COD) 1478cm(-1), hydroxyl apatite 959cm(-1), struvite 575cm(-1), uric acid 1283cm(-1) and oxammite (ammonium oxalate monohydrate) 2129cm(-1) are calculated using particular peaks of FT-Raman spectrum. The quantitative estimation of human urinary stones suitable for the single calibration curve was performed. PMID:23069621

Abstract Background and Purpose: The development of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract. We compared the use of semirigid and flexible ureteroscopy for the management of shockwave lithotripsy-refractory, isolated renal pelvic calculi by evaluating stone-free rates, operating room times, and associated complications. Patients and Methods: Ureteroscopic stone treatment was attempted in 47 patients with isolated renal pelvic stones between November 2008 and December 2010. The procedures were performed under general anesthesia. Semirigid ureteroscopy was routinely performed in all patients. If the stones were accessible in the renal pelvis with the semirigid ureteroscope (S-URS), they were then treated with the holmium:yttriu...

We analyzed 48 renal calculi by X-ray powder diffraction and electron microprobe techniques. In 35 of these, the presence of a minor constituent, not detected by X-ray diffraction, was revealed--hydroxyapatite was found in 24 stones, struvite in 6, and calcium oxalate in 5. The results of this study, as well as others, show that incomplete assignment of the crystalline constituents of urinary calculi is an inherent risk of the X-ray method and that conclusions concerning total chemical composition should be based on X-ray diffraction analyses coupled with data obtained from other analytical procedures.

Imaging of renal calculi is important for patients who suffered a urinary calculus prior to treatment. The available imaging techniques include plain x-ray, ultrasound scan, intravenous urogram, computed tomography, etc. However, the visualization of a uric acid calculus (radiolucent calculi) is difficult and often impossible by the above imaging methods. In this paper, a new detection method based on microwave-induced thermoacoustic tomography was developed to detect the renal calculi. Thermoacoustic images of calcium oxalate and uric acid calculus were compared with their x-ray images. The microwave absorption differences among the calcium oxalate calculus, uric acid calculus and normal kidney tissue could be evaluated by the amplitude of the thermoacoustic signals. The calculi hidden in the swine kidney were clearly imaged with excellent contrast and resolution in the three orthogonal thermoacoustic images. The results indicate that thermoacoustic imaging may be developed as a complementary method for detecting renal calculi, and its low cost and effective feature shows high potential for clinical applications.

A number of investigators have reported about heavy metal contents in food, blood, urine, and animal tissues, including bone, hair, feather, and tooth. However, few data concerning calculi are reported as yet. Heavy metal contents in the calculi might reflect the level of metals absorbed from respiratory tract, skin and intestine. When absorbed metals from respiration are distributed in blood, a part of cadmium is accumulated in liver and kidney, and of lead is in bone, annular vessel and kidney. The remainder is excreted in the urine through the urinary tracts. From intestine, they are distributed by the blood to the liver, and excreted in the urine in the same manner of respiration. It is well known that renal calculi are produced in the urinary tract. The present study is focused on the contents of cadmium, copper, zinc and lead in human renal calculi, samples collected from Hokuriku which is one of the most cadmium polluted areas and from Chugoku which is recognized as a non-polluted one in Japan.

Chemical analysis of various biological matrices is routinely used for assessment of human exposure to various toxic metals. In this work, 489 samples of urinary calculi originating from almost the whole of The Czech Republic, were collected and subjected to mineralogical and elemental analysis. This study was aimed at mercury, the content of which was determined using thermo-oxidation â?? cold vapor â?? atomic absorption spectrometry. The effects of mineralogical composition, sex, age and region were recorded in order to verify the applicability of urinary calculi for biomonitoring. Relationships with other minor and trace elements were also investigated. Association of mercury with whewellite mineral was observed as well as a remarkable relationship with selenium, confirming the role of ...

Chemical analysis of various biological matrices is routinely used for assessment of human exposure to various toxic metals. In this work, 489 samples of urinary calculi originating from almost the whole of The Czech Republic, were collected and subjected to mineralogical and elemental analysis. This study was aimed at mercury, the content of which was determined using thermo-oxidation ??? cold vapor ??? atomic absorption spectrometry. The effects of mineralogical composition, sex, age and region were recorded in order to verify the applicability of urinary calculi for biomonitoring. Relationships with other minor and trace elements were also investigated. Association of mercury with whewellite mineral was observed as well as a remarkable relationship with selenium, confirming the role of ...

Clinical use of extracorporeal shockwave lithotripsy (ESWL) in the noninvasive management of urinary calculi is highly effective and practical. But its results vary in relation to several factors including localization, size and the chemical composition of the stones. Moreover, the anatomy of the kidneys treated is another contributing factor to the success rate of ESWL in upper urinary tract stones. Currently, except cystine and struvite stones, the efficiency of ESWL has been proved and has become the most outstanding therapy for calculi in a great number of stone centers. In this study, the efficiency of ESWL treatment in respect to the concentrations of 4 different trace elements (Cu, Fe, Mg and Zn) in the chemical composition of Ca-oxalate monohydrate stones have been evaluated in 20 patients. PMID:8508898

Emphysematous pyelonephritis (EPN) is a rapidly progressive and life-threatening infection that is seen most commonly in persons with diabetes. The infecting organisms usually consist of mixed flora, including Escherichia coli (68%), Klebsiella pneumoniae (9%) and Proteus mirabilis. Females are affected twice as often as men, and mortality rates can be as high as 80%. Obstructive uropathy, urinary calculi, calyceal stenosis and neoplasms are significant predis-posing factors. We report a case of EPN in a patient with the human immunodeficiency virus infection, without diabetes mellitus or urinary tract obstruction, which responded remarkably to conservative management with antibiotics alone. PMID:22982922

To analyze ultrasonographic (US) findings of xanthogranulomatous pyelonephritis (XGP). Thirty-five cases of pathologically proven XGP in 32 patients (bilateral in three patients) were analyzed for preoperative US findings. Compared with findings of computed tomography (CT) and pathology, US findings were retrospectively analyzed for the appearance and size of the kidney, extent and pattern of the disease, and presence and characteristics of calculi, by three radiologists who made a consensus. Of 32 patients, 30 (94%) except two children were older than 27 years, and 25 (78%) were female. The mean age of the patients was 46 (range 3 to 62 years). Of 35 cases in 32 patients, US appearance of the kidney was reniform in all cases, with nephromegaly in 26 (74%) and hydronephrosis 27 (77%). XGP was diffuse in 28 (80%) and focal in 7 (20%). Hypoechoic or anechoic inflammatory lesions of XGP were found on US in 28 cases, but the lesions were not detected on US due to the echo pattern similar to the normal renal parenchyma in two cases and due to marked acoustic shadowing of staghorn calculi in five cases. Acoustic shadowing of renal calculi was minimal due to the dense peripelvic fibrosis in two cases. Of 21 cases with the extrarenal extension of XGP, the extrarenal extension was not definitely detected in five cases (24%) on US. Urinary calculi were detected in 20 (71%) of 28 cases on US. All of the 12 staghorn calculi were detected in US. XGP had variable US findings in addition to the classic ones. Absence of calculi, nephromegaly or diffusibility may be found on US of XGP. In spite of advantages of US, US also had some limitations in the evaluation of renal function, extrarenal extension, and renal parenchyma with large staghorn stone. CT and excretory urography may compensate for these US limitations.

The possible effects of Zn and Cu in oxalocalcic urolithiasis were investigated. The formation of calcium oxalate crystals in the presence of Zn and Cu demonstrated that their morphology is clearly affected by these ions. Thus, when such ions were present in a number of higher concentrations, a notable increase in the primary aggregation was clearly detected. On the other hand, Zn and Cu urinary levels were determined in groups of stone-formers and healthy people. Zinc urinary concentration was significantly lower for lithiasic than for healthy people and the copper urinary concentration was lower for lithiasic than healthy males, but both female groups had a similar copper urinary concentration. The mentioned differences disappeared when serum levels were considered. These obtained results have been comparatively evaluated with those obtained by other authors. When considering all the commented aspects, it is concluded that no important direct action of zinc and copper on oxalocalcic calculi genesis takes place. PMID:8506591

OBJECTIVE: To determine the effect of preoperative ureteral stenting on success rates of ureteroscopy (URS) for nephroureterolithiasis. MATERIALS AND METHODS: We retrospectively evaluated patients who underwent URS for nephroureterolithiasis without preoperative indwelling ureteral stents. These patients were matched according to age, sex, body mass index, and stone side, size, site, and number of stones per patient, with patients who had been prestented before URS. Patient data, stone-free rates (SFRs), and complications were compared. RESULTS: The study included 286 patients (143 stented vs 143 nonstented). The mean stone size was 5.69 ± 3 mm. The mean number of stones per patient was 1.35 ± 0.7. The overall SFR after 1 URS procedure was 90.9% and higher in prestented than in nonstented patients (95.1% vs 86.7%, P ? .013). For ureteral stones, the SFR was 99% in prestented and 90% in nonstented patients (P ? .0048). The SFR did not differ between the groups for ureteral stones calculi ?5 mm (98.2% vs 83.3%, P ? .0105). For urinary calculi ?5 mm, the overall SFR was higher in prestented than in nonstented patients (93.3 vs 78.3%, P ? .0054). Perioperative complications occurred in 27 patients (9.4%; Clavien I, 6.6%; Clavien IIIb, 2.8%) without differences between the groups. CONCLUSION: URS is a safe and efficacious procedure for the treatment of nephroureterolithiasis. Preoperative ureteral stent placement is associated with higher SFRs compared with nonstented patients for urinary calculi ?5 mm. Nonstented patients with urinary calculi ?5 mm should be informed about the risk for a second-look URS procedure. PMID:23084830

Abstract in portuguese OBJETIVO. Atualizar aspectos do diagnóstico e do tratamento da litíase urinária. MÉTODOS. Uma revisão dos principais artigos publicados sobre o tema em revistas indexadas no "Medline" entre 1979 e 2009. RESULTADOS. A ocorrência de cálculos é maior em pacientes com IMC > 30. A TC sem contraste promove o diagnóstico correto em até 98% dos casos. O uso de bloqueadores alfa-adrenérgicos aumenta a eliminação de cálculos ureterais menores que 8 mm em 29%. O índic (more) e de pacientes livres de cálculo após LEOC varia entre 35% e 91%, conforme seu tamanho e localização. Cálculos renais maiores que 2 cm são eliminados pela NLPC entre 60% e 100% dos casos. Cálculos de ureter distal são tratados com sucesso em até 94% dos casos pela ureteroscopia semirrígida contra 74% da LEOC. Já para cálculos de ureter superior as taxas de sucesso situam-se entre 77% e 91% para ureteroscopia e 41% e 82% para a LEOC. CONCLUSÃO. A associação da calculose urinária com obesidade e Diabetes mellitus está bem estabelecida. A TC sem contraste é atualmente o padrão-ouro no diagnóstico da litíase urinária. A LEOC é o método de eleição em nosso meio para tratamento de cálculos renais menores que 2 cm e com densidade tomográfica Abstract in english OBJECTIVE. To review developments in the diagnosis and treatment of urinary lithiasis. METHODS. A review of the most important articles on the subject published in Medline indexed periodicals between 1979 and 2009.RESULTS. Stones occur with greater frequency among people with BMI > 30. Computerized tomography without contrast provides the correct diagnosis in up to 98% of cases. Alpha-adrenergic blockers increase elimination of ureteral calculi smaller than 8 mm by 29%. T (more) he proportion of patients free from calculi after ESWL varies from 35% to 91%, depending on size and location. In between 60% and 100% of cases, renal calculi larger than 2 cm are eliminated with PCNL. Calculi of the distal ureter are successfully treated in up to 94% of cases using semi-rigid ureteroscopy, compared to 74% using ESWL. For calculi of the upper ureter success rates are around 77% and 91% for ureteroscopy and 41% and 82% for ESWL. CONCLUSION. The association between urinary lithiasis and Diabetes mellitus, is well-established. Computerized tomography without contrast is currently the gold standard for diagnosis of urinary lithiasis. In Brazil, ESWL is the method of choice for treating renal calculi smaller than 2 cm and with tomographic density

Infrared (IR) spectroscopy is used to analyze urinary calculus (renal stone) constituents. However, interpretation of IR spectra for quantifying urinary calculus constituents in mixtures is difficult, requiring expert knowledge by trained technicians. In our laboratory IR spectra of unknown calculi are compared with references spectra in a computerized library search of 235 reference spectra from various mixtures of constituents in different proportions, followed by visual interpretation of band intensities for more precise semiquantitative determination of the composition. To minimize the need for this last step, we tested artificial neural network models for detecting the most frequently occurring compositions of urinary calculi. Using constrained mixture designs, we prepared various samples containing ammonium hydrogen urate, brushite, carbonate apatite, cystine, struvite, uric acid, weddellite, and whewellite for use as a training set. We assayed known artificial mixtures as well as selected patients' samples from which the semiquantitative compositions were determined by computerized library search followed by visual interpretation. Neural network analysis was more accurate than the library search and required less expert knowledge because careful visual inspection of the band intensities could be omitted. We conclude that neural networks are promising tools for routine quantification of urinary calculus compositions and for other related types of analyses in the clinical laboratory. PMID:8070077

A case of massive irreducible procidentia with a hard palpable mass in the anterior vaginal wall mimicking an impacted faecal mass in a 57-year-old multiparous, post-menopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine CT of the abdomen and pelvis excluded intestinal pathology, but failed to reveal multiple vesical calculi as the procidentia was lying outside the imaging zone of the pelvic CT. However, targeted plain X-ray and ultrasound of the prolapsed mass disclosed the existence of multiple vesical calculi. The patient was managed with single-stage laparotomy and vaginal hysterectomy. Hysterectomy permitted the reduction of the prolapse and facilitated extraperitoneal vesicolithotomy. Laparotomy excluded bowel pathology. No reconstructive surgical steps for repair and reconstruction were combined. Currently, the patient is relieved of all symptoms and her asymptomatic stage II vault prolapse is managed conservatively. PMID:22531951

Purpose Residual fragments following ureteroscopy for calculi may contribute to stone growth, symptoms or additional interventions. We reviewed our experience with ureteroscopy for calculus disease to define the incidence and establish factors predictive of residual fragments. Materials and Methods Records associated with 667 consecutive ureteroscopic lithotripsy procedures for upper urinary calculi were reviewed. In 265 procedures (40%) computerized tomography was done between 30 and 90 days postoperatively. They comprised the study group. Residual fragments were defined as any residual ipsilateral stone greater than 2 mm. Results Included in the study were 121 men and 127 women with a mean age of 47 years. Mean target stone diameter was 7.6 mm. The stone location was the kidney in 30% of...

Abstract Background and Purpose: The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi. Patients and Methods: We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F "all-seeing needle" with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200??m holmium:yttrium-aluminum-garnet laser fiber. Results: A total of 21 patients (mean age 37.3±20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6±6.0?kg/m(2), and the mean stone size was 17.8±5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8±25.2 minutes and 150.5±92.8 seconds, respectively. The patients were discharged after a mean 37.5±14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8±0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe. Conclusion: Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi. PMID:22873714

Abstract in portuguese Objetivo: cálculos urinários atingem de 5 a 10% da população em alguma fase da vida. Destes casos, somente 2 a 3% são crianças. O tratamento da litíase urinária na faixa pediátrica, com o uso de métodos minimamente invasivos, representa uma alternativa cada vez mais atraente. O presente trabalho objetiva apresentar resultados de litotripsia extracorpórea como tratamento minimamente invasivo de litíase urinária na infância. Métodos: no período de setembro d (more) e 1991 a setembro de 2000, foram tratadas e acompanhadas 87 crianças, sendo que seis delas tinham dois cálculos; portanto foram tratados 93 cálculos urinários. Foi utilizado o equipamento de litotripsia extracorpórea por ondas de choque, da Dornier-Philips. Resultados: os cálculos piélicos, caliciais superiores e médios foram fragmentados e eliminados na porcentagem de 87,7% e 77,8%, respectivamente. Os cálculos localizados no cálice inferior foram eliminados em 64,7%. Dos três casos de cálculo coraliforme, somente um ficou livre do cálculo (33,3%). Os dez pacientes com cálculo ureteral ficaram livres de litíase (100%). Os cálculos vesicais foram tratados e eliminados em 60% dos casos. Conclusão: a litotripsia extracorpórea demonstrou ser uma forma eficiente de tratamento de cálculos piélicos, caliciais, ureterais e vesicais em crianças. Cálculos coraliformes não tiveram bons resultados quando tratados por meio de litotripsia extracorpórea. Os resultados deste método foram influenciados pela localização e tamanho dos cálculos. Abstract in english Objective: urolithiasis affects between five and 10% of the human population during their lifetime, only 2-3% of whom are children. Therapy of urolithiasis in the pediatric age group with minimally invasive methodology represents an attractive alternative. This study presents results of extracorporeal shockwave lithotripsy, a minimally invasive methodology, for the treatment of urolithiasis in children. Methods: in the period between September 1991 and September 2000, 87 (more) children were submitted to extracorporeal shockwave lithotripsy; as six of them presented with two calculi 93 urinary calculi were treated over that period. The Dornier-Philips lithotriptor was used in the procedures. Results: pelvic, superior and medium caliceal calculi were fragmented and eliminated in 87.7% and 77.8% of cases, respectively. Inferior caliceal stones were eliminated in 64.7% of cases. Only one of the three patients with staghorn calculi became stone-free after therapy (33.3%). All patients with ureteral calculi were stone-free after therapy. Bladder stones were fragmented and eliminated in 60% of cases. Conclusions: extracorporeal shockwave lithotripsy is a safe and effective treatment for pelvic, caliceal, ureteral and bladder urolithiasis in children. Staghorn calculi have not shown satisfactory results when treated by this method. Extracorporeal shockwave lithotripsy results were influenced in our experience by the position and size of the treated calculi.

Abstract in english INTRODUCTION: Due to the evolution of extracorporeal lithotripsy equipment (ESWL) and presently, the fact that most part of the equipment does not present ultrasound to localize urinary calculi, a system that allows adapting ultrasound equipment to ESWL equipment was developed, disposing only of fluoroscopy. Thus, this equipment was developed and was tested in urinary stones in canine models, to check its precision in relation to fluoroscopy. METHOD: Seven male dogs were (more) utilized with the introduction, in the bladder through the ureteral route, of chalkstones, with initial localization by fluoroscopy, with a further ultrasound coincidence check localization of the vesical stones, being submitted to ESWL with a 3-hour, 21 days and 60 days follow-up after the procedure. RESULTS: Success of localization in all animals was verified presenting elimination of stones in the first micturitions, after ESWL. No complications were verified in those animals for 60 days. CONCLUSION: We verified that this equipment can lead to an update of the equipment that use only fluoroscopy, increasing in this way, their technical capacity in the treatment of urinary calculi, mainly in cases of non-radiopaque stones.

Of 42 maned wolves in zoos or live-trapped in Brazil, 34 had excessive cystine in their urine. Renal clearance studies of five of the affected wolves revealed a variable defect for the reabsorption of cystine and dibasic amino acids. The renal tubular handling of other solutes including glucose, phosphate, sodium, potassium, and uric acid was considered normal. Urinary calculi composed of cystine were found in four wolves and proved fatal in three of them. With the exception of the high incidence in this species, this hereditary disease resembles the disorder described in dogs and humans. PMID:7233184

This guide provides information for 4-H Club members who have decided on a club goat project. Topics include general information in the following areas: show rules; facilities and equipment (barns/sheds, fences, feeders, water containers, and equipment); selection (structural correctness, muscle, volume and capacity, style and balance, and growth potential); nutrition (water, protein, carbohydrates and fats, minerals, and vitamins); health (enterotoxemia, internal parasites, urinary calculi, coccidiosis, soremouth, ringworm, pinkeye, illegal drugs, hoof trimming, and dehorning or tipping); management and feeding; and fitting (washing and shearing). (YLB)

Objective Bacterial imprints are always observed on highly carbonated apatite kidney stones but not struvite kidney stones. Struvite and carbonated apatite stones with a high CO32–/PO43– rate are believed to develop from infections, but their structural differences at the mesoscopic scale lack explanation. Methods We investigated 17 urinary calculi composed mainly of struvite or carbonated apatite by Fourier transform infrared, scanning electron microscopy, and powder neutron diffraction techniques. Results Carbonated apatite but not struvite stones showed bacterial imprints. If the same stone contained both carbonated apatite and struvite components, bacterial imprints were observed on the carbonated apatite but not the struvite part. Moreover, neutron powder diffraction exp...

The potential risk of recurrence and degradation of renal function justifies the etiological investigation of all lithiasis-associated pathologies. Therefore calculus analysis of the crystalline phases and morphological characteristics is an important factor in the etiological diagnosis of the disease. Microscopic examination and infrared spectroscopy of calculi from 727 children showed that calcium oxalate was the main component in 36.7% of cases, followed by calcium phosphate (31%), struvite (9.9%) and purine groups (7.7%). The most frequently observed crystalline from was carbapatite (26%), then whewellite (21%) and weddellite (15.7%). As regards the etiopathogenic aspect in adults, the relations between hypercalciuria and weddellite, and between hyperoxaluria and whewellite are also found in the child: in subjects with hypercalciuria, 82% of the calculi contained over 20% weddellite; and in subjects with hyperoxaluria, whewellite was the major constituent in 79% of cases (or 95% in the absence of associated hypercalciuria). In 27 calculi mainly composed of whewellite, the morphological analysis indicated primary hyperoxaluria; this diagnosis was confirmed in 25 cases by specific biological investigation. Urinary tract infection is frequently associated with lithiasis, but its lithogenic role cannot be confirmed without calculus analysis. Several criteria can be used as markers to determine the lithogenic etiology of the infection, i.e., the presence of struvite, the carbonate rate of carbapatite, and the whitlockite and/or protein content of the calculus. PMID:10985188

The causes of urolithiasis include such influences as diet, metabolic disorders, and genetic factors which have been documented as sources that aggravate urinary calculi depositions and aggregations, and, implicitly, as causes of urolithiasis. This study endeavors to detail the scientific mechanisms involved in calcium oxalate calculi formation, and, more importantly, their inhibition under growth conditions imposed by the traditional medicinal approach using the herbal extract, Larrea tridentata. The calculi were synthesized without and with Larrea tridentata infusion by employing the single diffusion gel technique. A visible decrease in calcium oxalate crystal growth with increasing amounts of Larrea tridentata herbal infusion was observed in photomicrographs, as well as a color change from white-transparent for pure crystals to light orange-brown for crystals with inhibitor. Analysis of the samples, which includes Raman, infrared absorption, scanning electron microscopy (SEM), and X-ray powder diffraction (XRD) techniques, demonstrate an overall transition in morphology of the crystals from monohydrate without herbal extract to dihydrate with inhibitor. Furthermore, the resulting data from Raman and infrared absorption support the possibilities of the influences, in this complex process, of NDGA and its derivative compounds from Larrea tridentata, and of the bonding of the magnesium of the inhibitor with the oxalate ion on the surface of the calculi crystals. This assumption corroborates well with the micrographs obtained under higher magnification, which show that the separated small crystallites consist of darker brownish cores, which we attribute to the dominance of growth inhibition by NDGA, surrounded by light transparent thin shells, which possibly correspond to passivation of the crystals by magnesium oxalate. The SEM results reveal the transformation from the dominant monoclinic structure of the calcium oxalate crystals grown alone to the tetragonal dipyramidal crystal structure of the calcium oxalate crystals grown with Larrea tridentata. Comparison between XRD experimental and simulated data, besides corroborating with our previous results, show that each sample is a combination of different structures.

A 7-month-old, 4.3-kg, spayed female bichon frise was referred for evaluation of chronic urinary incontinence. Abdominal radiographs revealed calculi within the right kidney and ureter. An ultrasound revealed a small right kidney. An abdominal computed tomography scan with contrast revealed that the left ureter was extramurally ectopic, inserting into the proximal urethra. A right intramural ectopic ureter was identified during cystotomy. Ureteronephrectomy was performed on the right, and ureteroneocystostomy was performed on the left. A telephone conversation with the owner 4 months after surgery revealed that the dog exhibited no evidence of urine dribbling, and urinary continence was maintained well on phenyl-propanolamine (1.75 mg/kg orally q 12 hours). This is the first report of successful surgical management of bilateral ureteral ectopia with concurrent, unilateral, renal dysplasia and urolithiasis. PMID:20439946

Extracorporeal shockwave lithotripsy (SWL) has remained the preferred method of treatment of urinary stones since its introduction in 1980. Although SWL is classified as a potential first-line treatment for renal stones smaller than 2?cm and its overall success rate is higher than 85% for stone clearance, not all renal calculi are successfully fragmented after SWL. Among the urinary stones, calcium oxalate monohydrate (COM) stone is one of the hardest stones to fragment. Several factors interfering with stone fragility are known to exist. In addition to technical properties for SWL to increase the quality and rate of stone disintegration, the composition of stones such as trace element levels may also interfere with the efficacy of SWL. Therefore, in the present study, we aimed to elucidat...

AbstractAims This ICI-RS report aims to analyze morphological or functional complications of the lower or upper urinary tract in elderly men, clarify the association between complications and benign prostatic obstruction (BPO) and define men who will develop these complications. Research proposals to further enlighten these associations were to be defined. Methods A think-tank discussion was held on the annual ICI-RS meeting in 2011. The published literature between 1966 and 2011 was reviewed and research proposals were defined with all congress participants. Results Post-void residual, bladder diverticula or calculi, vesico-ureteral reflux, hydronephrosis, renal insufficiency, and urinary retention appear with greater prevalence in patients with symptoms or signs of benign prostatic hyper...

Objective. Using two large-scale nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without urinary calculi. Design. Cross-sectional study. Setting. Taiwan. Patients. This study included 3694 women who had live singleton births and received a diagnosis of urinary calculi (UC) in the year prior to their delivery, as well as 18 470 matched women without UC used as a comparison group. Methods. Conditional logistic regression analyses were performed. Main outcome measures. Low birthweight, preterm birth, small-for-gestational-age, cesarean section, lower Apgar score and preeclampsia/eclampsia. Results. Women with UC had a higher prevalence of low birthweight neonates (7.4% vs. 6.0%, p= 0.003), preterm births (9.5% vs. 7.3%, p < 0.001), and cesarean sections (43.1% vs. 35.4%, p < 0.001) than women without UC. After adjusting for potential confounding factors, women with UC were more likely than women without UC to have low birthweight (OR = 1.21, 95%CI 1.05-1.39), preterm birth (OR 1.28, 95%CI 1.13-1.43), and cesarean sections (OR 1.37, 95%CI 1.28-1.48). Conclusions. There were increased risks for having low birthweight, preterm infants, and for experiencing cesarean section among women with UC in comparison to women without this. PMID:23017095

Study Type - Therapy (case series) Level of Evidence?4 What's known on the subject? and What does the study add? Large upper tract urinary calculi, greater than 2?cm, have historically been treated with percutaneous nephrostolithotomy. In general, there has been a growing interest in employing retrograde, flexible ureteroscopy and laser lithotripsy in select patients who are either poor medical candidates for percutaneous lithotripsy or who may prefer a less invasive intervention. Properly selecting patients for this approach, designing specific treatments based on complex stone presentation and offering general information with regard to long-term outcomes and surgical risks have historically been based on results from small, multicentre series lacking uniformity of technique and long-term outcomes. Our initial multicentre experience employing ureteroscopic techniques to treat large upper urinary tract calculi was presented in 1998. This current work represented the largest single-centre experience, accrued prospectively over 10 years, where there was uniformity of technique and treatment algorithms. This study frames an argument for retrograde ureteroscopic lithotripsy not only in those who are at high risk for percutaneous nephrostolithotomy but in all who present with large, non-infected stone burdens. OBJECTIVE: •? To define the safety and efficacy of retrograde ureteroscopic lithotripsy in treating large, non-infectious intrarenal and proximal ureteral stone burdens. PATIENTS AND METHODS: •? Between 2000 and 2011, 145 patients with 164 large (2?cm or greater in diameter on standard imaging) non-infectious upper intrarenal and proximal ureteral calculi were chosen for retrograde ureteroscopic lithotripsy. •? Patients were treated with small diameter flexible fibre-optic ureteroscopes and holmium laser lithotripsy by a single surgeon. •? Second-look ureteroscopy was performed in patients with the largest calculi in whom there was a high index of suspicion of significant residual fragments. •? Stone clearance was defined as no fragments or a single fragment less than or equal to 4?mm in diameter on standard radiograph and sonography at 3-month follow-up. RESULTS: •? Our study included 103 male patients and 42 female patients with an average age of 55 years (range 16-86 years) and a mean stone diameter of 29?mm (range 20-70?mm) including 36 partial staghorn stone burdens (mean diameter 37?mm). Overall, 266 ureteroscopies were performed on 164 stone burdens (1.6 procedures per stone burden), clearing 143 stone burdens (87%). •? The highest clearance rates were observed for proximal ureteral (97%) and renal pelvic (94%) stones, while the lowest clearance rates were observed for lower pole (83%) and staghorn calculi (81%). •? Three patients required subsequent percutaneous therapy due to infectious material encountered at the time of ureteroscopy or inaccessible stone burdens secondary to infundibular stenosis. •? There were five minor postoperative complications, including four fevers and one patient with gross haematuria and clot retention, with no major intraoperative complications. CONCLUSIONS: •? In select patients, large, complex, metabolic upper urinary tract calculi can be treated safely and efficiently with retrograde ureteroscopic techniques. •? Staged, retrograde, flexible ureteroscopy is an alternative to percutaneous therapy with acceptable efficacy and low morbidity. PMID:22757752

Urinary stone incidence and composition have changed markedly over the past half-century in industrialized countries, in parallel with profound changes in living standards and dietary habits, with a dramatic increase in the incidence of calcium oxalate stones. However, studies evaluating the influence of age and gender on the distribution of the various types of urinary calculi are scarce. We report the results of a study based on 27,980 calculi (from 19,442 males and 8,538 females) analyzed by infrared spectroscopy between 1976 and 2001. The relationships between age and sex and stone composition were investigated using a multivariate approach, based on correspondence factor analysis (CFA). We found a male predominance for calcium oxalate and uric acid, a female preponderance for calcium phosphate and struvite stones, and an increasing prevalence of uric acid stones with age in both genders. CFA was able to reconstruct in blind the age curve from stone composition. The first two axes of the multidimensional classification, which correspond to age, included 86.9% of the total variance, indicating that age was the main factor involved in stone type. Superimposition of age classes and stone components showed a strong relationship between age and whewellite, weddellite, brushite, carbapatite, octacalcium phosphate and uric acid, while other substances (whitlockite, amorphous carbonated calcium phosphate, struvite, proteins, mucopolysaccharides, triglycerides or ammonium urate) appeared weakly related to age. In addition, CFA suggests the role of common lithogenic factors between weddellite, carbapatite and brushite, which clustered in the same area, whereas the various crystalline forms of phosphate stones segregated into two different clusters, suggesting distinct pathogenic factors. In conclusion, this study provides a picture of the present epidemiology of urinary stones in France. CFA helped to confirm: (1) an etiopathogenic distinction between weddellite and whewellite, (2) etiopathogenic associations between chemical compounds, which were only suspected on a clinical basis, and (3) suggested yet unrecognized associations, especially with respect to the heterogeneous group of phosphate stones. PMID:15127165

Abstract in english OBJECTIVE: To assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. MATERIALS AND METHODS: Between February 2004 and September 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. Renal stones were associated with collecting system obstruction in 15 (34%) patients, failed extracorporeal shock-wave lithotripsy (SWL) occurred in 14 (3 (more) 2%) patients, unilateral multiple stones in 18 (41%) patients, and multiple bilateral stones in 3 (7%). In 29 (66%) patients, the stone was located in the inferior calyx. Perioperative and financial outcomes were also evaluated. RESULTS: 50 procedures were performed in 44 patients. The mean stone burden on preoperative CT scan was 11.5 ± 5.8 mm. The mean operative time was 61.3 ± 29.4 min. The stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. Therapeutic success occurred in 92% and 93% of patients with lower pole stones and SWL failure, respectively. Treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007), but not associated with inferior calyx location (p = 0.09). Surgical disposables were responsible for 78% of overall costs. CONCLUSION: Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure.

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20-39), and the mean gestation duration was 24 weeks (15-34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients. PMID:22215294

We evaluated the value of combining noncontrast helical computerized tomography (NCHCT) and color Doppler ultrasound in the assessment of the composition of urinary stones. In vitro, we studied 120 stones of known composition, that separate into the five main types: 18 calcium oxalate monohydrate (COM) stones, 41 calcium oxalate dihydrate (COD) stones, 24 uric acid stones, 25 calcium phosphate stones and 12 cystine calculi. Stones were characterized in terms of their Hounsfield density (HU) in NCHCT and the presence of a twinkling artifact (TA) in color Doppler ultrasound. There were statistically significant HU differences between calcium and non-calcium stones (p calcium oxalate stones and calcium phosphate stones (p calcium oxalate class (p > 0.05). We found that the TA does not enable differentiation between calcium and non-calcium stones (p > 0.999), calcium oxalate stones and calcium phosphate stones (p = 0.15), or uric acid stones and cystine calculi (p = 0.079). However, it did reveal a significant difference between COM and COD stones (p = 0.002). The absence of a TA is a predictive factor for the presence of COM stones (p = 0.008). Hence, the association of NCHCT and Doppler enables the accurate classification of the five types of stones in vitro. PMID:22402019

Purpose The true prevalence of urolithiasis in asymptomatic adults is unknown. Unenhanced computerized tomography represents the gold standard for detection. We evaluated the prevalence and symptomatic incidence of urolithiasis in a large cohort of asymptomatic adults using noncontrast computerized tomography. Materials and Methods Low dose noncontrast computerized tomography was performed in 5,047 consecutive asymptomatic adults (mean age 56.9 years, 2,747 women and 2,300 men) between 2004 and 2008. Presence, size and location of urinary calculi were recorded. Screening prevalence as well as the incidence of symptomatic stone disease during a 10-year interval (1997 to 2007) was compared against previously established clinical risk factors. Results The screening prevalence of asymptomatic ...

More than 500 uroliths from dogs, cats, minks, rabbits and 9 further animal species originating from various regions of former East Germany were analysed. The observations were made between 1980 and 1989 using X-ray diffraction and infrared spectroscopy. The urinary stones consisted of struvite, whewellite, weddellite, cystine, ammonium urate, brushite, whitlockite, hydroxyapatite or carbonate-apatite, calcium carbonate, silicon dioxide and organic matrix stones. In dogs, the most frequent types were struvite and apatite concrements, followed by calcium oxalate and cystine uroliths. Among the diseased animals poodles, dachshunds and terriers ranked first. In the analysed material from cats apatite and struvite predominated. With few exceptions, minks formed struvite uroliths only. The analysed calculi from rabbits consisted principally of calcium phosphate or calcium carbonate concrements. The present analysis has been compared with results of former studies, differences are discussed. PMID:9646551

This text for urologists and radiologists describes and illustrates endourologic techniques, uses, and sources of equipment. Brief case reports are also included. Selected Contents: Radiation and Radiation Protection in Endourology/Applied Anatomy of the Kidney/Urinary Obstruction: Pathophsiology and Evaluation/Percutaneous Nephrostomy as an Emergency Bedside Procedure/Percutaneous Nephrostomy in the Renal Transplant Recipient/Percutaneous Nephrostomy in Children: Diagnostic and Therapeutic Applications/Retrograde Percutaneous Nephrostomy/Dilatation of the Nephrostomy Tract/Nephrostomy Tubes: Insertion and Replacement/Re-establishment of the Nephrostomy Tract/Percutaneous Nephroscopes/Nursing Aspects of Percutaneous Stone Extraction/Lithotripsy/Perioperative Management of the Patient with Urolithiasis/Selection of the Nephrostomoy Site for Stone Extraction/Renal Vascular Complications of Nephrostolithotomy/Chemolysis of Calculi: Systemic and Local Approaches

Few data are available on the prevalence and the risk factors for the presence of kidney stones and hyperuricemia in patients with thalassemia intermedia. We retrospectively reviewed the charts and radiological studies of 89 patients with thalassemia intermedia followed at our clinic with routine biochemical examination and radiological imaging of the urinary tract. Renal calculi were identified in 11 patients (12%) and 22 patients (25%) were under uricosuric treatment for hyperucemia. The prevalence of nephrolithiasis increased with age but not in a statistically significant manner. Major risk factors for renal stone formation were splenectomy (in 91% of the cases) and higher number of erythroblasts. Patients with renal stones had higher mean creatinine level and lower GFR value with respect to those observed in patients not affected. Our data suggest that splenectomy, by further increasing erythrocyte turnover and number, may be directly involved in the pathogenesis of hyperuricemia and nephrolithiasis observed in thalassemia intermedia patients. PMID:22705193

Abstract Background and Purpose: The minimally invasive nature and effectiveness of shockwave lithotripsy (SWL) has made it one of the primary treatment modalities for urinary tract calculi. Several factors determining the success of SWL treatment have been studied, including stone factors (ie, location, size, and composition) and patient factors (ie, patient habitus and skin-to-stone distance). Our objective was to determine if either the assisting radiologic technologist or the amount of fluoroscopy time used has an impact on SWL success. Patients and Methods: We compared the outcome of 536 SWL treatments across three radiologic technologists. We also evaluated the average amount of fluoroscopy time used in treatment success vs failures in this same cohort. The outcomes measured were sto...

Introduction: Cystine stones represent 1% of urinary calculi in adults and 10% in children and are especially recurrent and resistant to ESWL. Medical therapy is often efficient but often poorly tolerated. In Morocco, various plants, Herniaria hirsuta, Opuntia ficus-indica, Zea mays and Ammi visnaga are proposed against nephrolithiasis. We assessed the effect of plant extracts on the disolution of cystine stones in vitro. Material and method: An extract of each plant was prepared by infusion of two grams of powdered plants during 30minutes in100ml of a boiled NaCl 9g/L aqueous solution. Each extract was then filtered and thereafter set in a flask containing a cystine stone. The medium was maintained under stirring during 8 weeks. NaCl 9g/L solution and sodium citrate 3mmol/L solution were ...

Ortho-phenylphenol (OPP) and sodium ortho-phenylphenate (NaOPP) are pesticides used commercially in the food industry that have been shown to be carcinogenic to rat urothelium. Dietary administration of 1.25% OPP or 2.0% NaOPP caused increased incidences of urothelial hyperplasia and eventually caused tumors in male F344 rats, with NaOPP apparently having a more potent effect. In other studies, various sodium salts such as saccharin and ascorbate enhanced bladder carcinogenesis, although the acid forms of these salts did not. In studies with high dietary doses of these sodium salts, an amorphous precipitate was produced in the urine; precipitate formation was pH dependent. In previous experiments in which high doses of OPP were fed for up to 17 weeks, severe hyperplasia of the urothelium was produced, but without the formation of an urinary amorphous precipitate, calculi, or abnormal microcrystalluria. In addition, we found no evidence of OPP-DNA adduct formation in the urothelium. The present study was conducted to determine if feeding NaOPP * 4 H(2)0 to male F344 rats as 2.0% of the diet resulted in the formation of an amorphous precipitate in the urine, and if NaOPP caused an increased mineral concentration in the urine and/or kidneys. NaOPP administration produced a higher urinary pH than did OPP fed as 1.25% of the diet. Neither amorphous precipitate nor other solids were observed in the urine of the OPP or NaOPP-treated rats, and urinary calcium concentrations in the treated groups were similar to control. OPP and NaOPP had similar proliferative effects on rat urothelium after 10 weeks of treatment by light microscopy, scanning electron microscopy (SEM), and bromodeoxyuridine (BrdU) labeling indices. The results of this study indicate that formation of abnormal urinary solids is not part of the mechanism by which OPP or NaOPP exert their effects on the rat bladder epithelium. PMID:11158728

Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented.

Abstract in spanish Se presenta un caso de litiasis de infección, conocida con el nombre de cálculos de estruvita y asociado a una enfermedad metabólica subyacente y diabetes mellitus tipo 2 de reciente debut, el cual se manifestó con oliguria e infección, como resultado de una obstrucción urinaria bilateral parcial. El paciente de 48 años de edad, con antecedentes de cardiopatía isquémica, hipertensión arterial y de expulsar cálculos de riñón, consultó su caso el 21 de enero d (more) e 2009. Manejaba cifras de creatinina, glicemia y acido úrico normales anterior al ingreso y estas tuvieron un comportamiento ascendente durante la obstrucción, excepto el ácido úrico. En el diagnóstico aportaron datos de interés la ecografía renal y de próstata, la Uro-TAC y gammagrafía renal con MAG-3. El diagnóstico diferencial incluyó toda causa extrínseca e intrínseca, esta última relacionada con cálculos, coágulos o papila renal necrosada, que provocaran alteración al libre flujo urinario. Se estableció como patrones de buena evolución, la recuperación del volumen urinario, la normalización de la glucemia y creatinina, así como la permanencia del urocultivo negativo. El manejo terapéutico motivó a la utilización de la nefrolitotomía percútanea como una de las opciones que ofrecen los procederes endorulógicos, además del control de las enfermedades de base, lo que resultó una favorable evolución del caso. Abstract in english A clinical case of lithiasis of infection is presented, known as calculi of struvite associated to an underlying metabolic disease and diabetes mellitus type-2 of recent onset, with oliguria and infection as a result of a partial bilateral urinary infection. A 48 years-old patient having medical records of ischemic heart disease, hypertension and expulsion of kidney stones attended to the office in January 21, 2009 presenting normal values of creatinine, glycemia and uric (more) acid before the admission; these values increased during the obstruction, except the uric acid. Renal and prostate imaging, the Uro-Computerized axial tomography and renal scintigraphy with MAG-3 showed data of interest. Differential diagnosis included extrinsic and intrinsic causes, the last one related to calculi, clots or renal necrotic papilla causing disorder of the free urinary flow. Patterns of good progress were established: recovery of the urinary volume, normal levels of glycemia and creatinine and a permanent negative uroculture. Therapeutic management motivated the use of percutaneous nephrolithotomy as one of the choices for endourologic procedures, as well as the control of the underlying diseases, being favorable for a good progress of the case.

We present two embeddings of infinite-valued Lukasiewicz logic L into Meyer and Slaney's abelian logic A, the logic of lattice-ordered abelian groups. We give new analytic proof systems for A and use the embeddings to derive corresponding systems for L. These include: hypersequent calculi for A and L and terminating versions of these calculi; labelled single sequent calculi for A and L of complexity co-NP; unlabelled single sequent calculi for A and L.

This thesis presents an automated tool for manipulation and analysis of mobile concurrent systems described in the Psi-calculi framework. Psi-calculi is a family of process calculi, parameterised on data, conditions and a logic. We provide a general framework for implementing instantiations of these...

Nephrolithiasis is a common disorder and a significant problem because of incidence, recurrence and severe consequences. Stone disease is a surgical as well as a medical problem. Major progress has been made recently in understanding the pathophysiological disturbances responsible for stone formation as well as in the techniques of stone removal. The introduction of extracorporeal shock wave lithotripsy has considerably reduced the need for surgery. Improvements in methods of kidney stone removal have not diminished the need for the application of an effective prophylactic program. The internist should take a complete history of stone events (number, composition, location and outcome of stone event), family history of stones, dietary habits (focusing on the consumption of animal protein, salt and dairy products), medications and physical examination. Radiopaque stones should be documented by plane X-ray films. Ultrasonography should be used to image calculi that are nonopaque, and to easily distinguish them from masses such as tumour or blood clot. Computed tomography is also an excellent method for imaging nonopaque renal calculi but higher cost and radiation exposure are disadvantages [2]. Crystallographic analysis is the essential diagnostic procedure. If available, previous stones should also be examined. "In stone disease, everything is measurement. What the laboratory cannot tell you, you will not know; what it tells you in error, you will not correct by using your instincts, your medical experience, or your art [3]". Reliable diagnostic protocols are available for the identification of different causes of stones. The complexity of protocols depend on the severity of nephrolithiasis. Patients with a single stone episode undergo simple protocol, and extensive detailed protocol is used for patients with recurrent stone disease, or patients at increased risk. Simple protocol, besides the already mentioned history of stone events, radiographic investigation and crystallographic analysis, includes serum urea, creatinine, uric acid, sodium, calcium, phosphorus and protein levels, urinary pH and volume, urine samples for culture and urinary calcium, uric acid, oxalate and citrate. Extensive metabolic evaluation includes simple protocol, determination of serum levels of alkaline phosphatase, parathyroid hormone, thyroxin, magnesium. A 24-h collection of urine specimen is analysed for urea, creatinine, uric acid, calcium, phosphate, sodium, magnesium, oxalate and citrate. Extensive protocol includes specialized evaluation tests [5]. Urinary acidification test is important for detecting distal renal tubular acidosis. Two 24-h urine specimens are collected while the patient is on the regular diet. The patient is then placed on a restricted diet (400 mg of calcium and 100 mEq of sodium) for a week, and another 24-h urine sample is collected. After that fasting and calcium load tests are performed (Sheme 1). Fasting urinary calcium is used to detect renal calcium leak, and calciuric response to oral calcium load provides an indirect measure of intestinal calcium absorption. Diagnostic criteria for major forms of stone disease [8] are presented in Table 1. There are some still unsolved questions: does time after passage of stones or urological intervention influence the frequency of urine abnormalities that can be detected; are there differences in 24-h urine composition between weekdays and weekends: what is the prevalence of the most important urinary risk factors of recurrent idiopathic calcium nephrolithiasis: do male patients differ from females with respect to urinary risk factors or recurrent idiopathic calcium nephrolithiasis? [7]. PMID:9863414

To determine the diagnostic value of ultrasound in patient with clinically suspected ureteral calculi, a prospective study was performed on 58 patients. Of these, 42 patients had 44 ureteral calculi and 16 patients had no calculi. The sonographic of a distal shadowign highly echogenic reflector along the ureter, with or without dilatation of the proximal ureter. Ultrasound correctly diagnosed 42 stones among 44 calculi and there was one false positive examination. The overall diagnostic accuracy was 95% Ultrasonography appears to be a very useful adjunct for the diagnosis of ureteral calculi when excretory urography is equivocal or contraindicated. Also ultrasonography was valuable in monitoring passage of radiolucent ureteral stones

Purpose: To evaluate the performance of computed tomographic (CT) examinations at 80 and 100 kV with tube current-time products of 75-150 mA and the effect of adaptive statistical iterative reconstruction (ASIR) on CT image quality in patients with urinary stone disease. Materials and Methods: In this HIPAA-compliant institutional review board-approved study, verbal consent for prospective low-dose CT and waivers of consent for retrospective review of CT scans were obtained. Between November 2010 and April 2011, 25 patients (15 men, 10 women; mean age, 35 years) with urolithiasis underwent 64-section multidetector CT with 75-150 mA and noise index of 30. Modified protocol was based on body weight (200 lb [90 kg], 100 kV). Images of 5-mm section thickness were reconstructed with filtered back projection (FBP) and 60% and 80% ASIR techniques, with 3-mm coronal and sagittal reformations. Two readers independently reviewed FBP and ASIR data sets for image quality (scale, 1-5), noise (scale , 1-3), and calculi (number, size, location). Confidence levels for urolithiaisis and alternate diagnoses were rated (scale, 1-3). In 13 patients, FBP CT images acquired with the reference standard departmental protocol were available for comparison. Radiation dose was compared between imaging series. Statistical analysis was performed with Wilcoxon signed rank and paired t tests. Results: Modified-protocol FBP images showed low image quality (score, 2.5), with improvement on modified-protocol ASIR images (score, 3.4) (P = .03). All 33 stones (mean diameter, 6.1 mm; range, 2-28 mm) at modified-protocol CT were diagnosed by both readers. In 20 of 25 patients (80%), ASIR images were rated adequate for rendering other diagnoses in the abdomen (score, 2.0), as opposed to FBP images (score, 1.3). Mean radiation dose for modified-protocol CT was 1.8 mGy (1.3 mGy for patients 200 lb) in comparison with 9.9 mGy for reference-protocol CT (P = .001). Conclusion: Image quality improvements with ASIR at reduced radiation dose of 1.8 mGy enabled effective evaluation of urinary calculi without substantially affecting diagnostic confidence. © RSNA, 2012. PMID:22891359

40 cases of intrahepatic calculi were studied by both sonography and cholangiography in Seoul National University Hospital over a period of two years. The patients, whose ages ranged from 21 to 65 years, consisted of 14 men and 26 women. Sonograms of intrahepatic calculi were classified into the following three types; type I (shadow echo within dilated bile duct), type II(shadow echo with proximal ductal dilatation), type III(hepatic shadow echo without ductal dilatation). 7 cases were classified as type I, 11 cases type II and 23 cases type III;Location of intrahepatic calculi was in the right lobe(13 cases), left(12 cases)and both lobes(15cases). There was no correlation between the location and sonographic type of intrahepatic stones. The following sonographic and cholangiographic parameters were analysed; (1)margin and intemal echogenecity of shadow echo in sonogram; (2)number, size of the calculi and impaction, aggregation of the calculi within the bile duct in cholangiogram. In sonogram, typel calculi showed relatively smooth margin and homogeneous internal ceho in contrast to type II and III with irregular margin and heterogeneous echo in majority. In cholangiogram, type I calculi showed small size less than 10mm and did not show aggregation or impaction into the bile duct. Type II calculi showed large size bigger than 10mm and tendency to impaction. Tyep III calculi revealed tendency of aggregation and impaction of calculi into the bile duct

Objectives Randall initially described calcified subepithelial papillary plaques, which he hypothesized as nidi for urinary calculi. The discovery of calcifying nanoparticles (CNP), also referred to as nanobacteria, in calcified soft tissues has raised another hypothesis about their possible involvement in urinary stone formation. This research is the first attempt to investigate the potential association of these two hypotheses. Methods We collected renal papilla and blood samples from 17 human patients who had undergone laparoscopic nephrectomy. Immunohistochemical staining (IHS) was applied using monoclonal antibody (mAb) against CNP. Homogenized papillary tissues and serum samples were cultured for CNP. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were performed on papillary samples. Serum samples were tested for CNP antigen and antibody with enzyme-linked immunosorbent assay (ELISA). Results Randall’s plaques (RP) were visible on gross inspection in 11 out of 17 samples. IHS was positive for CNP antigen in 8 of the visually positive samples, but in only 1 of the remaining samples. SEM revealed spherical apatite-formations in 14 samples confirmed by EDS analysis. In cultures, all serum samples and 13 tissue homogenates grew CNP. In ELISA, 14 samples were positive for CNP-antigen and 11 samples were positive for CNP-antibody. Conclusion There was evidence of a link between detection of CNP and presence of RP. Although causality was not demonstrated, these results suggest that further studies with negative control samples should be made to explore the etiology of RP formation, thus leading to a better understanding of the pathogenesis of stone formation.

PURPOSE: Common methods of commercial urolithiasis analysis such as light microscopy and Fourier Transform Infrared Spectroscopy provide limited or no information about the molecular composition of stones, which is vital when studying early stone pathogenesis. Our objective was to utilize synchrotron radiation based micro-focused X-ray fluorescence, X-ray absorption, and X-ray diffraction advanced imaging techniques to identify and map the elemental composition, including trace elements, of urinary calculi on a micrometer (0.0001 cm) scale. MATERIALS AND METHODS: Human stone samples were obtained during serial percutaneous nephrolithotomy and ureteroscopy procedures. A portion of each sample was sent for commercial stone analysis and a portion was retained for synchrotron radiation based advanced imaging analysis. RESULTS: Synchrotron radiation based methods of stone analysis correctly identify stone composition and give additional molecular detail about elemental components and spatial distribution in uroliths with resolution on the order of a few micrometers. CONCLUSIONS: Knowledge of all elements present in lithogenesis at this detail allows for better understanding of early stone formation events, which may provide additional insight to prevent and treat stone formation. PMID:23021997

Abstract in spanish Objetivo: Identificar factores predictivos de éxito después de una sesión única de litotricia extracorpórea por ondas de choque (LEOC) a las tres semanas de seguimiento. Material y métodos: Se revisaron los registros clínicos de 116 pacientes con cálculos urinarios únicos sometidos a LEOC entre octubre 2007 y agosto 2009. Las tomografías axiales computarizadas preoperatorias de todos los pacientes fueron revisadas por dos radiólogos en desconocimiento del desen (more) lace clínico. El éxito fue definido como la desaparición completa del cálculo o la persistencia de fragmentos Abstract in english Introduction: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. Material and methods: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clin (more) ical outcome. Success was defined as complete clearance or the persistence of fragments

Objectives: To report and discuss the role of the treatment of ipsilateral renal and upper middle ureteral stones in patients by combing retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy. Patients and Methods: Eleven patients associated with ipsilateral renal and upper middle ureteral stones underwent combing retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy after failure of shockwave or ureteroscopy lithotripsy. Their data were analyzed retrospectively including stone burden, perioperative complications and outcomes. Results: All the patients underwent retroperitoneal laparoscopic ureterolithotomy and tubeless mini-percutaneous nephrolithotomy successfully. Surgical time ranged from 80 to 160 min with a mean of 118 min. The mean hospital stay was 4 days (3-7 days). The mean length of retroperitoneal urinary drainage was 3 days (2-6 days). There were minor complications in 3 (27.2%) patients. The stone-free rate was 82% (9 patients). Two patients had a residual calyceal fragment that was treated with shockwave lithotripsy. All of them were followed up for 3-24 months. Renal function was improved in different degree. Conclusion: In carefully selected patients, combining retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy can treat ipsilateral renal and upper middle ureteral calculi by a single procedure with advantages of high stone-free rate, safety, reliability, rapid recovery and less complications. PMID:23108074

Abstract in english PURPOSE: To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. MATERIALS AND METHODS: A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were presc (more) ribed diclofenac injection (75 mg) intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. RESULTS: The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively). Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p

Abstract in spanish Objetivo: Presentar un caso de adenocarcinoma túbulovelloso de la pelvis renal. Método/Resultados: Paciente de 81 años de edad, se presenta en el servicio de urgencias con un cuadro infeccioso grave, en la TAC presencia de cálculo coraliforme de la pelvis renal con signos sugestivos de pionefrosis. Se procede a la nefrectomía revelando en el estudio histológico adenocarcinoma túbulovelloso de la pelvis renal. Conclusiones: El adenocarcinoma de la pelvis renal es un (more) a neoplasia infrecuente. Se relaciona con infecciones crónicas, inflamación y con la presencia de cálculos coraliformes de la pelvis renal. La opción terapeútica más adecuada es la nefrectomía. El adenocarcinoma túbulovelloso de la pelvis renal tiene un pronóstico sombrío. Abstract in english Objetive: To present a case of tubulovillous renal pelvis adenocarcinoma. Methods/Results: An 81 year-old patient presented at Emergency Departament with sepsis. CT scan showed a staghorn calculus with signs suggestive of pyonefrosis. A nephrectomy was performed and pathological exam revealed tubulovillous renal pelvis adenocarcinoma. Conclusions: Renal pelvis adenocarcinoma is a rare disease. It is usually accompanied by chronic urinary infections, an inflammatory state and staghorn calculi. The best therapeutic option is nephrectomy and the prognosis is poor.

Abstract in english Objective: To assess the evidence-based literature supporting the use of traditional Chinese medicine Kampo herbal and Acupuncture in stone disease management. Materials and Methods: Four of the most commonly used herbal components of Kampo medicine in the treatment of stone disease are described according to their in vitro and in vivo effects. We also reviewed the role of Acupuncture in urologic clinical setting as well as its proposed mechanisms of action and results. M (more) edline database was assessed using isolated and conjugated key words (Chinese Medicine, Kampo, Chinese Herbal, Calculi, Stone Disease, Kidney, Acupuncture, Herbal Medicine). Articles were reviewed and summarized. Results: Herbal medicine has been proven to be free from side-effects and therefore suitable for long term use therapy. Its antilithic beneficial effects include increased urinary volume, increased magnesium excretion (Takusya), inhibitory activity on calcium oxalate aggregation (Takusya, Wulingsan and Desmodyum styracyfolium), inhibition of calcium oxalate nucleation and hydroxyapatite internalization (Wulingsan). In contrast, acupuncture, has shown to be effective as a pre-treatment anxiolytic and analgesic during colic pain and extracorporeal shock wave lithotripsy treatment, reducing the need for complementary sedative drugs. Conclusion: Chinese traditional medicine is promising as regards its role in stone prevention. An effort must be made in order to standardize study protocols to better assess acupuncture results since each procedure differs in regards to selected acupoints, electrostimulation technique and adjunct anesthetics. Similarly, standardization of Kampo formulations and acceptable clinical endpoints (imaging vs. symptomatic events) is needed.

An in vitro study sought to determine the feasibility of using computed tomography (CT) to analyze the chemical composition of renal calculi and thus aid in selecting the best treatment method. Sixty-three coded calculi were scanned in a water bath. Region-of-interest measurements provided the mean, standard deviation, and minimum and maximum pixel values for each stone. These parameters were correlated with aspects of the stones' chemical composition. A multivariate analysis showed that the mean and standard deviation of the stones' pixel values were the best CT parameters for differentiating types of renal calculi. By using computerized mapping techniques, uric acid calculi could be perfectly differentiated from struvite and calcium oxalate calculi. The latter two types also were differentiable, but to a lesser extent. CT has a potential role as an adjunct to clinical and laboratory methods for determining the chemical composition of renal calculi in an effort to select optimal treatment.

We study N^2-1 dimensional left-covariant differential calculi on the quantum group SL_q(N) for which the generators of the quantum Lie algebras annihilate the quantum trace. In this way we obtain one distinguished calculus on SL_q(2) (which corresponds to Woronowicz' 3D-calculus on SU_q(2)) and two distinguished calculi on SL_q(3) such that the higher order calculi give the ordinary differential calculus on SL(2) and SL(3), respectively, in the limit q\\rightarrow 1. Two new differential calculi on SL_q(3) are introduced and developed in detail.

The optical absorption coefficients for biliary calculi are important in understanding the mechanism of laser-induced stone fragmentation. However, the heterogeneous composition of calculi and difficulties in producing optically thin samples prevent conventional spectrophotometric measurement techniques from being used. To overcome these limitations, we used a pulsed photothermal radiometry system to measure the optical absorption coefficients and thermal diffusivities of various biliary calculi. In the wavelength range examined (350-1060 nm), there was strong optical absorption which was greater for pigment stones than for cholesterol stones. The data support the theory that the initiation of the plasma accompanying laser fragmentation of calculi is a thermal process.

Abstract in spanish Introducción: La litiasis en la infancia es una patología en ascenso. En nuestro medio hoy en día se caracteriza por ser de oxalato cálcico y ureteral. Así se ha convertido en un problema muy similar al de la edad adulta, por lo tanto de está haciendo un esfuerzo para aplicar la experiencia y eficacia existente en ese grupo en la edad pediátrica. La litotricia extracorpórea por ondas de choque es ya la primera opción terapéutica y el abordaje endourológico debe (more) convertirse en un procedimiento habitual. Exponemos nuestra técnica y experiencia. Material y métodos: Estudio retrospectivo y descriptivo de los niños diagnosticados de litiasis en el tracto urinario superior, tratados mediante endourología en nuestro centro, desde enero de 1992 hasta enero del 2005. De su historial clínico hemos recogido las siguientes variables: 1º Variables preoperatorias: Edad, sexo, manifestación clínica predominante al diagnóstico, tamaño de la litiasis en milímetros (mm) y localización de la misma en el tracto urinario (dividimos éste en 1.) renal, 2.) tercio ureteral proximal, 3.) tercio ureteral medio y 4.) tercio ureteral distal). 2º Variables operatorias: Tipo de intervención endourológica practicada, consideramos la vía de acceso: anterógrada o nefrolitotomía percutánea (NLP) y retrógrada o ureterorrenoscopia (URSC) y si se requirió o no la reconversión a cirugía a cielo abierto. 3º Variables postoperatorias: tiempo de evolución, presencia de complicaciones precoces o tardías y el estado del paciente en la última revisión en consulta, donde valoramos: situación clínica y la ECO. Resultados: En este periodo hemos realizado 7 procedimientos endourológicos en 6 pacientes, 4 niños y 2 niñas. La mediana de edad es de 4 años con un rango de 2,5-13 años. La manifestación clínica más frecuente fue el dolor lumboabdominal (4/7). La hematuria macroscópica y una infección del tracto urinario fueron las otras formas de presentación. El tamaño de los cálculos oscilaba entre 4 y 7 mm, con la excepción de un cálculo coraliforme. La localización de la litiasis en la vía urinaria fue: ureteral distal 5 casos, ureteral proximal 1 caso y coraliforme el último. Los procedimientos que hemos realizado son: una NLP para el tratamiento del cálculo coraliforme y 6 URSC. Con el acceso percutáneo se consiguió la extracción de toda la masa litiásica. En 3 de las 6 URSC se consiguió la extracción de la litiasis completa y no se necesitó de ningún tratamiento adicional. Esto representa una tasa de éxito con ambas técnicas del 57% (5/7). En los 3 procedimientos restantes tuvimos que reconvertir a cirugía a cielo abierto para la extracción de la litiasis. Con un tiempo de seguimiento que varía de 1 a 13 años todos los niños están asintomáticos, la ECO dentro de la normalidad y con buena función renal. No han presentado complicaciones ni a corto ni a largo plazo. Conclusiones: Las técnicas endourológicas son factibles en la edad pediátrica. El desarrollo de material endourológico y la experiencia del cirujano son las claves para su desarrollo. Abstract in english Introduction: Urolithiasis in the pediatric age is a growing problem. In the developed world they are of calcium oxalate and in the upper urinary tract. It is very similar to the presentation of lithiasis in adults, so we have to make an effort to apply the experience in this age to the children. The shock wave lithotripsy is admitted as the first treatment for this pathology in the pediatric population already. The endourological approach must be use as a common approach (more) in this group. We present our technique and experience. Material and methods: A retrospective, descriptive study of the children diagnosed of lithiasis in the upper urinary tract that were treated by an endourological technique in our centre between January 1992 and January 2005. We gathered data on: 1.) Preoperative: age, sex, clinical manifestations, size (mm) and position of the lithiasis (we divided the upper urinary tract in: renal, proximal third, medial third and distal third) 2.) Operative variable: endourological technique: percutaneus neprolithotomy or ureteroscopy. Reconversion to open surgery. 3.) Postoperative variables: time since surgery, complications and the current state of the patient (ultrasonography and renal function). Results: Seven children, 4 boys and 2 girls with an age range of 2,5 to 14 years, underwent operation using an endourological technique. Lumboabdominal pain was the main clinical manifestation (4/7). The lithiasis size was 4-7mm, with the exception of a staghorn calculis. The calculis were: 5 ureteral proximal, 1 ureteral distal and one in the kidney (staghound stone). We performed one percutaneus neprolithotomy for the staghorn calculi. We removed completly the stone and had no complications. The 6 other procedures were ureteroscopies. In 3 of them we removed the calculi (4/7 success rate of 57%). The rest procedures we needed to transform in open surgery. With a following time of 1-13 years all of them are asymptomatic, and with ultrasonography and renal function in the normal limits. We did see no complications. Conclusion: The endourological treatment for urolithiasis in pediatric patients is possible but must be individualized in each case. With the development of new endourological material and more surgical experience this technique will be to the reach of the most of the urologists.

Abstract in portuguese Diversos fatores podem contribuir para a formação de cálculos urinários, dentre estes, o desequilíbrio nutricional e a dureza da água consumida pelos ruminantes. O objetivo deste estudo foi identificar as características de propriedades que predispõem à urolitíase, através da avaliação da água, da dieta e determinações séricas e urinárias de cálcio, fósforo, magnésio, cloretos, sódio, potássio, cálculo da excreção fracionada (EF) dos eletrólitos (more) , e da creatinina, proteína total, albumina e globulinas séricas. Foram colhidas amostras de sangue e urina de bovinos, Guzerá, criados semi intensivamente, distribuídos por dois grupos. O primeiro denominado grupo urolitíase (Gu), composto de animais com histórico, sinais clínicos e confirmação ultrassonográfica que apresentavam urolitíase; o segundo: grupo controle (Gc), sem histórico, nem sintomas da doença. Os bovinos do grupo urolitíase consumiam água com dureza total na concentração de 166,0mg CaCO3/L. A dieta dos animais do Gu apresentava maior concentração de fósforo e relação Ca:P inadequada. Os teores de fósforo sérico e urinário dos animais do Gu foram maiores do que os do Gc, assim como a concentração sérica de magnésio (p Abstract in english Many factors can contribute to the formation of urinary calculi, amongst these, the nutritional imbalances and the hardness of the water consumed by ruminants. The objective of this study was to identify the characteristics of properties which predispose to urolithiasis, through the evaluation in rural properties of the water, diet, and serum and urinary determinations of calcium, phosphorus, magnesium, chlorides, sodium, potassium, calculation of the fractional electroly (more) te excretion (FE), and creatinine, total protein serum levels, albumin and globulins. Samples of blood and urine of bovines, Guzerá, reared semi intensively, distributed for two groups, the first one, called urolithiasis group (Gu), composed by animals with history, clinical signals and ultrasonography confirmation of urolithiasis; the second one: controlled group (Gc), without history, nor signs of the illness. The bovines of the urolithiasis group consumed water with total hardness in the concentration of 166.0mg CaCO3/L. The diet of the animals of the Gu presented greater phosphorus concentration and inadequate Ca:P relation. The levels of serum and urinary phosphorus of the animals of the Gu were higher of the Gc, as well as the serum magnesium concentration (p

There is a correspondence between classical logic and programming language calculi with first-class continuations. With the addition of control delimiters, the continuations become composable and the calculi become more expressive. We present a fine-grained analysis of control delimiters and formali...

Analytic proof calculi are introduced for box and diamond fragments of basic modal fuzzy logics that combine the Kripke semantics of modal logic K with the many-valued semantics of Godel logic. The calculi are used to establish completeness and complexity results for these fragments.

Under the assumptions that q is not a root of unity and that the differentials du{sup i}{sub j} of the matrix entries span the left module of first order forms, we classify bicovariant differential calculi on quantum groups A{sub n-1}, B{sub n}, C{sub n} and D{sub n}. We prove that apart one dimensional differential calculi and from finitely many values of q, there are precisely 2n such calculi on the quantum group A{sub n-1} = SL{sub q}(n) for n {>=} 3. All these calculi have the dimension n{sup 2}. For the quantum groups B{sub n}, C{sub n} and D{sub n} we show that except for finitely many q there exist precisely two N{sup 2}-dimensional bicovariant calculi for N {>=} 3, where N = 2n + 1 for B{sub n} and N = 2n for C{sub n}, D{sub n}. The structure of these calculi is explicitly described and the corresponding ad-invariant right ideals of ker {epsilon} are determined. In the limit q {yields} 1 two of the 2n calculi for A{sub n-1} and one of the two calculi for B{sub n}, C{sub n} and D{sub n} contain the ordinary classical differential calculus on the corresponding Lie group as a quotient. (orig.)

In this paper we define internal cut-free sequent calculi for any n-valued Lukasiewicz logic Ln. These calculi are based on a representation of formulas of Ln, by n - 1 many {0, 1}-valued formulas of Ln. They enjoy the usual properties of sequent systems like symmetry, subformula property and invert...

This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), a...

A class of differential calculi is explored which is determined by a set of automorphisms of the underlying associative algebra. Several examples are presented. In particular, differential calculi on the quantum plane, the h-deformed plane and the quantum group GL{sub p,q}(2) are recovered in this way. Geometric structures such as metrics and compatible linear connections are introduced.

We improve the precision of a previous Control Flow Analysis for Brane Calculi, by adding information on the context and introducing causality information on the membranes. This allows us to prove some biological properties on the behaviour of systems specified in Brane Calculi.

We present tableau calculi for some logics of nonmonotonic reasoning, as defined by Kraus, Lehmann and Magidor. We give a tableau proof procedure for all KLM logics, namely preferential, loop-cumulative, cumulative and rational logics. Our calculi are obtained by introducing suitable modalities to interpret conditional assertions. We provide a decision procedure for the logics considered, and we study their complexity.

A class of differential calculi is explored which is determined by a set of automorphisms of the underlying associative algebra. Several examples are presented. In particular, differential calculi on the quantum plane, the $h$-deformed plane and the quantum group GLpq(2) are recovered in this way. Geometric structures like metrics and compatible linear connections are introduced.

The book gives an overview of the state of the art in formal methods of program design. The book treats both logic in programming and formal calculi in the discrete design of programs and systems, including foundations of logic, equational logic, modal logics, support systems for logical reasoning, and design calculi for programs and program specifications.

A new notion of an optimum first order calculi was introduced in [Borowiec, Kharchenko and Oziewicz, 1993]. A module of vector fields for a free differential is defined. Some examples of optimum algebras for homogeneous bimodule commutations are presented. Classification theorem for homogeneous calculi with commutative optimum algebras in two variables is proved.

A new notion of an optimal algebra for a first order coordinate differential was introduced in \\cite{BKO}. Some relevant examples are indicated. Quadratic identities in the optimal algebras and calculi on quadratic algebras are studied. Canonical construction of a quantum de Rham complex for the coordinate differential is proposed. The relations between calculi and various generalizations of the Yang--Baxter equation are established.

We investigate covariant first order differential calculi on the quantum complex projective spaces CP_q^{N-1} which are quantum homogeneous spaces for the quantum group SU_q(N). Hereby, one more well-studied example of covariant first order differential calculus on a quantum homogeneous space is given. Since the complex projective spaces are subalgebras of the quantum spheres S_q^{2N-1} introduced by Vaksman and Soibelman, we get also an example of the relations between covariant differential calculus on two closely related quantum spaces. Two approaches are combined in obtaining covariant first order differential calculi on CP_q^{N-1}: 1. restriction of covariant first order differential calculi from S_q^{2N-1}; 2. classification of calculi under appropriate constraints, using methods from representation theory. The main result is that under three reasonable settings of dimension constraints, covariant first order differential calculi on CP_q^{N-1} exist and are (for N >= 6) uniquely determined. This is a cl...

The existing call-by-need lambda calculi describe lazy evaluation via equational logics. A programmer can use these logics to safely ascertain whether one term is behaviorally equivalent to another or to determine the value of a lazy program. However, neither of the existing calculi models evaluation in a way that matches lazy implementations. Both calculi suffer from the same two problems. First, the calculi never discard function calls, even after they are completely resolved. Second, the calculi include re-association axioms even though these axioms are merely administrative steps with no counterpart in any implementation. In this paper, we present an alternative axiomatization of lazy evaluation using a single axiom. It eliminates both the function call retention problem and the extraneous re-association axioms. Our axiom uses a grammar of contexts to describe the exact notion of a needed computation. Like its predecessors, our new calculus satisfies consistency and standardization properties and is thus ...

Abstract in portuguese OBJETIVO: Avaliar os resultados da ureterolitotomia retroperitoneoscópica no tratamento do cálculo ureteral e a necessidade do cateter duplo J para reduzir complicações relacionadas ao procedimento. MÉTODOS: Estudo retrospectivo comparativo de 47 pacientes operados pela técnica de ureterolitotomia retroperitoneoscópica, dos quais 31 foram selecionados e divididos em dois grupos: Grupo 1, cujos pacientes não receberam cateter duplo J, e Grupo 2, que foram submetido (more) s ao implante de cateter duplo J transoperatório. Foram coletados dados de urografia excretora pré e pós-operatória, tempo cirúrgico, analgesia pós-operatória, tempo de internação e retirada do dreno. RESULTADOS: Os grupos foram semelhantes quando comparados na idade e sexo, grau de dilatação do trato urinário, posição e tamanho médio do cálculo (Grupo 1= 15,5 ± 6,6mm; Grupo 2= 16,3 ± 6,1mm). O tempo operatório também não teve diferença significativa (Grupo 1= 130 ± 40,3min; Grupo 2= 136,3 ± 49,3min). O Grupo 1 apresentou seis pacientes (37,5 %) com complicações precoces (quatro casos de fístula urinária) e tardias (um caso de estenose de ureter, um caso de exclusão funcional do rim operado), enquanto o Grupo 2 não teve complicações, sendo esta diferença estatisticamente significativa (p=0,011). CONCLUSÃO: O emprego do cateter duplo J foi associado a um número significativamente menor de complicações na ureterolitotomia retroperitoneoscópica. Tempo cirúrgico, analgesia pós-operatória e tempo de internação foram semelhantes entre os grupos com e sem cateter. Abstract in english OBJECTIVE: To evaluate the retroperitoneoscopic ureterolithotomy in the treatment of ureteral calculi and the need for double-J catheter to reduce the procedure-related complications. METHODS: We conducted a retrospective study with 47 patients submitted to retroperitoneoscopic ureterolithotomy, of which 31 were selected and divided into two groups: Group 1, whose patients did not have double-J catheter placement, and Group 2, who underwent perioperative double-J catheter (more) implantation. Data collected comprised pre-and post-operative excretory urography, operative time, postoperative analgesia, length of hospital stay and catheter removal. RESULTS: The groups were similar as for age and gender, degree of dilation of the urinary tract, position and average size of the calculi (Group 1 = 15.5 ± 6.6 mm, Group 2 = 16.3 ± 6.1 mm). Operative time was also not significantly different (Group 1 = 130 ± 40.3 min, Group 2 = 136.3 ± 49.3 min). Group 1 had six patients (37.5%) with early (four cases of urinary fistula) and late complications (one case of stenosis of the ureter, one case of functional exclusion of the operated kidney), while Group 2 had no complications. This difference was statistically significant (p = 0.011). CONCLUSION: The use of double-J catheter was associated with significantly fewer complications in retroperitoneoscopic ureterolithotomy. Surgical time, postoperative analgesia and length of stay were similar between groups with and without catheter.

Abstract in spanish La formación de un cálculo vesical como consecuencia de la erosión de la mucosa vesical secundaria a la colocación de una malla TVT es una complicación poco frecuente. El caso que presentamos es el de una mujer de 73 años intervenida en dos ocasiones mediante la colocación de una malla TVT con el objeto de tratar su incontinencia urinaria de origen mixto. La clínica de la paciente se caracterizaba por una intensa disuria, urgencia miccional, dolor perineal, diarre (more) a y síndrome constitucional de un año de evolución. Se llegó al diagnostico mediante una placa de abdomen y una RM. El tratamiento se realizó mediante una intervención de cistolitotomía y la sección de la malla protésica sobre la cual se había desarrollado el cálculo. La integridad de la vejiga y la ausencia de lesiones secundarias se constató mediante una cistoscopia realizada a los 6 meses de la intervención. Abstract in english The bladder stone formation due to intravesical mesh erosion of tension-free vaginal tape (TVT) is an infrequent complication. We report a case of 73 years old woman, treated in two occasions by means of the positioning of a TVT with the intention of treating its urinary incontinence. The symptoms, of a year of evolution, was characterized by disuria, pelvic pain, diarrea and constitutional syndrome. RM showed bladder stone fixed to bladder wall. The extraction of the bla (more) dder stone was made by the section of the polypropilene mesh on which the calculi had been developed. 6 months later, control cystoscopy revealed complete healing of bladder mucosa.

Aromatic amines, including 2-naphthylamine, 4-aminobiphenyl and benzidine, are known urinary bladder carcinogens in man and other species, but in rodents, aromatic amines and amides have usually induced liver tumors, occasionally also with tumors of the bladder and other tissues. Variations in organ specificity are related to differences in metabolism; for the production of bladder tumors, the rates of acetylation and deacetylation appear to be critical. Bladder specific carcinogens in rodents and other species have subsequently been identified, including N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) administered in the drinking water, N-[(4-(5-nitro-2-furyl)-2-thiazolyl]formamide (FANFT) in the diet and N-methyl-N-nitrosourea (MNU) instilled intravesically. When low doses of several bladder carcinogens (BBN, FANFT, 2-acetylaminofluorene, and 3,3'-dichlorobenzidine) are administered to rats, either simultaneously or sequentially, a synergistic effect is observed with respect to bladder carcinogenesis. In addition, a multistage carcinogenesis process has been demonstrated for the rat bladder using MNU or FANFT as initiators, and dietary sodium saccharin, sodium cyclamate, or tryptophan as promoters. Calculi (or pellets) appear to enhance the promotion process but are not necessary for it to occur. Recent studies also indicate that urine has a role in the promoting process. The urothelium normally has a very low mitotic rate. If mucosal proliferation is increased, such as during fetal development or during regeneration and repair of an ulcer, the bladder appears to be considerably more sensitive to the effects of promoting substances. For example, if sodium saccharin is administered to rats after ulceration of the bladder, even without prior administration of an initiator, bladder carcinoma develops. Under these conditions, the substance appears as a carcinogen. Human populations with increased bladder epithelial proliferation, such as fetus, infants, patients with bacterial cystitis or men with partially obstructive prostatism, may have increased susceptibility to the action of carcinogenic or promoting stimuli. PMID:6873031

Abstract in english Calcium oxalate (CaOx) crystals adhere to and are internalized by tubular renal cells and it seems that this interaction is related (positively or negatively) to the appearance of urinary calculi. The present study analyzes a series of mechanisms possibly involved in CaOx uptake by Madin-Darby canine kidney (MDCK) cells. CaOx crystals were added to MDCK cell cultures and endocytosis was evaluated by polarized light microscopy. This process was inhibited by an increase in (more) intracellular calcium by means of ionomycin (100 nM; N = 6; 43.9% inhibition; P<0.001) or thapsigargin (1 µM; N = 6; 33.3% inhibition; P<0.005) administration, and via blockade of cytoskeleton assembly by the addition of colchicine (10 µM; N = 8; 46.1% inhibition; P<0.001) or cytochalasin B (10 µM; N = 8; 34.2% inhibition; P<0.001). Furthermore, CaOx uptake was reduced when the activity of protein kinase C was inhibited by staurosporine (10 nM; N = 6; 44% inhibition; P<0.01), or that of cyclo-oxygenase by indomethacin (3 µM; N = 12; 17.2% inhibition; P<0.05); however, the uptake was unaffected by modulation of potassium channel activity with glibenclamide (3 µM; N = 6), tetraethylammonium (1 mM; N = 6) or cromakalim (1 µM; N = 6). Taken together, these data indicate that the process of CaOx internalization by renal tubular cells is similar to the endocytosis reported for other systems. These findings may be relevant to cellular phenomena involved in early stages of the formation of renal stones.

Functional abdominal pain--that is, pain without demonstrable organic abnormalities--has often been associated with psychologic stress. The aim of the present study was to investigate whether sympathetic nervous system response to laboratory stress and basal parasympathetic neural activity were disturbed in 22 patients with functional abdominal pain (functional group) as compared with 14 healthy controls (healthy group) and 26 patients with organic abdominal pain (organic group) due to duodenal ulcer (DU), gallstones, or urinary tract calculi. Plasma adrenocorticotrophic hormone (ACTH) and serum cortisol measurements were included, to assess the pituitary-adrenocortical axis. Heart rate, systolic blood pressure, and plasma adrenaline increased significantly in all groups in response to a stress test (mental arithmetic). Plasma noradrenaline increased in the DU patients only, and plasma ACTH and serum cortisol did not increase at all in any of the groups. As a measure of parasympathetic neural activity, independent of sympathetic neural activity, the beat-to-beat variation of the heart rate was calculated. The functional patients had a significantly higher beat-to-beat variation expressed as the mean square successive differences of the R-R intervals (MSSD), indicating a higher basal parasympathetic neural activity (mean MSSD +/- SEM = 64 +/- 6 msec in the functional group, 46 +/- 6 msec in the healthy group, and 49 +/- 6 msec in the organic group; P = 0.03). A reduced sympathetic neural response as indicated by a lesser stress-induced increment in heart rate, was seen in both patient groups (functional, 13 +/- 2 beats/min; organic, 10 +/- 2 beats/min) as compared with the healthy group (19 +/- 2 beats/min; P = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that wth unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.

We show that the bicovariant first order differential calculi on a factorisable semisimple quantum group are in 1-1 correspondence with irreducible representations $V$ of the quantum group enveloping algebra. The corresponding calculus is constructed and has dimension $dim V^2$. The differential calculi on a finite group algebra $C G$ are also classified and shown to be in correspondence with pairs consisting of an irreducible representation $V$ and a continuous parameter in $C P^{dim V -1}$. They have dimension $dim V$. For a classical Lie group we obtain an infinite family of non-standard calculi.

Under the assumption that the deformation parameter $q$ is transcendental all bicovariant first order differential calculi on the coordinate Hopf algebras of the quantum groups $SL_q(n+1)$ and $Sp_q(2n)$ are classified. It is shown that the irreducible bicovariant first order calculi are determined by an irreducible corepresentation of the quantum group and a complex number $\\zeta$ such that $\\zeta^{n+1}=1$ for $SL_q(n+1)$ and $\\zeta^2=1$ for $Sp_q(2n)$. All such calculi are inner and generated by a central element of the quantum Lie algebra.

This paper presents a logical approach to the translation of functional calculi into concurrent process calculi. The starting point is a type system for the {\\pi}-calculus closely related to linear logic. Decompositions of intuitionistic and classical logics into this system provide type-preserving translations of the \\lambda- and \\lambda\\mu-calculus, both for call-by-name and call-by-value evaluation strategies. Previously known encodings of the \\lam-calculus are shown to correspond to particular cases of this logical embedding. The realisability interpretation of types in the \\pi-calculus provides systematic soundness arguments for these translations and allows for the definition of type-safe extensions of functional calculi.

To navigate through daily life, humans use their ability to conceptualize spatio-temporal information, which ultimately leads to a system of categories. Likewise, the spatial sciences rely heavily on conceptualization and categorization as means to create knowledge when they process spatio-temporal data. In the spatial sciences and in related branches of artificial intelligence, an approach has been developed for processing spatio-temporal data on the level of coarse categories: qualitative spatio-temporal representation and reasoning (QSTR). Calculi developed in QSTR allow for the meaningful processing of and reasoning with spatio-temporal information. While qualitative calculi are widely acknowledged in the cognitive sciences, there is little behavioral assessment whether these calculi a...

The theories of apartness, equality, and n-stable equality are presented through contraction- and cut-free sequent calculi. By methods of proof analysis, a purely proof-theoretic characterization of the equality fragment of apartness is obtained.

Color Doppler twinkling is a well-defined but not well-understood phenomenon that may assist in the detection of renal calculi. However, the relationship between the appearance of color Doppler twinkling and color Doppler carrier frequency has not been described systematically. To evaluate this relationship, a retrospective review was performed on 20 cases of renal calculi detected by twinkling on renal color Doppler sonography and confirmed with unenhanced computed tomography. The variable strength of twinkling at and behind renal calculi was observed with color Doppler carrier frequencies ranging from 1.75-4.0 MHz. All 20 calculi (100%) demonstrated twinkling when a low color Doppler carrier frequency, 1.75 or 2 MHz, was applied, whereas 12 of 20 cases (60%) were absent of twinkling when...

Cartan calculi on the extended quantum superplane are given. To this end, the noncommutative differential calculus on the extended quantum superplane is extended by introducing inner derivations and Lie derivatives.

Controversy remains on how to treat lower pole calculi between 1 and 2 cm of size. Treatment options like shock wave lithotripsy (SWL) or percutaneous stone treatment (PCNL) are associated with poor stone-free rates or high morbidity.

Here we propose a direct approach to the construction of operational calculi connected with linear nonlocal boundary value problems for a large class of linear evolution equations with several space variables and one time variable.

This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL.

Indications and treatment results of ureteric calculi one year before and one year after the introduction of ESWL were analysed in 169 consecutive patients. Sex, age, former stone operation, stone localisation and stone size were not significantly different in the two groups. Before ESW1 47% of the patients received treatment against 54% after the introduction (p > 0.3). There was no tendency towards treatment of smaller calculi. Expectedly, the number of endoscopies and ureterolithotomies was significantly reduced (p < 0.05). The treatment period (from first contact till final control) was longer with ESWL, but not significantly. Judged from the length of the hospital stay there was no major economic benefit from ESWL. In conclusion, ESWL with a second generation lithotriptor is suitable for in situ treatment of ureteric calculi. It should be first choice for ureteric calculi.

Five cases of recurrent pyogenic cholangitis (RPC) were studied by ultrasonography, computed tomography (CT), and cholangiography. All patients were recent immigrants from the Orient or Indonesia and had had recurrent attacks of cholangitis for many years. The bile was infected by E. coli and the biliary ducts were dilated; in addition, extrahepatic bile-pigment calculi we represent in all 5 and intrahepatic calculi in 4. Abdominal ultrasound usually failed to demonstrate duct calculi and extrahepatic dilatation due to the soft, mud-like consistency of the stones. CT was successful in showing the calculi and the full extent of dilatation. The authors conclude that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT. Preoperative cholangiography provides excellent detail, but poses the danger of biliary sepsis requiring antibiotics.

Relations between differential calculi, quantum groups, integrable systems, and q-analysis are studied. Some new Hirota type formulas are established for qKP along with variations on classical Hirota formulas.

Several Markovian process calculi have been proposed in the literature, which differ from each other for various aspects. With regard to the action representation, we distinguish between integrated-time Markovian process calculi, in which every action has an exponentially distributed duration associated with it, and orthogonal-time Markovian process calculi, in which action execution is separated from time passing. Similar to deterministically timed process calculi, we show that these two options are not irreconcilable by exhibiting three mappings from an integrated-time Markovian process calculus to an orthogonal-time Markovian process calculus that preserve the behavioral equivalence of process terms under different interpretations of action execution: eagerness, laziness, and maximal progress. The mappings are limited to classes of process terms of the integrated-time Markovian process calculus with restrictions on parallel composition and do not involve the full capability of the orthogonal-time Markovian...

This volume represents the proceedings of the 5th Workshop on Membrane Computing and Biologically Inspired Process Calculi (MeCBIC 2011), held together with the 12th International Conference on Membrane Computing on 23rd August 2011 in Fontainebleau, France.

A case of concurrent preputial calculi and carcinoma of the penis is reported. The causal relationship of both the lesions is still controversial and the possible common aetiopathogenesis of the entity is discussed.

Abstract The objective of the study was to evaluate fluid-electrolyte and renal pelvic pressure (RPP) changes during ureteroscopic lithotripsy. Fifteen patients were detected with residual ureteral calculi after minimally invasive percutaneous nephrolithotomy (MPCNL), distal ureter calculi in three, midureter calculi in four, proximal calculi in eight. RPP was measured via the percutaneous nephrostomy tube by urodynamic study at irrigation pressures of 50, 100 and 200 mmHg. Haemoglobin (Hb), haematocrit (Hct), blood urea mitrogen (BUN), creatinine (Cre), serum sodium (Na+), potassium (K+), chlorine (Cl-) were recorded before and after ureteroscopic lithotripsy. There were no significant differences between Hb, Hct, BUN, Cre, Na+, K+, Cl- values. Baseline RPP was (16.37 +- 3.14) cmH2O, RPPs...

Sialolithiasis is a common disease of the major salivary glands. A supplement to the traditional therapies is extracorporeal shock wave lithotripsy of the calculus. This method has been adopted from the therapy of renal or bladder calculi. Patients with a solitary calculus of parotid or submandibular gland were treated with a specially designed lithotriptor. In a retrospective study the results of this therapy were analysed. The success rate was far better for parotid gland calculi than for submandibular calculi. We could not find better results than those published in literature with other devices. In our therapeutic concept, sialolithotripsy is the therapy of first choice for single parotid gland calculi. For submandibular gland calculus this method is advisable in selected cases only. PMID:15955661

Drug-induced calculi and other rare stone types, such as ammonium acid urate or protein matrix stones, represent only about 2% of all renal calculi. However, the chance to easily reverse stone formation risk by discontinuing the offending drug makes identification of these entities important for clinicians. Additionally, study of these rare stone types contributes to understanding the biochemistry of stone formation. Drug-induced calculi may be classified into two groups based on the mechanism of stone formation. The first group includes drugs that provoke calculi composed of principally the drug and its metabolites. These medications tend to be poorly soluble, highly excreted in urine, and required at high dosages for long durations of therapy. Historically, sulfonamides, triamterene, and...

In 24 patients with duodenal diverticula, demonstrated by ERCP, food-stimulated gastrooesophageal reflux was demonstrated in 33% of the patients and biliary tract calculi in 81%. This is in contrast to a previous study (3) in patients with duodenal diverticula demonstrated by barium examination where gastrooesophageal reflux occurred in 81% and biliary tract calculi in 38% of the patients. Differences in clinical selection are believed to be the underlying cause to these varying results.

We introduce a large class of bicovariant differential calculi on any quantum group $A$, associated to $Ad$-invariant elements. For example, the deformed trace element on $SL_q(2)$ recovers Woronowicz' $4D_\\pm$ calculus. More generally, we obtain a sequence of differential calculi on each quantum group $A(R)$, based on the theory of the corresponding braided groups $B(R)$. Here $R$ is any regular solution of the QYBE.

The purpose of this note is to show how calculi on unital associative algebra with universal right bimodule generalize previously studied constructions by Pusz and Woronowicz [1989] and by Wess and Zumino [1990] and that in this language results are in a natural context, are easier to describe and handle. As a by--product we obtained intrinsic, coordinate--free and basis--independent generalization of the first order noncommutative differential calculi with partial derivatives.

We study some aspects of the theory of non-commutative differential calculi over complex algebras, especially over the Hopf algebras associated to compact quantum groups in the sense of S.L. Woronowicz. Our principal emphasis is on the theory of twisted graded traces and their associated twisted cyclic cocycles. One of our principal results is a new method of constructing differential calculi, using twisted graded traces.

Programming language technology can contribute to the development and understanding of Systems Biology by providing formal calculi for specifying and analysing the dynamic behaviour of biological systems. Our focus is on BioAmbients, a variation of the ambient calculi developed for modelling mobility in computer systems. We present a static analysis for capturing the spatial structure of biological systems and we illustrate it on a few examples.

A review of the use of scanning electron microscopy (SEM) and electron probe microanalyses in the study of dental calculus showed that such studies provided confirmatory and supplementary data on the morphological features of human dental calculi but gave only limited information on the identity of the crystalline or inorganic components. This study aimed to explore the potential of combined SEM and microanalyses in the identification of the crystalline components of the human and animal dental calculi. Human and animal calculi were analyzed. Identification of the crystalline components were made based on the combined information of the morphology (SEM) and Ca/P molar ratios of the crystals with the morphology and Ca/P molar ratio of synthetic calcium phosphates (brushite or DCPD; octacalcium phosphate, OCP; Mg-substituted whitlockite, beta-TCMP; CO/sub 3/-substituted apatite, (CHA); and calcite. SEM showed similarities in morphological features of human and animal dental calculi but differences in the forms of crystals present. Microanalyses and crystal morphology data suggested the presence of CaCO/sub 3/ (calcite) and CHA in the animal (cat, dog, tiger) and of OCP, beta-TCMP and CHA in human dental calculi. X-ray diffraction and infrared (IR) absorption analyses confirmed these results. This exploratory study demonstrated that by taking into consideration what is known about the crystalline components of human and animal dental calculi, combined SEM and microanalyses can provide qualitative identification.

We classify all 4-dimensional first order bicovariant calculi on the Jordanian quantum group $GL_{h,g}(2)$ and all 3-dimensional first order bicovariant calculi on the Jordanian quantum group $SL_{h}(2)$. In both cases we assume that the bicovariant bimodules are generated as left modules by the differentials of the quantum group generators. It is found that there are 3 1-parameter families of 4-dimensional bicovariant first order calculi on $GL_{h,g}(2)$ and that there is a single, unique, 3-dimensional bicovariant calculus on $SL_{h}(2)$. This 3-dimensional calculus may be obtained through a classical-like reduction from any one of the three families of 4-dimensional calculi on $GL_{h,g}(2)$. Details of the higher order calculi and also the quantum Lie algebras are presented for all calculi. The quantum Lie algebra obtained from the bicovariant calculus on $SL_{h}(2)$ is shown to be isomorphic to the quantum Lie algebra we obtain as an ad-submodule within the Jordanian universal enveloping algebra $U_{h}(sl...

Abstract in spanish Objetivo: El fenotipo final del paciente con cistinuria depende, por una parte, de la ausencia o defecto molecular más o menos grave en el transporte de cistina y aminoácidos dibásicos; y por otra parte también de factores ambientales. El objetivo del presente estudio es conocer el efecto de la modulación de diversos factores ambientales (pH urinario, ingesta de líquido, tratamiento farmacológico y en especial la dieta) sobre el fenotipo final del paciente con cist (more) inuria. Métodos: Se estudiaron 45 sujetos diagnosticados como pacientes con cistinuria (25 hombres y 20 mujeres), 42 individuos pertenecientes al árbol genealógico de estos pacientes con cistinuria (15 hombres y 27 mujeres) y 90 controles. Se obtuvieron datos antropométricos, clínicos (antecedentes personales y familiares de infecciones urinarias, cólicos, expulsión de cálculos y problemas renales), bioquímicos (análisis microscópico de orina y cuantificación de aminoácidos en orina) y estilo de vida (dieta y tratamiento recibido). El estudio estadístico incluyó, además de pruebas de comparación de frecuencias y de medias, regresión logística y análisis multivariante. Resultados: De los 45 pacientes con cistinuria, sólo el 20% presentaban cristales de cistina en orina; el resto de manifestaciones fenotípicas de la enfermedad, se encontraron con la misma prevalencia que en el grupo de familiares y el grupo control. El 50% de los pacientes no estaban siguiendo ninguna pauta terapéutica, y de estos, solo en el 50% era efectivo. En pacientes con cistinuria, la presencia de cristales de cistina se asoció a una dieta rica en carnes y baja en productos lácteos (p Abstract in english Objectives: The final phenotype of patients with cystinuria depends on the absence or molecular defect, more o less acute, of the transport of cystine and dibasic aminoacids, and, also on environmental factors. The objective of this work is to study the effect of the modulation of some environmental factors (urinary pH, intake of liquids, pharmacological treatment and, specially, diet) on the final phenotype of the patient with cystinuria. Methods: We study 45 patients wi (more) th cystinuria (25 men and 20 women), 42 relatives (15 men and 27 women) and 90 unrelated controls. Anthropometric, clinical (personal and familiar history of urinary infections, colics and calculi expulsion), biochemical (microscopy analysis of urine and urinary aminoacids cuantification) and life style (diet and medical treatment) variables were obtained. Statistical analysis was performed using tests to compare means and frequencies and, also, logistic regression and multivariate analysis. Results: Of the 45 patients with cystinuria, only 20% showed cystine cristalls in urine, the rest of the phenotypical manifestations of cystinuria were found with the same prevalence as in relatives and in the control group. 50% of the patients did not undergo any therapeutic intervention; of these, only 50% were effective. In patients with cystinuria, the presence of cystine cristalls was associated with a diet rich in meats and poor in milk products (p

Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

Study Type - Therapy (case series) Level of Evidence?4 What's known on the subject? and What does the study add? The open simple prostatectomy (OSP) is the 'gold standard' for high-volume prostate adenomas. It shows very good functional results despite its invasiveness. Minimally invasive approaches, e.g. laparoscopy or holmium laser enucleation of the prostate, have been 'tested' but none have proved a substitute for the OSP. The robot-assisted approach provides optimal functional results and is easy to perform for experienced robotic surgeons. Extending the indication of robotics to low-incidence pathologies can take advantage of the opportunity to 'see the procedure' using available information technology, e.g. Youtube™ that presents as an unexpectedly useful tool. OBJECTIVE: •? To evaluate the outcome, feasibility and reproducibility of a robot-assisted (RA) approach for simple prostatectomy (SP) in cases of high-volume symptomatic benign prostatic hyperplasia (HVS-BPH). PATIENTS AND METHODS: •? In all, 35 consecutive patients underwent RASP for HVS-BPH using a previously described technique. •? The mean prostate volume on preoperative transrectal ultrasonography was 106.6?mL. •? All but two patients (with bladder calculi) had an adenoma volume of >65?mL and 27 (77.1%) >80?mL. Nine patients (25.7%) had an indwelling catheter. •? The mean International Prostate Symptom Score (IPSS) was 28. RESULTS: •? The median operative duration was 180?min and the mean hospital stay was 3.17 days. •? The mean catheter duration was 7.4 days and discontinuous or continuous catheter irrigation was required in two and seven patients, respectively (25.1%). •? In all, 10 patients (28.6%) had practically no blood loss. No patients had a transfusion. •? The mean postoperative peak urinary flow was 18.9?mL/s (P < 0.001), while the mean IPSS was 7 (P < 0.001). •? For costs, while superficially RASP appeared more expensive than open SP (OSP), when considering the higher costs of hospitalisation for OSP, RASP was cheaper. Also, bipolar-TURP costs in patients with large-volume prostates had rather similar costs to RASP. CONCLUSIONS: •? RASP is a feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). As a result, a RA approach is worth considering in cases of high-volume prostate adenomas. •? Extending the indication of the RA approach, to the SP, requires firstly that the surgeon be proficient in RA surgery and secondly that as the incidence rate of HVS-BPH is low, the surgeon has had the opportunity to 'see the procedure'. PMID:22607242

The visualization rate of magnetic resonance cholangiopancreatography (MRCP) with a moderate magnetic field (0.5 T) was compared in terms of the maximum diameter of calculi and the imaging method. MRCP with a fast spin echo (FSE) and/or single-shot fast spin echo (SSFSE) sequence was performed in 53 patients diagnosed with extrahepatic biliary lithiasis by endoscopic retrograde cholangiopancreatography (ERCP). The visualization rate of MRCP was 84.9% (45/53). The visualization rate of calculi 5 mm or less in diameter was low, but those 6 mm or more in diameter were visualized in almost every case. Examination by each of the imaging methods yielded a visualization rate of 78.4% (49/51) by FSE, 82.8% (24/29) by SSFSE, and 85.2% (23/27) by a combination of both methods. No calculi 5 mm or less in diameter were detected by FSE, but 4-5 mm calculi were detected in 2 out of 5 cases (40%) by SSFSE. Calculi 6 mm or more in diameter were detected in 40 out of 43 patients by FSE and 22 out of 23 patients by SSFSE. MRCP with a moderate magnetic field was as useful in diagnosing choledocholithiasis as with a high magnetic field. Of the two imaging methods tested, SSFSE appeared to be preferable to FSE. (K.H.)

Aim: To evaluate whether computed tomography (CT) of the renal tract in suspected renal colic using reduced exposure factors maintains diagnostic accuracy. METHODS: Prospective multi-centre cohort study. Patients with suspected renal colic were examined using computed tomography (CT) of the renal tract followed by intravenous urography (IVU) in four different centres with five different CT systems. RESULTS: Sixty-nine patients with suspected renal colic had CT of the renal tract followed by IVU. CT was performed with reduced exposure factors, giving a mean CT effective dose of 3.5 (range 2.8-4.5) mSv compared with 1.5 mSv for IVU. Ureteric calculi were detected in 43 patients: CT and IVU detected 40 (93%) ureteric calculi. CT identified other lesions causing symptoms in five patients and identified renal calculi in 24 patients. IVU identified renal calculi in six patients and made false positive diagnosis of renal calculi in seven patients. Mean examination time for CT was 5 minutes and for IVU was 80 minutes. CONCLUSION: CT examination at reduced exposure factors maintains the diagnostic accuracy recorded in other series. Meagher, T. et al. (2001)

Laparoscopic nephrectomy has become the gold standard procedure for nonfunctioning or symptomatic benign kidneys due to renal calculi, obstructive, refluxive, and inflammatory nephropathies or renovascular hypertension. We aimed to investigate the effect of renal calculi as a reason of non-functioning on the progress and complication rates of the retroperitoneoscopic nephrectomy (RPN).During a 2-year period, 108 patients with benign renal conditions underwent RPN by single surgeon. Among these patients, total of 27 (Group 1) with a non-functioning kidney due to renal calculi were retrospectively compared with 27 patients (Group 2) with other benign renal conditions. The two groups were matched for age, body mass index, and previous renal surgery. We analyzed operative and post-operative fi...

Urolithiasis is a very frequent illness found in Argentina; however, stone analysis is not routinely performed. In this work, 86 renal calculi (from cities of Luján and San Antonio de Areco, State of Buenos Aires, Argentina) have been analyzed by infrared and Raman spectroscopies, and the results correlated with the main possible pathological conditions. Calcium oxalate monohydrate (whewellite) and mixtures of calcium oxalate monohydrate and carbonate apatite were the most frequent compounds found in our samples. In order to improve the identification of different phases present in calculi [particularly whewellite and weddellite (calcium oxalate dihydrate)], the second derivative spectra were used. The FTIR spectroscopy together with the second derivative analysis provides the urologist with a good method for calculi component determinations. PMID:20686758

Studies of the effect of excess deuterium concentrations on living organisms have a long standing past history. However, a number of problems have not been solved. One of them is the effect of deuterium in drinking water on the growth of calculi in the following human internal organs: liver, kidneys, and a gallbladder. The development of methods for the direct measurement of D:H isotope ratios in fragments of human calculi [with dry mass of about n x (1 - 10) mg] is essential in solving this problem. Mass-spectrometric analysis makes it possible to determine the D : H ratios with relative errors no higher than 0.1%. However, the isolation of hydrogen isotopes as water in amounts of no less than 2 to 3 mg from the samples is required for implementing this technique. For this purpose, the decomposition of a sample weighing as much as n x (0.1 - 1)g is necessary; this procedure is impossible in examining fragments of calculi.

Biological systems typically involve large numbers of components with complex, highly parallel interactions and intrinsic stochasticity. To model this complexity, numerous programming languages based on process calculi have been developed, many of which are expressive enough to generate unbounded numbers of molecular species and reactions. As a result of this expressiveness, such calculi cannot rely on standard reaction-based simulation methods, which require fixed numbers of species and reactions. Rather than implementing custom stochastic simulation algorithms for each process calculus, we propose to use a generic abstract machine that can be instantiated to a range of process calculi and a range of reaction-based simulation algorithms. The abstract machine functions as a just-in-time compiler, which dynamically updates the set of possible reactions and chooses the next reaction in an iterative cycle. In this short paper we give a brief summary of the generic abstract machine, and show how it can be instant...

In a prospective study, 276 consecutive patients were evaluated using percutaneous transhepatic cholangiography (PTC) with a Chiba needle prior to surgery for cholestasis. Biliary calculi were diagnosed in 109 patients. The success rate was 92.4% overall, 93.6% among patients with biliary calculi, 83.3% in those with cholelithiasis, 97.3% in those with choledocholithiasis, and 100.0% in those with intrahepatic stones. The overall morbidity rate was 4.6%, including hemoperitoneum in 1.8% and bile leakage in 2.8%. There were no deaths. This technique offers a more definitive diagnosis than noninvasive procedures, especially with small calculi, but is also more traumatic. PTC may play an important role when noninvasive methods are inconclusive or in difficult cases, particularly following surgery on the common bile duct.

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21–62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3–8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPS...

Oriental cholangiohepatitis (OCH) also called recurrent pyogenic cholangitis is characterized by intrahepatic duct calculi, strictures, and recurrent infections. In turn cholangitis can result in multiple hepatic abscesses, further biliary strictures, and in severe cases, progressive hepatic parenchymal destruction, cirrhosis, and portal hypertension. Magnetic resonance cholangiopancreatography (MRCP) and conventional T1-weighted (T1 W) and T2-weighted (T2 W) magnetic resonance imaging (MRI) findings have been described in patients with OCH. MRCP findings include duct dilation, strictures, and calculi. MRCP can help to localize the diseased ducts and determine the severity of involvement. T1 and T2 W sequences reveal the parenchymal changes of atrophy, abscess formation, and portal hypertension in addition to calculi. Post-treatment changes are also well depicted using MRI. Comprehensive, non-invasive assessment is achieved by using conventional MRI and MRCP in OCH providing a roadmap for endoscopic or surgical management.

During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi.

Urinary markers for renal dysfunction are gaining interest but effects of sampling method, storage conditions, and urinary tract inflammation or infection on these markers are unclear Therefore, the objectives of the current study were to determine the difference in urinary albumin (uALB), urinary r...

Background: Proteinuria is a feature of pyometra-associated renal dysfunction, but its prevalence and clinical relevance are not well characterized. Objectives: To define which subset of dogs with pyometra has clinically relevant kidney injury by quantification of proteinuria; light, immunofluorescence, and electron microscopic examination of kidney biopsy specimens; and measurement of urinary biomarkers. Animals: Forty-seven dogs with pyometra. Ten clinically healthy intact bitches of comparable age. Methods: Prospective study. Routine clinicopathological variables including urinary protein to creatinine ratio (UPC) were analyzed. Validated assays were used to quantify urinary biomarkers for glomerular (urinary albumin, urinary immunoglobulin G, urinary C-reactive protein, urinary thrombo...

Abstract Urolithiasis, the category of diseases associated with the formation of kidney stones, has many causes. However, only a few have been documented as aggravating calculi depositions and aggregations. This amply justifies continued work in developing effective and efficient inhibition and treatment techniques. The recent resurgence in reviews on plant antiurolithiatic activity has given credence to the application of modern spectroscopic analysis, and has led us to this study. Results obtained from Raman and infrared (IR) absorption analysis of inhibited calculi growth resulting from laboratory synthesis of calcium oxalate crystals accompanied by the natural infusion of Larrea tridentata are reported. A visible decrease in calcium oxalate crystal growth with increasing amounts of L. ...

The differential caluli $(Gamma,d)$ on quantum groups are classified due to the property of the generating element $X$ of its differential $d$. There are, on the one hand differential caluli which contain this element $X$ in the basis of one- forms that span $Gamma$, called Inner Differential Calculi. On the other hand, one has the differential caluli which do not contain the generating element $X$ of its differential $d$, thus they are called Outer Differential Calculi. We show that this two classes of differential caluli, for a given quantum group ${\\cal A}$, are related by homomorphisms, which map the elements of one class on elements of the other class.

We describe the technique and illustrate results of renal calculi analyses utilizing correlative analytical scanning electron microscopy and x-ray microdiffractometry on the same 100 micrometer Spurr embedded sections. Essential to the technique is the employment of an extremely sensitive x-ray microdiffractometer, and for morphological analysis, pretreatment of the sections with a sodium ethoxide etching solution. This technique facilitates more precise identification of crystalline constituents especially calcium apatite and magnesium ammonium phosphate hexahydrate (struvite). Further, the technique permits detection and mapping of both crystalline and amorphous constituents within calculi.

The Hajós calculus is a nondeterministic procedure which generates the class of non-3-colorable graphs. If all non-3-colorable graphs can be constructed in polynomial steps by the calculus, then NP=co-NP holds. Up to date, however, it remains open whether there exists a family of graphs that cannot be generated in polynomial steps. To attack this problem, we propose two graph calculi PHC and PHC* that generate non-3-colorable planar graphs, where intermediate graphs in the calculi are also restricted to be planar. Then we prove that PHC and PHC* are sound and complete. We also show that PHC* can polynomially simulate PHC.

We present two rewriting systems that define labelled explicit substitution lambda-calculi. Our work is motivated by the close correspondence between Levy's labelled lambda-calculus and paths in proof-nets, which played an important role in the understanding of the Geometry of Interaction. The structure of the labels in Levy's labelled lambda-calculus relates to the multiplicative information of paths; the novelty of our work is that we design labelled explicit substitution calculi that also keep track of exponential information present in call-by-value and call-by-name translations of the lambda-calculus into linear logic proof-nets.

We deal with quantum spaces of particular importance in physics, i.e., q-deformed Minkowski space and q-deformed Euclidean space in three and four dimensions. For all these cases representations of their covariant differential calculi have been worked out. The explicit formulae refer to left representations, as right representations can be easily deduced from left ones. We are going to show for all cases how this can be done. Additionally, the complete Hopf structures of all considered differential calculi are listed, from which the q-deformed versions of Leibniz rules can directly be obtained.

This article is devoted to the presentation of lambda_rex, an explicit substitution calculus with de Bruijn indexes and a simple notation. By being isomorphic to lambda_ex - a recent formalism with variable names -, lambda_rex accomplishes simulation of beta-reduction (Sim), preservation of beta-strong normalization (PSN) and meta-confluence (MC), among other desirable properties. Our calculus is based on a novel presentation of lambda_dB, using a swap notion that was originally devised by de Bruijn. Besides lambda_rex, two other indexed calculi isomorphic to lambda_x and lambda_xgc are presented, demonstrating the potential of our technique when applied to the design of indexed versions of known named calculi.

Bilateral ureterocele is a rare congenital condition that is usually diagnosed antenatally or in childhood. We present the case of a 64 year-old woman who was admitted for incidentally discovered microscopic hematuria. A bilateral ureterocele and secondary pelvic ureteral calculi were diagnosed by clinical examination (vaginal touch), ultrasound, plain radiography and intravenous urography. A transurethral incision of the ureterocele and extraction of calculi was performed by endoscopic approach. The postoperative recovery was uneventfull. Considering the risk for development of vesicoureteral reflux or recurrence of obstruction at the ureterovesical junction, a close long-term follow-up is required. PMID:20191891

Abstract. Within the framework of basic-deformed and finite-difference calculi, as well as deformation procedures proposed by Tsallis, Abe, and Kaniadakis and generalized by Naudts, we develop field-theoretical schemes of statistically distributed fields. We construct a set of generating functionals and find their connection with corresponding correlators for basic-deformed, finite-difference, and Kaniadakis calculi. Moreover, we introduce pair of additive functionals, which expansions into deformed series yield both Green functions and their irreducible proper vertices. We find as well formal equations, governing by the generating functionals of systems which possess a symmetry with respect to a field variation and are subjected to an arbitrary constrain. Finally, we generalize field-theo...

We present a proofs-as-programs correspondence between linear logic and process calculi that permits non-deterministic behaviours. Processes are translated into wireless proof nets, i.e. proof nets of multiplicative linear logic without cut wires. Typing a term using them consists in typing some of ...

Abstract in english INTRODUCTION: This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. MATERIALS AND METHODS: From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. RESULTS: Co (more) nsidering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. CONCLUSIONS: Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.

A variety of three-dimensional left-covariant differential calculi on the quantum group SU_q(2) is considered using an approach based on global U(1) -covariance. Explicit representations of possible q -Lie algebras are constructed in terms of differential operators. A gauge covariant differential algebra is uniquely determined. The non-standard Leibnitz rule is obtained for a corresponding q-Lie algebra.

A higher-order process calculus is a calculus for communicating systems which contains higher-order constructs like communication of terms. We analyse the notion of bisimulation in these calculi. We argue that %, if static binding is assumed, both the standard definition of bisimulation (i.e., the o...

Concurrent constraint programming (ccp) is a well-established model for concurrency that builds upon operational and algebraic notions from process calculi and first-order logic. Bisimilarity is one of the central reasoning techniques in concurrency. The standard definition of bisimilarity, however,...

Topiramate belongs to the new class of neuromodulators, which has carbonic anhydrase inhibitor activity and been associated with renal calculi. It has also been shown to cause renal potassium wasting; however, it is generally clinically insignificant. Here, we describe a case of refractory hypokalemia in a patient with severe comorbidities who was on topiramate for seizures. PMID:23075579

Explicit construction of the second order left differential calculi on the quantum group and its subgroups are obtained with the property of the natural reduction: the differential calculus on the quantum group $GL_q(2,C)$ has to contain the 3-dimensional differential calculi on the quantum subgroup $SL_q(2,C)$, the differential calculi on the Borel subgroups $B_{L}^{(2)}(C)$, $B_{U}^{(2)}(C)$ of the lower and of the upper triangular matrices, on the quantum subgroups $U_{q}(2)$, $SU_{q}(2)$, $Sp_{q}(2,C)$, $Sp_{q}(2)$, $T_{q}(2,C)$, $B_{L}(C)$, $B_{U}(C)$, $U_{q}(1)$, $Z_{-}^{(2)}(C)$, $Z_{+}^{(2)}(C)$ and on the their real forms. The classical limit ($q\\to 1$) of the left differential calculus is the nondeformed differential calculus. The differential calculi on the Borel subgroups $B_{L}(C)$, $B_{U}(C)$ of the $SL_{q}(2,C)$ coincide with two solutions of Wess-Zumino differential calculus on the quantum plane $C_q(2|0)$. The spontaneous breaking symmetry in the WZNW model with $SL_{q}(2,R)$ quantum group sy...

The modern management of urolithiasis requires a multi-disciplinary approach. Imaging plays a central role in both diagnosis and planning therapy of renal and ureteric calculi. This article reviews the current status of diagnosis and management of stone disease, and the contribution of radiological imaging in accurately triaging a given case to the most appropriate therapy.

We study *-differential calculi over compact quantum groups in the sense of S.L. Woronowicz. Our principal results are the construction of a Hodge operator commuting with the Laplacian, the derivation of a corresponding Hodge decomposition of the calculus of forms, and, for Woronowicz' first calculus, the calculation of the eigenvalues of the Laplacian

The present report aims at making a first evaluation of refinement calculi having some potential for the development of distributed systems. Refinement constitutes an integral part of formal software development, with the aim of providing a framework within which an executable software system can be constructed from a high level specification by going through a number of provably correct development steps. Many formal methods have their own refinement calculi, represented by sets of rules and pragmatic guidelines for relating pairs of specifications in a way that captures the essential idea of formal software development: to systematically produce a program that satisfies its specification. Based on a survey of a large number of relevant refinement calculi, seven selected methods were evaluated with respect to identified criteria. The results from the evaluation can be utilized in any software development project where a selection of refinement calculi is required. The evaluation in the present report complements those provided in other research projects at the OECD Halden Reactor Project, in particular INT-FS, EVAL-FS, and VV-FT (author) (ml)

Investigation of a patient with a history of renal colic, who had taken the equivalent of 2 g magnesium trisilicate after every meal for many years, showed that he was forming silica calculi. The nature of the stone was diagnosed only after quantitative analysis.

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3-8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (Pcalculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy. PMID:22796735

Behavioral theory for higher-order process calculi is less well developed than for first-order ones such as the ?-calculus. In particu- lar, effective coinductive characterizations of barbed congruence, such as the notion of normal bisimulation developed by Sangiorgi for the higher- order ?-calculus...

A method of management of 212 patients whose common bile duct calculi were removed through the Ampulla of Vater across the duodenum is described. One patient died from haemorrhagic pancreatitis directly related to the procedure and 11 others died from causes related to the need for a major procedure...

Abstract in english Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

We introduce the calculus of Mellin pseudodifferential operators parameters based on "twisted" operator-valued Volterra symbols as well aas the abstract Mellin calclus with holomorphic symbols. We establish the properties of the symblic and operational calculi, and we give and make use of explicit o...

The path integral representations the evolution of q-oscillators with root of unity values of q-parameter is constructed using Bargmann-Fock representations with commuting and non-commuting variables, the differential calculi being q-deformed in both cases. For q{sup 2} = -1 a new form of Grassmann-like path integral is obtained. (author). 14 refs.

To navigate through daily life, humans use their ability to conceptualize spatio-temporal information, which ultimately leads to a system of categories. Likewise, the spatial sciences rely heavily on conceptualization and categorization as means to create knowledge when they process spatio-temporal data. In the spatial sciences and in related branches of artificial intelligence, an approach has been developed for processing spatio-temporal data on the level of coarse categories: qualitative spatio-temporal representation and reasoning (QSTR). Calculi developed in QSTR allow for the meaningful processing of and reasoning with spatio-temporal information. While qualitative calculi are widely acknowledged in the cognitive sciences, there is little behavioral assessment whether these calculi are indeed cognitively adequate. This is an astonishing conundrum given that these calculi are ubiquitous, are often intended to improve processes at the human-machine interface, and are on several occasions claimed to be cognitively adequate. We have systematically evaluated several approaches to formally characterize spatial relations from a cognitive-behavioral perspective for both static and dynamically changing spatial relations. This contribution will detail our framework, which is addressing the question how formal characterization of space can help us understand how people think with, in, and about space. PMID:22806649

Urinary tract infections are frequently a result of insufficient urinary drainage. Abnormalities of the urinary tract, bladder and/or urethral dysfunction and bad voiding habits often lead to poor bladder emptying. Foreign bodies in the urinary tract increase the risk of urinary tract infections. In hospitals the primary risk factor is instrumentation of the urinary tract mainly by catheterisation. It is important to diagnose the causes of possible insufficient drainage. The use of catheterisation should be clearly indicated and documented in the patient's medical records. Udgivelsesdato: 2007-Dec-3

Abstract in spanish Objetivo: La litiasis de oxalato cálcico monohidrato (COM) se divide en dos grupos según su estructura morfocristalina: papilares (punto de anclaje sobre una lesión en la papila renal), y de cavidad (formados en una cavidad con baja eficacia urodinamica). Las escasas diferencias entre la bioquímica urinaria de los formadores de COM con respecto a la población sana sugiere que otros factores no relacionados con la bioquímica urinaria (actividad profesional, hábitos (more) dietéticos, enfermedades sistémicas) pueden estar relacionados con la calculogénesis. El objetivo de este trabajo es el estudio de estos factores, y su comparación en ambos grupos de COM (papilar y de cavidad). Métodos: Se estudian 40 pacientes con litiasis de COM (20 pacientes con COM papilar y 20 pacientes con COM de cavidad). Se realiza historia clínica (antecedentes familiares de litiasis; enfermedades asociadas como hipertensión arterial, diabetes mellitus, hiperuricemia, hipercolesterolemia, ulcera gastroduodenal; encuesta de alimentación para valorar consumo de fitatos ; profesiones con riesgo de exposición a agentes tóxicos), bioquímica de orina de 24 horas, orina de 2 horas (pH), bioquímica plasmática. El estudio estadístico se realiza utilizando la t de Student y la X². Resultados: Existe una elevada prevalencia de antecedentes familiares de litiasis renal (45%) sin diferencias entre ambos grupos. No existen diferencias en la bioquímica urinaria ni plasmática. Existe un bajo consumo de alimentos que contienen fitatos en ambos grupos, sin existir diferencias significativas. Existe una tendencia hacia una mayor exposición a agentes citotoxicos en el grupo papilar (45%) frente a cavidad (25%). La hipertensión arterial e hiperuricemia son mas prevalentes en el COM cavidad ( ?= 0,025 y ?= 0,010; respectivamente). La ulcera gastroduodenal es mas prevalente en el COM papilar (? =0,025). No existen diferencias significativas en la prevalencia de hipercolesterolemia y diabetes mellitus entre ambos grupos. Conclusiones: Los cálculos COM papilares se asocian un déficit de inhibidores de la cristalización (fitatos), y a alteraciones del epitelio que recubre la papila renal (exposición a agentes citotóxicos, ulcera gastroduodenal). Los cálculos COM de cavidad se asocian a un déficit de inhibidores de la cristalización (fitatos) y a una mayor presencia de nucleantes heterogéneos (materia orgánica inducida por enfermedades como la hipertensión arterial, hiperuricemia, hiperglucemia e hipercolesterolemia). Abstract in english Objectives: The monohydrate calcium oxalate lithiasis (MCO) is divided in two groups depending on the morphologic-crystal structure: papillary (anchorage point on a renal papilla lesion) and cavity (formed in a cavity with low urodynamic capacity). The minimal differences between urinary biochemistry of MCO makers in comparison with healthy population suggests that other factors different than urine biochemistry (professional activity, dietetic habits, systemic diseases) (more) may be related with lithogenesis. The objective of this work is to study such factors, and compare them in both groups of MCO lithiasis (papillary and cavity). Methods: We study 40 patients with MCO lithiasis (20 patients papillary and 20 patients cavitary). Medical history was performed (family history of lithiasis; associated diseases such as high blood pressure, diabetes, hyperuricemia, hypercholesterolemia, peptic ulcer disease; dietetic survey to evaluate phytate consumption; professions with high-risk of exposure to toxic agents); 24-hour urine biochemical tests, two-hour urine (pH), and serum biochemical profile were performed. Statistical analysis was performed using student's t test and chi-square. Results: There is a high prevalence of family history of renal lithiasis (45%) without differences between groups. There are not differences in urine or blood biochemical tests. There is a low consumption of phytate-containing foods in both groups, without significant differences. There is a trend to a greater exposure to cytotoxic agents in the papillary group (45%) vs. the cavity group (25%). Hypertension and hyperuricemia are more prevalent in the cavity MCO group (?= 0.025 and ?= 0.010, respectively). Peptic ulcer disease is more prevalent in the papillary MCO group (?= 2.025). There are no significant differences in prevalence of hypercholesterolemia or diabetes mellitus between groups. Conclusions: Papillary MCO calculi are associated with a deficit of crystallization inhibitors (phytates), and disorders of the epithelium covering the renal papilla (cytotoxic agents exposure, peptic ulcer disease). Cavity MCO calculi are associated with a deficit of crystallization inhibitors (phytates) and a greater amount of heterogeneous nucleants (organic material induced by diseases such as hypertension, hyperuricemia, hyperglycemia, and hypercholesterolemia).

Abstract Background. Urinary angiotensinogen (AGT) was reported as a marker of renal injury in chronic kidney disease patients. However, the main source of urinary AGT is unknown in proteinuric patients because the disrupted filtration barrier might cause AGT filtration. We investigated the origin and the clinical importance of urinary AGT in proteinuric IgA nephropathy (IgAN) patients. Methods. In patients with biopsy-proven IgAN, urinary and plasma AGT was measured using a sandwich ELISA and compared with intrarenal AGT expression. The patients were followed up for 3 years. Results. Natural logarithm of the urinary AGT/creatinine (ln (urinary AGT/Cr)) was positively correlated with intrarenal expression of AGT (ln (urinary AGT/Cr) versus AGT/b-actin, r = 0.620, P < 0.0001; ln (urinary AG...

1 The potassium-sparing diuretics, triamterene and amiloride, reduced urinary magnesium excretion in conscious saline-loaded rats. 2 Urinary magnesium-conservation was also detected when amiloride was used in combination with the potent 'loop-blocking' diuretic, frusemide.

The incidence of antibody-coated bacteria (ACB) in the urinary sediments as an indication of the site of urinary tract infections (UTI) was investigated in 103 adult subjects with persistent bacteriuria by means of a direct immunofluorescence technique.

Background: A previous study observed associations of urinary perchlorate with thyroid hormones based on the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Increased levels of urinary perchlorate were associated with increased levels of thyroid stimulating h...

We tested the reliability of a paper strip test for urinary glucose in the diagnosis of urinary tract infection in babies. Though the number of false positive results (0·7%) was acceptable, 36% false negative results was regarded as unsatisfactory for a screening test for urinary tract infection, an...

Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented. (orig.)

Savage, M. O., Wilkinson, A. R., Baum, J. D., Roberton, N. R. C. (1975). Archives of Disease in Childhood, 50, 709. Frusemide in respiratory distress syndrome. The effect of frusemide on urinary volume, urinary sodium excretion, and urinary calcium excretion in 7 premature infants with severe respir...