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Stone Disease (stone + disease)
Selected AbstractsUrinary Stone Disease: The Practical Guide to Medical and Surgical ManagementBJU INTERNATIONAL, Issue 3 2008John Fitzpatrick No abstract is available for this article. [source] The prothrombin gene is expressed in the rat kidneyFEBS JOURNAL, Issue 1 2000Implications for urolithiasis research There is considerable interest in determining the role of prothrombin fragments, especially urinary prothrombin fragment 1 (UPTF1), in the pathogenesis of calcium oxalate (CaOx) urinary calculi. This fragment is present in abundance in the matrix of CaOx crystals generated in human urine in vitro and has also been detected in human urinary stones containing calcium. More recently, prothrombin gene expression has been reported in the human kidney. However, studies examining the renal biosynthesis of prothrombin or perhaps only its fragments during experimental lithogenesis, and in consequence, the role of UPTF1 in stone formation, cannot be carried out in humans. The aim of this investigation therefore was to determine whether prothrombin gene expression is present in the rat kidney. Total RNA was isolated from the kidneys and livers of 12 rats. Using reverse transcriptase PCR, mRNAs corresponding to the thrombin and fragment 1 + 2 (F1+2) regions of prothrombin were analysed by agarose gel electrophoresis. The expression of glyceraldehyde 3-phosphate dehydrogenase was also examined to determine whether the quality of the tissue mRNAs was adequate for analyses. The amplified products were identified by sequence analysis. All kidneys displayed evidence of expression of the thrombin and F1+2 domains of the prothrombin gene. Furthermore, the sequences of these PCR-derived products from kidney were identical to those from liver. This suggests that the prothrombins secreted by these two organs are identical. The fact that prothrombin biosynthesis occurs in both the human and rat kidney presents an opportunity for using established rat models of stone disease to evaluate the influence of lithogenic conditions on prothrombin gene expression, and the potential role of UPTF1 in vivo. [source] Intrascrotal calculi: A very rare stone diseaseINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006BEKIR SUHA PARLAKTAS Abstract, A stone in the hydrocele sac is very rarely encountered, whereas the occurrence of multiple stones in the hydrocele cavity has not been reported before. Numerous intrascrotal stones were encountered in the hydrocele sac of a patient during operation and has prompted us to report this case. [source] Kidney stone disease and risk factors for coronary heart diseaseINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2005SATOSHI HAMANO Abstract Background:, We conducted a case-control study to examine the impact of coronal heart disease (CHD) risk factors on calcium oxalate (CaOX) stone formation. Methods:, Variables included body mass index (BMI), current alcohol use, smoking habit, hypertension, hypercholesterolemia, diabetes mellitus, and hyperuricemia. Data suf,cient for analysis were obtained for 181 CaOX stone formers and 187 controls. Results:, Seven of 181 stone formers (3.9%) had a history of CHD compared with none of 187 control subjects (P = 0.007). In univariate logistic regression analysis, smoking habit (OR 4.41, 95% CI 2.85,6.84, P < 0.0001), hypertension (OR 4.24, 95% CI 2.61,6.91, P < 0.0001), hypercholesterolemia (OR 3.03, 95% CI 1.77,5.20, P < 0.0001) and BMI (OR 1.10, 95% CI 1.04,1.17, P = 0.007) reached statistical signi,cance. In a multivariate logistic regression analysis, smoking habit (OR 4.29, 95% CI 2.68,6.86, P < 0.0001), hypertension (OR 3.57, 95% CI 2.11,6.07, P < 0.0001), and hypercholesterolemia (OR 2.74, 95% CI 1.51,5.00, P = 0.001) reached statistical signi,cance, while BMI (OR 1.06, 95% CI 0.99,1.12, P = 0.09) did not. Conclusions:, CaOX stone formers are signi,cantly associated with several CHD risk factors, including smoking habit, hypertension, hypercholesterolemia, and obesity. [source] Hospitalized Nephrolithiasis after Renal Transplantation in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2003Kevin C. Abbott The national incidence of and risk factors for hospitalized nephrolithiasis (NEP) in renal transplant (RT) recipients has not been reported. We conducted a historical cohort study of 42 096 RT recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. The 1-year incidence of NEP (ICD-9 codes 592.x) after RT in 1997 was compared to the rate of NEP in the general population using the National Hospital Discharge Survey. Associations with time to hospitalizations for a primary diagnosis of nephrolithiasis were assessed by Cox Regression. NEP was uncommon after RT (104 cases per 100 000 person years in 1997). However, females, but not males, had a statistically significant increased risk of NEP compared to the general population (rate ratio for females, 2.84, 95% confidence interval, 2.35,3.58). Kidney stones were more common than ureteral stones, and percutaneous procedures were more common than ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The only risk factor identified for NEP was renal failure due to stone disease (only one case). NEP was uncommon after RT, but was still more common than in the general population. We identified differences in the presentation and management of NEP after RT in comparison to the general population. [source] Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompressionANZ JOURNAL OF SURGERY, Issue 6 2003Joyce S. B. Koh Background: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. Methods: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic para-meters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. Results: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. Conclusions: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression benefits patients with acute cholangitis. [source] Variation in the incidence of and risk factors for the development of nephrolithiasis after radical or partial nephrectomyBJU INTERNATIONAL, Issue 8 2010Aditya Bagrodia Study Type , Prevalence (retrospective cohort) Level of Evidence 2b OBJECTIVE To examine incidence of and risk factors for the development of nephrolithiasis in patients treated with radical nephrectomy (RN) or partial nephrectomy (nephron-sparing surgery, NSS). PATIENTS AND METHODS The study comprised a single-centre review of 749 patients treated with RN or NSS from August 1987 to June 2006. Demographics, medical and stone history, metabolic variables and postoperative stone events were recorded. Data were analysed within subgroups based on treatment (RN vs NSS). Multivariate analysis was used to identify risk factors for postoperative stone formation. RESULTS In all, 499 patients had RN and 250 had NSS (mean age 57.9 years; mean follow-up 6.3 years). There were no significant differences in their demographic factors, but tumours were significantly larger in RN (P < 0.001). There was no significant difference in preoperative urinary pH < 6.0 or stone history. Significantly fewer patients after NSS than RN formed calculi (NSS 1.6% vs RN 8.4%, P < 0.001), developed hypobicarbonataemia (NSS 7.2% vs RN 12.8%, P= 0.020), and a urinary pH of <6.0 (NSS 11.2% vs RN 19.4%, P= 0.004). Multivariate analysis showed that RN (odds ratio 18.18), postoperative urinary pH < 6 (15.63), previous stone disease (13.7), age <60 years (7.33, all P < 0.001), body mass index ,30 kg/m2 (3.26, P= 0.033), male gender (2.67, P= 0.039), and hypobicarbonataemia (2.46, P= 0.034) were significantly associated with the development of postoperative calculi. CONCLUSIONS Patients undergoing RN have a significantly higher incidence of postoperative nephrolithiasis than a well-matched cohort undergoing NSS. In addition to RN, male sex, urinary pH < 6.0, hypobicarbonataemia, history of stone disease, obesity, and age <60 years were significantly associated with postoperative stone formation. [source] A critical analysis of the role of gut Oxalobacter formigenes in oxalate stone diseaseBJU INTERNATIONAL, Issue 1 2009Siddharth Siva Hyperoxaluria is a major risk factor for the formation of calcium oxalate stones, but dietary restriction of oxalate intake might not be a reliable approach to prevent recurrence of stones. Hence, other approaches to reduce urinary oxalate to manage stone disease have been explored. The gut-dwelling obligate anaerobe Oxalobacter formigenes (OF) has attracted attention for its oxalate-degrading property. In this review we critically evaluate published studies and identify major gaps in knowledge. Recurrent stone-formers are significantly less likely to be colonized with OF than controls, but this appears to be due to antibiotic use. Studies in animals and human subjects show that colonization of the gut with OF can decrease urinary oxalate levels. However, it remains to be determined whether colonization with OF can affect stone disease. Reliable methods are needed to detect and quantify colonization status and to achieve durable colonization. New information about oxalate transport mechanisms raises hope for pharmacological manipulation to decrease urinary oxalate levels. In addition, probiotic use of lactic acid bacteria that metabolize oxalate might provide a valid alternative to OF. [source] Outcomes using a fourth-generation lithotripter: a new benchmark for comparison?BJU INTERNATIONAL, Issue 6 2007Michael S. Nomikos OBJECTIVE To evaluate the efficacy of a fourth-generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx-en-Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986. PATIENTS AND METHODS The Sonolith Vision uses an innovative electroconductive shock-wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio-opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location. RESULTS Data from 309 patients who had a complete follow-up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone-free rate for stones of <10 mm was 77%, for 11,20 mm was 69% and for >20 mm was 50%. The overall stone-free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone-free. Additional procedures to render patients stone-free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone-free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications. CONCLUSIONS When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM-3 machine but with lower analgesia requirements and very low re-treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark-gap machines. [source] | ||||||||||