Medical management of renal lithiasis; increasing the protective urinary colloids with hyaluronidase.
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Urine is a highly saturated solution due to the presence of certain colloids. The protective action of urinary colloids is of major importance in preventing precipitation, agglomeration and conglomeration of crystalloids from a super-saturated solution. If the concentration of such protective colloids is insufficient, stone formation begins or is accelerated. In 680 human subjects, the incidence of stone was found to be almost inversely proportional to the degree of protective urinary colloids present. Urine specimens were subjected to ultramicroscopic examination, determination of electric charge carried by the colloidal particles, determination of the surface tension, and photo-ultramicrographic studies. Subcutaneous injection of hyaluronidase mixed with physiologic saline solution greatly increases the content of protective colloids in the urine. The colloids are caused to set up to a gel, thereby preventing electrolytes present from crystallizing. They act as excellent dispersing agents and prevent the formation of stone. Hyaluronidase therapy, using 150 turbidity reducing units every 24 to 72 hours, was effective in preventing calculous formation or reformation during a period of 11 to 14 months in 18 of 20 patients in whom, previously, stones formed rapidly. In a second series of ten patients in whom stones formed rapidly, larger doses of hyaluronidase, averaging 300 turbidity reducing units every 24 to 48 hours, were given. The period of observation at the time of report was from six to ten months. In this group, there was no new stone formation or enlargement of existing stones as evidenced by x-ray studies at 30- to 60-day intervals. (+info)
The biphasic nature of renal calcification.
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RENAL CALCIFICATION, INDUCED IN RATS BY AN INJECTION OF URANIUM, IS ACCOMPLISHED IN TWO STAGES: a primary accumulation of calcium in association with anions other than phosphate and a secondary conversion of this calcium complex into a precipitate of calcium phosphate. Except for the exclusion of chondroitin sulfate, the nature of the primary anions remains undefined. The accumulation of calcium in the kidney was converted into a precipitate of minimum solubility, and thus the evidence of its primary causation was obliterated. This may well hold true of calcification at other situations. (+info)
Santorinicele containing a pancreatic duct stone in a patient with incomplete pancreas divisum.
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Santorinicele, a focal cystic dilatation of the distal duct of Santorini, has been suggested as a possible cause of the relative stenosis of the accessory papilla, is associated with complete pancreas divisum, which results in acute episodes of pancreatitis or pain. This report describes a case of a santorinicele, which was initially detected by upper gastrointestinal endoscopy as a polypoid mass, in a patient with recurrent abdominal pain. The mass was subsequently proved to be a santorinicele containing a pancreatic duct stone associated with incomplete pancreas divisum on endoscopic retrograde pancreatography. To the best of our knowledge this is believed to be the first description of a santorinicele associated with these characteristic findings. (+info)
A large intrascrotal calculus.
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A large stone with 8.7 cm multiply 7.2 cm multiply 6.5 cm in size and 420 g in weight dropped down spontaneously from a 93-year-old man's scrotum, who had suffered from left intrascrotal mass and pain for more than 20 years. The component of the stone was magnesium ammonium phosphate. To the best of our knowledge, it is the largest intrascrotal calculus reported in the world. We hereby present the case and discuss the diagnosis and etiology of scrotal calculi. (+info)
Giant tonsillolith: report of a case.
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Tonsilloliths or tonsil stones are calcifications that form in the crypts of the palatal tonsils. These calculi are composed of calcium salts either alone or in combination with other mineral salts, and are usually of small size - though there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. We present the case of a 55-year-old woman with a one-year history of dysphagia and pharyngeal discomfort with a foreign body sensation, though the manifestations had recently intensified. Exploration of the oral cavity revealed a hard bulging submucosal mass in the region of the soft palate, at right anterior tonsillar pillar level. The mucosa overlying the lesion appeared erythematous. Computed tomography revealed a large, delimited and highly calcified oval image measuring 2.5 x 1.5 cm, which was subsequently surgically removed. (+info)
Two cases of broncholith removal under the guidance of flexible bronchoscopy.
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Most broncholiths are related to infection with fungus or tuberculosis and they involve the lymph nodes; those cases that are caused by silicosis are rarely seen. Broncholith might lead complication such as bronchial rupture into the mediastinum, which can result in hemoptysis, cough, repeated pneumonia and so on. Flexible bronchoscopy plays an important part in the diagnosis of broncholithiasis, but its therapeutic application in the clinical setting is controversial. We report here on two cases of broncholith removal without complication with the use of a balloon catheter and tripod forceps using flexible bronchoscopy. (+info)
A review of pancreatico-pleural fistula in pancreatitis and its management.
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Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural cavity, most commonly from an enlarging pseudocyst. We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulae and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleural fistula associated with pancreatic duct obstruction. The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient was managed conservatively. However, deterioration in the patients' condition led to an urgent but not emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The patient subsequently completely recovered. (+info)
Crohn's disease with enterolith treated laparoscopically.
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Symptomatic enteroliths are relatively rare. Most occur from ingestion of undigestible materials such as pits or bones. Primary enteroliths are usually from the condition of partial bowel obstruction, diverticular type diseases such as Meckel's or congenital bands. Gallstone ileus is also a more common cause of gastrointestinal stones. Enteroliths associated with Crohn's disease is an extremely rare condition with fewer than 25 cases reported in the literature. Presented herein is such a case successfully treated laparoscopically. (+info)