Search

The urinary stone, serum and 24-hour urine concentrations of 14 trace elements were determined in urinary stone patients by inductively coupled plasma atomic-emission spectroscopy. The data obtained for 25 active stone patients and 32 whose last stone episode had occurred at least 12 months previously were compared with those of 25 healthy individuals. Urinary nickel, manganese and lithium excretion, and serum nickel, manganese and cadmium concentrations were statistically significantly lower for active stone patients compared to those with previous stone episodes and healthy individuals. No difference in the concentrations of trace elements could be found, however, for patients with previous stone episodes and healthy individuals. Nickel, manganese, lithium and cadmium could be of significance in the pathological mechanism of stone formation, not from mineralogical or crystallographic viewpoints but for the smooth flow of enzymatic reactions in biological systems.

In 111 patient suffering from calcium oxalate lithiasis more than 168 citrate and calcium analyses have been performed in 24 hour urine. In 69 patients with a single stone episode no significant difference of citrate concentration was found in comparison with 63 healthy volunteers. However, in 42 recurrent stone formers was the citrate concentration significantly diminished (p less than 0.005). The calcium/citrate ratio was in recurrent stone formers markedly higher (5.19 +/- 8.6) than in patients with a single stone episode (3.34 +/- 4.9). However, because great deviation of citrate values the calcium/citrate ratio may not be suitable for evaluation of stone formation risk.

Data from 120 patients diagnosed as having renal cell carcinoma (RCC), and treated in an organ-preserving surgical manner were analyzed from 11 participating Austrian urological centers. The male to female ratio was 66:54. The subjects age ranged from 27 to 75 years with mean age of 59 years. The indication for conservative tissue-saving surgery was a solitary kidney in 48 instances, a bilateral RCC in 18 cases and, in 2 patients, a horseshoe kidney tumor. In 52 cases the indication for conservative surgery was a peripheral, easily resectable, low-stage tumor (elective indication). Results were comparable to radical nephrectomy of low-stage tumors especially relating to survival rates. Ninety-nine patients survived and were tumor free at the point of check up (December 1988). Thirteen patients had either local tumor recurrence and/or metastases and 5 patients died from the disease. The operative mortality and the morbidity rate was very low.

Of 264 patients with urolithiasis those with pure uric acid or urate stones were compared to those with other types of calculi for differences in epidemiologic factors and uric acid, calcium and phosphate metabolism. Patients with uric acid stones were predominantly older men. These patients had comparatively lower incomes and spent less money on food but consumed more alcohol. The urinary pH was lower than in the other groups. The absence of abnormally elevated serum uric acid levels and elevated 24-hour urinary uric acid excretion suggests this variety of uric acid lithiasis to be idiopathic in nature. This finding is supported by the results of standardized oral purine loading, which showed no post-loading differences in serum levels and revealed urinary concentrations in 12 patients with pure uric acid stones and 10 normal subjects. However, there is evidence to suggest that this condition may be a precursor of primary gout. Hereditary mechanisms are absent and the relapse rate is the same as in patients with other stones. Therefore, our results suggest the existence of an idiopathic variety of uric acid lithiasis that, at least in central Europe, occurs more frequently than previously assumed. The condition is not inherited, alcohol consumption is a major etiologic factor and there is no evidence of a causative role of abnormalities in purine metabolism.

10 patients with normocalcemic secondary hyperparathyroidism due to renal hypercalciuria and 1 patient with normocalcemic primary hyperparathyroidism are presented. The diagnostic criteria of both manifestations of disturbed calcium metabolism are outlined. Successful therapeutic approach depends on the exact discrimination between each form of normocalcemic hyperparathyroidism.

The present paper demonstrates the various methods in surgical treatment of complicated nephrolithiasis. The techniques of extended intrasinusal pyelocalicotomy, multiple radial nephrotomies, classic anatrophic nephrotomy, doppler-guided nephrotomies and highly selective anatrophic nephrotomy are described. The advantages and disadvantages of these methods are summarized and the results of treatment in 58 patients are presented.

30 patients who developed an irradiation bladder after radiotherapy of carcinoma uteri were treated with submucosal infiltration of orgotein. In this homogeneous series (same cancer, dosage and exposition of radiation, same sex) the success rate of 86% improvement of subjective symptoms or complete healing was excellent, not to be reached by any other mode of treatment. In one patient an anaphylactic shock was seen. Despite of this event--which happens in great published series in only 1 permille--orgotein infiltration should be the therapy of choice in actinic damaged urinary bladders.

In the rabbit model renal cortical blood flow after 60 min of normothermic ischemia is seen to rise significantly in the early reperfusion period. Under otherwise identical conditions this phenomenon is absent after hypothermic ischemia produced by surface cooling of the kidney and in sham-operated kidneys. It is still unclear whether postischemic hyperemia is a physiologic counterregulatory mechanism in response to 60-min normothermic ischemia of the rabbit kidney or a contributory factor in the development of acute postischemic renal failure.

The infiltration of the ureters, bladder or urethra by recurrent colorectal carcinoma raises both urodynamic and surgical problems. These include the question of whether reconstruction or urinary diversion is indicated. The present paper describes the surgical procedures carried out in 19 patients with tumour extention of recurrent colorectal carcinoma to the urinary tract. In the majority of cases the treatment of choice can be decided only intraoperatively. It is important to choose the procedure which guarantees both surgical radicality and minimal discomfort to the patient.

The relationships between eating and drinking habits, and serum as well as 24-hour urinary concentrations of calcium, inorganic phosphate uric acid and urinary pH were studied in 379 patients in whom stones form. The 24-hour urinary calcium excretion was found to be increased in patients who preferably eat animal proteins and farinaceous foods (p less than 0.1). Regarding drinking habits, urinary calcium and inorganic phosphate excretion was found to increase significantly as a function of alcohol ingestion (p less than 0.01 and p less than 0.001, respectively). Similarly, an increased alcohol intake was found to be associated with higher serum uric acid concentrations (p less than 0.01). A significant increase in urinary pH was confined to patients preferably eating vegetables (p less than 0.05). The results of our study suggest alcohol consumption to be a potentiating factor for the risk of stone formation.

The social infrastructure was investigated in 379 patients with urinary stones. The rates of 50% for employees and 32% for old-age pensioners were surprisingly high. 16% of the patients were employed in jobs with hard manual labour. Only 9% of the patients went in for regular physical activity in their leisure. A significant increase in urinary excretion of calcium and uric acid (p - 0.01) and inorganic phosphate (p less than 0.001) was seen in connexion with increase in net income. On the other hand, urinary pH was lowest in the highest income group (p = 0.01). According to these findings an increased net income combined with a lack of physical exercise seems to enhance the risk of stone formation.

Oral purine loading: a diagnostic procedure in stone forming patients. 95 stone formers (83 patients with calcium oxalate and calcium phosphate, 12 patients with uric acid stones) and 10 healthy volunteers were given 2 g guanosine as an oral purine load. Calcium oxalate and caldium phosphate stone formers showed two different patterns of uric acid excretion after oral purine loading, correlating with different incidence of recurrent stone formation. Patients with uric acid lithiasis showed initially lower values of urate excretion, after oral purine load no difference of uric acid excretion compared to normal controls was seen.

3 patients with U-tube pyelonephrostomy were treated conservatively for multiple struvite (triple phosphate) stones in the kidney by means of constant irrigation with citrate buffer (pH 4.8). Complete dissolution of the stones was achieved in 2 patients. Conservative therapy was unsuccessful in the third case in view of narrowing of the renal calyces. Combined therapy by means of direct irrigation and oral chemotherapy is recommended.

We present a model for oral uric acid loading which may be used to study the relapsing tendency of stone-formers. The oral administration of 2 g of guanosine was associated with two different response patterns of urinary uric acid excretion in patients with urolithiasis. The two groups also had considerably different relapse rates. The relapsing tendency in the group with the comparatively decreased reaction of urate excretion was less pronounced than in the group with enhanced uric acid excretion after oral purine loading.

Contrast filling of the liver after lymphography is described in one patient. The authors agree with the literature which indicates the significance of lymphatic blocks and caval obstruction. A splenoportogram was demonstrated during the performance of a cavogram and in this way direct contrast filling of the liver is demonstrated for the first time.