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A 67 year old patient with advanced congestive heart failure (CHF) caused by coronary artery disease (CAD) was referred for evaluation of cardiac resynchronisation therapy (CRT). After implantation of a dual chamber pacemaker six months earlier, the clinical status of the patient had worsened from New York Heart Association (NYHA) functional class III …

Stones originating in the tubular system may grow in the renal calyces without being excreted. From the analysis of flow dynamics nearly steady turbulences with long retention times should be expected, in which particles with a density of about 1.0 can grow. By this, hydrodynamics would support the matrix theory of stone genesis. Microscopic structures of the central stone regions also support 'organic early stages in urolith genesis.'

Transmitted light microscope and scanning electron microscope investigations reveal various shapes of urine calcium oxalate crystals. In addition to tetragonal bipyramids, weddellite forms further crystal shapes that have been heretofore interpreted exclusively as whewellite crystals. Weddellite is stabilized by urine foreign ions. In vivo formation of whewellite crystals occurs with massive crystallization only.

The concentration of ashes, Ca, Mg, P, K, Na, Fe, Zn and Cu in testicle, epididymis, seminal vesicle, prostate and ejaculates from 21 healthy human males between 16 and 37 was analysed and compared, and the values discussed. With the exception of K (referred to dry weight) the ejaculate contained the highest quantum and tracer element concentration in comparison with those organs producing and storing the ejaculate liquid. The quantities of various elements found in various organs made conclusions possible about organs, through which such elements are put into the ejaculate liquid.

The relationship between high dose progestagen treatment and changes on the intravenous urogram were studied in 27 patients. For this purpose, six specific features in the urogram were examined. Our findings in the patients available to use indicate that there is no demonstrable dilatation of the renal pelves and ureters as a result of the administration of progestational substances alone. These results are discussed in relation to the relevant literature.

The relationship between high dose progesterone treatment and pregnancy and dilatation of the upper urinary tract was investigated by doing intravenous urograms on eight female rabbits. Ten features of the urogram were studied. It was concluded that the administration of sex hormones to rabbits without any mechanical change in the ureters, did not lead to urographically demonstrable dilatation of the ureters. Negative findings in pregnant animals indicate that the mechanical situation in rabbits differs from that found in human pregnancy. The results are discussed with relation to the available literature.

7 female rabbits were given subcutaneous implants of ethinyl estradiol; 2 rabbits were given subcutaneous placebo implants. Urographic tests were performed before the implantations and 3 6 and 12 weeks after the implantations. The urethral width was measured at 11 places along the upper part of each ureter. In some cases there were significant reductions in the diameter of the ureter. It was concluded that the administration of estrogens without simultaneous mechanical manipulation does not cause dilatation of the urethra. (Summary in ENG)

In profile urines from oxalate stone patients and normal persons the progress of concentration and excretion of 10 urine parameters was investigated. For the majority of lithogenic and litholytic urine substances, especially for oxalic acid, a day-and-night rhythm was proven. This may be transferred to a principle of zonary structure of weddellite crystals, explaining the periodically recurring change of weddellite layers of different dissolution resistances arising from different growth rates due to different concentrations of supersaturated urine.

To check the effect of different therapies on stone formation in animals two models were used: 1. sterile foreign body implantation into the urinary bladder. 2. production of intrarenal calcium oxalate crystals by means of ethylene glycol and sodium glyoxylate intoxication.

Disturbances in purine metabolism with hyperuricaemia and/or hyperuricosuria are a risk factor in uric acid and Ca oxalate stone formation. By way of a competitive xanthine oxidase inhibition, the formation of uric acid is reduced by allopurinol. In investigations on two groups of patients, Milurit could be demonstrated to decrease the uric acid levels in serum and urine. No differences could be seen in the dosages of 3 x 100 mg or 1 x 300 mg Milurit. Therefore, in stone recurrence prevention, the administration of Milurit 300 is recommended.

Responses to a questionnaire on the terms urolith and recurrent urolith from 29 stone research workers from all over the world were analyzed. Although a general definition of urolith was possible from these responses the term recurrence raised various opinions and objections. Until more data are obtained on stone genesis additional stone formation in a patient should be referred to as a recurrence, irrespective of its composition, site and interval since the preceding stone episode.

25 to 30% of calcium oxalate urinary calculi consist of the metastable Weddellite crystal phase. By fractionation of urine it was found that mineral substances are stabilising factors. The stability was checked in dry condition at room temperature at 38 degrees C and at 110 degrees C. These results could be confirmed by precipitation from synthetic solutions. Mg, Zn, Ni, Co, Mn and Cu individually, and above all in combination, promote the formation of Weddellite. The formation of mixed crystal phases must be considered one of the main factors for the stabilisation of Weddelite in the urinaty calculus.

Modern physicochemical methods, X-ray diffraction, infrared spectroscopy and thermoanalysis yield the best results in the differentiation of the constituents of urinary calculi. The comparison of 100 analyses did not bring any erroneous diagnosis, the main constituent was unambiguously ascertained. Slight differences in the results have no bearing upon therapy. The equipment needed for these determinations is very expensive. The effective and absolute time consumptions differ depending on the method. These economic factors are disregarded in the present work. The quantitative chemical analysis cannot compete with other methods, though with a 2% limit of error it is well suitable for practice.