Urinary Calculi and Ulcerative Colitis

A survey of 458 patients treated for ulcerative colitis either medically or surgically by colectomy and the establishment of an ileostomy has provided further evidence that in Australia at least there is a significant association between ulcerative colitis and urinary calculi. The actual risk to the unoperated patient is not particularly high but is in the vicinity of 4%. The survey further confirms that the risk continues after colectomy and ileostomy, when the overall incidence of stones is roughly doubled. Finally, suggestive though admittedly somewhat inconclusive evidence supports the proposition that uric acid stones are more common in this group of patients.     

Cancer and Ulcerative Colitis

Ulcerative colitis is a potential precursor of cancer of the colon or rectum. In a series of patients with ulcerative colitis operated on between 1952 and 1968 seven developed carcinoma in the residual rectal stump after total colectomy and ileorectal anastomis. After assessment of the risks of the other available forms of treatment, I believe that ileorectal anastomosis is the best operation in the majority of cases.     

Surgical treatment of idiopathic megacolon]

The authors discuss own experience in diagnosis and surgical treatment of 32 patients with idiopathic megacolon. Three surgical techniques were compared: 1) partial excision of the colon, 2) nearly complete excision of the colon with cecum-rectal anastomosis, and 3) total colectomy with ileorectal anastomosis. Basing on the authors' own experience and available literature the third approach is recommended as the most appropriate in the treatment of the persistent, chronic constipation accompanying idiopathic megacolon.     

Ileal vasoactive intestinal peptide (VIP) levels and VIP receptor/effector system in ileal epithelial cells after colectomy in the rat

The interaction of VIP (binding to specific receptors and stimulation of cyclic AMP accumulation) with ileal epithelial cells and the levels of the neuropeptide in the ileal segment were determined after colectomy (removal of cecum and colon followed by ileorectal anastomosis) in the rat. The number of VIP receptors (but not the affinity) and the efficiency (but not the potency) of the neuropeptide upon stimulation of cyclic AMP accumulation in ileal epithelial cells increased 21 (but not 7) days after colectomy, whereas VIP ileal levels followed an inverse pattern. These changes could be interpreted in terms of a consequence or a cause of some of the phenomena that appear after colectomy, i.e., chronic watery diarrhea.     

Tissue prostanoids as biomarkers for chemoprevention of colorectal neoplasia: correlation between prostanoid synthesis and clinical response in familial adenomatous polyposis

Recent studies indicate that sulindac, a nonsteroidal anti-inflammatory drug (NSAID), lowers mucosal prostanoid levels and regresses colorectal adenomas in patients with familial adenomatous polyposis (FAP). To determine whether they are biomarkers for sulindac-mediated chemoprevention of colorectal adenomas, levels of 5 prostanoids [prostaglandin (PG) D2, PGE2, PGF2alpha, thromboxane B2, and 6-keto-PGF1alpha] in the normal-appearing rectal mucosa from 7 FAP patients with a history of subtotal colectomy and ileorectal anastomosis and 4 FAP patients without surgery, were measured in the absence or presence of exogenously added arachidonic acid before the initiation and at the end of 3 months of sulindac treatment. The addition of arachidonic acid resulted in a uniform increase in the levels of all 5 prostanoids although this increase was selectively attenuated in patients with ileorectal anastomosis who took sulindac. In the latter patients, arachidonic acid also augmented the inhibition of prostanoid synthesis by sulindac. In contrast, sulindac failed to attenuate the increase in prostanoid levels resulting from arachidonic acid in patients without previous surgery. Importantly, when measured in the presence of arachidonic acid, the reduction in the levels of all 5 prostanoids due to sulindac was statistically correlated with a reduction in the size and number of adenomas in the two groups of patients combined. These results suggest that tissue prostanoids measured in the presence of arachidonic acid may serve as sensitive and reliable biomarkers in monitoring the clinical responsiveness of FAP patients undergoing chemoprevention for colorectal neoplasia with NSAIDs.     

Effect of Neostigmine on Integrity of Ileorectal Anastomoses

Patients undergoing total colectomy and ileorectal anastomosis for chronic ulcerative colitis were divided into two groups depending on whether neostigmine was administered during the anaesthetic to reverse the muscle relaxant. Those receiving neostigmine showed a postoperative anastomotic leakage rate of 36%. In the group not receiving neostigmine the leak rate was 4%, an apparently highly significant difference. Neostigmine may produce this effect by causing contractions of the gut musculature or by vasoconstriction of the blood vessels to the suture line, resulting in local ischaemia.     

80例血液透析患者上尿路结石患病率及危险因素分析

摘要 目的：分析血液透析患者上尿路结石的患病率及其危险因素,为早期干预提供依据。方法：回顾性分析2017年1月至2018年12月我院肾内科收治的CKD 5期持续性血液透析患者（血液透析组）上尿路结石的患病情况,并与健康体检者80名（对照组,n=80）、CKD1~3期患者（非血液透析组,n=80）进行比较。比较血液透析患者中结石和非结石者人口学资料、血清白蛋白、血糖、血脂、肾功能等生化指标,并记录二者透析时间及24 h尿量。采用多因素logistic回归分析上尿路结石的患病情况的危险因素。结果：血液透析组上尿路结石患病率为25.0%,显著高于非血液透析组13.8%、对照组10.0%(P<0.05);非血液透析组、对照组上尿路结石患病率比较,差异无统计学意义(P>0.05)。结石与非结石患者在性别、透析时间、TG、TC、UA、ALB、24 h尿量方面比较,差异均有统计学意义（P<0.05）。多因素logistic回归分析显示,透析时间、UA、TC是血液透析患者发生上尿路结石的独立危险因素,而ALB则是保护性因素（P<0.05）。结论：血液透析患者上尿路结石的患病率较高,对血脂代谢异常、高血UA、低血清ALB及长期透析者应早期筛查,并纠正脂代谢紊乱和低蛋白血症。     

Hospital Topics: Examination of the Whole Colon with the Fibreoptic Colonoscope

During examination of the intact colon with the Olympus CF LB 185-cm colonoscope it has proved possible to reach the caecum or terminal ileum in 47 out of 50 cases (94%). Careful bowel preparation, moderately heavy sedation, and some x-ray screening are necessary for the procedure, but it was well tolerated by all patients and there was no morbidity. The average time taken to the caecum was 40 minutes and the average time to completion of examination 90 minutes. The long colonoscope was as convenient to use as the fibresigmoidoscope in examinations confined to the sigmoid colon or in patients with a colostomy, ileostomy, or ileorectal anastomosis. Of the two, the long colonoscope is the instrument of choice for clinical use.Because of the expense, time, and equipment involved colonoscopy appears to be best offered as a specialist service after x-ray studies. There is alo a limited place for colonoscopy during abdominal surgery, when it is technically an easier procedure. In this series 10 patients were saved exploratory laparotomy by examination with the colonocope, and we also diagnosed four resectable carcinomas not seen on double-contrast barium-enema studies. The colonoscope provides an effective new means of diagnosis of lesions throughout the colon.     

内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值

摘要 目的：探讨内毒素、降钙素原（PCT）联合中性粒细胞与淋巴细胞比值（NLR）对经皮肾镜碎石术（PCNL）术后患者发生尿源性脓毒血症的预测价值。方法：选取2020年5月-2023年5月于西安医学院第二附属医院和空军军医大学第一附属医院泌尿外科行PCNL的患者750例作为研究对象。根据尿源性脓毒症发生情况分为尿源性脓毒血症组（n=45）和非脓毒血症组（n=705）。检测PCNL术前血清内毒素、PCT、中性粒细胞与淋巴细胞水平，并计算NLR。对比两组血清内毒素、PCT水平及NLR。采用多因素Logistic回归模型分析PCNL术后患者发生尿源性脓毒血症的影响因素。绘制受试者工作特征（ROC）曲线分析血清内毒素、PCT联合NLR预测PCNL术后患者发生尿源性脓毒血症的临床效能。结果：与非脓毒血症组相比，尿源性脓毒血症组血清内毒素、PCT及NLR更高（P<0.05）。多因素Logistic回归模型分析结果显示，血清内毒素升高、PCT升高、NLR升高、尿白细胞阳性、术前发热及鹿角型结石是PCNL术后患者发生尿源性脓毒血症的独立危险因素（P<0.05）；ROC曲线分析结果显示，血清内毒素、PCT联合NLR检测预测PCNL术后患者发生尿源性脓毒血症的曲线下面积（AUC）为0.913，高于上述各指标单独检测。结论：PCNL术前血清内毒素、PCT和NLR升高可能与术后患者发生尿源性脓毒血症有关。血清内毒素、PCT水平升高、NLR升高、术前发热、尿白细胞阳性、鹿角型结石是PCNL术后患者发生尿源性脓毒血症的危险因素。血清内毒素、PCT联合NLR检测对PCNL术后患者发生尿源性脓毒血症具有较高预测价值。     

Management of Patients with Urinary Calculi

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 anatomical abnormality of the urinary tract. The same was true of the stone composition and the need for surgery. It seems that neither routine radiological examination nor regular follow-up is likely to help identify patients whose stones are going to recur.     

Chronic Ulcerative Colitis Before and After Colectomy

There is a proper time to advise removal of the colon and creation of a permanent ileostomy in the course of progressive toxic ulcerative colitis. When a thorough trial of medical therapy, including corticosteroids, has failed to halt progression of the disease, a properly timed colectomy may give the patient a new lease on life and enable him to maintain himself socially and economically.The development of ileostomy (Q-T) clubs has been an important factor in preparing them for and sustaining these young patients through the psychological trauma of an ileostomy. Two patients are described who illustrate the value of properly timed surgery and the contribution that ileostomy clubs can make.     

Plasma levels and urinary excretion of amino acids by subjects with renal calculi

Plasma levels and urinary amino acid excretions were estimated by high-performance liquid chromatography in 15 control subjects and 36 stone formers (SFs) classified according to the stone type: (1) 22 cases with calcium oxalate stones; (2) four cases with pure uric acid stones; (3) 10 cases with magnesium-ammonium phosphate stones, either pure or mixed with apatite. Some types of stones (namely oxalate and uric acid calculi) are mainly formed as a result of a metabolic deficiency that may affect the amino acid metabolism, and thus may be reflected in the urinary amino acid pattern. Data demonstrated clearly that there is a general tendency towards decreased amino acid excretions in all SFs with all types of stones. As a whole, one can observe a higher percentage of patients with calcium oxalate and phosphate calculosis, who have low urine excretions of amino acids; about 50% are the SFs with lower urine excretion of serine, glycine, taurine and i-leucine; the high percentage of patients with CaOX calculi shows lower urine excretions of tyrosine and ornithine.     

Urinary diversion in therapy of pelvic cancer; an appraisal of ileal-ureteral anastomosis

In 43 cases, diversion of the urinary stream was carried out by means of an end-to-side anastomosis of ureters into an ileal segment. Forty-one of these operative procedures were performed in conjunction with the primary or secondary surgical treatment of malignant neoplasm arising in the pelvis. There were six postoperative deaths in this group of patients, none due to the urinary diversion. The remaining patients were observed for periods of from three to sixty months, the mean average eighteen months. During that period, only one patient died (at 42 months) as the result of urinary diversion. In that case death came about because the patient insisted on wearing a Foley retention catheter rather than an ileostomy bag, and the catheter perforated the ileal segment. In only three of the patients did pyelonephritis develop, and the disease was controlled by giving chemotherapeutic agents. In ten patients, some changes in postoperative intravenous pyelograms were observed.     

URINARY DIVERSION IN THERAPY OF PELVIC CANCER—An Appraisal of Ileal-Ureteral Anastomosis

In 43 cases, diversion of the urinary stream was carried out by means of an end-to-side anastomosis of ureters into an ileal segment. Forty-one of these operative procedures were performed in conjunction with the primary or secondary surgical treatment of malignant neoplasm arising in the pelvis.There were six postoperative deaths in this group of patients, none due to the urinary diversion.The remaining patients were observed for periods of from three to sixty months, the mean average eighteen months. During that period, only one patient died (at 42 months) as the result of urinary diversion. In that case death came about because the patient insisted on wearing a Foley retention catheter rather than an ileostomy bag, and the catheter perforated the ileal segment.In only three of the patients did pyelonephritis develop, and the disease was controlled by giving chemotherapeutic agents. In ten patients, some changes in postoperative intravenous pyelograms were observed.     

The Control of Precancerous Conditions of the Colon and Rectum

The early diagnosis and treatment of precancerous lesions is an important means of control of intestinal cancer. The precancerous tendency is relatively slight with solitary colo-rectal polyps, ulcerative colitis and bilharzial infestation, but it is exceptionally severe in familial colonic polyposis.For more than 30 years, research into the inheritance and treatment of familial polyposis has been continued at St. Mark''s Hospital, London, England, and more than 90 families have been investigated and family pedigrees prepared. These now include 1050 “members”, of whom 343 have had either polyposis or intestinal cancer, or both, the number with cancer being 243. One hundred and one of these 343 patients have been operated on at St. Mark''s, 61 undergoing colectomy and ileorectal anastomosis.Cancer control is achieved by keeping under supervision all members of a family who have already developed polyposis or who may do so later.     

RPLU术对重度肾积水的上尿路结石患者尿ET-1、AQP-1、MCP-1水平的影响

摘要 目的：探讨后腹腔镜下输尿管切开取石术（RPLU）对重度肾积水的上尿路结石患者尿内皮素-1（ET-1）、水通道蛋白-1（AQP-1）、单核细胞趋化蛋白-1（MCP-1）水平的影响。方法：收集2018年4月~2019年11月我院收治的106例重度肾积水的上尿路结石患者为研究对象,按照随机数字表法分为对照组和研究组,每组53例,对照组采用输尿管镜取石术治疗,研究组采用RPLU术治疗,对比两组手术情况,手术前后血红蛋白、肾功能、尿ET-1、AQP-1、MCP-1水平,手术并发症发生情况。结果：研究组手术时间及住院时间多于对照组,结石清除率高于对照组,比较差异有统计学意义（P<0.05）;两组术中出血量、术后排气时间比较差异无统计学意义（P>0.05）。术后,两组血红蛋白较术前无显著差异（P>0.05）。术后,两组血肌酐及血尿酸氮均下降,两组比较差异无统计学意义（P>0.05）。术后,两组尿ET-1、AQP-1、MCP-1水平均下降,两组比较无统计学意义（P>0.05）。两组并发症总发生率比较无统计学意义（P>0.05）。结论：RPLU术是治疗重度肾积水的上尿路结石清除率高,创伤小,可作为重度肾积水伴上尿路结石安全、有效的术式。     

Excretion of inhibitors of calcification in urine. Part I. Findings in control subjects and patients with renal stones.

The total excretion of inhibitors of in vitro calcification was measured (in inhibiting units per day) in 24-hour urine samples of 11 control subjects and 20 patients with renal calculi. A semiquantitative method incorporating the rachitic rat cartilage technique was used. In both groups there was a significant positive correlation between the number of inhibiting units per day and the daily urine volume. The mean number of inhibiting units per day was significantly (P smaller than 0.05) higher in the stone patients than in the controls. However, the stone-formers had significantly larger (P smaller than 0.01) 24-hour urine volumes. When corrections were made for urine volume there was no significant difference between the two groups. These data suggest that the underlying abnormality responsible for renal stone formation is not a persistent decrease in the total concentration of urinary inhibitors of calcification.     

Hydrochlorothiazide, allopurinol and magnesium oxide in the treatment of recurrent calcium urolithiasis]

The study aimed at presenting own experience in prevention of new urinary calculi in 18 patients with metabolically active calcium urolithiasis treated with hydrochlorothiazide in daily doses of 100 mg (group I) for 2 years, and in 6 patients with the same disease treated with magnesium oxide in daily doses 300 mg twice a day (group II) for average period of 10 months. In 9 patients a new calculus was formed during the treatment with hydrochlorothiazide, in 7 patients no recurrence was noted, and in 2 remaining patients the results were controversial (coral calculus). Therefore, patients were subdivided into group Ia (failure of hydrochlorothiazide therapy), and group Ib (no recurrence noted). Hydrochlorothiazide did not lead to the stable decrease in the saturation of the urine with calcium oxalate in group Ia whereas in group Ib (without recurrence of urolithiasis) the content of calcium oxalate in the urine was significantly lower than that in group Ia after a 2-year treatment with hydrochlorothiazide (p < 0.01) Recurrence of the disease was seen only in one patient of group II, i.e. treated with magnesium oxide. The treatment of the recurrent calcium urolithiasis is justified and efficient in those patients in whom therapy decreases the content of calcium oxalate in the urine.     

Struvite Urolithiasis in Long–Evans Rats

Struvite urinary calculi, which are composed of magnesium, ammonium, and phosphate, can cause complications including sepsis and renal failure. Struvite calculi were identified within the urinary bladder and renal pelvis of 2 Long-Evans rats that died within days after arrival from a commercial vendor. The remaining rats in the shipment were screened by physical examination, radiography, and ultrasonography, revealing an additional 2 animals that were clinically affected. These rats were euthanized, necropsied, and yielded similar findings to those from the first 2 rats. In addition, urine samples had an alkaline pH and contained numerous bacteria (predominantly Proteus mirabilis), leukocytes, and crystals. All calculi were composed completely of struvite. Another 7 rats in the shipment had alkaline urine with the presence of blood cells; 6 of these rats also had abundant struvite crystals, and P. mirabilis was cultured from the urine of 3 rats. Further investigation by the vendor identified 2 of 100 rats with struvite calculi from the same colony. Although no specific cause could be implicated, the fact that all the affected rats came from the same breeding area suggests a genetic or environmental triggering event; a contribution due to diet cannot be ruled out. Our findings suggest that the affected rats had metabolic disturbances coupled with bacterial infection that predisposed them to develop struvite calculi. During sudden increases of struvite urinary calculi cases in rats, urine cultures followed by appropriate surgical intervention and antibiotic therapy is warranted. Additional factors, including diet, merit attention as well.Struvite, also known as triple phosphate, is a crystalline substance composed of magnesium ammonium phosphate (MgNH₄PO₄• 6 H₂0)¹⁰ that was first identified in the 18th century. This mineral is what consolidates into urinary calculi, or stones, both in humans and animals. Other frequently encountered types of urinary stones include calcium oxalate, calcium phosphate, uric acid, and cysteine.¹⁷ Although only 2% to 3% of stones from humans are composed of struvite,⁴³ struvite calculi are important clinically because they can lead to sepsis and renal failure.⁴³In both humans and animals, stones in the urinary tract can obstruct the urine outflow, with subsequent extreme pain, hydronephrosis, and (possibly) rupture of the urinary bladder. In addition, disruption of kidney function can lead to metabolic imbalances, such as uremia, seizures, depression, anorexia, dehydration, even coma and death.^1,8 Here we present a case study describing the spontaneous presentation of struvite urolithiasis in a recently imported cohort of rats and related significant clinical findings.     

Immunochemical studies of serum, urine and calculus proteins in urolithiasis

Total serum protein levels in 70 patients with urolithiasis were not significantly different from those in 20 control subjects, although certain variations were detected in individual protein patterns. In contrast, total urinary protein was significantly higher in patients with urolithiasis. 4-6 different components, i.e., albumin, alpha 1-acidic glycoprotein, alpha 1-antitrypsin, Gc-globulin, fibrinogen and immunoglobulin G, were found in the matrices of calculi and in urine, suggesting that proteinuria may play a role in the formation of stones in patients with urolithiasis.