Eficacia y seguridad de la técnica americana modificada en un puerto de trabajo para colecistectomía laparoscópica / Efficacy and safety of the modified american technique in a working port for laparoscopic

Objetivo: Evaluar la eficacia y seguridad de la técnica americana modificada con un puerto de trabajo (TAMPT) en línea media para colecistectomía laparoscópica. Métodos: Se elaboró estudio prospectivo, comparativo, descriptivo de corte transversal, en pacientes con litiasis vesicular en el servicio de Cirugía General del Hospital Universitario de Caracas, durante enero-agosto 2022. Resultados: se realizaron 79 colecistectomía laparoscópicas, 34 por técnica americana y 45 con TAMPT. La TAMPT (40.26%) se ejecutó con intervalo de 30-60 min. La estancia hospitalaria promedio global fue 1,75 ± 0,87 días. El promedio global de dolor a las 24 horas fue de 4,43 ± 0,68, según escala visual analógica (EVA). Los procedimientos realizados con TAMPT no presentaron complicaciones, con la técnica americana, se reportó dos: bilioma y lesión de víscera hueca, representando 2.54%. Conclusiones: La TAMPT, ha demostrado ser una técnica segura y eficaz como tratamiento quirúrgico de la litiasis vesicular, tanto para procedimientos electivos como de emergencia(AU)

Objective: To determine the efficacy and safety of the modified American technique in a working port (MATWP) for laparoscopic cholecystectomy. Methods: A prospective, comparative, descriptive, cross-sectional, descriptive study was elaborate. In patients with vesicular lithiasis in the General Surgery Service of the Hospital Universitario de Caracas, during January-August 2022.Results: 79 laparoscopic cholecystectomies were performed, 34 by American technique and 45 with modified technique. The modified technique (40.26%) was performed with an interval of 30-60 min. The overall average hospital stay was 1.75 ± 0.87 days.The global average pain at 24 hours was 4.43 ± 0.68, according to visual analog scale (VAS).The procedures performed with MATWP did notpresent complications; the American technique reported two bilioma and hollow viscera lesion, representing an overall rateof 2.54%. Conclusions: MATWP has proven to be a safe and effective technique for surgical treatment of gallbladder stones, both for elective and emergency procedure(AU)

Colangitis aguda por coledocolitiasis múltiple en un paciente con COVID-19 tratada mediante colangiopancreatografía retrógrada endoscópica

Introducción: La coledocolitiasis es una enfermedad en la cual el conducto biliar común está ocupado por cálculos. La colangiopancreatografía retrógrada endoscópica juega un papel importante en el tratamiento, al conseguir el aclaramiento de la vía biliar principal y restaurar el paso normal de la bilis. Objetivo: Presentar un paciente con la COVID-19 y colangitis aguda por coledocolitiasis múltiple, que se le realizó colangiopancreatografía retrógrada endoscópica. Caso clínico: Mujer de 58 años, antecedentes de cálculos en vesícula biliar, que ingresó en estado de shock séptico por posible colangitis aguda y síntomas respiratorios leves, con prueba positiva para la COVID-19. Por ultrasonido abdominal se le diagnosticó coledocolitiasis y se le realizó colangiopancreatografìa retrógrada endoscópica, se visualizaron múltiples cálculos en colédoco. Se logró el drenaje exitoso de la vía biliar principal, sin complicaciones y evolución favorable. Conclusión: La terapéutica realizada fue una buena opción, en el contexto clínico, de una paciente con la COVID-19 y colangitis aguda por litiasis coledociana.

Introduction: Choledocholithiasis is a disease in which the common bile duct is occupied by stones. Endoscopic retrograde cholangiopancreatography plays an important role in the treatment where the normal passage of bile is restored. Objective: To present a patient with COVID-19 and acute cholangitis due to multiple choledocholithiasis, who underwent endoscopic retrograde cholangiopancreatography. Clinical case: A 58-year-old woman, with a history of gallbladder stones, who was admitted in a state of septic shock due to possible acute cholangitis and mild respiratory symptoms, with a positive test for COVID-19. Choledocholithiasis was diagnosed by abdominal ultrasound and endoscopic retrograde cholangiopancreatography was performed, showing multiple stones in the common bile duct. Successful drainage of the main bile duct was achieved, without complications and favorable evolution. Conclusion: The treatment performed was a good option, in the clinical context, of a patient with COVID-19 and acute cholangitis due to common bile duct stones.

Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Fístula colecistoduodenal sin migración de cálculo: reporte de caso / Cholecystoduodenal fistula without gallstones migration: case report / Fístula colecistoduodenal sem migração de cálculos: relatório de caso

El síndrome de Bouveret es una causa infrecuente de íleo biliar, posee una elevada morbimortalidad. Se produce por la migración de un cálculo, generalmente de gran tamaño, hacia el tracto gastrointestinal a través de una fistula colecistoduodenal. El objetivo de esta carta científica es presentar un paciente con un estadio previo de la enfermedad donde la fistula se encuentra constituida, pero sin migración del cálculo, por lo que el diagnóstico oportuno tendría un impacto favorable en el tratamiento y pronóstico debido a que no se encuentra instaurado el cuadro obstructivo intestinal.

Bouveret's syndrome is a rare cause of biliary ileus, with a high morbimortality. It is caused by the migration of a stone, usually large, into the gastrointestinal tract through a cholecystoduodenal fistula. The objective of this scientific letter is to present a patient with a previous stage of the disease where the fistula is constituted, but without migration of the calculus, so that the timely diagnosis would have a favorable impact on the treatment and prognosis because the obstructive intestinal condition is not established.

A síndrome de Bouveret é uma causa rara de íleo biliar com uma morbilidade e mortalidade elevadas. É causada pela migração de uma pedra, geralmente grande, para o tracto gastrointestinal através de uma fístula colecystoduodenal. O objectivo desta carta científica é apresentar um doente com uma fase anterior da doença em que a fístula está presente, mas sem migração da pedra, para que o diagnóstico atempado tenha um impacto favorável no tratamento e prognóstico, uma vez que a condição obstrutiva instestinal não está estabelecida.

Obstrucción intestinal alta secundaria a íleo biliar. Un reto diagnóstico en el adulto mayor

El íleo biliar es una patología poco frecuente y surge más frecuentemente en el adulto mayor como complicación de la colelitiasis. Se trata de una enfermedad en que un cálculo proveniente del árbol biliar condiciona obstrucción mecánica con dilatación y posterior inflamación de asas intestinales. Su presentación clínica suele ser inespecífica, resultando un reto diagnostico la misma, se acompaña de dolor y distensión abdominal, náuseas, vómitos y alteración del ritmo evacuatorio. El tratamiento generalmente requiere del abordaje quirúrgico en busca de prevenir el desarrollo de otras complicaciones. Se presenta el caso clínico de un paciente varón, adulto mayor que acude al Instituto de Gastroenterología Boliviano Japonés de Cochabamba, Bolivia, con una presentación inespecífica del cuadro clínico tras una internación previa que no resolvió el cuadro inicial y cuyo diagnóstico requirió de la realización de estudios de imagen ampliados, como tomografía axial computarizada con contraste, para su posterior resolución quirúrgica.

Gallstone ileus is a rare pathology and it arises more frequently in the elderly as a complication of cholelithiasis. It is a disease in which a stone from the biliary tree conditions mechanical obstruction with dilatation and subsequent inflammation of intestinal loops. Its clinical presentation is usually non-specific, resulting in a diagnostic challenge it is accompanied by pain and abdominal distension nausea, vomiting and alteration of the evacuatory rhythm. Treatment generally requires a surgical approach in order to prevent the development of other complications. We present the clinical case of a male patient, elderly, who attends the Japanese Bolivian Gastroenterology Institute of Cochabamba, Bolivia, with a nonspecific presentation of the clinical picture after a previous hospitalization that did not resolve the initial picture and whose diagnosis required performance of extended imaging studies, such as contrast- enhanced computed tomography, for subsequent surgical resolution.

Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

Causes and Countermeasures of Complications After Bariatric Surgery / 中国医学科学院学报

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy characterized by simple operation and few postoperative complications have gradually become the two most commonly used surgical methods in clinical practice.A series of complications often occur after bariatric surgery,including gallstone disease,anemia,malnutrition,gastroesophageal reflux disease,kidney stones,and birth defects in offspring of women of childbearing age.There are controversies regarding the causes and countermeasures of these complications.This article mainly reviews the risk factors and countermeasures for the complications after bariatric surgery.

A single-center study of the clinical characteristics of stone cultures and preoperative urine cultures of patients with kidney stones / 现代泌尿外科杂志

【Objective】 To analyze the clinical characteristics of stone culture and preoperative urine culture of patients with renal calculi in Songjiang area of Shanghai and the relationship with postoperative infection. 【Methods】 The clinical data of 213 patients with kidney stones treated at our hospital during Jan.2020 and Jun.2022 were retrospectively analyzed. All patients underwent preoperative clean midcourse urine culture, drug sensitivity test and stone culture. The gender difference between male and female patients and the difference in postoperative infection between stone/bacterial culture positive and negative patients were analyzed. 【Results】 Among the 213 patients, 47(22.1%) had positive urine culture, and the most common bacterium was Escherichia coli (20 strains, 42.6%). The proportion of Escherichia coli was significantly higher in female patients than in male patients [12 strains (48.0%) vs.8 strains (36.4%), P<0.05], while the proportion of Klebsiella pneumoniae was significantly higher in male patients than in female patients [5 strains (22.7%) vs. 3 strains (12.0%), P<0.05]. Drug sensitivity results showed the main Gram-negative bacteria were highly resistant to ampicillin/sulbactam, cefazolin and cefuroxime, but sensitive to imipenem, kanamycin and piperacillin/tazobactam. The main Gram-positive bacteria were highly resistant to clindamycin, erythromycin and levofloxacin, but sensitive to vancomycin, teicoplanin and linezolid. Stone culture was positive in 31 cases (14.6%), and the most common bacterium was Proteus mirabilis (9 strains, 29.0%). However, there was no significant difference in the main bacterial spectrum between male and female patients. The positive rate of urine culture/stone culture in patients with postoperative fever/urosepsis was significantly higher than that in patients with negative urine culture/stone culture (P<0.05). 【Conclusion】 Escherichia coli is the main urinary spectrum of patients with kidney stones in Songjiang area, which is greatly different from the stone culture results. In clinical practice, etiological detection and antibiotics are necessary to reduce the occurrence of postoperative infection.

Associations of Oxalate Consumption and Some Individual Habits with the Risk of Kidney Stones / 中国医学科学杂志(英文版)

Kidney stone is a highly recurrent disease in the urinary tract system. Most kidney stones are calcium stones, usually consisting of either calcium oxalate or calcium phosphate. Supersaturation of soluble calcium, oxalate, phosphate, and citrate in the urine is the basis for calcium stone formation. Genetics, diet, low physical activity, and individual habits contribute to the formation of kidney stones. In this review, the associations of the risk of kidney stones with oxalate consumption and some individual habits, such as smoking, alcohol drinking, and opium consumption, are summarized.

Diagnosis and treatment of four cases of asymptomatic and non-hydrous ureteral calculi / 北京大学学报(医学版)

This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.

Effect of Quercus Salicina Extract Capsules on preventing adherent stones on ureteral stent tube after percutaneous nephrolithotomy / 国际外科学杂志

Objective:To explore the effect of Quercus Salicina Extract Capsulese on preventing the formation of adherent stones on ureteral stent tube after percutaneous nephrolithotomy (PCNL).Methods:The clinical data of 186 patients who underwent PCNL due to unilateral renal stone in the Affiliated Hospital of Xuzhou Medical University from October 2018 to April 2020 were retrospectively analyzed. All of the patients were indwelling 6 F ureteral stent tube during operation. After postoperative reexamination of kidneys, ureters and bladder, it was confirmed that the postoperative residual stones were clinically meaningless stones (maximum diameter ≤ 4 mm). According to postoperative medication, they were divided into drug group ( n=62) and control group ( n=124). Patients in the drug group were given oral Quercus Salicina Extract Capsules, while patients in the control group did not take the drug. Both groups received the same health education and dietary guidance after operation. The formation of adherent stones on ureteral stent tube was observed when the ureteral stent tube was removed 6 weeks after PCNL. Meanwhile, the adverse reaction, complication and treatment satisfaction of the patients were recorded during the period of taking the drug. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the count data between groups. Results:When the ureteral stent tube was removed 6 weeks after PCNL, the weight of adherent stones on ureteral stent tube in the drug group was (334.20±26.65) mg for male, and (336.00±25.64) mg for female. In the control group, the weight of adherent stones on ureteral stent tube was (374.11±42.28) mg for male, (374.42±42.44) mg for female. The weight of adherent stones on ureteral stent tube in the drug group was significantly lighter than that in the control group, and the difference was statistically significant ( P<0.01). The drug group had no obvious serious adverse reaction during the period of taking the drug. At the same time, the complications of the drug group during the intubation period were significantly less than the control group, and the difference was statistically significant ( P=0.040). The satisfaction of patients in the drug group was 93.5%, and that in the control group was 82.3%. The difference was statistically significant between the two groups ( P=0.036). Conclusion:Quercus Salicina Extract Capsules can effectively prevent the occurrence of adherent stones on ureteral stent tube after PCNL, and there are no serious adverse reaction, which is worthy of clinical promotion.

Predictive value of dual-source stone energy spectrum CT for uric acid stones / 中华泌尿外科杂志

Objective:To investigate the predictive value of stone composition prediction method based on dual-source stone energy spectrum CT for uric acid stones.Methods:The clinical data of 204 patients with urinary stones, 159 males and 45 females, admitted to Shanghai Sixth People's Hospital from July 2020 to July 2022 were retrospectively analyzed. The average age was (50.7±14.3) years. There were 187 cases of upper urinary tract (kidney, ureter) stones and 17 cases of lower urinary tract (bladder, urethra) stones. All patients underwent preoperative dual-source stone energy spectroscopy CT, measuring CT values at 150 kV and 100 kV, respectively, and the calculated dual energy ratio (Ratio) was used to predict stone composition. Of the 204 cases in this group, 33 cases underwent percutaneous nephrolithotomy and 171 cases underwent ureteroscopic lithotripsy. Postoperative stone specimens were analyzed for stone composition by infrared spectroscopy. Subject work characteristic (ROC) curves were used to analyze the efficacy of preoperative dual-source stone energy spectrum CT to predict uric acid stones.Results:In 204 patients, preoperative CT predicted 28 cases of uric acid stones and 176 cases of non-uric acid stones, including 136 cases of calcium oxalate stones, 38 cases of hydroxyapatite, and 2 cases of cystine stones. Postoperative IR spectral analysis detected 26 cases of uric acid stones and 178 cases of non-uric acid stones, including 129 cases of calcium oxalate stones, 47 cases of hydroxyapatite, and 2 cases of cystine stones. Compared with the preoperative CT results, there were 2 false positives and no false negatives in the classification of uric acid stones. The ROC curve showed that the sensitivity of the CT value for predicting uric acid stones at 100 kV was 96.2%, the specificity was 99.5%, and the area under the ROC curve (AUC) was 0.995, with the best prediction value of 620 HU.The sensitivity of the CT value for predicting uric acid stones at 150 kV was 96.2%, specificity was 85.5%, AUC was 0.916, and the best predictive value was 597.5 HU. The sensitivity of using Ratio values for predicting uric acid stones was 100.0%, specificity was 97.9%, AUC was 0.996, and the best predictive value was 1.14. The CT values for uric acid stones at 100 kV and 150 kV were (558.58±77.07) HU and (521.12±83.54) HU, CT values for calcium oxalate stones were (1 335.26±301.82) HU and (878.21±200.21) HU, CT values for hydroxyapatite were (1 104.09±203.61) HU and (710.38±178.44) HU, respectively.The CT values of cystine stones were (684.5±67.18) HU and (573.5±67.10) HU, respectively, and the differences between uric acid stones and other components were statistically significant ( P<0.01). The Ratio values of uric acid stones, calcium oxalate stones, hydroxyapatite, and cystine stones were 1.08±0.06, 1.52±0.08, 1.62±0.40, and 1.19±0.02, respectively, and the differences were statistically significant ( P<0.01) when comparing uric acid stones with other components. Conclusion:The CT and Ratio values of dual-source stone energy spectrum CT can effectively distinguish uric acid stones from other types of stones, and the accuracy, sensitivity, and specificity of this method for predicting uric acid stones are high.

Highlights and interpretation of urinary stone research at 2023 AUA / 中华泌尿外科杂志

The research highlights and latest developments on urinary tract stones at the 2023 American Urological Association (AUA) annual meeting mainly include several aspects, including stone metabolism and basic research, drug treatment and dietary prevention, application of new technologies in lithotripsy, development of new equipment, and innovation in the combination of artificial intelligence and medical industry. In term of basic research, new breakthroughs have been made in the formation mechanism of Randall plaque and stones microbiology and proteomics. The update and iteration of new lithotripsy instruments make minimally invasive technology efficient and safe. The widespread application and in-depth expansion of artificial intelligence machine learning and imageomics have shown strong advantages in preoperative diagnosis and postoperative prediction. The drug treatment and dietary prevention for genetic related stone diseases have been given special attention. In addition, public social media platforms and medical self media have begun to provide more active science popularization and education for the public.

Progress on biliary flora and primary intrahepatic stone formation / 公共卫生与预防医学

Primary intrahepatic stone （PIS）is one of the intractable diseases in hepatobiliary surgery and an important cause of death from benign biliary tract diseases, and it has a high prevalence in the Yangtze River basin and southeastern coastal areas of China. At present, the mechanism of PIS occurrence has not been fully elucidated, but the role of biliary flora in the formation of PIS has been recognized by more and more studies. This article reviews the research progress of biliary flora in the formation of PIS with a view to strengthening the clinical understanding of mechanism of PIS, increasing the attention to the detection of biliary flora, and providing a reference for the prevention and treatment of PIS and the improvement of prognosis.

Experience on the surgical management of biliary stones in Sokoto,North West Nigeria

Background:Cholelithiasis are relatively rare in Nigeria and Africaat large. However, recently the incidence has been reported to be on the rise. We present a ten-year review of our experience in managing gallstones to highlight the recent trends in our practice.Methods:This is a 10-year retrospective study on patients who were managed for gall bladder disease in the Usmanu Danfodiyo university teaching hospital Sokoto from August 2011 to July 2021. The biographic data, clinical features, radiologic, operative findings, histologic findings and outcome of treatment were analyzed with IBM SPSS 25. Results:There were 82 patients over the period of the study comprising of 18 (22%) males and 64 females (78%). Their ages range was 17 to 60 years with a mean of 37.59 years �.02. All patients had right upper quadrant pain as the main complaint with 24 patients (29.3%) having associated epigastric pain and 14 patients (17.1%) presented with jaundice. Preoperative ultrasound (USS) diagnosis was in keeping with intraoperative diagnosis in 97.6%. All patients had cholecystectomy out of which 62 patients (75.6%) had open cholecystectomy while 20 patients (24.4%) had laparoscopic cholecystectomy. There was no hospital mortality, the average hospital stay was 8.2 days following open cholecystectomy however this was shorter, 4.5 days for laparoscopic procedure.Conclusions:The prevalence of gallstones is still comparatively low when compared to the western world. Ultrasonography is very sensitive imaging modality.Laparoscopic cholecystectomy is safe and superior to open surgery in our environment.

Xanthogranulomatous pyelonephritis in a pediatric patient / Pielonefrite xantogranulomatosa em paciente pediátrico

Abstract Introduction: Xanthogranulomatous pyelonephritis consists of a chronic infectious and inflammatory process of the renal parenchyma, a variant of chronic obstructive pyelonephritis. It is more prevalent in middle-aged adults, rare in pediatric patients, with less than 300 cases reported in children worldwide. Report: Preschooler, aged 2 years and 11 months, male, with 2 months of abdominal distention, increased temperature and intense pallor, associated with microcytic anemia refractory to the use of ferrous sulfate. 1 week before, he had a bulging in his left flank and a hard palpable mass there. Imaging exams (ultrasound and tomography) revealed an overall enlargement of the left kidney, destruction of the renal parenchyma and intense calyceal dilation, forming the "bear's paw" sign, with a staghorn calculus in the pelvis. He underwent treatment with antibiotic therapy and total nephrectomy, with a specimen sent for pathological examination. Discussion: a disease of uncertain incidence in the pediatric age group, xanthogranulomatous pyelonephritis is more prevalent in male children and affects mainly the left kidney, being frequently associated with the presence of stones. Clinically, it has nonspecific symptoms, the most common being abdominal distension and asthenia. Laboratory exams shows microcytic, leukocytosis, thrombocytosis and increased inflammation, pyuria, hematuria and proteinuria, in addition to bacterial growth in urine culture. The diagnosis is anatomopathological, but it can be hinted by contrasted CT scan, with the classical sign of the "bear's paw". Treatment may include nephrectomy and broad-spectrum antibiotic therapy.

Resumo Introdução: A pielonefrite xantogranulomatosa consiste em um processo infeccioso e inflamatório crônico do parênquima renal, variante da pielonefrite obstrutiva crônica. É mais prevalente em adultos na meia-idade, de ocorrência rara em pacientes pediátricos, com menos de 300 casos relatados em pediatria no mundo. Relato: Pré-escolar de 2 anos e 11 meses, do sexo masculino, com quadro de 2 meses de distensão e aumento da temperatura abdominal e palidez intensa, associado a anemia microcítica refratária ao uso de sulfato ferroso. Apresentava ainda, havia 1 semana da internação, abaulamento em região do flanco esquerdo e massa palpável, de consistência endurecida. Exames de imagem (ultrassonografia e tomografia) revelaram aumento global do rim esquerdo, destruição do parênquima renal e intensa dilatação calicial formando o sinal da "pata de urso", com presença de cálculo coraliforme em pelve. Submetido a tratamento com antibioticoterapia e nefrectomia total, com produto enviado para anatomopatológico. Discussão: Doença de incidência incerta na faixa pediátrica, a pielonefrite xantogranulomatosa é mais prevalente no sexo masculino na infância e acomete principalmente o rim esquerdo, estando frequentemente associada à presença de cálculos. Clinicamente apresenta-se como quadro arrastado de sintomas inespecíficos, sendo os mais comuns distensão abdominal e astenia. Laboratorialmente, apresenta-se com anemia microcítica, leucocitose, trombocitose e aumento de provas inflamatórias, piúria, hematúria e proteinúria, além de crescimento bacteriano em cultura de urina. O diagnóstico é anatomopatológico, porém pode ser sugerido pela tomografia computadorizada com contraste, que tem como sinal clássico a "pata de urso". O tratamento pode incluir nefrectomia e antibioticoterapia de amplo espectro.

Descripción de las características sociodemográficas y clínicas de pacientes con litiasis renal

Contexto: los cálculos renales son cúmulos o depósitos de minerales que se forman en los cálices, la pelvis renal o el tracto urinario. Objetivo: describir las características sociodemográficas y clínicas de una muestra de pacientes con litiasis renal, mayores de 18 años. Metodología: estudio observacional descriptivo de pacientes atendidos en una consulta ambulatoria de Nefrología en Manizales en el periodo 2010-2020, donde se contaba con estudios en sangre, orina de 24 horas y estudio fisicoquímico del cálculo, además de datos sociodemográficos y clínicos relacionados. Se fragmentaron en grupos, de acuerdo con los hallazgos encontrados en los cálculos disponibles, dividiéndose en oxalato de calcio en su totalidad, calcio mixto con otro compuesto y el último grupo de cálculo no calcio. Resultados: se identificaron 54 pacientes con nefrolitiasis, de los cuales 14 de ellos fueron excluidos. Finalmente, 40 pacientes cumplieron con los criterios de inclusión. La mediana de edad fue 52,5 años, predominio del sexo masculino (55 %), donde se encontró en 20,5 % hiperuricemia, hipercalcemia en 17,6 %, hiperfosfatemia en 5 % e hipercaliemia en 7,5 %. En orina se encontró: hipocitraturia en el 71,1 %, seguido de hipercalciuria (12,5 %), hiperuricosuria (10 %) e hiperoxaluria (5 %). En 17 de los pacientes (42,5 %) se logró el estudio de la composición fisicoquímica del cálculo, en ellos la variedad de calcio mixto fue la más frecuente (55,5 %). Conclusiones: este estudio describe las características de pacientes con cálculos renales, mostrando que la mayoría tiene alteraciones metabólicas asociadas a nefrolitiasis, siendo la hipocitraturia el hallazgo más frecuente y que la mayoría de los cálculos tiene calcio en su composición.

Background: Kidney stones are accumulations or mineral deposits that form in the calyces, renal pelvis, or urinary tract. Purpose: To describe the sociodemographic and clinical characteristics of a sample of patients with kidney stones over 18 years of age. Methodology: Descriptive observational study. Patients treated in an outpatient nephrology and urology consultation in Manizales during the years 2010 to 2020, in which there were studies in blood, 24-hour urine, and a physicochemical study of the stone, as well as related sociodemographic and clinical data. They were divided into groups, according to the findings found in the available stones, dividing into calcium oxalate in its entirety, calcium mixed with another compound and the last group of non-calcium stone. Results: 54 patients with nephrolithiasis were identified, 14 of them were excluded. Finally, 40 patients met the inclusion criteria. Median age was 52.5 years, male predominance (55%), hyperuricemia was found in 20.5%, hypercalcemia in 17.6%, hyperphosphatemia in 5% and hyperkalemia in 7.5%. In urine, hypocitraturia was found in 71.1%, followed by hypercalciuria (12.5%), hyperuricosuria (10%), and hyperoxaluria (5%). In 17 patients (42.5%) there was a result of the physicochemical composition of the stone, in them the mixed calcium variety was the most frequent (55.5%). Conclusions: This study describes the characteristics of patients with kidney stones, showing that the majority have metabolic alterations associated with nephrolithiasis, hypocitraturia being the most frequent finding, and that most stones have calcium in their composition.

Cáncer de vesícula biliar, una visión actual / Gallbladder cancer, a current view

Introducción. El diagnóstico de cáncer de vesícula biliar se realiza generalmente de forma incidental durante el estudio de las piezas quirúrgicas o cuando la enfermedad está avanzada y se expresa por su diseminación. Muy pocas veces se diagnostica de forma preoperatoria. Corresponde a la neoplasia más común de las vías biliares y su incidencia varía de acuerdo a la región geográfica. La región andina en Latinoamérica presenta una de las mayores incidencias a nivel mundial. Métodos. Se realizó una revisión narrativa de la literatura, para presentar una información actualizada en lo referente a los factores de riesgo (incluyendo las alteraciones genéticas y moleculares), al diagnóstico y al tratamiento de esta patología. Basados en los datos actuales, presentamos algunas recomendaciones dirigidas al diagnóstico temprano, que permita un manejo más adecuado de nuestros pacientes. Resultados. Se han implicado nuevos factores de riesgo relacionados con la etiología del cáncer de vesícula biliar, como la obesidad, factores genéticos y moleculares. A pesar de la disponibilidad de los métodos diagnósticos imagenológicos, no ha ocurrido una importante variación porcentual en cuanto al estadio al momento del diagnóstico. Conclusiones. El manejo quirúrgico del cáncer de vesícula biliar está indicado en los estadios más tempranos de la enfermedad y es importante evaluar las opciones terapéuticas en pacientes con enfermedad avanzada. Se considera de suma importancia el estudio anatomopatológico de la pieza quirúrgica y la revisión del informe por parte del cirujano.

Introduction. The diagnosis of gallbladder cancer is generally made incidentally during the study of the surgical pieces or when the disease is advanced and is expressed by its dissemination. It is rarely diagnosed preoperatively. It corresponds to the most common neoplasm of the bile ducts and its incidence varies according to the geographical region. The Andean region in Latin America presents one of the highest incidents worldwide. Methods. A narrative review of the literature was carried out to present updated information regarding risk factors (including genetic and molecular alterations), diagnosis and treatment of this pathology. Based on current data, we present some recommendations aimed at early diagnosis, which allows a more adequate management of our patients. Results. New risk factors related to the etiology of gallbladder cancer have been implicated, such as obesity, genetic and molecular factors. Despite the availability of diagnostic imaging methods, there has not been a significant percentage variation in terms of stage at diagnosis. Conclusions. Surgical management of gallbladder cancer is indicated in the earliest stages of the disease and it is important to evaluate therapeutic options in patients with advanced disease. The pathological study of the surgical piece and the review of the report by the surgeon are considered of utmost importance.

Laparoscopic Common Bile Duct Exploration for Treatment of Common Bile Duct Stones:Clinical Analysis of 158 Cases / 中国医学科学院学报

Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.

Minimally invasive treatment with anterograde multiple endoscopes for upper urinary tract stones in allograft kidney / 中华泌尿外科杂志

Objective:To discuss the clinical experience and efficacy of minimally invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney.Methods:We retrospectively analyzed 14 patients with upper urinary tract stones in allograft kidney admitted to our hospital from June 2018 to August 2020. 8 cases were female and 6 cases were male, with an average age of 47.3±11.1 years. 3 patients had hyperuricemia and four had hypertension and diabetes. The history of renal transplantation was over ten years in 3 cases, three to five years in 4 cases, two years in 3 cases, 1 year in 3 cases, and 4 months in 1 case. 3 patients had a history of RIRS, and the operation was terminated due to severe ureteral tortuosity resulting in failure of sheathing or ureteroscopy. Ureteral stent was performed in 2 cases due to stone obstruction and hydronephrosis. Serum creatinine was normal in 7 patients before operation, and serum creatinine was 91-139μmol/L in 4 patients in the compensatory stage of chronic renal insufficiency. The serum creatinine was 292, 544 and 708μmol/L respectively in 3 patients in the decompensated stage of chronic renal insufficiency or renal failure stage. The preoperative average hemoglobin was 117.5g/L. 3 cases were partial staghorn calculi, 4 cases were single caliceal or renal pelvis calculi, 2 cases were renal pelvis or caliceal calculi with upper ureteral calculi, and 5 cases were renal pelvis or renal caliceal calculi with multiple calculi. Stone size were 1 case of single upper caliceal stone of 0.7cm, 3 cases of lower caliceal stones of 1.5, 1.6 and 2.0cm, 1 case of renal pelvic stone of 1.5cm, 2 cases of middle and upper caliceal stones of 2.8 and 3.1cm, 2 cases of middle and lower caliceal stones of 1.5 and 3.2cm, respectively. 3 cases of middle upper caliceal and renal pelvic stones were 2.2, 2.5 and 2.6cm. 2 cases of renal pelvis with upper ureteral stones were 1.3 and 1.7cm, 0.7 and 0.5cm respectively. Preoperative routine urine examination showed that 9 cases had urinary tract infection, among which 5 cases had positive urine culture. Surgery was performed after therapeutic improvement with sensitive antibiotics. According to the size and distribution of stone, the combination of single access or multi-access PCNL in different diameters was adopted, supplemented by FURS. Surgical methods selection and performance: 2 cases performed in single S-PCNL with stone size were 2.2cm and 2.6cm, 2 cases performed in single M-PCNL with stone size were 1.5cm and 1.5cm, 1 case performed in Needle-perc with stone size was 0.7cm, 2 cases performed in S-PCNL combined M-PCNL with stone size were 2.8cm and 3.1cm, 3 cases performed in S-PCNL combined Needle-perc with stone size were 2.0cm, 2.5cm and 3.2cm, 2 cases performed in M-PCNL combined Needle-perc with stone size were 1.5cm and 1.6cm, 2 cases performed in S-PCNL combined anterograde FURS with stones size were 1.3cm and 1.7cm in allograft kidney and ureter stone were 0.7cm and 0.5cm, a total of 7 kinds of way, and postoperative stone free rate, laboratory indexes (serum creatinine, blood hemoglobin), surgical complications, postoperative hospital stay were analyzed.Results:All 14 patients (mean age was 47.3±11.1 years) were successfully operated. Postoperative examination revealed 1 case had 0.6cm residual stone and it was cleared at the second stage anterograde FURS through the original access. The mean operative time and postoperative hospital stay were 68.2±21.6min and 6.2±1.3 days. Compared with preoperative serum creatinine changes, 2 cases showed slight increase (mean 12.6±0.3μmol/L), 3 cases showed significant decrease (mean 329.6±216.6μmol/L), and the other 9 cases showed no significant change (range<10μmol/L), among which 5 cases showed an increase (mean 5.4±0.7 μmol/L) and 4 cases showed a decrease (mean 3.7±0.4 μmol/L). The mean decrease of hemoglobin was 9.3±4.1g/L. Two patients had fever and their body temperature returned to normal after anti-inflammatory treatment. No blood transfusion, abdominal organ injury or urogenic sepsis occurred.Conclusions:Invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney is a single or combined operation using single-channel PCNL, multi-channel PCNL of different sizes and diameters and anterograde FURS according to individual differences, which can effectively reduce renal function injury is safe, efficient and feasible.