Crystallization conditions in urine of patients with idiopathic recurrent calcium nephrolithiasis and with hyperparathyroidism.

The highest degree of urinary supersaturation with respect to calcium oxalate monohydrate (COM) and brushite at which secondary nucleation and growth of small amounts of COM and hydroxyapatite (HAP) are inhibited was determined by new and simple methods. There were 39 subjects who produced 24 h-urine collections (11 idiopathic stone formers (ISF), 12 patients suffering from primary hyperparathyroidism (HPT) and 16 healthy controls (HC). These subjects had a moderate calcium and low oxalate intake. The results obtained were compared with the state of urinary saturation and with urine chemistry. The measurements of crystallization conditions with respect to COM were repeated in 26 subjects (11 ISF, 5 HPT, 10 HC) after a dietary oxalate load. In 24 h-urines of HC diluted to 2.4 1/24 h the degree of supersaturation necessary to induce crystallization of COM and HAP was 2-5 times higher than the state of urinary saturation measured under the same test conditions. ISF showed a decreased pyrophosphate concentration and a decreased inhibitory activity to HAP crystallization in their 24 h-urine. The urinary inhibitory activity towards crystallization of HAP showed a positive correlation to urinary pyrophosphate concentration. In the 24 h-urine of HPT hypercalciuria and increased saturation with respect to brushite which reached values to induce HAP crystallization were found. After a dietary oxalate load urinary supersaturation with respect to COM reached values to induce COM crystallization in ISF and HPT but not in HC.

[Surgical treatment of staghorn calculi of the kidneys]. / Die operative Behandlung von Nierenausgusskonkrementen.

Between 1971 and 1981, 120 patients or 127 kidneys underwent surgery for staghorn calculi in the Department of Urology at the University of Berne. The following surgical procedures were performed: 7 primary nephrectomies, 29 intrasinusal pyelotomies by the method of Gil-Vernet, 69 nephrotomies, 17 partial resections and 5 nephrotomies combined with partial resection of the kidney. All the surgical procedure in the parenchyma were done in cold ischemia produced by regional cooling of the surface with ice. In our retrospective study special emphasis is placed on important functional aspects of the surgical technique and possible intraoperative and early postoperative complications. Secondary nephrectomy was necessary in only one case. In 102 patients it was possible to record the late results after an average observation time of 4.8 years. 75% of the patients showed good results i.e. they were free of infections and stones and the intravenous urogram was functionally satisfactory. 15.6% had residual stones or recurrent stone formation whereas only 4.9% presented with chronic urinary infections resistant to therapy despite the absence of detectable stones. In 25 patients who underwent differential 131I-hippuran clearance studies the average loss of function was 8.6% for the kidney operated on in hypothermia. In the same 10-year period there were only 7 cases with staghorn calculi (all over 55 years of age) in which primary nephrectomy was necessary because of silent hydronephrosis or pyonephrosis. Our results are compared with a series published by Blandy and Singh who followed 60 patients in whom staghorn calculi were treated exclusively by conservative means. Today new surgical techniques make it possible to free the kidney of staghorn calculi without major loss of renal function, and they remain free of calculi and infection if the metaphylaxis is carefully followed.

[Accidental rupture of the renal vein in radical tumor nephrectomy of a local bleeding hypernephroid carcinoma. Case report]. / Akzidentelle Durchtrennung der Vena renalis bei radikaler Tumornephrektomie eines lokal blutenden hypernephroiden Karzinomas.--Fallbericht.

This case-report aims to stress the increased difficulty of operating on a locally widespread hypernephroma in presence of a complicating haemorrhage. It also shows an easy method of managing a rare intraoperative vascular complication.