Is There A Relation Between Serum Uric Acid Values and Prostatic Calculi Presence?

OBJECTIVE: We planned to examine the connection between serum uric acid (UA) values and prostatic calculi (PCal) presence and to evaluate the relation between PCal and other etiological factors. METHODS: Patients between 20 and 60 years of age who were referred to the clinic with any reason and had non-contrast abdominal tomography (NCACT) for PCal were included in the study. While the patients were separated into 2 groups based on their serum UA level as ≥7 mg/dL (Group 1) and < 7 mg/dL (Group 2), NCACT was also divided into 2 groups as PCal presence (PCal+) and lack (PCal-) serum UA, calcium, phosphorus, sodium, prostate-specific antigen levels and urinary analysis results of the patients were evaluated and compared. RESULTS: PCal were detected in 38 of 169 patients (22%). PCal presence was detected to be significantly high in Group 1 (p = 0.015). While Type A localization PCal were present both in Groups 1 and 2. Based on PCal presence, UA level was detected to be significantly high in PCal+ patients (p = 0.01). No significant difference was detected among the groups in biochemical parameters and urine-related parameters other than UA. CONCLUSION: A significant relation was found between high UA value and PCal in this study. These results may show that UA plays an active role in PCal etiology.

Por qué y cómo hemos de analizar los cálculos urinarios / Why and how we must analyse urinary calculi

Contexto: Existe una heterogeneidad de criterio sobre la utilidad del análisis del cálculo urinario, así como de cuál es la metodología más adecuada. En esta revisión se presenta el análisis de la litiasis mediante la técnica del estudio morfoconstitucional basada en la combinación de la microscopía estereoscópica (MEST) con el estudio de infrarrojos (EIR). Resumen de evidencia: Existen múltiples técnicas de análisis del cálculo: análisis químico, microscopía electrónica, difracción por rayos X, MEST y EIR. Mediante la revisión de cada una de estas técnicas y el estudio de varios casos clínicos, el presente trabajo muestra la utilidad clínica del análisis del cálculo, así como las ventajas e inconvenientes de cada uno de los citados métodos. Por otro lado, se evidencia cómo el análisis mediante el estudio morfoconstitucionales el que más información clínica de utilidad ofrece al urólogo. Asimismo, se presenta la clasificación de las litiasis basadas en este método y su correlación clínica con el paciente. Conclusiones: El análisis del cálculo mediante la técnica del estudio morfoconstitucional aporta más información que el resto de técnicas y permite establecer una clasificación del cálculo de gran utilidad clínica y diagnóstica (AU)

Context: There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). Summary of the evidence: There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients is presented. Conclusions: Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility (AU)

Stone or stricture as a cause of extrahepatic cholestasis--do liver function tests predict the diagnosis?

BACKGROUND: Cholestasis, roughly divided into intrahepatic and extrahepatic forms, is a clinical challenge. Extrahepatic cholestasis, characterized by dilated bile ducts, is caused by either a bile duct stone or stricture, with stricture most often related to a malignancy. The aim of the present study was to analyze the value of common liver function tests in separating patients with malignant bile duct strictures from those with stones. METHODS: All consecutive patients admitted for endoscopic retrograde cholangiopancreatography (ERCP) were included in the study population if a bile duct stricture related to a malignancy was found by ERCP (n=103) or if a bile duct stone was successfully extracted during ERCP, thus confirming the diagnosis of a stone (n=109). Plasma alkaline phosphatase, gamma-glutamyltransferase, alanine aminotransferase and bilirubin values were determined in the morning before ERCP. RESULTS: Plasma bilirubin (p<0.001), alkaline phosphatase (p<0.001) and alanine aminotransferase (p=0.040) levels were significantly higher in patients with malignant bile duct strictures than in those with bile duct stones. In addition, gamma-glutamyltransferase levels seemed to be higher in patients with malignant strictures than in those with stones, although the difference did not reach statistical significance (p=0.053). In receiver operating characteristic analyses, bilirubin proved to be the best laboratory test in differentiating patients (p=0.001 vs. alkaline phosphatase, p<0.001 vs. alanine aminotransferase and p<0.001 vs. gamma-glutamyltransferase). With a plasma bilirubin cutoff value of 145 micromol/L, four out of five patients were categorized correctly. CONCLUSIONS: Plasma bilirubin seems to be the best liver function test in distinguishing patients with malignant bile duct strictures from those with bile duct stones. This routine test should receive more attention in clinical decision-making than has previously been given.

Prostatic calculi do not influence the level of serum prostate specific antigen in men without clinically detectable prostate cancer or prostatitis.

PURPOSE: Prostatic calculi are common but little is known of their effect on serum prostate specific antigen (PSA). We investigated whether prostatic calculi might influence serum PSA in men with clinically undetectable prostatic cancer or prostatitis. MATERIALS AND METHODS: Between November 1999 and November 2001, 581 consecutive patients underwent serum PSA determination and digital rectal examination. Of these patients 486 without detectable prostatic cancer, or a history or symptoms of prostatitis and with other specified exclusion criteria were included in the study. The detection and volume measurement of prostatic calculi, and the measurement of prostate volume were performed by transrectal ultrasonography. RESULTS: Prostatic calculi were detected in 198 of the 486 men (40.7%). Mean patient age, prostate volume and serum PSA were not significantly different in men with and without prostatic calculi. Prostate volume was significantly greater in patients with abnormally elevated serum PSA than in those with normal levels. However, no significant difference was found between the percent of men with prostatic calculi or the volumes of prostatic calculi in the 2 groups. Univariate logistic regression analysis indicated that the presence or volume of prostatic calculi was not a risk factor for elevated PSA. Multivariate analysis showed that age and prostate volume were associated with elevated PSA. CONCLUSIONS: The presence or volume of prostatic calculi had no significant effect on serum PSA. Our results suggest that the influence of prostatic calculi is irrelevant in men with elevated PSA.

Etiologic significance of defects in cholesterol, phospholipid, and bile acid metabolism in the liver of patients with intrahepatic calculi.

Intrahepatic calculi, highly prevalent in the Far East, including Japan, are characterized clinically by chronic proliferative cholangitis with frequent stone recurrences. Intrahepatic calculi consist of 2 groups, i.e., brown pigment stones, including a high cholesterol content, and cholesterol stones, with the former predominating. To gain insights into the pathogenesis of intrahepatic calculi, cholesterol and bile acid biosynthesis, as well as alterations in intracellular transport and/or canalicular secretion of phospholipid and bile acid were investigated in liver of patients with intrahepatic calculi. Enzyme activities of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase were increased (12.8 +/- 1.9 pmol/min/mg protein, mean +/- SEM vs. 5.5 +/- 0.4 in controls; P < .01) and cholesterol 7 alpha-hydroxylase activities were decreased (1.3 +/- 0.4 vs. 4.9 +/- 0.6; P < .01) in liver specimens of patients with brown pigment stones. In addition, messenger RNA (mRNA) levels of multidrug resistance P-glycoprotein 3 (MDR3 Pgp) and phosphatidylcholine transfer protein (PCTP) were markedly low in the liver specimens compared with the levels in specimens of control subjects, gallbladder stone patients, and patients with obstructive cholestasis. The protein levels and the immunohistochemical staining were decreased for MDR3 Pgp and PCTP in the liver. Consistently, the concentrations of phospholipid were markedly reduced in the hepatic bile from both affected and unaffected hepatic segments. In patients with intrahepatic calculi, biliary cholesterol supersaturation and the formation of cholesterol-rich brown pigment as well as cholesterol stones may be attributed to decreased hepatic transport and biliary secretion of phospholipids, in the setting of increased cholesterogenesis and decreased bile acid synthesis.

Copper, zinc and magnesium levels in fibrocalculous pancreatic diabetes.

Alterations in trace elements and mineral homeostasis have been documented both in insulin-dependent diabetes mellitus and non-insulin dependent diabetes mellitus. No data are available about trace elements in fibrocalculous pancreatic diabetes, a unique form of secondary diabetes mellitus. This study evaluated the plasma concentrations of copper, zinc and magnesium in this form of diabetes. Twenty-five patients (9 men and 16 women) with fibrocalculous pancreatic diabetes and 25 healthy non-diabetic subjects (16 men and 9 women) were studied. Patients with overt nephropathy were excluded. Plasma copper, zinc, and magnesium levels were analyzed using a GBC 902 double beam absorption spectrophotometer. The effect of glycemic control, microalbuminuria, sex and modality of treatment received on the plasma levels of copper, zinc and magnesium was assessed. Results of the study revealed that plasma copper, zinc, and magnesium levels were comparable between patients with fibrocalculous pancreatic diabetes and control subjects. Plasma copper levels were significantly higher in patients with controlled diabetes (16.15 +/- 0.67 micromol L(-1)) as compared to those with uncontrolled diabetes (13.75 +/- 0.61 micromol L(-1)) and healthy controls (13.91 +/- 0.55 micromol L(-1)). This merits further investigation. Microalbuminuria, modality of treatment received and sex did not influence the levels of these elements in fibrocalculous pancreatic diabetes.

Serum-soluble interleukin-2 receptor in patients with hepatolithiasis: a preliminary report.

BACKGROUND/AIMS: Hepatolithiasis is prevalent in Southeast Asia and remains a difficult problem to manage. Recent studies in immunology have provided evidence for the provocative roles of cytokines in many diseases. This study was designed to explore the possible relationship between the serum-soluble interleukin-2 receptor and the pathogenesis of hepatolithiasis. METHODOLOGY: In this pilot study, 34 patients with hepatolithiasis were included. All of the patients met the following criteria: (1) presence of hepatolithiasis; (2) no obvious clinical evidence of associated intrahepatic cholangiocarcinoma; (3) no clinical manifestation of cholangitis for at least 72 hours; (4) no intake of immunomodulatory agents in the previous 3 weeks; and (5) no blood transfusions in the previous 3 weeks. Venous blood samples were collected before surgery, and the concentrations of serum soluble interleukin-2 receptor were measured with an enzyme immunoassay method. Fifteen healthy subjects were used as the control group. Bile specimens routinely obtained during surgery were cultured for aerobes and anaerobes. The cholangiography films were reviewed in detail. RESULTS: The mean value of soluble interleukin-2 receptor in patients with hepatolithiasis was 706 +/- 294 units/ml, and that of the control group was 326 +/- 62 units/ml. The difference was significant (p < 0.01). Bacteria were present in the bile of all patients. The total number of bacterial species in the 34 patients was 119, and there was an average of 3.5 bacterial species cultured per patient. Intrahepatic bile duct strictures were present in 30 patients (88%). CONCLUSIONS: In addition to a high incidence of intrahepatic bile duct strictures and bacterial infection of the bile, significantly high levels of the serum soluble interleukin-2 receptor were also found in the patients with hepatolithiasis. The preliminary results in the present study seem to be promising, and the specific role of the soluble interleukin-2 receptor in patients with hepatolithiasis deserves further investigation and elucidation.

Circulating intercellular adhesion molecule-1 (ICAM-1) in patients with hepatolithiasis.

We evaluated the role of circulating intercellular adhesion molecule-1 in the pathogenesis of hepatolithiasis. From December 1994 to May 1995, 40 patients with hepatolithiasis were included. All the patients met the following criteria: (1) presence of hepatolithiasis, (2) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma, (3) no clinical manifestation of cholangitis for at least 72 hr, (4) no immunomodulatory agents in the last three weeks, and (5) no blood transfusion in the last three weeks. Venous blood samples were collected both before surgery and at least three months after complete clearance of the stones, and the serum concentrations of circulating intercellular adhesion molecule-1 were measured with a sandwich enzyme immunoassay method. Fifteen healthy subjects were used as a control group. Bile specimens routinely obtained during surgery were cultured for aerobes and anaerobes. The x-ray films of cholangiography were all reviewed in detail. The mean value (834 +/- 128 ng/ml) of circulating intercellular adhesion molecule-1 (ICAM-1) in the patient group before surgery was significantly higher than that (346 +/- 68 ng/ml) of the control group (P < 0.01). The mean value (677 +/- 139 ng/ml) of circulating ICAM-1 in the patient group at least three months after complete clearance of the stones was significantly lower than that (834 +/- 128 ng/ml) of the patients before surgery (P < 0.01), but this mean value (677 +/- 139 ng/ml) was still significantly higher than that (346 +/- 68 ng/ml) of the control group (P < 0.01). Bacteria was present in the bile of all patients. The total number of bacterial species was 135, and there were an average of 3.4 bacterial species cultured per patient. Intrahepatic stricture was demonstrated in cholangiography in 33 patients (82.5%). In addition to the high incidence of intrahepatic bile duct strictures and bile infection, a significant elevation in circulating intercellular adhesion molecule-1 (sICAM-1) was shown in patients with hepatolithiasis. Our preliminary results seem to be promising and the real role of sICAM-1 deserves further investigation and elucidation.

Longitudinal changes of plasma pancreatic enzymes and hormones in experimental pancreatolithiasis in dogs.

Plasma pancreatic enzymes and hormones were longitudinally observed after producing partial obstruction of the major pancreatic duct in dogs to study an initial state of chronic pancreatitis or pancreatolithiasis. Fasting plasma immunoreactive cationic trypsin was elevated during the first six months and then decreased in a subgroup with pancreatic calculi, marked fibrosis, or duct dilatation when compared with the corresponding opposite at the end of the 12-month period. Similar but less prominent changes were found in fasting plasma immunoreactive pancreatic polypeptide (IRPP). Plasma amylase, glucose, or immunoreactive insulin or glucagon (IRG) show no significant variation. Plasma IRG and IRPP responses to intravenous insulin were reduced in the subgroups with marked pancreatic changes towards the end of the 12-month period. These results suggest that plasma pancreatic enzymes and hormones remain elevated as long as pancreatic damage is mild and then start to decline as the damage progresses in chronic pancreatitis or pancreatolithiasis.

Extracorporeal shock wave lithotripsy of pancreatic duct stones.

Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extracorporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted pancreatic duct stones. An electromagnetic lithotriptor (Siemens Lithostar, Erlangen, FRG) was used. Patients were treated in prone position under fluoroscopic control. A mean of 6,813 shock waves (range 1,500-10,000) was delivered in one or two sessions. Disintegration of stones was achieved in 6/8 patients, initial relief of pain in 7/8 patients, and total clearance of the pancreatic duct in 3/8 patients. One patient had an exacerbation of her pancreatitis one day after ESWL, which resolved rapidly with medical treatment. No other complications were observed. Four of five patients with fragmented stones had no abdominal complaints at follow-up (mean 17 months, range 3-27). Three patients in whom ESWL was not completely successful (two without and one with partial fragmentation) underwent an operation according to Puestow. Two of them still have abdominal complaints after surgery. From these data, we conclude that ESWL of pancreatic duct stones is a promising new alternative for surgery, when endoscopic stone extraction fails.

Serum immunoreactive trypsin in tropical pancreatic diabetes syndrome.

Fifteen patients with tropical pancreatic diabetes syndrome (TPDS), 16 insulin-dependent diabetics (IDD), 27 non-insulin-dependent diabetics (NIDD) and 14 normal subjects, all from India, were investigated for markers of beta-cell (C-peptide) and exocrine (immunoreactive trypsin; IRT) reserve. IRT and C-peptide concentrations were the lowest in TPDS, lower than normal in IDD, and not significantly different from normal in NIDDs. There was a highly significant correlation (rs = 0.93; P less than 0.0001) between IRT and C-peptide (measured in 50% of patients and controls) concentrations when all diabetic groups were combined. Such a correlation was absent when TPDS patients were considered in isolation, largely because of the markedly low IRT concentration. Fourteen of 15 patients (93%) with TPDS had subnormal IRT concentrations, of which 11 had IRT values of less than 50 micrograms/L. These IRT values are similar to those previously reported in cystic fibrosis. Only 6 of 16 IDDs (38%) had subnormal IRT concentrations, of which only one was below 50 micrograms/L. These data suggest that exocrine pancreatic reserve is markedly diminished in TPDS and that a subnormal IRT concentration may be a useful biochemical marker for this form of diabetes.

Erythrocyte insulin binding abnormalities in fibro calculous pancreatic diabetes.

Insulin binding to erythrocyte insulin receptors was studied in 17 patients (13 men and 4 women) with fibrocalculous pancreatic diabetes mellitus (FCPD) and compared with that of 14 newly diagnosed NIDDM patients matched for age, sex and severity of hyperglycemia, and 14 age and sex-matched non-diabetic control subjects. In the uncompensated diabetic state, mean (+/- S.D.) specific binding of insulin was lower in both FCPD and NIDDM patients, compared with non-diabetic controls (P less than 0.001). Control of diabetes with short term therapy (2-6 weeks) resulted in a significant improvement in the mean specific insulin binding in both FCPD and NIDDM patients (P less than 0.001) due to increased binding affinity in the former, and increased affinity and the number of binding sites in the latter. As compared to short term therapy, chronic therapy (5-8 months) in FCPD patients resulted in a marginal decrease in specific insulin binding. However, this was still significantly higher than the basal value (P less than 0.05). FCPD patients had an initial low mean basal plasma IRI and a much lower mean stimulated IRI response as compared to NIDDM and non-diabetic controls.

Impotence associated with low biological to immunological ratio of luteinizing hormone in a man with a pituitary stone.

Quantitative reduction in LH secretion resulting from hypothalamic-pituitary dysfunction is a known cause of impotence. Qualitative abnormalities of secreted LH, however, have not been described under these circumstances. During evaluation of a 39-yr-old man with impotence and a calcified pituitary mass (pituitary stone), we detected a qualitative abnormality of LH characterized by a low ratio of bio- to immunoactivity (B:I). Initial work-up revealed basal morning serum testosterone levels of 2.14, 3.18, 3.97, and 3.11 ng/ml on 4 separate days, low to low normal urinary LH (300, 200, and 478 mIU/h), and normal GH, TSH, PRL, and ACTH secretion after provocative testing. The response of impotence to testosterone but not placebo in a double blind trial confirmed the clinical significance of the borderline low androgen levels. These findings prompted a systematic analysis of 24-h LH pulses as well as clomiphene and GnRH responsiveness. By RIA, mean serum LH levels [9.1 +/- 0.3 (+/- SE) mIU/ml] and all other response parameters were normal. In striking contrast, mean serum LH by bioassay was low (9.9 +/- 0.4 mIU/ml vs. 41.4 +/- 5.7 in normal subjects), as were B:I ratios (1.0 +/- 0.03 vs. control values of 3.1 +/- 0.5 to 5.3 +/- 0.3). Only during maneuvers designed to increase GnRH were B:I ratios increased to 3.3 +/- 0.22 (exogenous GnRH) and 1.8 +/- 0.12 (clomiphene). Mean testosterone levels before and after exogenous GnRH treatment were 3.28 +/- 0.24 and 4.76 +/- 0.16, respectively (P less than 0.001). The results suggest an association between the low LH B:I ratio and the anatomical disruption of the hypothalamic-pituitary portal system by the pituitary stone. The increased B:I ratio during GnRH or clomiphene administration indicates a functional link between pituitary GnRH exposure and the greater potency of the LH secreted.

[Measurement of plasma 1,25 dihydrovitamin D. Normal and pathological values in adults (author's transl)]. / Dosage plasmatique de la 1,25 dihydroxyvitamine D. Valeurs normales et pathologiques chex l'adulte.

Plasma levels of 1,25 dihydrovitamin D (1,25 (OH)2D) were measured in normal subjects and in patients with various diseases, using a radiocompetition method. Mean values of 89 +/- 58 pmol/l (1 s.d.) were found in normal adults, irrespective of sex. Plasma 1,25 (OH)2D values were high in 12/31 patients with lithiasis and hypercalciuria, in 1/7 patients with lithiasis and normal calciuria and in 2/4 patients with idiopathic parathyroid adenoma; they were normal in 2 patients with essential hypoparathyroidism. 1,25(OH)2D was undetectable in 5 patients with chronic renal failure, low in 7 and normal in 4. Following successful kidney transplantation (serum creatinine less than 120 mumol/l) one-half of the patients had normal values and the other half high values.

Calcifications within the duct of Wirsung in calcific pancreatitis.

A review of abdominal radiographs of 50 patients with the clinical diagnosis of chronic pancreatitis showed calcific pancreatitis in 27 patients. Ten patients had severe pain associated with weight loss. Five had obstruction of the duct of Wirsung: one by a pseudocyst and four by large stones near the ampulla of Vater. The radiologic workup presented emphasizes the need to study the duct of Wirsung in patients with chronic pancreatitis to guide the surgical approach for relief of intractavle pain. Theories regarding the pathophysiology of calcium deposition and stone formation and migration are reviewed.

Evaluation of biliary and pancreatic function in pancreolithiasis. Value of the determination of gamma-glutamyl transpeptidase.

Ten patients with pancreolithiasis and ten controls underwent a 110-minute pancreozymin-secretion test in which post-pancreozymin collection periods were prolonged to 30 minutes. Gamma-Glutamyl transpeptidase concentrations and outputs of duodenal aspirate in response to pancreozymin and to secretin were greatly increased in patients with pancreolithiasis. No correlation was noted between gamma-glutamyl transpeptidase and bile pigment concentrations. The mean concentrations and outputs of amylase in disease were much less than those in control subjects throughout the test. Two categories of pancreolithiasis were distinguished with respect to the distribution and size of the calculi and amylase secretion. We suggest that, in pancreolithiasis, there is an increase in ductal or centroacinar cell mass.