A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort.

BACKGROUND: Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. METHODS: The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors. RESULTS: Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades. CONCLUSIONS: The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.

Evolución de la composición de las litiasis urinarias en un área sanitaria española en las últimas cuatro décadas / Evolution of urinary lithiasis composition in a Spanish health care area over the last four decades

OBJETIVO: Obtener una descripción actualizada de las características epidemiológicas de las litiasis urinarias de un área sanitaria occidental durante las últimas cuatro décadas. MÉTODOS: Revisamos retrospectivamente 2704 litiasis analizadas en un área sanitaria española entre 1980 y 2015. El análisis se realizó mediante microscopía de luz polarizada, y si dicho método presentaba resultados dudosos se recurrió a la difracción con rayos X. Las variables recogidas fueron: la composición química de las litiasis (oxalatos, fosfatos, ácido úrico, infecciosas, cistina, mixtas, otras), la fecha del análisis agrupada en cuatro periodos (1980-1989, 1990-1999, 2000- 2009, 2010-2015), el sexo y la edad del paciente. RESULTADOS: La edad media al diagnóstico fue de 48,32 años (49,37 en varones vs 46,53 en mujeres, p = 0,005). Se encontró un predominio masculino (58,7%), y a lo largo de las cuatro décadas, la afectación en mujeres disminuyó. Las litiasis más frecuentes fueron las compuestas por oxalatos (43,3%), seguidas de las de ácido úrico (16,9%) y las infecciosas (10,7%). Las litiasis úricas y oxálicas fueron más frecuentes en varones que en mujeres (67,4% vs 32,6% y 59,1% vs 40,9%, respectivamente, p < 0,001); sin embargo, las de origen infeccioso fueron más frecuentes en mujeres que en varones (56,3% vs 43,7%, p < 0,001). Se apreció una tendencia al aumento de las litiasis oxálicas y a la disminución de las úricas y por fosfatos. Además, observamos un incremento de las litiasis infecciosas en los últimos 5 años. CONCLUSIONES: En nuestro medio, las litiasis aparecen con más frecuencia en varones en la cuarta década de la vida. Las más frecuentes son las oxálicas, cuya proporción ha aumentado a lo largo de las últimas décadas, mientras que las de ácido úrico y fosfato han disminuido

OBJECTIVE: To provide an updated epidemiological description of urinary lithiasis in a health area in the Western hemisphere over the past four decades. METHODS: 2704 urinary lithiases analysed in our institution between 1980 and 2015 were retrospectively reviewed. They were analyzed using polarized light microscopy, and in the case this method had questionable results we used X-ray diffraction. The variables collected were the lithiasis chemical composition (oxalates, phosphates, uric acid, infectious, cystine, mixed, other). Regarding the date of the analysis, the series of cases was grouped into four periods (1980-1989, 1990- 1999, 2000-2009, and 2010-2015), and also by sex and age of the patient. RESULTS: The mean age at diagnosis was 48.32 years (49.37 in men vs 46.53 in women, p = 0.005). A male predominance was found (58.7%). Throughout the four decades, the involvement of women has progressively diminished compared to men. Of all the lithiases, the most frequent were those composed of oxalates (43.3%), followed by uric acid (16.9%) and infectious types (10.7%). The uric acid and oxalate lithiases were more common in men than in women (67.4% vs. 32.6% and 59.1% vs. 40.9%, respectively, p p < 0.001), while the lithiasis of infectious origin was more frequent in women than in men (56.3% vs. 43.7%, p < 0.001). Throughout the time period, a trend of increasing oxalic lithiases and decreasing uric acid and phosphate lithiases was observed, as well as an increase of infectious lithiases over the past five years. CONCLUSIONS: In our setting, urinary lithiases appear more frequently in males at the end of the fourth decade of life. The most common lithiases are composed of oxalates, and their frequency has increased over time, while uric acid and phosphates lithiases have decreased

Preliminary study of a new pathological evolution-based clinical hepatolithiasis classification.

AIM: To investigate clinical features, treatment strategies and outcomes of patients with hepatolithiasis (HL) undergoing surgical treatment, using a new clinical classification. METHODS: Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December 2012 and they were classified into four HL types according to pathological evolution of the disease. These four HL types included type I primary type (defined as no previous biliary tract surgery), type II inflammatory type (with previous biliary tract surgery and cholangitis), type III mass-forming type (HL complicated by hepatic mass-forming lesion), and type IV terminal type (with secondary biliary cirrhosis and resultant portal hypertension). The perioperative data including general information, imaging data, postoperative complications, and immediate and final stone clearance rate were obtained and analyzed. RESULTS: In all 68 patients, the proportion of HL type I-IV was 50% (34/68), 36.8% (25/68), 10.3% (7/68) and 2.8% (2/68), respectively. Abdominal pain was the main clinical manifestation in type I (88.2%), fever was predominant in type II (52.0%), the malignancy rate in type III was high (71.4%), and portal hypertension and spleen enlargement were common in type IV (2/2, 100.0%). Liver resection rate for types I-III was 79.4%, 72.0% and 71.4%, respectively. The overall incidence of postoperative complications was 23.5% (16/68). There were no perioperative deaths. The average length of hospital stay was 12.7±7.3 d. Immediate and final stone clearance rate was 73.5% (50/68) and 89.7% (61/68), respectively. Fifty-nine of 68 patients (86.8%) were followed- up for >1 year after surgery, and 96.6% of these patients (57/59) had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life. CONCLUSION: The pathological evolution-based clinical classification of HL has a role in optimizing treatment strategy, and patients can benefit from this classification when it is used properly.

Classification of broncholiths and clinical outcomes.

BACKGROUND AND OBJECTIVE: We evaluated effective treatments of broncholithiasis based on its radiographical and bronchoscopic features. METHODS: This retrospective study conducted at Samsung Medical Center, Korea enrolled patients who were suspected of having broncholithiasis based on chest computed tomography (CT). The broncholiths were classified as intraluminal, mixed (both intraluminal and extraluminal) and extraluminal based on chest CT and bronchoscopic findings. RESULTS: The study enrolled 46 patients between 1995 and 2009. Symptoms included cough (n = 21, 45.7%), hemoptysis (n = 19, 41.3%) and purulent sputum (n = 11, 23.9%). Cough was more common in intraluminal boncholiths than in other type of broncholiths (P = 0.03). Based on chest CT, there were 15 (32.6%) intraluminal, 15 (32.6%) mixed and 16 (34.8%) extraluminal broncholiths. All 15 intraluminal broncholiths were removed completely via flexible (n = 2) or rigid (n = 13) bronchoscopy. For the 15 mixed broncholiths, seven (46.7%) bronchoscopic interventions were performed, but complete removal of the broncholiths was not accomplished. Six (40%) mixed and four (25%) extraluminal broncholiths were treated by surgical resection for symptom control. None of the patients who underwent surgical resection suffered morbidity or postoperative mortality. CONCLUSIONS: The treatment of broncholithiasis should be based on chest CT and bronchoscopic findings. Intraluminal broncholiths can be removed via bronchoscopy, while surgery should be considered for symptomatic mixed or extraluminal broncholiths.

Caracterización clínica y ecográfica de pacientes con diagnóstico ultrasonográfico de litiasis vesicular en Potosí, Bolivia / Clinical and ultrasonographic characterization of patients presenting vesicular lithiasis in Potosi, Bolivia

Se realizó un estudio observacional, descriptivo y trasversal para analizar clínica y epidemiológicamente a los pacientes diagnosticados de manera ecográfica de litiasis vesicular en Potosí, Bolivia. El universo estuvo constituido por los 7890 pacientes que acudieron al servicio de ecografía de tres hospitales integrales comunitarios desde junio de 2006 a mayo de 2008. La muestra estuvo conformada por 952 pacientes a los cuales se les diagnosticó ecográficamente litiasis vesicular. Fue más frecuente la afección en el sexo femenino y el grupo de edades de 60 años y más. La mayoría de los pacientes no presentó síntomas ni signos, pero entre los sintomáticos el dolor en hipocondrio derecho resultó ser el síntoma más referido. Según el número de cálculos presentes predominó la litiasis múltiple. La colecistitis aguda fue la complicación más frecuentemente observada(AU)

Se realizó un estudio observacional, descriptivo y trasversal para analizar clínica y epidemiológicamente a los pacientes diagnosticados de manera ecográfica de litiasis vesicular en Potosí, Bolivia. El universo estuvo constituido por los 7890 pacientes que acudieron al servicio de ecografía de tres hospitales integrales comunitarios desde junio de 2006 a mayo de 2008. La muestra estuvo conformada por 952 pacientes a los cuales se les diagnosticó ecográficamente litiasis vesicular. Fue más frecuente la afección en el sexo femenino y el grupo de edades de 60 años y más. La mayoría de los pacientes no presentó síntomas ni signos, pero entre los sintomáticos el dolor en hipocondrio derecho resultó ser el síntoma más referido. Según el número de cálculos presentes predominó la litiasis múltiple. La colecistitis aguda fue la complicación más frecuentemente observada(AU)

Nystagmus parameters and subtypes of benign paroxysmal positional vertigo.

CONCLUSION: Although computational models suggest the existence of canalithiasis and cupulolithiasis subtypes of benign paroxysmal positional vertigo (BPPV), these subtypes cannot be distinguished from each other based on characteristics of nystagmus. Therefore, although the subtypes probably exist more information is needed from each patient than is available without invasive procedures. Also, some patients may have clinical syndromes that include both canalithiasis and cupulolithiasis subtypes. OBJECTIVE: To determine if the parameters of nystagmus provide sufficient information to determine the subtype of nystagmus in a patient with BPPV. METHODS: Patients (n = 118) had unilateral BPPV of the posterior canal; 15 patients also had BPPV of the lateral canal. The main outcome measures were parameters of nystagmus in response to the Dix-Hallpike maneuver: latency to onset of nystagmus, maximum slow phase velocity, and maximum duration. RESULTS: Correlations between pairs of variables showed minimal or no relationships. Also, cluster analyses showed no significant subtypes. The contralateral eye moved significantly faster than the ipsilateral eye.

Alterações anatômicas em pacientes com nefrolitíase / Anatomical alterations in patients with nephrolithiasis

Introdução: Nefrolitíase é uma doença multifatorial e tem relação com desordens genéticas e fatores ambientais. Cálculos renais são mais comuns em adultos e são associados com várias desordens metabólicas e anatômicas. As principais anormalidades anatômicas como obstrução da junção ureteropélvica, rim em ferradura, ureter duplicado completa ou incompletamente, pelve bífida e rim esponja medular são conhecidas como responsáveis pela formação dos cálculos. O objetivo deste estudo é avaliar alterações anatômicas em pacientes com nefrolitíase em nossa região. Métodos: estudo retrospectivo em 1.378 pacientes com evidência de formação recente de cálculos renais. investigação laboratorial e análise disponibilidade. Técnicas de imagens renais incluíram pelo menos ultrassonografia renal e urografia excretora. Resultados: 1.378 pacientes com nefrolitíase foram atendidos, dentre os quais somente 367 (26,5%) foram submetidos à investigação anatômica e 132 (36,0%) tiveram pelo menos uma alteração anatômica. a idade média dos pacientes investigados foi de 36,8 +- 4,3 anos e 198 (54,5%) eram do sexo feminino. As alterações anatômicas mais frequentemente encontradas foram cisto renal, ureter duplicado completa ou incompletamente e obstrução da junção ureteropélvica. Conclusões: Alterações anatômicas foram encontradas em 36% dos pacientes investigados. Cisto renal, duplicação ureteral e obstrução da junção ureteropélvica foram alterações anatômicas mais comuns neste grupo.

Introduction: Nephrolithiasis is a multifactorial disease and is related to genetic disorders and environmental factors. Gallstones are more common in adults and are associated with various anatomical and metabolic disorders. The major anatomical abnormalities such as ureteropelvic junction obstruction, horseshoe kidney, ureter duplicated completely or incompletely, pelvis bifida and medullary sponge kidney are known to be responsible for gallstone formation. The aim of this study is to assess anatomical changes in patients with nephrolithiasis in our region. Methods: A retrospective study of 1378 patients with evidence of recent formation of kidney stones. laboratory research and analysis available. Imaging techniques included renal ultrasonography at least kidney and excretory urography. Results: 1378 patients with nephrolithiasis were treated, of whom only 367 (26.5%) underwent anatomical study and 132 (36.0%) had at least one anatomic change. the average age of patients studied was 36.8 + - 4.3 years and 198 (54.5%) were female. Anatomical abnormalities were most frequently encountered renal cyst, completely or incompletely duplicated ureter and ureteropelvic junction obstruction. Conclusions: Anatomical changes were found in 36% of the cases. Renal cyst, ureteral duplication and ureteropelvic junction obstruction were the most common anatomical changes in this group.

Testicular microlithiasis: our experience of 10 years.

OBJECTIVE: Testicular microlithiasis (TM) is characterized on sonography by multiple microprecipitates in the testes. The correlation between TM and testicular malignancies is variable. The purpose of this study was to review our 10-year experience regarding the prevalence of TM and its association with testicular malignancies. METHODS: This was a retrospective study in which 3254 testicular sonographic examinations over a 10-year period identified 137 patients with TM. Testicular microlithiasis was divided into 2 groups: classic TM (CTM; >or= 5 calcifications per image) and limited TM (<5 calcifications/image). A control population without TM was also randomly selected during the same period. Associations with testicular cancers and other findings were then noted and compared between the TM and control groups. RESULTS: One hundred thirty-seven (4.6%) of the 2957 individual patients with scrotal sonographic examinations had TM; 8 (5.8%) of the 137 patients with TM had testicular cancer, whereas 1 (0.73%) of the 137 patients without TM had primary testicular cancer (P = .04). There were 9 testicular neoplasms in 8 patients, all of whom had CTM. Thirty patients with TM and no malignancy were followed for an average of 19 months (range, 1-90 months; SD, 19.7 months); none had tumor development. CONCLUSIONS: We found a strong association between TM and testicular malignancy. We think that the most prudent use of resources for early detection of malignancy would be to have all patients with CTM perform testicular self-examinations, and follow-up sonography should be limited to a subgroup of patients with CTM and other associated risk factors.

Hepatolithiasis: a Turkey experience.

BACKGROUND/AIMS: The aim of this study was to report our experience of hepatolithiasis, diagnosed in 55 patients between June 1995 and March 2003. METHODS: Fifty-five patients who underwent endoscopic retrograde cholangiopancreatography for hepatolithiasis between June 1995 and March 2003 at our institution were evaluated. Diagnosis of hepatolithiasis was based on cholangiography, ultrasonography and computed tomography. Patients with hepatolithiasis were classified according to Tsunoda classification. RESULTS: Fifty-five patients with hepatolithiasis (22 female, 33 male; mean age: 48.2 +/-14.9, range: 22-83) were included in this study. The major causes of hepatolithiasis were previous bilio-digestive surgery and Caroli disease, with rates of 49% and 14.5%, respectively. While 37 of 55 patients (67.3%) presented with only intrahepatic lithiasis, 18 patients (32.7%) had intrahepatic lithiasis associated with common bile duct (16/18, 29%) or gallbladder (2/18, 3.6%) stones. According to Tsunoda classification, 4 patients were classified as type I, 32 type II, 9 type III and 10 type IV. Patients with types I and II had significantly better stone clearance rates in comparison to those with types III and IV (p<0.05). Complete eradication of stones in the patients with proximal strictures was significantly lower than in the patients with distal strictures (p<0.01). While complete clearance of stones was achieved in 22 cases (40%), incomplete clearance was achieved in 17 cases (30.9%) with endoscopic retrograde cholangiopancreatography . Mean number of endoscopic retrograde cholangiopancreatography procedures for clearance of stones was 4 (ranges: 1-9). CONCLUSION: The etiology of hepatolithiasis in our patients is similar to that observed in Western populations and endoscopic approach appears to be an effective alternative to surgery.