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January, 1942 RECURRENT UROLITHIASIS—HAWES 21 Fig. 1. A flat plate of an 18 year old Jewish male complaining of cloudy urine. Urinalysis showed many cystin crystals. After removal of the stones from the left kidney, the chemical analysis showed pure cystin. ville(27) in 1936 published an article in which he stated his opinion that vitamin B deficiency and oxaluria were associated. However, up to the present time this concept has not been stressed by urologists in general. Uric Acid and Xanthine: These products are the end result of the metabolism of nucleic acid, which is produced by the ingestion of purine substances (liver, brain, sweetbreads, kidney, mushrooms, etc.). Uric acid stones are much more common than xanthine calculi, possibly because uric acid is only a further oxidation product of xanthine. Kretschmer(25) in 1937 reviewed the literature and collected 15 cases of xanthine calculi, to which he added his case. From 0.4 to 1 Gm. of uric acid is excreted in the urine of the average individual daily. When there is an excess ingestion of purine substances, there results an excess excretion of uric acid in the urine, which favors the formation of uric acid stones. Phosphaturia: The presence of phosphates in an alkaline urine is not an uncommon finding, and this factor alone is not 27. Neville. D. W.: Constitutional Factor in Oxaluria Urol, and Cutan. Rev. 39:32-33 (January) 1035. sufficient for the production of concrements. However, when there also exists a urea-splitting renal infection, which produces a strongly alkaline urine, then these factors are frequently associated with recurrent urolithiasis. Snapper has suggested that phosphaturia may be clinically eradicated by administering 2 Gm. of sodium benzoate three times a day, and that this may be important in preventing recurrent calculi in patients with urea-splitting infections. Trauma: The time to begin the program for prevention of recurrence is at the operating table. Unnecessary handling and rough manipulation of the kidney is to be condemned. If one is dealing with calculi of the renal pelvis, the posterior aspect of the pelvis can be exposed by intelligent retraction and the calculus delivered through a posterior pyelotomy. There is one point which should be stressed in performing pyelotomy: the uretero-pelvic junction should be avoided in making the pyelotomy incision, for this is the most favorable site for a postoperative stricture to develop, with resultant urinary stasis. Usually when there is only a low grade renal infection, the muscle layers of the pyelotomy incision are closed with 0000 chromic catgut sutures on an atraumatic needle. The pelvic mucosa is never sutured, lest encrustation or precipitation of calcium on the suture might form a nucleus for a recurrent stone. When pronounced renal infection is present nephrostomy is the procedure of choice in order that free drainage may be established. Since the advent of ribbon gut, nephrostomy has been used more frequently because hemorrhage can be controlled and there is less destruction of parenchymal tissue. When the pelvis is intrarenal or inaccessible at the time of operation, it is usually best to remove the calculus by nephrolithotomy and establish adequate urinary drainage. Twinem has pointed out the advisability of performing a calycealectomy when dealing with a poorly draining dependent calyx where the calculus apparently originated. This is easily accomplished by sharp dissection of a wedge-shaped portion of renal tissue overlying the diseased calyx, and removal of the calyx by a small bone rongeur. A nephrostomy tube is inserted in the renal pelvis, a piece of fat placed in the kidney wound for hemostasis, and the true renal capsule approximated with ribbon gut.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-003.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 21 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003-0027 |
Form General | Periodicals |
Page Type | all; all images; x-ray; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed31942medi_0027.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Issue Number | 1 |
Page Number | 21 |
Health Discipline | Medicine |
Full Text | January, 1942 RECURRENT UROLITHIASIS—HAWES 21 Fig. 1. A flat plate of an 18 year old Jewish male complaining of cloudy urine. Urinalysis showed many cystin crystals. After removal of the stones from the left kidney, the chemical analysis showed pure cystin. ville(27) in 1936 published an article in which he stated his opinion that vitamin B deficiency and oxaluria were associated. However, up to the present time this concept has not been stressed by urologists in general. Uric Acid and Xanthine: These products are the end result of the metabolism of nucleic acid, which is produced by the ingestion of purine substances (liver, brain, sweetbreads, kidney, mushrooms, etc.). Uric acid stones are much more common than xanthine calculi, possibly because uric acid is only a further oxidation product of xanthine. Kretschmer(25) in 1937 reviewed the literature and collected 15 cases of xanthine calculi, to which he added his case. From 0.4 to 1 Gm. of uric acid is excreted in the urine of the average individual daily. When there is an excess ingestion of purine substances, there results an excess excretion of uric acid in the urine, which favors the formation of uric acid stones. Phosphaturia: The presence of phosphates in an alkaline urine is not an uncommon finding, and this factor alone is not 27. Neville. D. W.: Constitutional Factor in Oxaluria Urol, and Cutan. Rev. 39:32-33 (January) 1035. sufficient for the production of concrements. However, when there also exists a urea-splitting renal infection, which produces a strongly alkaline urine, then these factors are frequently associated with recurrent urolithiasis. Snapper has suggested that phosphaturia may be clinically eradicated by administering 2 Gm. of sodium benzoate three times a day, and that this may be important in preventing recurrent calculi in patients with urea-splitting infections. Trauma: The time to begin the program for prevention of recurrence is at the operating table. Unnecessary handling and rough manipulation of the kidney is to be condemned. If one is dealing with calculi of the renal pelvis, the posterior aspect of the pelvis can be exposed by intelligent retraction and the calculus delivered through a posterior pyelotomy. There is one point which should be stressed in performing pyelotomy: the uretero-pelvic junction should be avoided in making the pyelotomy incision, for this is the most favorable site for a postoperative stricture to develop, with resultant urinary stasis. Usually when there is only a low grade renal infection, the muscle layers of the pyelotomy incision are closed with 0000 chromic catgut sutures on an atraumatic needle. The pelvic mucosa is never sutured, lest encrustation or precipitation of calcium on the suture might form a nucleus for a recurrent stone. When pronounced renal infection is present nephrostomy is the procedure of choice in order that free drainage may be established. Since the advent of ribbon gut, nephrostomy has been used more frequently because hemorrhage can be controlled and there is less destruction of parenchymal tissue. When the pelvis is intrarenal or inaccessible at the time of operation, it is usually best to remove the calculus by nephrolithotomy and establish adequate urinary drainage. Twinem has pointed out the advisability of performing a calycealectomy when dealing with a poorly draining dependent calyx where the calculus apparently originated. This is easily accomplished by sharp dissection of a wedge-shaped portion of renal tissue overlying the diseased calyx, and removal of the calyx by a small bone rongeur. A nephrostomy tube is inserted in the renal pelvis, a piece of fat placed in the kidney wound for hemostasis, and the true renal capsule approximated with ribbon gut. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://hsl.lib.unc.edu/specialcollections/nchealthhistory/nchh-17-pdf |
Document Sort | all; nchh-17 |
Article Title | Recurrent Urolithiasis |
Article Author | G A Hawes |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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