Small Calculi Research Articles

Higher-Order Asynchronous Effects

We explore asynchronous programming with algebraic effects. We complement their conventional synchronous treatment by showing how to naturally also accommodate asynchrony within them, namely, by decoupling the execution of operation calls into signalling that an operation's implementation needs to be executed, and interrupting a running computation with the operation's result, to which the computation can react by installing interrupt handlers. We formalise these ideas in a small core calculus and demonstrate its flexibility using examples ranging from a multi-party web application, to pre-emptive multi-threading, to (cancellable) remote function calls, to a parallel variant of runners of algebraic effects. In addition, the paper is accompanied by a formalisation of the calculus's type safety proofs in Agda, and a prototype implementation in OCaml.

ThP5.13 - Lessons learnt from a neuroendocrine tumour presenting as choledocholithiasis

Abstract A 79 year old male presented to A&E with obstructive jaundice. A computerised tomography (CT) scan of his abdomen and pelvis showed intra- and extra-hepatic duct dilation, a small calculus within the lumen of the common bile duct (CBD), and gallbladder distension. His liver function tests were deranged, with an alkaline phosphatase of 280IU/L. Successful stone retrieval was achieved by endoscopic retrograde cholangiopancreatography (ERCP), with an interim CBD stent inserted. Within the same admission, the patient underwent an uncomplicated emergency cholecystectomy. Histological analysis highlighted moderate chronic inflammation and fibromuscular hyperplasia, cholesterolosis, and ruled out dysplasia or malignancy. Four weeks later, the patient re-presented with septic obstructive jaundice. A repeat CT scan identified a dilated CBD of 2.2cm, suggesting an occluded stent. On ERCP for stent removal, ampulla narrowing was identified, hence concurrent brush cytology was performed. Due to clinical suspicion, a CT Positron emission tomography (PET) was requested, which identified metabolically active disseminated malignancy, likely pancreatic in origin, and with nodal, liver, and likely peritoneal metastases. A Ca 19-9 subsequently came back raised at 157 kIU/L. Liver biopsy confirmed a poorly differentiated neuroendocrine carcinoma (NEC) with intermediate features between small and large cell NEC. In such cases with discrepancies between treatment success and lack of biochemical improvement, a low threshold of suspicion for further investigation and oncological consideration is imperative.

Endoscopic interventions in pancreatic strictures and stones-A structured approach.

Chronic pancreatitis (CP) is an irreversible disease of varied etiology characterized by destruction of pancreatic tissue and loss of both exocrine and endocrine function. Pain is the dominant and most common presenting symptom. The common cause for pain in CP is ductal hypertension due to obstruction of the flow of pancreatic juice in the main pancreatic duct either due to stones or stricture or a combination of both. With advances in technology and techniques, endoscopic retrograde cholangiography (ERCP) and stenting should be the first line of therapy for strictures of the main pancreatic duct (MPD). Small calculi in the MPD can be extracted by ERCP and balloon trawl. Extracorporeal shockwave lithotripsy (ESWL) remains the standard of care for large pancreatic calculi and aims to fragment the stones 3mm or less that can easily be extracted by a subsequent ERCP. Single operator pancreatoscopy with intraductal lithotripsy is a technique in evolution and can be tried when ESWL is not available or is unsuccessful in producing stone fragmentation.

Simultaneous cholecystectomy for asymptomatic gallstones during elective colorectal cancer surgery

Asymptomatic gallstones are commonly detected using preoperative imaging in patients with colorectal cancer (CRC), but its management remains a topic of debate. Clinicopathologic characteristics of patients who had asymptomatic gallstones presenting during the colorectal procedure were retrospectively reviewed. Medical records, including postoperative morbidity, mortality, and long-term gallstone-related diseases, were assessed. Of 134 patients with CRC having asymptomatic gallstones, 89 underwent elective colorectal surgery only (observation group), and 45 underwent elective colorectal surgery with simultaneous cholecystectomy (cholecystectomy group). After propensity score matching (PSM), the complications were similar in the 2 groups. During the follow-up period, biliary complications were noted in 11 patients (12.4%) in the observation group within 2 years after the initial CRC surgery, but no case was found in the cholecystectomy group. After PSM, the incidence of long-term biliary complications remained significantly higher in the observation group than in the cholecystectomy group (26.5% vs 0.0%; P<.01). Multivariable logistic regression analysis identified female gender, old age (≥65 years old), and small multiple gallstones as independent risk factors for the development of long-term gallstone-related diseases in patients from the observation group. Simultaneous prophylactic cholecystectomy during prepared, elective CRC surgery did not increase postoperative morbidity or mortality but decreased the risk of subsequent gallstone-related complications. Hence, simultaneous cholecystectomy might be a preferred therapeutic option for patients with CRC having asymptomatic gallstones in cases of elective surgery, especially for older patients (≥65 years old), female patients, and those with small multiple calculi.

Verus: Verifying Rust Programs using Linear Ghost Types

The Rust programming language provides a powerful type system that checks linearity and borrowing, allowing code to safely manipulate memory without garbage collection and making Rust ideal for developing low-level, high-assurance systems. For such systems, formal verification can be useful to prove functional correctness properties beyond type safety. This paper presents Verus, an SMT-based tool for formally verifying Rust programs. With Verus, programmers express proofs and specifications using the Rust language, allowing proofs to take advantage of Rust's linear types and borrow checking. We show how this allows proofs to manipulate linearly typed permissions that let Rust code safely manipulate memory, pointers, and concurrent resources. Verus organizes proofs and specifications using a novel mode system that distinguishes specifications, which are not checked for linearity and borrowing, from executable code and proofs, which are checked for linearity and borrowing. We formalize Verus' linearity, borrowing, and modes in a small lambda calculus, for which we prove type safety and termination of specifications and proofs. We demonstrate Verus on a series of examples, including pointer-manipulating code (an xor-based doubly linked list), code with interior mutability, and concurrent code.

A Case of Small Intestinal Anisakiasis Diagnosed as a Result of Small Intestinal Calculus

A Case of Small Intestinal Anisakiasis Diagnosed as a Result of Small Intestinal Calculus

Dispepsija u primarnoj zdravstvenoj zaštiti - prikaz slučaja

Dyspepsia is a term originated from the Greek prefix dys-(bad) and the word pepsis (digestion) and it means indigestion. Dyspepsia is a symptom which indicates occasional or constant pain in the region of the upper abdomen or discomfort which is described in the form of early satiety or a feeling of fullness in the stomach. Sometimes it can be accompanied by nausea, vomiting and heartburn. The symptoms of dyspepsia are not specific enough to indicate a particular disease. And if indicated, additional diagnostics are performed in order to prove or rule out a physical disorder. Dyspepsia is a frequent reason for visiting the doctor. About 40% of the world's population has symptoms of dyspepsia, most often the working population aged between 20-40 years, equally in both sexes. About 25% of patients seek doctor's help, while the rest seek help for their problems at a pharmacy. Dyspepsia is the reason for 40% of performed gastroenterology consultations. This article presents the clinical picture, therapeutic and diagnostic course, as well as the outcome of the treatment of a 53-year-old patient who came to the doctor with symptoms of dyspepsia. The symptoms of dyspepsia had lasted for several years before coming to the doctor. During the first examination, an anamnesis was taken, the review of systems was performed, and a basic blood test done in the local Health center. Given that there was no data on the existence of alarming symptoms in this patient, symptomatic therapy and advised change of habits were included, as well as a planned checkup in one month. At the checkup, the patient reported a decrease in frequency and intensity of abdominal pain, so it was decided to perform additional diagnostics: test for Helicobacter pylori, fecal occult blood test, and ultrasound examination of the abdomen. Requested result of FOBT was negative, but the test for Helicobacter pylori was positive. Ultrasound examination revealed the presence of small calculi in the gallbladder, but there were no other significant clinical findings. Eradication therapy for helicobacter infection was included, and an examination by a gastroenterologist for further diagnostics (esophagogastroduodenoscopy) was planned. Gastroscopy findings were described as chronic non-atrophic gastritis, predominantly antral. A follow-up gastroscopy was planned in five-year interval, the patient was given the proton pump inhibitors therapy, as well as dietary instructions. Given that dyspepsia often occurs in clinical practice, it was necessary to make a proper assessment regarding further diagnostics, on the one hand for economic reasons and on the other hand for medical reasons. Here, the decision was made to carry out further diagnostics considering the duration of the health problems, the presence of the problems during symptomatic therapy, the age of the patient and his concerns. Given the absence of alarming symptoms, appointments were scheduled for all examinations, so a complete diagnosis of organic dyspepsia was reached after 13 months.

Extracorporeal Shock Wave Lithotripsy Success Rate and Prognostic Factors

Background: Urinary tract stones are common urological problems with a considerable burden worldwide. Management strategies mostly rely on the stone’s characteristics and the patient’s clinical conditions. Extracorporeal shock wave lithotripsy (ESWL) is a method of choice for managing small calculus. However, the success rate of ESWL and the prognostic factor of success widely vary among different studies. The aim of the present study was to evaluate these prognostic factors in an Iranian population undergoing ESWL. Methods: The present retrospective study was conducted in Imam Ali Hospital of Bojnurd, Iran. Every patient who was referred for the ESWL of distal urethral calculus (5-20 mm) and failed to respond to medical treatment enrolled in this study. The prevalence and relationship between various individual factors and ESWL outcomes were evaluated among the study patients. Results: Among 49 patients (24 males and 25 females) who had urinary tract stones, the mean (±standard deviation) of age was 42.7 (14.04) years. ESWL could successfully treat urinary tract stones in 43 patients (85%). The kidney stone diameter was not related to having a successful procedure (P=0.447). Moreover, the stroke number and receiving tamsulosin were not significantly associated with favorable ESWL outcomes (P=0.909 and P=0.590, respectively). Twenty-seven patients (45.1%) received pethidine during the procedure. There was a significant relationship between receiving analgesics and favorable ESWL outcomes (P=0.033). Conclusion: The results demonstrated that 85% of the distal urinary tract stones that are smaller than 20 mm can be successfully managed by ESWL, and providing analgesics was significantly related to better outcomes.

Learning curve of semi-rigid ureteroscopy for small calculi: how many cases are necessary?

semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.

203. Gardnerella vaginalis Bacteremia in Male Patients: A Case Series and Review of the Literature

Background Introduction: Gardnerella vaginalis is a colonizer of the female genitourinary tract and can cause serious morbidity as a pathogen. It is an uncommon cause of infection in men and bacteremia with this organism is rare. We describe two cases of G. vaginalis bacteremia in male patients. A literature search was performed for cases of G. vaginalis bacteremia in men. A total of 13 patients were identified and discussed.Methods Case 1: A 52-year-old man with diabetes and prior nephrolithiasis presented for dysuria, hematuria, and left sided flank pain. He was febrile and tachycardic with mild left costovertebral angle tenderness, leukocytosis and acute kidney injury. Urinalysis revealed pyuria. Computed tomography of the abdomen and pelvis showed pyelonephritis and a small calculus of the proximal left ureter. He was treated with ceftriaxone and then piperacillin-tazobactam. Aerobic culture of the urine yielded < 10,000 cfu/mL of mixed gram-positive flora. Blood cultures yielded G. vaginalis after 48 hours. He was treated with ciprofloxacin 500 mg orally twice daily for 7 total days and clinically recovered. Case 2: A 61-year-old man with alcohol use disorder and gout, presented with altered mental status. He had leukocytosis and acute kidney injury and was treated with vancomycin and cefepime with clinical improvement. Admission blood cultures demonstrated G. vaginalis in the anaerobic bottle of 1 of 2 cultures, reported 96 hours after collection. Urine culture was negative. The patient was treated with amoxicillin-clavulanate on discharge to complete a 14-day course with clinical resolution.Resultssee aboveGram stain of G. vaginalis on blood culture Conclusion Discussion: G. vaginalis is a facultative anaerobic gram-positive pleomorphic rod, which can be gram variable due to poor staining of the thin peptidoglycan cell wall. Isolation and identification are often delayed. Bacteremia in men is rare but nearly all have originated in the genitourinary tract. The most severe cases of G. vaginalis bacteremia implicate endocarditis, urethral stricture and an empyema as the sources. Collection of blood cultures and speciation are often delayed, ranging from 48 hours to 7 days. Selection and duration of treatment have ranged widely in previously reported cases, likely due to the lack of guidance regarding effective treatment.Disclosures Andrew Chou, MD, bluebird bio (Shareholder)

Уроки COVID-19 для медицинской практики. Метиленовый синий — инновация, проверенная временем

Значение метиленового синего (МС) в лечении метгемоглобинемии, малярии и инфекций мочевыводящих путей (ИМП) хорошо известно. Антимикробный, противовоспалительный и антиоксидантный эффекты МС были продемонстрированы в различных исследованиях in vitro и in vivo. Необходимость найти лекарство от COVID-19 привлекла внимание исследователей и практических врачей во всем мире к МС. Обзор включает различный опыт использования МС, в том числе у пациентов, получавших МС во время эпидемии COVID-19 с профилактической целью, а также собственный опыт по этой теме. МС широко применяется как краситель в различных областях биологии — в диагностических процедурах и лечении различных заболеваний, включая отравления цианидом и угарным газом, и считается нетоксичным. Эффективность МС при лечении пациентов с множественными небольшими камнями в почках, особенно с инфицированными камнями, и предупреждение образования новых камней были продемонстрированы в 5-летнем исследовании. Кроме того, благодаря противогрибковому потенциалу и антимикробному эффекту МС уменьшает симптомы ИМП, улучшает качество жизни и предотвращает рецидивы заболевания. Запатентованный комплекс МС с экстрактом листьев шалфея и экстрактом плодов клюквы крупноплодной (Пембина-Блю®) продемонстрировал значительное уменьшение боли, спазмов у больных циститом. Принимая во внимание ограниченное количество доступных методов лечения ИМП и одновременное увеличение резистентности к препаратам, необходимость поиска новых безопасных и эффективных методов лечения ИМП чрезвычайно актуальна. Учитывая то, что МС является одобренным FDA соединением, уже используется для решения различных терапевтических задач, а также благодаря отдельным антиоксидантным, противогрибковым, антибактериальным и противовоспалительным механизмам, которые приведены в данном обзоре, МС можно рассматривать как многообещающее лекарство в будущем.

Umbolith: A Rare Case of Umbilical Lithiasis in Adult

A 20-year old non-diabetic non-hypertensive non-smoker male farmer presented with purulent umbilical discharge for one year. He used to live an unhygienic life. He had throbbing pain, intermittent fever preceded by chills and rigors for fifteen days. He was treated with various antibiotics, analgesics, antipyretics for a long time by local physicians. But he was not cured. The umbilical and periumbilical area were found inflamed, edematous and red with a palpable small hard infra umbilical mass. The mass was irreducible, non-pulsatile, non-compressible and not trans illuminating with no visible and no palpable impulse on coughing. Just prior to incision, a probe was introduced through the umbilicus that had not passed beyond the abdominal wall into the peritoneal cavity indicating that it was a sinus and not a fistula.The infra-umbilical smile incision was deepened and a flap was raised upwards until multiple small calculi of variable consistency were found at a depth. These were extracted. The sinus tract and the accompanying small abscess cavity were excised and sent to the laboratory for culture and sensitivity tests, histopathological examination and other relevant tests. The studies revealed Staphylococcus aureus sensitive to gentamycin and amikacin. The histopathological examination revealed acute inflammatory cells with no granuloma and no malignancy. The patient was given parenteral antibiotics as per the sensitivity test result plus metronidazole against possible anaerobic co-infection. The post-operative period was smooth and uneventful. We like to share our experience of managing this very rare disease of umbilical lithiasis. KYAMC Journal.2021;12(02): 111-113

Utilization of the Glue-clot Technique for Removal of Small Lower Pole Calculi in Pediatric Patients: Case Series

Glue-clot technique has been described as a method to remove small stone fragments in adults undergoing endourological management of renal calculi. In this case series, we share our experience of using this technique for retrieval of stone fragments in 4 children who underwent ureterorenoscopy. The fragments were mainly located in the lower calyces rendering stone extraction challenging. We were able to achieve complete clearance in all patients. This series represents the first use of glue-clot technique in pediatric ureterorenoscopy.

Minimal Translations from Synchronous Communication to Synchronizing Locks

In order to understand the relative expressive power of larger concurrent programming languages, we analyze translations of small process calculi which model the communication and synchronization of concurrent processes. The source language SYNCSIMPLE is a minimalistic model for message passing concurrency while the target language LOCKSIMPLE is a minimalistic model for shared memory concurrency. The former is a calculus with synchronous communication of processes, while the latter has synchronizing mutable locations - called locks - that behave similarly to binary semaphores. The criteria for correctness of translations is that they preserve and reflect may-termination and must-termination of the processes. We show that there is no correct compositional translation from SYNCSIMPLE to LOCKSIMPLE that uses one or two locks, independent from the initialisation of the locks. We also show that there is a correct translation that uses three locks. Also variants of the locks are taken into account with different blocking behavior.

Maturity Onset Diabetes of the Young Masquerading as New Onset Diabetes Mellitus Type 1

Introduction:/background: Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic disorders with autosomal dominant mode of inheritance. Mutation in hepatocyte nuclear factor-1β (HNF-1β) gene results in an error of embryonic development of pancreas and nephron, leading to MODY type 5. MODY 5 accounts for 1% of maturity-onset diabetes of the young. It has peak incidence in adolescence/early adulthood, and is associated with renal pathology. Clinical Case: A 15-year boy with history of hypertension and Hashimoto thyroiditis with normal thyroid function was referred for Hb A1C of 6.7% (< 6.4%). Physical exam was remarkable for normal weight at 64%, normal BMI at 83%, absence of thyromegaly or acanthosis nigricans. Diabetes was confirmed by 2 hour Oral Glucose Tolerance Test study (baseline glucose 154 mg/dL (<126 mg/dL), 2 hour glucose 384 mg/dL (<140 mg/dL)). Small doses of insulin (total daily dose 0.1 units/kg/day) resulted in good glucose control. Further labs were significant for weakly positive TTG and GAD antibodies (tTG Ab IgA 55.5 U/mL (<4.0 U/mL), GAD-65 Ab 0.05 nmol/L (< 0.02 nmol/L)), positive TPO (0.0 - 34.9 IU/mL) and detectable ATA antibodies 45.8 IU/mL (0.0 - 40.0 IU/mL), C-peptide 2.9 ng/mL (0.9–7.1 ng/mL). Islet cell, Insulin and Zinc transporter 8 antibodies were negative. Over the next few months he was weaned off insulin and subsequently he had a high insulin of 29.43 uU/mL (3.0 - 17.0 uU/mL) with glucose level of 169 mg/dL. Renal US was performed as part of the work up for hypertension and revealed a small right calculus with no hydronephrosis and a small 8-mm cortical cyst in the right kidney. Urinalysis showed microalbuminuria. Upper GI endoscopy and colonoscopy with biopsy ruled out celiac disease. Presumptive diagnosis of MODY was entertained despite positive TPO, ATA, TTG and GAD antibodies suggesting autoimmune endocrinopathies. His Hb A1C levels were in the range of 5.7 to 6 % during the 15 months of follow up. Genetic testing for MODY resulted in heterozygous deletion of exons 1–9 of the HNF1B gene consistent with MODY5. Conclusion: This is a case of MODY 5 with weakly positive GAD 65 antibodies that was initially misdiagnosed as type 1 diabetes. The presence of weakly positive antibodies should not preclude a work up for MODY in a patient who does not have the clinical features of classic type 1 DM.

Asynchronous effects

We explore asynchronous programming with algebraic effects. We complement their conventional synchronous treatment by showing how to naturally also accommodate asynchrony within them, namely, by decoupling the execution of operation calls into signalling that an operation’s implementation needs to be executed, and interrupting a running computation with the operation’s result, to which the computation can react by installing interrupt handlers. We formalise these ideas in a small core calculus, called λ æ . We demonstrate the flexibility of λ æ using examples ranging from a multi-party web application, to preemptive multi-threading, to remote function calls, to a parallel variant of runners of algebraic effects. In addition, the paper is accompanied by a formalisation of λ æ ’s type safety proofs in Agda, and a prototype implementation of λ æ in OCaml.

Catching Gall Bladder Cancer Early- Importance of Cholelithiasis and Radiologist

Introduction: Increased relative risk of Gall Bladder (GB) cancer in patients with gall stones has been reported in literature but there are few reports on nature of stones. However, it is difficult to predict which patient suffering from cholelithiasis and cholecystitis may develop or already has early stages of carcinoma. Aim: The present study was undertaken to assess the malignant potential and relevance of gall stones, age and gender in GB carcinoma to propose a screening protocol and early intervention for high risk patients. Materials and Methods: This was a retrospective study done at Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India from May 2012 to May 2019. This study included 200 histopathologically- Fine Needle Aspiration Cytology (FNAC) or postoperative specimen biopsy proven GB carcinoma and 200 control patients with upper abdominal pain but without any evidence of neoplastic changes on USG. All cases and controls were subjected to USG evaluation first followed by plain CT scan with oral contrast only and Contrast Enhanced CT (CECT) scan of whole abdomen as per protocol. Scans were evaluated for detection of gall stone profile in terms of number (solitary/multiple), size (small/large) and density (radio-opaque/ radiolucent). The statistical analysis was done by using IBM Statistical Package for the Social Sciences (SPSS) version 18.0. Results: Male to female ratio in this study was 1:2. GB calculi cannot be considered as bystander as overall 25% patients of both sexes had cholelithiasis. In the present study, 25% who were having carcinoma GB have been detected to have gall stones and out of which 74% were having small calculi. The study showed the association between GB cancer and solitary and multiple large calculi over different age groups to be not statistically significant (p-value=0.3976; χ2=0.716). Association of small and multiple calculi came out to be highly significantly associated with carcinoma in 67% of patients. Furthermore, it was observed that the association between multiple small calculi and GB cancer over the different age groups came out to be extremely statistically significant (p-value=0.0001; χ2=28.62). The association between gall stones in GB cancer patients differ statistically significant over the age groups from cases with gall stones in control group (p-value=0.005497; χ2=7.7082). Conclusion: From the findings of the study author proposed screening via ultrasound and guided FNAC for females over 40 years of age with multiple small calculi not undergoing immediate cholecystectomy to detect early emergence of carcinoma. It is also suggested that clinicians should post patients with multiple, small GB calculi for cholecystectomy on a priority basis and histopathology should be done in each case of GB wall thickening.

Clinico-diagnosis and Surgico-therapeutic Management of Lower Urinary Tract Disorders in Dogs

Background: The available literature and work done so far on diagnosis and therapeutic management of lower urinary tract affections in canine practice is very meagre specially on urethro-cystoscopic examinations, medicinal dissolution of calculi and immunotherapy for neoplasia of UB in dogs. Methods: The present study was carried in 55 dogs with lower urinary tract affections classify according to pathological conditions and therapeutic management. The diagnostic modalities like radiography, ultrasonography in all dogs, urethro-cystoscopy in seven dogs and their findings were studied. The response of therapeutics were also studied.Conclusion: The dogs having small size calculi treated according to urine pH with oral medicinal dissolution using Ammonium Chloride (Group 1A, n=9) and Di Sodium Hydrogen Citrate (Group 1B, n=10) for sixty days, Group 1C (n=25) dogs with cystitis (n=17) subjected for bacterial culture treated according to sensitive antibiotics, TCC of bladder (n=7) with immunotherapy using BCG vaccine and a dog with leiomyosarcoma with cystotomy. The dogs (Group 2, n=11) with large size calculi (n=10), a lodge catheter in UB and dogs (Group 3, n=6) did not responded medicinal dissolution from group 1A (n=2) and 1B (n=4) treated surgically. One to multiple, variable size recovered calculi (n=24) revealed highest brown colour grossly, calcium oxalate type, higher in Pomeranian breed and dogs fed with combination of vegetarian and commercial feed.

Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi

BackgroundSmall renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi.MethodsWe studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation).ResultsThe mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond.ConclusionESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.

Urethral Calculi: Presentation, Evaluation and Management

Urethral calculi are common in developing countries. There are only a few studies that have been conducted so far on these subsets of patients with very limited literature from developing countries. Urethral calculi are divided into primary which forms in urethra and secondary, which migrates from upper urinary tract. Primary urethral calculi are usually small and multiple, and secondary migratory calculi are usually large. Small calculus is commonly found in the anterior urethra and larger calculi usually occur in the posterior urethra. Primary urethral stones are generally composed of magnesium ammonium phosphate (struvite) or uric acid.