[Silica-containing urinary stones--clinical issues to keep in mind]. / Silikathaltige Harnsteine im Klinikalltag. Was gibt es zu beachten?

Formation of calculi in efferent urinary passages is always due to supersaturation of urinary calculi substances and associated increased crystallization. Apart from the typical calculi, consisting of calcium oxalate, inorganic phosphates, uric acid or cystine, there are occasional signs of rare substance classes. Although more than 50 silicate stones have already been reported internationally, this stone entity remains relatively unknown. In particular, the occurrence of silicate stones in the absence of magnesium trisilicate abuse is extremely rare. A medium-sized left-sided ureterolith was removed from a 54-year-old male patient using a ureteroscope. X-ray diffraction showed it to be a compound stone consisting of 40% silicate. The patient, who in 1986 was living close to the nuclear reactor accident in Chernobyl, showed no signs of a constant uptake of magnesium trisilicate. However, he had undergone partial (2/3) gastrectomy 4 months before for a drug-refractory gastric ulcer, which had been diagnosed at the end of the 1980s and treated with excessive dosages of a magnesium trisilicate antacid preparation until the time of the operation. The patient had also been suffering from unstable angina pectoris since 1986 and treated with Pentalong (pentaerythrityltetranitrate) for 17 years. We were also able to detect silicium dioxide in components of this drug using X-ray diffraction. Silicate uroliths are extremely rare but they can be clearly identified by X-ray diffraction or infrared spectroscopy and distinguished from artifacts or quartz pebbles. Formation of calculi can be prevented by increasing diuresis as well as switching to a different drug and reducing the dosage.

Eficacia del tetranitrato de pentaeritritol en pacientes con angina de esfuerzo estable / Efficiency of pentaerythritol tetranitrate in patients with stable angina

Se estudiaron 18 pacientes (13 hombres) con una edad promedio de 57 años, los cuales presentaron angina de esfuerzo estable. Se realizó la prueba ergométrica sin tratamiento y después se administró un ciclo de tetranitrato de pentaeritritol y otro de propranolol durante 14 días; al finalizar cada uno se repitió la prueba de esfuerzo. La dosis de tetranitrato de pentaeritritol fluctuó entre 120 y 240 mg y la dosis media de propranolol fue de 122 mg. Ambos medicamentos prolongaron el tiempo total de ejercicio, redujeron el desnivel del segmento RS-T y el doble producto. No hubo diferencias significativas al comparar las 2 drogas. Los resultados sugieren que el tetranitrato de pentaeritritol mejora la capoacidad de esfuerzo físico en pacientes con angina de esfuerzo estable, por lo que se considera útil en el tratamiento de esta afección

[Probable stenocardial effects of combined oral contraceptives]. / Probabili effetti stenocardici dei contraccettivi orali di tipo combinato.

One case of myocardial infarction and one case of coronary insufficiency, observed in women treated with oral contraceptives, are presented. Pathogenetic hypotheses are put forward and stress is laid on the necessity of evaluating risk factors as well as carrying out the various hemogenic tests in these patients.