First finding of tiemannite, HgSe, in human bladder stones: An electron microprobe study.

Human bladder stones, surgically removed from a 4 years old boy, were studied by X-ray diffraction (XRD) and by electron microprobe analyses (EPMA). XRD data show that the bladder stones are mainly composed of struvite with minor apatite. Tiny particles, <10 µm in size, composed of mercury (Hg) and selenium (Se) were found using scanning electron microscopy (SEM) and quantitative analysis by wave-length dispersive system (WDS). On the basis of their composition, the particles consist of tiemannite, a rare mineral with the ideal formula HgSe. The young patient was not exposed to relevant mercury contamination and has no teeth fillings of amalgam. Although this observation is not conclusive, we suggest that Hg was introduced as methylmercury by food. The discovered tiemannite can be classified as endogenous mineral, i.e., directly precipitated from the same fluids that formed the host bladder stones. This assumption is supported by the fact that tiemannite and struvite can crystallize at the same temperature and pH values. As proposed for the formation of tiemannite previously reported in the liver of cetaceans, we suggest that the tiemannite in the human body represents a probable product of demethylation of Hg. In this contribution, we suggest that Hg and Se were initially collected by urine in the human body and finally precipitated to form tiemannite under appropriate chemical-physical conditions together with the formation of the host bladder stone. This observation suggests that the precipitation and accumulation of metals, including Hg and Se, in the human body can be considered a physiological response to eliminate part of these trace elements, thus enabling detoxification.

Effect of extract of Phyllanthus niruri on crystal deposition in experimental urolithiasis.

Phyllanthus niruri (Pn) is a plant that has been shown to interfere in the growth and aggregation of calcium oxalate (CaOx) crystals. In the present study we evaluated the effect of Pn on the preformed calculus induced by introduction of a CaOx seed into the bladder of male Wistar rats. Pn treatment (5 mg/ rat/day) was initiated immediately or 30 days after CaOx seeding and thus in the presence of a preformed calculus. Animals were sacrificed 50 or 70 days after surgery. The resulting calculi were weighed and analyzed by X-ray diffraction, stereomicroscopy and scanning electronic microscopy. Precocious Pn treatment reduced the number (75%, P < 0.05) and the weight (65%, P < 0.05) of calculi that frequently exhibited a matrix-like material on its surface, compared to the untreated CaOx group. In contrast, Pn treatment in the presence of a preformed calculus did not prevent further calculus growth; rather, it caused an impressive modification in its appearance and texture. Calculi from Pn-treated animals had a smoother, homogeneous surface compared to the spicule shape of calculi found in the untreated CaOx group. XRD analysis revealed the precipitation of struvite crystals over the CaOx seed and Pn did not change the crystalline composition of the calculi. This suggests that Pn interfered with the arrangement of the precipitating crystals, probably by modifying the crystal-crystal and/or crystal-matrix interactions. Results suggest that Pn may have a therapeutic potential, since it was able to modify the shape and texture of calculi to a smoother and probably more fragile form, which could contribute to elimination and/or dissolution of calculi.

[Multiple enterolithiasis, coexisting with bladder and gallbladder lithiasis, associated with colon adenocarcinoma]. / Enterolitiasis múltiple, coexistiendo con litiasis biliar y vesical, asociada a adenocarcinoma de colon.

Enteroliths are calculi primarily formed in the intestine. Enterolithiasis is a rare condition frequently associated with intestinal stasis. Usually it causes no symptoms in most cases, but it can be an important diagnostic clue in patients presenting intestinal occlusive symptoms. We report a case of multiple enterolithiasis, very infrequent pathology, coexisting with bladder and gall bladder lithiasis in a patient with colon adenocarcinoma. Diagnosis was made by X-rays and CT images. Calculi were analysed by several methods: chemical, infrared spectroscopy, stereoscopic microscopy and atomic emission spectroscopy; they showed that caluli are made up of organic material and whilokita (calcium and magnesium ortophosphate). No risk factors for lithogenesis were found in this patient excluding the intestinal stasis caused by intestinal narrowing as a result of adenocarcinoma. Genetic factors are suggested as main contributors to hyperlithogenesis observed in this patient. The physiopathological conditions were studied in depth and literature about this subject reviewed.

Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases.

PURPOSE: We report our experience with the combination of ballistic lithotripsy (BL) and transurethral resection of the prostate (TURP) in 120 patients with benign prostatic hyperplasia (BPH) and bladder stone(s). PATIENTS AND METHODS: The mean stone size, appreciated by measuring the greatest diameter, was 18.5 mm (range 10-80 mm). The mean prostate volume was 35.4 cc (26-62 cc). All procedures were monitored under direct endoscopic control with a videocamera. RESULTS: Lithotripsy and evacuation of fragments was performed in an average time of 27.5 minutes (10-80 minutes). The only intraoperative complication was mild hematuria in 38 patients (32%), which did not affect vision for TURP. The mean resection time was 42 minutes (range 15-65 minutes). Four patients experienced mild postoperative bleeding, and one patient had clot retention. The mean hospital stay was 1.2 days (range 1-4 days). CONCLUSIONS: Combined BL and TURP is effective, safe, and economical.

[Urinary calculi, consisting of dehydrated calcium phosphate. Clinical, biological, radiologic aspects, clinical course and management]. / Lithiase urinaire de brushite. Particularités cliniques, biologiques, radiologiques, évolutives et thérapeutiques.

Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.

Evaluation of Musa (Paradisiaca Linn. cultivar)--"Puttubale" stem juice for antilithiatic activity in albino rats.

The fresh juice of Musa stem (Puttubale) was tested for its antilithiatic activity. Zinc discs were implanted in the urinary bladder of albino rats to induce urolithiasis. The stones formed were mainly of magnesium ammonium phosphate with traces of calcium oxalate. Musa stem juice (3 mL/rat/day orally) was found to be effective in reducing the formation and also in dissolving the pre-formed stones.

Fluoride metabolism and fluoride content of stones from children with endemic vesical stones.

Twenty children with endemic vesical stones showed normal plasma and urinary excretion of fluoride on a mean fluoride intake of 2.5 +/- 0.8 mg/24 h. The mean fluoride content of the stones obtained from these children was 315.6 +/- 264.9 micrograms/g in the nucleus and 229.9 +/- 212.8 micrograms/g in the periphery (this was not statistically significant). Calcium-containing stones had a higher fluoride content than stones containing uric acid and ammonium urate. It was concluded that children with endemic vesical stones have normal fluoride metabolism. Trace quantities of fluoride present equally in the nucleus and peripheral parts of the stones suggest that fluoride does not cause initiation or growth of the nucleus of vesical stones and is adventitiously deposited with calcium salts in these stones.