Stone infectious

The true scientific era of the salicylates began in England in 1763, when the Reverend Edward Stone presented a report to the Royal Society on the use of willow bark as a fever treatment. Stone was a believer in the rather curious Doctrine of Signatures, which maintained that one could find cures where the diseases themselves were spawned. Since fevers were often associated with swamps, probably because of mosquito-borne infectious agents, Stone searched swamplands for cures. He tasted a sprig of willow and was stunned by its bitterness. Aware that quinine, an equally bitter substance, was useful in the treatment of malarial fever. Stone decided to give willow... 

Biofilms play key roles in several chronic human infections including infectious kidney stones, bacterial endocarditis, and cystic fibrosis lung infections, and the roles of biofilm formation in these diseases have been reviewed [27]. Biofilms also serve as environmental reservoirs for... 

The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. Some of the newly formed enzyme enters the circulation to increase the enzyme activity in serum. The elevation tends to be more notable (greater than threefold) in extrahepatic obstruction (e.g., by stone or by cancer of the head of the pancreas) than in intrahepatic obstruction and is greater the more complete the obstruction. Serum enzyme activities may reach 10 to 12 times the upper reference limit and usually return to normal on surgical removal of the obstruction. A similar increase is seen in patients with advanced primary liver cancer or widespread secondary hepatic metas-tases. Liver diseases that principally affect parenchymal cells, such as infectious hepatitis, typically show only moderately (less than threefold) increased or even normal serum ALP activities (Table 21-3). Increases may also be seen as a consequence of a reaction to drug therapy. Intestinal ALP... 

Despite its ubiquitous distribution, serum NTP activities appear to reflect hepatobiliary disease with considerable specificity. NTP is increased threefold to sixfold in those hepatobiliary diseases in which there is interference with the secretion of the bile. This may be due to extrahepatic causes (a stone or tumor occluding the bile duct), or it may arise from intrahepatic conditions, such as cholestasis caused by chlorpromazine, malignant infiltration of the liver, or bihary cirrhosis. When parenchymal cell damage is predominant, as in infectious hepatitis, serum NTP activity is only moderately elevated. 

There are sixteen to twenty-four cases of nephrolithiasis per 10,000 persons reported in the United States yearly. Males have a three-fold to four-fold increased risk of the development of renal calculi over females. Uric acid and calcium stones are the most prevalent types of calculi found in men, whereas infectious stones are more common in females. 

Lithiasis may develop in association with a UTI it can develop either with no other favoring factor (the pathogen involved is often Proteus mirabilis) or when there is any cause favoring renal stasis (Kraus et al. 1999) (Figs. 15.1, 15.18). The work-up must differentiate a metabolic and/or genetic origin from a specifically infectious origin (infectious stones). These stones are often poorly calcified and may appear stratified on CT. 

Roubach 1981). Although stones used to be most common during the first 5 years of life, there is now a more equal age distribution (Bruhl et al. 1987), at times even with a strong preponderance in children over 10 years old (Hoppe et al. 2007). In contrast to the infectious stones, which are mostly found in infants and young children, the incidence of calcium stones increases from the age of 5 years. In contrast to adults, uric acid stones are very rare in childhood, at least in the Western world Western Europe 1%, Eastern Europe and the Middle East 5%-10% (Table 20.1) (Basaklar and Kale 1991 Bruhl et al. 1987). Primary bladder stones used to be very frequent, but have almost disappeared in the Western world (Ashworth 1990). Stones are less frequently seen in black children. There is a family history in more than one-third of cases (Danpure 2000). 

An infectious (Fig. 20.8) or metabolic cause for stone formation is detected in the majority of pediatric patients (Hoppe et al.2007). All children with urolithiasis should therefore undergo careful examination (Table 20.4). Anatomical anomalies are often found to be the reason for stone disease. Renal calculi then develop due to disturbances in urine transport, because of urine stasis or flow changes (Fig. 20.9) (Burton et al. 1995). 

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