Background

The Gallstone Elimination Report

Gallstone Natural Solutions by David Smith

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The first radiograph of a urinary calculus was obtained by John McIntyre in 1896 within months of Roentgen's original report (6). In the following century, many reports in the radiologic and urologic literature overestimated the ability of plain abdominal radiographs or KUBs to detect ureteral calculi (3). In 1962, Herring examined the composition of 10,000 urinary calculi and found that approximately 90% of these contained calcium (7). This report has been cited as evidence that 90% of ureteral calculi therefore are visible on KUB radiographs (8). However, in studies by Roth et al. (9) and Mutgi et al. (10), in which radiographs in patients with known urinary tract calculi were retrospectively reviewed, sensitivities of 62% and 58% for plain film detection of urinary tract calculi were reported. Given this relatively low sensitivity, reliance on the KUB film alone has not been recommended (unless it is obviously positive). Therefore, currently, the KUB examination alone has a limited role in initial clinical stone diagnosis.

The primary factors that affect the detection of ureteral stones on KUBs include stone size, composition, and location. Stone size has the greatest effect on clinical detection on plain radiographs. Smaller stones are more difficult to identify than larger ones. The radiopacity of ureteral calculi also affects the detectability of any stone on plain radiographs. Stones composed of calcium phosphate have the greatest density of common stones, followed by slightly less opaque stones of calcium oxalate

Uric Acid Stones

Figure 1 Uric acid stones (A) CT SPR image obtained at 80 kVp and 300mA reveals no opaque renal stones. A large calcified gallstone (arrow) projects over the right-upper quadrant of the abdomen. (B) Unenhanced CT scans demonstrate a 2 cm stone in the right renal pelvis and a tiny caliceal tip renal stone. (C) Renal pelvic stone appears as a filling defect (arrow) on the bone window setting of the pyelographic phase image of a subsequently performed enhanced CT. (D) CT SPR image obtained eight minutes after intravenous contrast administration shows the large uric acid stone as a filling defect (large arrow) in the right renal pelvis (calcified gallstone, small arrow). Abbreviations: CT, computed tomography; SPR, scanned projection radiography.

Figure 1 Uric acid stones (A) CT SPR image obtained at 80 kVp and 300mA reveals no opaque renal stones. A large calcified gallstone (arrow) projects over the right-upper quadrant of the abdomen. (B) Unenhanced CT scans demonstrate a 2 cm stone in the right renal pelvis and a tiny caliceal tip renal stone. (C) Renal pelvic stone appears as a filling defect (arrow) on the bone window setting of the pyelographic phase image of a subsequently performed enhanced CT. (D) CT SPR image obtained eight minutes after intravenous contrast administration shows the large uric acid stone as a filling defect (large arrow) in the right renal pelvis (calcified gallstone, small arrow). Abbreviations: CT, computed tomography; SPR, scanned projection radiography.

and magnesium ammonium phosphate. Uric acid stones are radiolucent (Fig. 1), and small cystine stones are frequently radiolucent. Cystine stones that grow larger than 1.5 cm in size become faintly radiopaque. The accumulation of calcium and other mineral salts within larger cystine and uric acid stones also increases the likelihood of their detection on plain radiographs. Rarely encountered matrix stones are usually radiolucent. This relative opacity scale for various stones has been derived from film radiograph interpretations, including the term radiolucent. (A similar stone composition analysis based on CT appearances is not yet available.) The position of the stone also can lead to difficulty in detection either by obscuring overlying bowel contents or bone, or from misinterpretation of calcific densities in the abdomen or pelvis such as arterial calcifications, calcified lymph nodes, calcified masses, or phleboliths. The detection of stones located in the soft tissues of the pelvis is a particularly common clinical problem because of the presence of pelvic phleboliths. The dilemma of confusing a pelvic phlebolith with a distal ureteral stone was noted as a limitation of plain radiography as early as 1908 in a study by Orton (11).

In 1929, Swick first introduced EU as a practical procedure (12). Urographic opacification of the ureter permitted the determination of the ureteral position in relation to the calcification seen on the plain radiograph of the abdomen and pelvis to determine whether the opacity was a ureteral stone or an extraureteral calcification. In addition to delineating the course of the ureter to the level of stones, signs of stone-induced ureteral obstruction could be detected, including delayed nephro-gram, delayed excretion of contrast material, dilatation of the intrarenal collecting system, forniceal rupture with perinephric contrast extravasation, and dilatation of the ureter down to the presumed stone seen on the plain radiograph. Of course, there are occasional limitations. Excretion into the obstructed renal collecting system can be delayed. An EU may take hours to complete in patients with moderate or highgrade obstructions. Also, EU cannot be performed in patients with contraindications for intravascular injection of iodinated contrast material.

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Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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