Lange and associates50 performed a study in which healthy adults were administered a large amount of dietary oxalate and

a normal amount of calcium. Meals were administered either with the amounts of dietary calcium and oxalate being balanced for breakfast, lunch, and dinner, or imbalanced. Urinary collections throughout the day demonstrated no significant differences in stone risk between these two regimens. This suggests that, as long as a normal amount of dietary calcium is consumed, the sequence in which this is done does not alter stone risk when increased amounts of dietary oxalate are eaten. Urinary uric Inhibitors,research,lifescience,medical acid is thought to promote calcium oxalate stone formation and urinary magnesium is considered an inhibitor. Riley and colleagues51 used molecular dynamic simulations using Not (just) Another Molecular Dynamics program and Chemistry at Harvard Macromolecular Mechanics force fields in an attempt to define how these Inhibitors,research,lifescience,medical chemicals may impact stone formation. They demonstrated that uric acid prolongs the contact time between calcium and oxalate, thus perhaps Inhibitors,research,lifescience,medical allowing for the perfect storm: stone formation while magnesium reduces

this interaction. Shock wave lithotripsy is still commonly used to treat patients with renal and ureteral stones. Modifications in technique have been demonstrated to enhance results including proper application of coupling gel. If this is not done correctly air pockets in the gel may alter focal zone acoustics that are involved in stone comminution. The Indianapolis group was the first to recognize this and reported at this meeting that it occurred most commonly when the air pockets were near the center of the coupling field.52 Therefore, special attention is especially important when Inhibitors,research,lifescience,medical applying gel to this area. Patients may have associated sepsis with stone

events and require appropriate and timely antibiotic LDN-193189 clinical trial therapy. Marien Inhibitors,research,lifescience,medical and colleagues53 reported that antibiotic resistance is now common in patients with obstructing ureteral stones, fever, and associated urinary tract infection. Therefore, it is important for the practitioner to be aware of local resistance patterns when selecting antibiotic regimens in this clinical scenario. The performance of stone and cultures in patients undergoing percutaneous nephrostolithotomy (PCNL) is now being increasingly advocated. Information from two studies was presented at this meeting to justify this practice. De Cogain and associates54 and Bhojani and colleagues55 reported that 10% to 20% of patients with sterile urine will have positive stone cultures, including patients with metabolic stones. The latter group reported discordance between urine and stone cultures. Therefore, a stone culture provides a head start on isolating and characterizing the pathogen causing sepsis during or after PCNL. An increasing number of people are using iPad® technology (Apple, Cupertino, CA) and this may now facilitate PCNL.