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Since the early days of medicine one concern of doctors has been the removal of kidney stones and prevention of recurrence. Owing to the hesitancy of progress in the prevention of initial stone formation and of relapse, however, removal of stones from the kidney and ureter were developed to highly refined techniques and they formerly accounted for a major proportion of the urological operations performed. In the last few years developments in the treatment of kidney stones have taken a completely different turn. In the majority of cases suit able methods are available to bring about spontaneous passage of the stones, while in a smaller proportion drug-induced litholysis is pos sible. Stones that cannot be passed are now treated mainly with extra corporeal shockwave lithotripsy, percutaneous litholapaxy or uretero renoscopy. These methods are often used in combination and comple ment each other. Nonetheless, despite the accumulating experience with the new methods there will still be situations in which stones can not be removed except by open surgery. "Our skill as surgeons and the management of the brilliantly designed equipment would amount to nothing more than highly skilled mechanical work if they did not go hand in hand with enhanced insight into the cause of lithiasis and thus into ways of preventing it - or at least of preventing the relapse that is the lot of most patients.
This volume is a report of the proceedings of the Third International Nephro-Lrological Course held in the Ettore Majorana Centre for Scientific Culture, Erice, Sicily, from 12th to 18th May 1980. Contributions were accepted on the understanding that the editors could make certain changes leading towards a uniformity of style but accepting as a Driority the importance of early publi cation, if necessary at the expense of stylistic perfection. The meeting, directed by A. Vercellone (Torino), R. Maiorca (Brescia) and M. Pavone-Macaluso (Palermo), was sponsored by: the Italian Associations of Nephrology, Immunology and Urology; the Ministries of Scientific Research and Public Education of the Republic of Italy; the Sicilian Regional Government; the National Research Council and the University of Palermo. Immunologic problems in renal disease Rnd metabolic and medical aspects of urolithiasis were the two subjects of the Congress, which was attended by numerous invi~ed speakers and participants. The first part was introduced by A. Vercellone (Torino), who discussed the major steps in the development and the present per spectives of nephrology, a relatively newly born science, recognized as such only in 1960. He called attention to the great significance of our present knowledge of the immunologic mechanisms (circulating immune complexes or in situ mounting, cellular immunity, activation of complement) which are involved in the pathogenesis of glomerulo nephritis.
Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long and wide experience of the surgery of calculous disease and gives us in this volume something of the wisdom that he has gained thereby, but he has also been a pioneer in the setting up of a research department largely concerned with the investigation of this complex group of disorders, so that he is able to present in terms readily intelligible to the general medical reader the results of extensive biochemical investigation in this area.