The Journal of lithotripsy & stone disease最新文献

Male Copenhagen rats implanted with Dunning R3327 prostate carcinoma were treated with regional hyperthermia and high energy shock waves (HESW). Twenty-four rats were divided into four equal groups. All rats in one group were matched with the corresponding rats in the other three groups according to tumor size. Hyperthermia was created by the resistive heating of a 22-gauge 1.5-cm needle; HESW were generated by the Dornier XL-1 experimental lithotripter. In two hyperthermia treatments administered 48 hours apart, the tumor was heated to 46.5 degrees C for 2 hours; HESW treatment involved 1,600 shocks at 18 kV. Twenty-nine days after initiation of this study, animals were sacrificed and tumor growth calculated. Tumor growth in group 1 (combined hyperthermia and HESW) was significantly delayed between the 7th and 29th day (p = 0.05). In group 2 (HESW alone), tumor growth was significantly delayed between the 7th and 22nd day (p = 0.01), while tumor growth in group 3 (hyperthermia alone) was delayed between the 3rd and 22nd day (p = 0.02). On day 22, mean percent change in tumor growth in the control group exceeded that of group 1 by 449% (p = 0.015) as well as that of groups 2 and 3, by 350% (p = 0.034) and by 268% (p = 0.049), respectively. As previous reports demonstrate the efficacy of hyperthermia in combination with irradiation or chemotherapy for the treatment of prostate carcinoma, our results indicate hyperthermia in combination with HESW may also be a useful treatment modality.

Twelve elderly, ill patients with large common bile duct stones and cholelithiasis were treated with endoscopically placed biliary endoprostheses after endoscopic attempts at stone removal were unsuccessful. The patients were classified according to the American Society of Anesthesiologists' Physical Status Classification criteria and were Classes III and IV. The endoscopic procedures were tolerated well without complication. Resolution of biliary symptoms occurred in all patients. After extended follow-up of up to 60 months, no patient has required surgery for biliary symptoms or complications. One patient died following elective biliary surgery, six others have died from nonbiliary causes. The results suggest that management of large common bile duct stones by endoprosthesis placement can be done safely, and satisfactory long-term outcomes can be achieved.

Cholecystectomy is the gold standard treatment for symptomatic gallstones. However, within the last decade peroral drug chemolysis, methyl-tert-butyl ether lavage, shock wave lithotripsy, and percutaneous cholecystolithotomy have been introduced. This article compares and contrasts the presently available therapeutic modalities for gallstones and highlights the limitations of each treatment option.

Early comparative data is now available from several different American Gallstone Lithotripsy, ("GSL") trials (Technomed, Dornier, and Medstone). While the 6-month gallbladder clearance results appear to be remarkably similar (36%-43% in less than 20-mm solitary stones), they do not appear to match the results obtained by the Munich group in their first 175 patients (63% clearance at 4-8 months). We review the currently available American data and describe our on-going national clinical trial with the Technomed Sonolith 3000 investigation. In this trial, patients are randomized to lithotripsy plus ursodiol (Actigall,¿ Ciba Geigy), or lithotripsy alone to determine the effect of oral bile salts on the gallbladder fragment clearance rate. To date, the early success rate is clearly better in the GSL plus ursodiol arm. Following one or two lithotripsy sessions, 62.1% of patients with solitary stones, 5-20 mm in size, have had fragmentation to 7 mm or less. In the same group, 39.1% of gallbladders are clear at 6 months. While the 6-month gallbladder clearance rate appears to be a reliable indicator of eventual gallbladder status it should not be regarded as the end point of therapy and it clearly does not represent the final efficacy rate for gallstone lithotripsy. A review of the results obtained from on-going American IDE trials is compared with the published German results using GSL and combination oral dissolution therapy.

The Direx Tripter X-1 is a modular extracorporeal shock wave system that uses underwater spark gaps as its source for lithotripsy. Experience with 712 treatments in 541 patients has given a fragmentation rate of 99%. Of these patients, 27% had stones larger than 2 cm or multiple stones. A stone free situation at 3 months follow-up was achieved in 75% of the cases. Seventeen percent had small fragments less than 4 mm and 8% had fragments greater than 4 mm. Auxiliary procedures following ESWL were required in 7%. No major complications were seen. The advantages of this system are: modularity, mobility, flexibility, and low cost.

A third shock head has been added to the Lithostar. This overhead module with integrated ultrasound complements the existing bilateral undertable shock heads with biplane x-ray amplifiers for stone targeting. Extracorporeal shock wave treatment of urinary tract stones, pancreatic stones, and stones in the gallbladder and bile ducts has thereby become possible in one true multipurpose lithotripter. Technical information and clinical experience in the biliary tract with the overhead module is presented.

The mechanical and ultrasonic parameters of kidney stones have been measured in vitro. The techniques used for these measurements are briefly described and the data are presented. It was found that the mechanical crushing strength correlates with the acoustic velocity in the calculi, which in turn is a function of the stones' chemical deposition. It was shown that the crushing strength increased exponentially with velocity in the range from approximately 22 kg/mm2 to approximately 100 kg/mm2. The corresponding ultrasonic velocity in the stones varied between approximately 2,200 m/sec to about 3,000 m/sec. It is suggested that these data could be used to determine the desirable characteristics of a piezoelectric lithotripter.

Uniform uric acid calculi were used to map out the effectiveness of the Dornier HM-3 lithotripter in fragmenting stones at measured distances from the F2 focal point. Clinical application of findings for stones not able to be focused at F2 is suggested.

We have used electrohydraulic lithotripsy for the treatment of ureteral calculi in a total of 29 patients. By combining the use of a 3.0 Fr electrode and a 9.5 Fr rigid ureteroscope, we have been able to successfully treat the majority of our patients with ureteral calculi. Bypass stenting of obstructing ureteral stones aided in access and effectiveness of ureteroscopy and endoscopic lithotripsy. The success rate in our series of 30 primary treatments was 80%; failures were primarily related to stone composition. In summary, we have found electrohydraulic lithotripsy of ureteral calculi to be a safe and effective treatment modality and routinely used it for stones throughout the length of the ureter that were either impacted or too large to extract primarily.