0000000000342482
AUTHOR
A. Rambow
Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.
Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were obse…
Endoskopische Diagnostik und Therapie der akuten biliären Pankreatitis
Endoskopische retrograde Cholangiopankreatikographie (ERCP) und endoskopische Papillometrie (EPT) sind wesentliche Saulen der Diagnostik und Therapie der akuten biliaren Pankreatitis. Patienten mit Pankreatitis sowie klinischen und laborchemischen Hinweisen auf eine extrahepatische Cholestase sollten unbedingt endoskopiert werden. Die EPT ermoglicht eine effektive und komplikationsarme Therapie, wenn die Pankreatitis mit Konkrementen in den Gallenwegen oder der Papille assoziert ist. Bei Patienten mit akuter Cholezystitis bei Cholezystolithiasis lassen sich mittels endoskopischer Manometrie funktionele Storungen der Papillenmotilitat nachweisen, die als Ursache von Cholestase und Pankreatit…
Investigation of the Effect of Duodenoscopy on Sphincter of Oddi Manometry
To investigate whether endoscopy affects sphincter of Oddi (SO) manometry, three patients who had undergone previous cholecystectomy and had a T-tube in situ for drainage were studied. Manometry was performed using a perfused triple lumen manometry catheter (diameter 1.7 mm), which was advanced into the SO lumen through the T-tube. SO motility, baseline pressure, common bile duct pressure and duodenal pressure were monitored before and during endoscopy while the tip of the endoscope was in the mouth, esophagus (upper third, precardial), stomach and duodenum. Endoscopy and even a moderate insufflation of air necessary to pass the pylorus and inspect the papilla of Vater did not affect the pa…
Die retraktile Mesenteritis*: Diagnostische und therapeutische Aspekte
An 18-year-old boy, who had severe abdominal pain for 18 months associated with marked weight loss, was found to have a stenosed ileal sling on double-contrast radiology of the small intestine. At operation a plate-like tumour was extending from the pancreas to the aortic bifurcation. Histological examination of removed tissue revealed retractile mesenteritis (mesenteric panniculitis; liposclerotic mesenteritis). The symptoms regressed and the patient again gained weight under immunotherapy with 1 mg/kg of prednisone and 2 mg/kg of cyclophosphamide daily. Subsequently, under prednisone alone, there was a recurrence, which responded within five weeks to daily 60 mg prednisone and 125 mg cycl…
Extrakorporale Stoßwellenlithotripsie von Gallenblasensteinen: Wie viele Patienten sind geeignet?
The proportion of patients with gallbladder stones suitable for extracorporeal shockwave lithotripsy (ESWL) was analysed prospectively in 200 patients aged 17-76 years (62 males, 138 females) with symptomatic cholecystolithiasis. Criteria for inclusion were clinical symptoms, solitary stones (diameter 10-30 mm) or up to three stones with comparable total volume, contractile gallbladder, no calcification of stones, normal biliary tract anatomy. To check these criteria a step-by-step diagnostic procedure was instituted which consisted of history, ultrasonography with contractility test, abdominal X-ray film, computed tomography measurement of stone density, and endoscopic retrograde cholangio…
Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.
. First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11–30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) …
Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones
A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17-76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had …
Lithotripsy of gallbladder stones in 1992: Improved indications and actual results
ESWL of gallbladder stones and subsequent adjuvant oral dissolution is a safe and comfortable therapy of symptomatic cholecystolithiasis. This method is limited on highly selected 10 to 15% of patients. Recent experience indicates that the ideal indication is given in patients with radiolucent solitary gallstones (diameter ≤2 cm) which are harboured in a gallbladder with unimpaired contractility. 1 year after ESWL 80% of those patients present with a stone free gallbladder. Computed tomography of gallstones may probably improve selection of patients and therapeutic success.
Extrasystolie während extrakorporaler biliärer Stoßwellenlithotripsie: Inzidenz und klinische Bedeutung*
Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (…
Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones
First-generation extracorporeal shock-wave sources disintegrate 97% of kidney stones [1, 2]. Recently, in selected patients gallbladder and common bile duct stones were also treated. The technique available so far, however, requires immersion of the patient’s body in a tank of degassed water. The procedure is therefore inconvenient, time consuming, and relatively expensive. The high pressure of shocks (up to 1000 bar) generated by underwater spark discharge causes pain, and general anesthesia is necessary in most patients [3, 4].
Analysis of radiolucent gallstones by computed tomography for in vivo estimation of stone components.
. Successful oral litholytic and other non-operative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows a prediction of the composition of radiolucent gallstones. Twenty-eight patients presenting with 29 radiolucent gallbladder (n= 17) or common bile duct stones (n=12) were included. Prior to operative or endo-scopic therapy the attenuation values (Hounsfield Units, HU) were assessed in vivo by CT under standardized conditions (Somatom II, 125 KV, 130 mAs). After surgical or endoscopic stone removal the con…