The Journal of stone disease最新文献_第2页

Biliary lithotripsy--FDA limbo forever? 胆道碎石术，FDA永远不批准?

The Journal of stone disease Pub Date : 1993-07-01

J N Macaluso

引用次数: 0

Piezoelectric lithotripsy of radiopaque gallstones: results and six-month follow-up. 不透射线胆结石的压电碎石:结果和六个月的随访。

The Journal of stone disease Pub Date : 1993-04-01

J K Han, B I Choi, Y B Yoon, Y H Park, C W Kim, M C Han

{"title":"Piezoelectric lithotripsy of radiopaque gallstones: results and six-month follow-up.","authors":"J K Han, B I Choi, Y B Yoon, Y H Park, C W Kim, M C Han","doi":"","DOIUrl":"","url":null,"abstract":"Sixty-eight patients with radiopaque gallbladder stones (38 with a single stone, 30 with multiple stones) were treated with piezoelectric extracorporeal shock wave lithotripsy (ESWL) and results were compared with those of 69 patients with radiolucent stones (28 with a single stone, 41 with multiple stones). Stones were fragmented to 4 mm or less in 76.8% after 41,466 +/- 36,504 shock waves in the radiolucent stone group and 77.9% after 54,686 +/- 51,024 shock waves in the radiopaque stone group (p = 0.876 and 0.130, respectively). In 137 patients, ten patients were lost to follow-up. Average period of follow-up was 220 +/- 198 days. Six-month clearance rate of the radiolucent stone group was 43.5% and that of the radiopaque stone group was 16.4% (p less than 0.05) Figure 1. Six-month clearance rate of patients with single stones smaller than 2 cm was also significantly higher in the radiolucent stone group than in the radiopaque stone group (69.5% vs 18.6%; p less than 0.01). However, in patients with multiple stones, the presence of calcification did not affect rates of successful fragmentation or 6-month clearance. There was no statistically significant difference in incidence of complications between the radiolucent and radiopaque stone groups. Although the number of cases are small and the follow-up period is short, our results of ESWL on radiopaque gallstones are so far not satisfactory in terms of stone clearance. Strict patient selection is needed unless there is an improvement in the lithotripsy procedure or post-lithotripsy management.","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 2","pages":"89-95"},"PeriodicalIF":0.0,"publicationDate":"1993-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21020044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Eligibility for extracorporeal shock wave lithotripsy of gallbladder stones using different entry criteria. 采用不同入路标准的体外冲击波碎石治疗胆囊结石的资格。

The Journal of stone disease Pub Date : 1993-04-01

P W Plaisier, R L van der Hul, H G Nijs, R den Toom, O T Terpstra, H A Bruining

{"title":"Eligibility for extracorporeal shock wave lithotripsy of gallbladder stones using different entry criteria.","authors":"P W Plaisier, R L van der Hul, H G Nijs, R den Toom, O T Terpstra, H A Bruining","doi":"","DOIUrl":"","url":null,"abstract":"Extracorporeal shock wave lithotripsy (ESWL) was introduced as a nonsurgical treatment for uncomplicated, symptomatic gallstone disease. Due to its limited results and the possibility of stone recurrence, ESWL is mainly indicated for patients who reject or cannot tolerate cholecystectomy. For budgetary and planning purposes, it is essential to know what percentage of patients are eligible for this form of therapy. In the literature suitability is either reported variably (ranging from 10% to 53%) or not mentioned. We respectively assessed eligibility for ESWL for different entry criteria, based on the histories of 694 consecutive patients, who were referred for gallstone therapy from April 1, 1988 to October 1, 1991. Only 10.3%-46.9% of symptomatic patients were found eligible for ESWL, depending on the entry criteria used. When the overall results are compared with eligibility, there is no inverse relationship. This suggests that patient selection is not the only factor determining the results of therapy. It is concluded, therefore, that other factors, such as treatment schemes, the lithotripters used, and experience of the treating physicians, are important factors for the outcome of ESWL therapy.","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 2","pages":"125-30"},"PeriodicalIF":0.0,"publicationDate":"1993-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21020048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-effective shock wave hydrophones. 高性价比的冲击波水听器。

The Journal of stone disease Pub Date : 1993-04-01

M E Schafer

引用次数: 0

The ability of the acoustic energy/stone burden ratio to predict gallstone clearance in biliary lithotripsy. 胆道碎石术中声能/结石负荷比预测结石清除的能力。

The Journal of stone disease Pub Date : 1993-04-01

P O Moon, D E Scheeres, K Mills

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Results of combined electrohydraulic shock wave lithotripsy and oral litholytic therapy of gallbladder stones. 电液冲击波碎石联合口服溶石治疗胆囊结石的效果。

The Journal of stone disease Pub Date : 1993-04-01

J W Maher, R W Summers, T R Dean, J Swift, D Heitshusen, G Quinn

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Electromagnetic shock wave lithotripsy of gallbladder stones in vitro: the role of different stone characteristics and treatment variables. 体外电磁冲击波碎石治疗胆囊结石:不同结石特征及治疗变量的作用。

The Journal of stone disease Pub Date : 1993-04-01

H Vergunst, K Brakel, H G Nijs, E Matura, J Drexler, G Steen, F H Schröder, O T Terpstra

{"title":"Electromagnetic shock wave lithotripsy of gallbladder stones in vitro: the role of different stone characteristics and treatment variables.","authors":"H Vergunst, K Brakel, H G Nijs, E Matura, J Drexler, G Steen, F H Schröder, O T Terpstra","doi":"","DOIUrl":"","url":null,"abstract":"From 40 sets of five human gallstones obtained at cholecystectomy, four stones were subjected to either 125/250 (maximum generator output) or 250/500 (half maximum generator output) electromagnetic shock waves (treatments I/II and III/IV, respectively); the fifth stone was used for computed tomography (CT) and chemical analysis. Overall, 130 (81%) of 160 stones fragmented, including 72 (45%) adequately (fragments less than or equal to 5 mm). For the treatments I, II, III, and IV the overall fragmentation rates were 80%, 95%, 70%, and 80%, respectively. The corresponding percentages of adequate fragmentation ( less than or equal to 5 mm) were 38%, 70%, 30%, and 42%, respectively. The best results were thus obtained after application of 250 shock waves (maximum generator output; treatment II). Pure cholesterol stones (p less than 0.01), stones with a mean CT density less than or equal to 110 HU (p less than 0.001), and stones with a calcified rim (p < 0.05) fragmented significantly better, but adequate fragmentation ( less than or equal to 5 mm) was significantly determined by stone weight and diameter (p less than 0.001), bilirubin content (p less than 0.02), and calcium content (p less than 0.05). A weight greater than 500 mg and a diameter > 10 mm could be defined as stone characteristics with significant negative predictors of adequate fragmentation. However, because the experimental conditions in this in vitro study did not completely simulate clinical settings for various reasons, these observations must be interpreted accordingly.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 2","pages":"105-12"},"PeriodicalIF":0.0,"publicationDate":"1993-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21020047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sonographic classification of gallstones and outcome of extracorporeal shock wave lithotripsy. 胆囊结石的超声分类及体外冲击波碎石的疗效。

The Journal of stone disease Pub Date : 1993-04-01

A Andriulli, L Gremo, G Limerutti, A Bianchi, E Berti, A Arrigoni, G Napolitano, R Cirillo

{"title":"Sonographic classification of gallstones and outcome of extracorporeal shock wave lithotripsy.","authors":"A Andriulli, L Gremo, G Limerutti, A Bianchi, E Berti, A Arrigoni, G Napolitano, R Cirillo","doi":"","DOIUrl":"","url":null,"abstract":"The success of extracorporeal shock wave lithotripsy (ESWL) for gallstone elimination is dependent on the lithotripter's ability to reduce the stone to fragments less than 5 mm in diameter, but wide variation in successful fragmentation rates have been reported even with the same instrument. This variation is probably due in part to differences in stone composition. Tsuchiya et al. have recently related the pre-operative ultrasound properties of gallstones to their chemical compositions. In the present study, 138 patients with cholecystolithiasis were treated with ESWL and results were evaluated in light of the pre-treatment sonogram patterns as classified by the aforementioned authors. Complete fragmentation (CF), i.e., fragments less than 5 mm, was achieved in 90% of patients with type I a patterns (pure cholesterol stones); stone number, diameter, and volume had no effects on fragmentation. Significantly lower CF rates were obtained with I b and I c (mixed cholesterol), and type II (combination) stones (p less than 0.0003). No fragmentation at all was achieved in the six stones with type III (bilirubinate) patterns. Twelve months after treatment, 45%, 25%, and 9% of the patients with type 1 a, type I b, and types I c or II (the latter two combined), respectively, were stone-free. Pure and mixed cholesterol gallstones without calcification seem to respond best to ESWL; effective treatment can be expected even when stones are numerous (4-10) or large ( greater than 35 mm). We recommend the inclusion of ultrasound properties of gallstones in the selection criteria for candidates for ESWL.","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 2","pages":"96-104"},"PeriodicalIF":0.0,"publicationDate":"1993-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21020045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Flashlamp exited pulsed dye laser and electrohydraulic lithotripsy: in vitro study on tissue effects. 闪光灯脉冲染料激光与电液碎石术:体外组织效应的研究。

The Journal of stone disease Pub Date : 1993-04-01

T Lingenfelser, A Routschka, T Grossmann, S Dette, A Distler, W Renn

{"title":"Flashlamp exited pulsed dye laser and electrohydraulic lithotripsy: in vitro study on tissue effects.","authors":"T Lingenfelser, A Routschka, T Grossmann, S Dette, A Distler, W Renn","doi":"","DOIUrl":"","url":null,"abstract":"Intracorporal lithotripsy has gathered momentum in the management of gallstone disease due to the increasing sophistication of technical equipment for the percutaneous, as well as the retrograde-endoscopic route. Laser-induced shock wave lithotripsy (LISL) and electrohydraulic lithotripsy (EHL) have proved feasible by allowing reliable fragmentation of biliary calculi. Evaluation of therapeutic risks, e.g., effects of accidental irradiation of the gallbladder wall, has been performed in small sample sizes only. We investigated the effects of LISL and EHL on multiple sets of human and porcine gallbladders under in vitro conditions. Gallbladders were freshly harvested, mounted, and immersed in different mediums (normal saline, blood, bile). They were swiftly exposed to LISL (Pulsolith¿) and EHL (Lithotron EL 23¿) under differing experimental conditions (energy setting, pulse mode, exposition time, medium, probe pressure) and subjected to standard procedures for morphometric evaluation (Bioquant¿). Tissue effects were described by the depth (d) and width (w) of the cratered lesions, as well as the extension of the damage in the surrounding tissue(s). Serial cuts of the exposed areas yielded 894 section for morphometric analysis. Multivariate analysis of variance (MANOVA) revealed a significant effect of laser energy (p[d] less than 0.002, p[w] < 0.05, p[s] < 0.05), medium (p[d] less than 0.03, p[w] < 0.001, p[s] < 0.04, and exposition time (p[d] less than 0.001, p[s] < 0.001) on the degree of tissue lesion.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 2","pages":"118-24"},"PeriodicalIF":0.0,"publicationDate":"1993-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21022062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for urinary calculi: comparison of immediate and long-term effects. 体外冲击波碎石术与经皮肾取石术治疗尿路结石的近期与远期效果比较。

The Journal of stone disease Pub Date : 1993-01-01

K J Carlson, S P Dretler, R A Roth, E Hatziandreu, K Gladstone, A G Mulley

{"title":"Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for urinary calculi: comparison of immediate and long-term effects.","authors":"K J Carlson, S P Dretler, R A Roth, E Hatziandreu, K Gladstone, A G Mulley","doi":"","DOIUrl":"","url":null,"abstract":"Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy have become widely used technologies for removal of urinary calculi, despite a lack of adequate evaluative studies. The possibility of long-term adverse effects of these treatments has been raised, particularly an increase in stone recurrence and development of hypertension following extracorporeal shock wave lithotripsy. We conducted a retrospective study of 1,000 patients treated with extracorporeal shock wave lithotripsy or percutaneous nephrostolithotomy for upper tract stone disease to assess immediate effectiveness and complications, with prospective follow-up to assess stone recurrence and development of hypertension. The effectiveness of each treatment (defined in terms of patients rendered stone-free or having only fragments at discharge) was similar for most stone types. While stone recurrence rates in the first 2 years after treatment were similar in the two groups, cumulative recurrence at 3 years was higher following extracorporeal shock wave lithotripsy compared to percutaneous nephrostolithotomy (39% vs. 23%, p = 0.04). However, logistic regression and Kaplan-Meier analyses showed no significant difference in clinically evident recurrence for patients treated with extracorporeal shock wave lithotripsy. Cumulative incidence of clinically evident stone recurrence did not differ significantly between patients with fragments at discharge (20%) and patients rendered stone-free (15%) (p = 0.24). There was no difference in the development of new hypertension requiring medical treatment. Our findings indicate that extracorporeal shock wave lithotripsy is effective and associated with lower short-term morbidity than percutaneous nephrostolithotomy. Stone fragments left behind by lithotripsy do not appear to confer significant risk of early stone recurrence. Further study is necessary to define long-term risk of recurrence following extracorporeal shock wave lithotripsy.","PeriodicalId":80218,"journal":{"name":"The Journal of stone disease","volume":"5 1","pages":"8-18"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21020096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0