Changing therapy for gallstone disease

Article Abstract:

Two decades ago, surgery was the only effective means of treating gallstones. Since that time, new methods have emerged which may reduce the need for surgery. Bile acids were found to be effective in dissolving some gallstones, and while gallstones are likely to recur in a majority of patients treated by this method, the technique is nevertheless safe and effective for many patients. More recently, shock wave lithotripsy was introduced; this method generates shock waves from ultrasound which travel into the body and can fracture some gallstones, which are firmer than the surrounding soft tissue. The technique is not for everyone; the method works best on solitary stones of less than 2 centimeters. In the November 1, 1990 issue of The New England Journal of Medicine, researchers evaluated the contribution made by the addition of a particular bile acid, ursodiol, to the lithotripsy protocol. They demonstrated a higher rate of effectiveness for the combination treatment than for lithotripsy alone. However, lithotripsy still remains controversial. It is not effective for the majority of patients, and the patients studied in most trials of lithotripsy are preselected for the most amenable stones. The procedure remains costly and the chance of recurrence is so high that the patient, in effect, becomes a gallstone patient for life. The procedure should be judged in relation to the alternatives, conventional surgical removal of the gall bladder and gall bladder laparoscopy. In gallbladder laparoscopy, a laparoscope for visualization and the surgical instruments are inserted through four small holes in the abdomen, each no larger than a centimeter. This method for removal of the gall bladder is effective, but more experience is needed to determine if the frequency of problems and complications is acceptably low. The procedure should be rigorously evaluated, since it provides not only permanent freedom from gallstones, but improved recovery compared with the conventional surgical technique. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gallstones, Bile acids, Laparoscopy, Ultrasonic lithotripsy, editorial, Lithotripsy

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Calcific tendinitis of the shoulder

Article Abstract:

More research is needed before ultrasound can be used to treat calcific tendinitis of the shoulder. This occurs when calcium is deposited on the tendons in the shoulder. It can cause pain during movement, but many patients have no symptoms. A 1999 study found that ultrasound was effective in treating this condition when compared to a sham treatment in which no ultrasound was used. Animal studies show that ultrasound can increase calcium metabolism, so there is some rationale for its use. However, the dosage should be as low as possible to minimize the adverse effects of ultrasound.

Editorial

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Ultrasound therapy for calcific tendinitis of the shoulder

Article Abstract:

Ultrasound therapy appears to be effective in treating calcific tendinitis of the shoulder. This condition is characterized by calcium deposits in the shoulder joint. Researchers randomly assigned 54 people with this condition to receive ultrasound therapy or a sham treatment that did not use ultrasound. Treatment was daily for three weeks, then three times a week for six weeks total. Nine months later, calcium deposits were gone in 42% and reduced in 23% of the shoulders treated with ultrasound, compared to 8% and 12%, respectively, in the sham treatment group.

Shoulder pain

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