Extracorporeal shock wave lithotripsy of gall stones: an in vitro comparison between an electrohydraulic and a piezoceramic device

Article Abstract:

Gallstones are solid masses that form in the gallbladder or bile ducts. They are commonly composed of cholesterol which is present in a greater concentration than is found in solution in the bile; the precipitated cholesterol forms a compact mass. Gallstones may not produce symptoms, or they may interfere with the flow of bile and produce pain, loss of appetite, and flatulence. A commonly used procedure for treating gallstones is lithotripsy, or the application from without the body of focussed shock waves that shatter the gallstones, allowing them to pass harmlessly through the biliary system. There are several types of lithotriptors (machines for performing lithotripsy) that operate on different principles; no direct comparisons have been made between these different methods of fragmenting gallstones. Two different types of lithotriptor, one operating by underwater spark discharge (Dornier MPL 9000) and the other operating on the piezoceramic principle (Piezolith), were compared by in vitro techniques for their ability to shatter gallstones (which had been removed during gallbladder operations). All stones were disintegrated (broken into segments smaller than 2 millimeters) successfully by both machines. At the highest setting, the Piezolith required 1.65 times more shocks than the Dornier to effect a given level of disintegration. The volume of the gallstones was the only parameter that affected the ease of destruction; neither composition nor density had any effect on the number of shocks required to fragment the stones. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Surgery, Surgical equipment and supplies, Surgical instruments, Lithotripsy

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Piezoelectric lithotripsy and soft tissue injury. Safety limits in the experimental and clinical setting

Article Abstract:

Gallstones, concretions of solidified cholesterol that may block the passageway from the gall bladder, are a painful affliction that formerly were only treatable by surgery. In recent years, lithotripsy, a technique that involves the shattering of these stones by shock waves generated outside the body by a machine, has come to be recognized as an alternative treatment. It is claimed that the shock waves produced by these devices (lithotripters) selectively destroy the noncompliant gallstones, while having little effect on the soft tissues surrounding them. To investigate this safety claim, two studies, one using an animal model (anesthetized guinea pigs) and another using human subjects, were performed. The guinea pigs were subjected to one of several doses of shock waves (6000 to 48000 shocks) applied at one of several different frequencies (2.5 to 20 shock waves per second). The amount of tissue damage that occurred was proportional to the number of shock waves administered. Repeated low doses did not produce cumulative damage. Even at the high doses, satisfactory healing of soft tissue damage occurred within one month after treatment. Human subjects were administered either 6000 or 36000 shock waves one day before elective surgery for gall bladder removal. Patients receiving the higher number of shock waves suffered more tissue damage than those receiving the low dose. As in the animal studies, repeated low doses (up to six treatments at weekly intervals) produced no cumulative damaging effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Shock waves, Ultrasonic lithotripsy, Gallbladder

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Management of acute cholecystitis in UK hospitals: time for a change

Article Abstract:

Acute cholecystitis is at present a condition managed by general surgeons with widely differing subspecialist interests. Despite evidence, which strongly advocates early cholecystectomy, this practice is routinely carried out by only 11% of the consultants in the UK at present.

United Kingdom, Science & research, Management dynamics, Health aspects, Research, Practice, Surgeons, Cholecystitis, Cholecystectomy

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