The Munich gallbladder lithotripsy study

Article Abstract:

A nonsurgical approach to gallstone disease, known as lithotripsy, employs the use of shock waves to fragment gallstones, which can then be cleared by the gallbladder. A 5-year study of 711 patients was conducted to assess the efficacy and success rate of lithotripsy. The patients were divided into three groups. Group A had lithotripsy with a machine that required patients be immersed in a water tank; groups B and C were treated with a newer machine that transmitted shock waves through a water cushion, at low (group B) and high (group C) energy levels. Patients with single stones less than 20 millimeters (mm) in diameter had the greatest clearance rate, while those with single stones between 21 and 30 mm in diameter had intermediate rates of clearance, and those with 2 or 3 stones had the lowest rates of clearance. Patients in group B had lower clearance rates than those in groups A and C regardless of the number of stones they had. Clearance was generally achieved over the course of several months, as measured by ultrasound examination of the number and size of gallstone fragments still present, and was enhanced by the administration of bile acids, which help to dissolve gallstones. Some of the complications of lithotripsy included hemorrhage in the skin (8 percent of patients), bloody urine (4 percent of patients), and episodes of gallstone-related pain (6 percent of patients before hospital discharge; 36 percent before complete fragment clearance). The study demonstrated that the ability of lithotripsy to clear gallstones depended on the number and size of the original stones and patient compliance in the use of bile acids to promote fragment dissolution. The procedure was felt to be a safe and effective therapy to treat gallstones in selected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Surgery, Gallstones

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Severe hemorrhage after extracorporeal shock-wave lithotripsy

Article Abstract:

Extracorporeal shock-wave lithotripsy uses high-energy shock waves to break up kidney stones. No anesthesia is necessary when newer, more focused shock-waves lithotripters are used. Although hematomas (collections of trapped blood) are known to occur, severe hemorrhage experienced during lithotripsy is rare. A 76-year-old woman with high blood pressure was anesthetized before lithotripsy. Although her heart rate and blood pressure were normal during the procedure, they subsequently dropped while she was in recovery. Ultrasonographic evaluation, the use of high frequency sound to visualize the kidney, was unrevealing. Despite exhaustive efforts to maintain cardiopulmonary stability, the patient died. Bleeding originating in the left kidney was discovered after autopsy. In another case, a 70-year-old man with multiple stones experienced a normal uneventful treatment with shock-wave lithotripsy. Back pain, low blood pressure and rapid heart rate developed two hours after treatment. Ultrasonographic evaluation of the kidney revealed an accumulation of fluid in the left kidney. The patient remained stable after receiving blood transfusions. Since lithotripsy can be performed on an outpatient basis, warning signs of hemorrhage, must be communicated to the patients before leaving the hospital. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Hemorrhage

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Decreased high-density lipoprotein cholesterol and increased low-density cholesterol levels in patients with colorectal adenomas

Article Abstract:

Individuals with decreased blood levels of high-density lipoprotein (HDL) cholesterol and increased blood levels of low-density lipoprotein (LDL) cholesterol may have a higher risk of developing colorectal adenomas than other individuals. Colorectal adenomas are benign tumors that can develop into into colorectal cancer. Among 822 colonoscopy patients who underwent measurement of their blood levels of HDL cholesterol, LDL cholesterol and very low density lipoprotein (VLDL), 194 were diagnosed with colorectal adenomas. Patients with colorectal adenomas were more likely to have decreased blood levels of HDL cholesterol than those without colorectal adenomas. Individuals with colorectal adenomas were also more likely to have increased blood levels of LDL cholesterol and VLDL than those without colorectal adenomas.

Risk factors, Physiological aspects, Colorectal cancer, Cholesterol, LDL, VLDL cholesterol lipoproteins, Cholesterol, HDL, HDL cholesterol lipoproteins, Adenoma

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