Safety and Effectiveness of Successive Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis under Intravenous Bolus Pethidine Administration Alone / 대한소화기학회지

BACKGROUND/AIMS: A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone. METHODS: Ninety patients with calcified pancreatic stones (> or =5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy. RESULTS: A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5+/-20.7 mg per session. As ESWL-related complications, four (4.3%) patients developed mild acute pancreatitis. CONCLUSIONS: In case of endoscopically difficult-to-treat pancreatic duct stones, combined therapy with ESWL is an effective method, and treatment with multiple sessions of ESWL on successive days under intravenous bolus of pethidine alone is safe and well tolerated.

First-line Treatment for Chronic Pancreatitis with Stones: Extracorporeal Shock Wave Lithotripsy? / 대한소화기학회지

No abstract available.

Two Cases of Broncholith Removal under the Guidance of Flexible Bronchoscopy

Most broncholiths are related to infection with fungus or tuberculosis and they involve the lymph nodes; those cases that are caused by silicosis are rarely seen. Broncholith might lead complication such as bronchial rupture into the mediastinum, which can result in hemoptysis, cough, repeated pneumonia and so on. Flexible bronchoscopy plays an important part in the diagnosis of broncholithiasis, but its therapeutic application in the clinical setting is controversial. We report here on two cases of broncholith removal without complication with the use of a balloon catheter and tripod forceps using flexible bronchoscopy.

Disintegration of Pancreatic Duct Stones with Extracorporeal Shockwave Lithotripsy / 대한소화기학회지

BACKGROUND/AIMS: Treatment of pancreatic duct stones by extracorporeal shockwave lithotripsy (ESWL) serves as a nonsurgical treatment modality in patients with stones that are located in upstream of the strictures or in patients with impacted stones. We present the results of ESWL in endoscopically unretrievable pancreatic duct stones in the past 2 years. METHODS: Between January 2002 and December 2003, 58 patients with chronic pancreatitis were treated by ESWL for pancreatic duct stones. ESWL was performed with an electrohydraulic lithotripter ultrasound focusing system. RESULTS: The mean number of shockwave treatments was 2.5, and the patients received 4,578 (1,527-10,155) shockwave discharges with a mean energy of 15.8 kV. Fragmentations of the stones were achieved in 54 patients (93.2%), and complete clearance of the stones were noticed in 27 patients (46.6%). Fragmentation of stones equal or less than 3 mm in diameter was associated with successful removal of stones (p<0.05). Complete relief of pain occurred in 32 patients (55.2%). The procedures were well tolerated and no patient had significant complications such as acute pancreatitis. CONCLUSIONS: ESWL is an effective and a safe procedure for endoscopically unretrievable main pancreatic duct stones. ESWL combined with endoscopic therapy can increase the success rate of nonsurgical removal of pancreatic duct stones in patients with chronic pancreatitis.

Endoscopic treatment of chronic pancreatitis.

Endoscopic therapies, originally utilized for problems in the biliary tree, have been adapted for use in the pancreas. Despite widespread adoption and implementation of these techniques, there are few controlled studies comparing pancreatic endotherapy with either surgery or traditional medical treatment. This review attempts to summarize current endoscopic practice in treating the ductal obstructions and leaks associated with chronic pancreatitis and place these techniques into perspective with respect to alternative management strategies.

Upper renal tract stone surgery in patients with normal and abnormal renal functions

Upper renal tract [renal and ureteric] calculi can cause renal impairment. Surgery in patients with renal impairment is associated with renal and extra renal complications. In our study 110 patients with normal renal function [normal serum creatinine] and 40 patients with abnormal renal function [raised serum creatinine] with upper renal tract calculi underwent surgery. Patients with abnormal renal function had significantly higher rate [35.7%] of postoperative complications compared with patients with normal renal function [8.8%]. There was no mortality in patients with normal renal function while one patient who had abnormal renal functions died postoperatively

Litiasis intrahepatica / Intrahepatic lithiasis

La litiasis intrahepática es una entidad poco frecuente en el Hemisferio occidental. Su prevalencia en nuestro medio no es conocida. Estudiamos 342 pacientes con colangiografía retrógeda esdoscóspica realizada por patología litiásica de las vías biliares en el Servicio de Gastroenterología del Hospital Universitario de Caracas, desde el 6 de enero de 1993 al 7 de abril de 1995. De los 342 pacientes, 9 correspondierona litiasis intrahepática, (1,16 por ciento). Siete casos fueron pacientes de Caracas y dos fueron pacientes referidos del interior. Siete pacientes fueron del sexo femenino y dos del masculino, con edades entre 15 y 67 años. La manifestación clínica más frecuente fue el dolor abdominal. El diagnóstico se realizó por econografía y colangiografía retrógrada endoscópica en todos los casos. El tratamiento definitivo fué endoscopico en dos casos. En seis casos se requirió tratamiento quirúrgico, con dos resecciones hepáticas y 4 laparotomias biliares. Un caso egreso sin tratamiento

Disolución de calcificaciones pancreáticas con citratos por vía oral en una mujer con pancreatitis crónica idiopática / Solubilization of pancreatic stones with oral citrate in a female with chronic pancreatitis

Uno de los objetivos del tratamiento médico de la pancreatitis crónica calcificante (PCC) es el control del dolor abdominal que se supone, es debido a la obstrucción intraductal condicionada por calcificaciones, tapones proteicos y zonas de estenosis. Estudios experimentales han demostrado que tanto las calcificaciones como los tapones proteicos son solubles en citratos. En este trabajo informamos el caso de una mujer joven portadora de una PCC idiopática que después de haber sido sometida a una pancreatectomía parcial y drenaje del conducto pancreático desarrolla nuevamente episodios de dolor y calcificaciones pancreáticas que son disueltas por la administración de citratos por vía bucal. El caso confirma observaciones previas e ilustra la potencial utilidad de los citratos en los sujetos con PCC.