Analgesia in anesthesia-free extracorporeal shock wave lithotripsy: a standardized protocol.

We treated 101 patients at our stone facility with the Dornier HM3 lithotriptor modified with the anesthesia-free design upgrade. A protocol designed by our anesthesiologists consisting of intravenous and intramuscular injections for sedation was used without any general or regional anesthesia required. Pre-medication with intramuscular meperidine and promethazine, and oral diazepam was sufficient sedation in 43 patients, while 37 required additional intravenous meperidine and/or midazolam during the procedure, 16 were treated with intraprocedural medication alone and 5 required no medication at all. Care before, during and after the procedure was rendered by the urology staff for patients in American Society of Anesthesiologists risk category I or II. Treatment was successfully completed in all patients without complications. We compared this group to the 99 patients treated consecutively before the modification. Voltage used, number of shocks and stone burden were comparable in the 2 groups but average treatment time was prolonged with the upgraded equipment (39.2 versus 27.1 minutes) to a significant degree (p less than 0.001).

Human insulin: facile synthesis by modification of porcine insulin.

Human insulin differs from porcine insulin by a single amino acid- the carboxyl terminal residue of the B chain. By means of chemical and enzymatic treatment, it is possible to remove quantitatively and selectively the carboxyl terminal octapeptide from porcine insulin B chain. This fragment can be replaced by an analogous synthetic human octapeptide to give a protein which is identical to human insulin by a number of criteria. By this method, human insulin can be prepared on a large scale simply and inexpensively from porcine insulin. The method is also useful for preparing specifically labeled radioactive human insulin, as well as insulins with modified amino acid sequences, for research purposes.