[Extracorporeal shockwave lithotripsy (SWL) of common bile duct calculi without previous endoscopic papillotomy]. / Extrakorporale Stosswellenlithotripsie (ESWL) von Gallengangsteinen ohne vorherige endoskopische Papillotomie.

In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-duct stones after recent laparoscopic cholecystectomy or age below 25 years) the chances of successful treatment by ESWL without sphincterotomy were examined. In 15 patients with solitary stones measuring up to 14 mm "pulverization-ESWL" produced complete freedom from stones after spontaneous migration of fragments through the intact papilla. Only two patients with two ductal stones measuring up to 15 mm still had residual fragments in the bile duct after treatment. The ideal stone for ESWL without sphincterotomy is thus the solitary bile-duct stone measuring up to 14 mm. Before performing a high-risk sphincterotomy, before re-operation and in young patients one should therefore always examine whether ESWL without sphincterotomy is indicated.

Chronic inflammation in the myocardium of patients with clinically suspected dilated cardiomyopathy.

Dilated cardiomyopathy continues to be an etiologically unknown heart muscle disease. Recent clinical and experimental data have suggested a causal relation to viral myocarditis. The clinical diagnosis, however, is unspecific, and diagnostic yield of the histologic evaluation of endomyocardial biopsies by light microscopy according to the Dallas classification is poor. The authors analyzed the biopsy specimens of 120 patients with suspected dilated cardiomyopathy by immunohistologic methods to obtain a more sensitive and specific identification and quantification of infiltrating lymphocytes, indicating an activated immunologic process within the myocardium. Increased lymphocytic infiltrates and inflammatory endothelial activation were demonstrated in patients with clinically suspected dilated cardiomyopathy. These findings are associated with the often seen progression of ventricular dysfunction. Further studies are necessary to prove whether these immunohistologically positive patients will improve under immunosuppressive therapy.