[Sonographic acute and follow-up diagnosis after blunt abdominal trauma]. / Sonographische Akut- und Verlaufsdiagnostik nach stumpfem Bauchtrauma.

Experience with ultrasonographic acute and follow-up diagnostic as noninvasive imaging procedure for blunt abdominal trauma was analysed in a retrospective study. Between 1986 and 1989 166 organ lesions were noticed in 440 patients with clinically regarded diagnosis of a blunt abdominal trauma. 107 patients were laparotomised. Retrospectively, the sensitivity concerning free fluid in the abdominal cavity caused by lesion of an intrabdominal organ was 0.96 and the specifity 0.98. The predictive value of a positive test was 0.91 and the predictive value of a negative test was 0.99. The rate of negative laparotomy was 1.3%. Thus the sole use of ultrasonographic diagnostic and the non-use of peritoneal lavage seems justified in case of blunt abdominal trauma. Some figures illustrate typical cases and our own results.

[Extracorporeal piezoelectric gallstone lithotripsy: initial surgical experience with a new treatment. Technique and indications]. / Extrakorporale piezoelektrische Gallensteinlithotripsie: erste chirurgische Erfahrungen mit einer neueren Therapie. Technik und Indikationen.

The extracorporeal piezoelectric lithotripsy (EPL) is a new method for non-operative therapy of symptomatic gallbladder and problematic bile duct stones. The rare intrahepatic calculi were similarly disintegrated. Best results were reached with EPL as adjuvant measure or combined with oral cheno- and ursodeoxycholic acid therapy. EPL compared to other lithotripsy techniques is performed without any analgesia. That means advantage and patient's benefit.

Large-bile-duct stones--extracorporeal piezoelectric lithotripsy as adjuvant measure for endoscopic basket extraction.

Extracorporeal piezoelectric lithotripsy (EPL) was performed in 12 patients with large-bile-duct stones and intrahepatic stones. The Piezolith 2300 lithotripter (Wolf, Knittlingen, FRG) was used in all patients in whom routine endoscopic approaches for removal of the calculi had failed or were considered inappropriate because of large stone size or difficult localization. In 9 of the 12 patients the stones were fragmented. Complete stone clearance from the bile ducts was obtained in 8 of 10 patients by EPL alone or combined with one of the following: endoscopic extraction, mechanical lithotripsy or installation of solvents. Adjuvant EPL in conjunction with endoscopic therapy increased the success rate of nonsurgical treatment for bile duct stones from 73% to 95%. No clinically significant side effects or complications were noted.

[Epidemiology and pathogenesis of gallstones. Status of knowledge and therapeutic consequences]. / Epidemiologie und Pathogenese von Gallensteinen. Kenntnisstand und therapeutische Konsequenzen.

The prevalence of gallstones in Europe is 7% for mean and 12 to 14% for women with figures increasing with age. Most gallbladder stones remain asymtomatic, leading to complications in less than 2%, and to biliary pain in 18% of initially asymptomatic patients over a period of 20 years. On the basis of such observations it has been concluded that only symptomatic gallbladder stones need to be treated. Stones in the bile ducts, however, must be removed whether symptomatic or not. In Europe more than 80% of gallbladder stones are cholesterol stones. The remaining stones are black pigment stones, composed predominantly of calcium bilirubinate. Brown pigment stones usually occur in the pathogenesis of cholesterol stones, may lead to new therapeutic or prophylactic approaches.

[Significance of ultrasonic-guided pleural punctures/thoracic drainage after abdominal procedures and blunt abdominal/thoracic trauma]. / Bedeutung der ultraschallgesteuerten Pleurapunktion/Thoraxdrainage nach Abdominaleingriffen und stumpfem Bauch-/Thoraxtrauma.

The sensitivity of ultrasonographic diagnosis of pleural fluid accumulations and the value of ultrasonographically guided thoracentesis were studied prospectively. One hundred ten patients were examined after abdominal operations and chest trauma. Most of the examinations were performed in a half-sitting position. Pleural fluid of clinical relevance, diagnosed by real-time ultrasonography, was treated by thoracentesis under ultrasonographic guidance in 38 cases. The amount of aspirated fluid ranged from 150 to 1350 ml. The sensitivity of the method was 97.1%. The complication rate was 2.6%. There are now 240 patients treated by ultrasonographically guided thoracentesis and 160 cases with pleural drainage. In our view, ultrasonographically guided thoracentesis represents the method of choice in critically ill and immobile patients.

[Ultrasound diagnosis following blunt abdominal trauma. Sonography in acute and follow-up diagnosis]. / Ultraschalldiagnostik nach stumpfem Abdominaltrauma. Sonographie in der Akut- und Verlaufsdiagnostik.

Experience with ultrasonography as a non-invasive imaging procedure for acute and follow-up diagnostic evaluation of blunt abdominal trauma was analysed in a retrospective study. Between 1980 and 1988, more than 2,000 ultrasonographic investigations were performed for blunt abdominal trauma; 246 patients were laparotomized. Retrospectively, false results based on ultrasonography were less than 1% of all cases, so that the sole use of ultrasonographic diagnosis and the non-use of peritoneal lavage seems justified in cases of blunt abdominal trauma. A number of figures illustrate typical cases.