High-energy v low-energy shockwave lithotripsy in treatment of ureteral calculi.

The size of the crater formed in a urinary calculus subjected to shockwave lithotripsy (SWL) is directly proportional to the energy delivered to the stone surface. This study compared the effect of high and low energy levels on the outcomes of ureteral SWL. Ureteral calculi (N = 336) were treated with the conventional low-energy Siemens Lithostar and 62 with the higher-energy (1.02 v 0.5 mJ/mm2) modification of the Lithostar, the Siemens Shock Tube C. Stone locations included all regions of the ureter. The average stone treated with the standard Lithostar measured 8.1 mm in diameter and received 5461 shockwaves (treatment time 45 minutes) at 17.2 kV (range 14.5-19.0 kV). The stone-free rate was 72%, with stents being used in 16% of patients and a retreatment rate of 9%. The typical stone treated with Shock Tube C was 10.4 mm in diameter and received 3528 shockwaves (treatment time 30 minutes) at an average energy setting of 4.1 (range 1.5-8.0). The stone-free rate was 75%, with stents being used in 9.8% of cases, and a retreatment rate of only 1.6% (P < 0.003). In this study, Shock Tube C yielded stone-free rates equivalent to those of the conventional machine. However, the number of shockwaves, treatment time, and retreatment rate were significantly lower with the new shock tube. High-energy lithotripsy is more efficient than low-energy treatment of ureteral calculi.

Safety and effectiveness of Lithostar shock tube C in the treatment of urinary calculi.

Over 14 years of clinical use of extracorporeal shockwave lithotripsy (SWL), great technical modifications resulted in the development of many second-generation lipthotripters. The Siemens Lithostar machine, with its standard shockwave tube, was introduced in 1986. The objective of this study was to assess the safety and effectiveness of the newly proposed Lithostar shock tube C in the treatment of urinary calculi. Between July 1992 and August 1993, 319 patients (214 males and 105 females, average 49.7 years) with 433 renal or ureteral stones or both were treated at five centers in Canada and the United States. Most of the stones (72%) were located in the kidneys, while 28% were located in the ureters. Most (81%) of the treated sides (side = kidney and ureter) presented with single stones, 11% presented with two stones, and 8% presented with three or more stones. The average stone burden was 13.6 mm. The average duration of treatment for the whole population of patients was 39.3 minutes using an average number of shockwaves of 3633 in a minimum and maximum energy setting of 0.11 and 3.82, respectively. The majority of treatments (92%) were performed without anesthesia. Fragmentation was achieved in 93.5% of treatments, with a 3-month stone-free rate of 62.5% and a success rate (stone free or fragment < 5 mm) of 72%. Auxiliary procedures were necessary in conjunction with 108 treatments, and most of them were in form of catheter/stent placement. Treatment applied on a separate occasion to different stones but in the same collecting system (either a kidney or a ureter) were considered retreatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of the pulsed dye laser and ultrasonic lithotriptor for removal of multiple intrahepatic gallstones.

Two established urologic modalities used for removal of kidney stones were applied in a complementary manner for percutaneous transhepatic removal of multiple intrahepatic gallstones. A pulsed dye laser was used through a flexible nephroscope to fragment a large impacted stone. A stone basket was used to remove stone fragments and a few small entrapped stones. Subsequently, an ultrasonic lithotriptor carried by a rigid nephroscope was tried and found to be a much more efficient means of removing the remaining small stones.

Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management.

Controversy surrounds the management of prostatomembranous urethral injuries. We herein present 38 patients and review the findings of 538 in 19 reported series. Results indicate a high risk of stricture, impotence and incontinence if conventional early urethral realignment techniques are used. Therefore, it is suggested that this approach be reserved for cases demanding immediate intervention (high riding bladder, associated rectal tear, concomitant bladder neck injury or continued bleeding), and that all others be managed by initial suprapubic cystostomy alone and delayed urethroplasty. Urethroplasty selection is discussed.

[Therapy of Amanita phalloides poisoning. Results of clinical and experimental studies]. / Zur Therapie der Knollenblätterpilz-Vergiftung. Ergebnisse klinischer und experimenteller Untersuchungen.

On the basis of experimental and clinical results evidence accumulates that supportive therapy is still the milestone in the therapy of death cap poisoning. Today the letality is 20%. The main cause of the intoxication are the amatoxines which inhibit DNA dependent RNA Polymerase II or B. Parts of the supportive therapy are: diuresis with 150--200 ml urin/hour, careful corrections of disturbances in electrolyte and acid-base-metabolism, oral administration of charcoal and oral gut sterilization. In spite of a multitude of experimental and clinical reports on the effectivity of Penicillin G, thiocticacid and steroids there are no controlled studies to demonstrate the advantage of one regimen over the other. The time course of resorption and excretion of amatoxines clearly shows that hemoperfusion and/or hemodialysis are only of value if applied within the first 24 hours after poisoning. At this time neither anamnestic nor biochemical data give any clues to the probable course of the disease. Heterologous baboon liver perfusion may be lifesaving in coma hepaticum grade IV, but the small amount of cases so far does not yet allow any comments on its effectivity.

An alternative to radical surgery for cancer of the prostate.

We have used the technique of retropubic implantation of 125I seeds, as introduced by Whitmore and associates in 1972, in 12 selected patients with prostatic cancer. Morbidity has been minimal, and the tumor has been effectively controlled. This technique delivers more radiation and has fewer side effects than external cobalt irradiation, and it should be offered to the patient as an effective alternative to radical prostatectomy. It is best suited for patients with stage A, stage B, or small stage C lesions who have negative bone scans. Edema of the penis follows the lymphadenectomy but gradually subsides.

The index line as a new aid in clinical and forensic toxicology.

On behalf of the German Federal Ministry for Research and Technology, we investigated the use of electronic data processing for clinical toxicological purposes. Initially, sufficient funds were available for a comprehensive approach to the problem and programs covering the following areas were established: 1. A casuistic data program; 2. an identification program for wild fruits; 3. a program for the identification of tablets by their shapes. Due to a subsequent lack of funds, it was necessary to develop a partial solution: this solution is what we call the Index Line. The Index Line--limited data on poisonings--should enable the user to receive information by telex from the German Institute for Medical Documentation and Information, i.e., information on "who has what, where". As a first step the continuous Index Line registration of all cases of poisoning recorded at the poison control centers in Munich, Freiburg, Hamburg, and Nürnberg as well as at the State Institute for Food, Pharmaceutical and Forensic Chemistry in Berlin was founded in 1975. To participate in the program, complete instructions are necessary.