The implantation of new self-expanding mesh stents (20 mm in diameter, when fully expanded) in a 67-year-old woman with extensive esophageal cancer stenosis is reported. Prosthesis insertion was easily accomplished without the need for general anesthesia. The patient has been doing well since. The potential advantages of the new stenting procedure suggest further investigation.
SUMMARYThe tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave application to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative.Non-surgical procedures for the treatment of cholecystolithiasis must be measured against the effectiveness of cholecystectomy and its low morbidity (7%) and mortality (0.4%) rates.' In contrast with oral chemolitholysis alone, extracorporeal shockwave lithotripsy in combination with chemolitholytic post-treatment, appears to be a promising alternative to cholecystectomy in selected patients.2 Sauerbruch et al adapted a kidney stone lithotripter that worked on the basis of the high voltage spark gap discharge principle to the requirements of the biliary system, and reported a 78% stone free rate in patients with solitary stones (up to 20 mm) after four to eight months.3Using a new type of lithotripter that generates shockwaves using the piezoelectric principle, we have been able to show that gall stones can be disintegrated reliably and reproducibly.45 The
Piezoelectric lithotripsy was undertaken on 50 patients with gallbladder stones, none of them requiring anaesthesia, analgetics or sedatives. Stone fragmentation was achieved in all patients during the first treatment. In 44 patients the maximum fragment size was less than 50% of the initial stone diameter. The mean maximum fragment size after the first treatment was 4.3 mm (+/- 3.3 mm). After a follow-up of 0-2 months in 14 of the 50 patients and of 2-4 months in 6 of 13 patients, no more stones could be seen by ultrasonography. After an average period of 8 weeks, 17 of 50 patients were free of stones. Piezoelectric lithotripsy did not have any severe side effects besides a mild pancreatitis in one patient.
The case of a young woman is reported, presenting multiple peripheral lung nodules, preceding the onset of classical rheumatoid arthritis 3 months later. The nodules observed seemed to be of pleural origin because they all had contact with the pleura which was partly thickened as demonstrated by computer-assisted tomography. The histopathology of material obtained by an open-lung biopsy revealed rheumatoid necrobiotic nodules. Although very rare, rheumatoid arthritis should be considered as a differential diagnosis of pulmonary nodules of unknown origin.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.