Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether.

Abstract

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.

Health effects of oxygenated fuels.

“…Reference Rat 250, 1000, 3300 ppm, 6 hr/day, gestation days [6][7][8][9][10][11][12][13][14][15] No effects in dams/offspring (27) Mouse 1000, 4000, 8000 ppm, 6 hr/day, gestation days 6-16 Decreased weight gain in dams/fetuses, increased (28) fetal resorption and incidence of skeletal malformations Mouse 250, 1000, 2500 ppm, 6 hr/day, gestation days [6][7][8][9][10][11][12][13][14][15] No effects in dams, increased fused sternebrae in (29) offspring Rabbit 1000, 4000, 8000 ppm, 6 hr/day, gestation days [6][7][8][9][10][11][12][13][14][15][16][17][18] Decreased weight gain in dams, increased liver weight (30) in dams, no fetal toxicity or malformations aNumbers in bold indicate concentrations at which effects were seen. exhaled as CO2, and only a small fraction is excreted directly through the lung (2.5%) or in the urine (1%) at methanol doses smaller than 1 g/kg.…”

Exposure to MTBE and Acute Human Health Effects: A Critical Literature Review

“…Those included reports of experimental exposure studies and also studies of populations with ambient or occupational exposures. Another 12 reports described the clinical use of parenteral MTBE for dissolution of cholesterol gall stones (Allen et al, 1985;Di Padova et al, 1986;Hellstern et al, 1990;Leuschner et al, 1991;McNulty et al, 1991;Saraya, Rai, and Tandon, 1990;Neoptolemos et al, 1990;Ponchon, Baroud, Pujol et al, 1988;Murray, Laferla, and Fullarton, 1988;Brandon et al, 1988 Simunic, and Radanovic, 1992;Thistle et al, 1989). Although the exposure route in these studies differed from that in the occupational, ambient and experimental exposure studies, we anticipated that the much greater administered parenteral doses might provide insight into the physiological effects of acute MTBE exposure.…”

Increased blood levels of methyl tert-butyl ether but not of ethyl propionate during instillation with contact gallstone dissolution agents in the pig

“…In patients in whom MTBE has been used for contact dissolution of cholesterol gallstones there have been no reports of serious systemic toxic effects. Nonetheless, MTBE has central nervous system side effects such as somnolence, nausea, and vomiting; abdominal pain suggesting local tissue irritation has also been described (7,12,16,18,19,(24)(25)(26)(27) In this study, we examined blood levels of EP and MTBE during gallbladder instillation in the piglet under conditions simulating contact dissolution of cholesterol gallbladder stones in human beings. We tested the hypothesis that blood levels of EP would be lower than those of MTBE because of the more rapid metabolism of EP.…”