Dose-Dependent Influence on Canine Renal Morphology After Application of Extracorporeal Shock Waves with Wolf Piezolith

Neisius, D.; Seitz, Gerhard; Gebhardt, Th.; Ziegler, M.

doi:10.1089/end.1989.3.337

Cited by 19 publications

(10 citation statements)

References 7 publications

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“…This corresponds to the observations recorded by Jung and Neisius [25,36] with the new generator of the Piezolith 2500. Generator voltage mainly determines the peak pressure in the focal zone, although all other physical parameters of the shockwave (i.e.…”

Section: Influence Of Generator Voltagesupporting

confidence: 90%

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Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

et al. 1993

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Using the new electromagnetic shockwave source of the Modulith SL 20 shockwave-induced renal trauma was evaluated by acute and chronic studies in the the canine kidney model. In a further study the electromagnetic shockwave source of the Lithostar Plus Overhead module was tested. Overall, 92 kidneys were exposed to shock waves coupled either by water bath (Modulith lab type) or by water cushion (Modulith prototype, Lithostar Overhead) under ultrasound localization. The generator voltage ranged between 11 and 21 kV, the number of impulses between 25 and 2500. After application of 1500/2500 shocks the extent of the renal lesion depended strictly on the applied generator voltage and was classified into 4 grades: Grade 0, no macroscopic trauma detectable (at 11-12 kV); grade 1, petechial medullary bleeding (at 13 kV); grade 2, cortical hematoma (at 14-16 kV); and grade 3, perirenal hematoma (17-20 kV). Whereas at low and medium energy levels the number of shocks played only a minor role, at maximal generator voltage (20 kV) even 25 impulses induced a grade 2 and 600 shocks a grade 3 lesion, emphasizing the importance of shockwave limitation in the upper energy range. In shockwave-induced renal trauma a vascular lesion was predominant and cellular necrosis was secondary. Coupling with a water cushion resulted in a 15%-20% decrease in the disintegrative and traumatic effect, which was compensated for by increasing the generator voltage by 2 kV. Long-term studies showed complete restitution following grade 1 and 2 trauma, whereas after a grade 3 lesion a small segmental and capsular fibrosis without hyperplasia of the juxtaglomerular apparatus was observed. Based on the characteristic ultrasound pattern found in the first study, the threshold for induction of grade 1 lesion was investigated. With both lithotripters a wide range for induction of a grade 1 lesion (Modulith 234-411, Lithostar Plus 220-740) and also a significant overlapping with grade 0 and 2 lesions was seen at low energy settings (levels 2-4). In contrast, the range of shocks (Modulith 96-150, Lithostar Plus 90-142) and overlapping was minimal when high energy was used (levels 7-9). Finally, the disintegration-trauma coefficient combining the results obtained in a standard stone model with those of the canine kidney model was introduced.

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Section: Influence Of Generator Voltagesupporting

confidence: 90%

“…These issues are of major importance, particularly with the development of new shockwave sources [16,19,36,40,51]. Most of these systems have been developed to improve disintegrative capacity, but tissue trauma must be to a minimum.…”

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confidence: 99%

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

et al. 1993

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“…That tissue damage in the kidney was increased when the number of discharges was increased is not surprising (Delius et al 1988b;Neisius et al 1989;Recker et al 1989). A high pulse energy had the same effect (Rassweiler et al 1993).…”

Section: Pulse Energymentioning

confidence: 95%

“…A hematoma (large arrow) is easily differentiated from diffuse hemorrhages (small arrows). Scale in cm kidney stone fragmentation, the effects of all types of shock wave generators have been examined at this organ (Newman et al 1987;Abrahams et al 1988;Delius et al 1988b;Gunasekaran et al 1989;Neisius et al 1989;Recker et al 1989). On their way to the pelvis, shock waves caused small, needlepin-like bleedings at the skin, the tissues of the body wall, and in the fatty tissue around the kidney.…”

Section: Shock Wave Action On the Kidneymentioning

confidence: 99%

Medical applications and bioeffects of extracorporeal shock waves

Delius¹

1994

Shock Waves

163

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Abstract. Lithotripter shock waves are pressure pulses of microsecond duration with peak pressures of 35-120MPa fotlowed by a tensile wave. They are an established treatment modality for kidney and gallstone disease. Further applications are pancreatic and salivary stones, as well as delayed fracture healing. The latter are either on their way to become established treatments or are currently under investigation. Shock waves generate tissue damage as a side effect which has been extensively investigated in the kidney, the liver, and the gallbladder. The primary adverse effects are local destruction of blood vessels, bleedings, and formation of blood clots in vessels. Investigations on the mechanism of shock wave action revealed that lithotripters generate cavitation both in vitro and in vivo. An increase in tissue damage at higher pulse administration rates, and also at shock wave application with concomitant gas bubble injection suggested that cavitation is a major mechanism of tissue damage. Disturbances of the heart rhythm and excitation of nerves are further biological effects of shock waves; both are probably also mediated by cavitation. On the cellular level, shock waves induce damage to cell organelles; its extent is related to their energy density. They also cause a transient increase in membrane permeability which does not lead to celJ death. Administered either alone or in combination with drugs, shock waves have been shown to delay the growth of small animal tumors and even induce tumor remissions. While the role of cavitation in biological effects is widely accepted, the mechanism of stone fragmentation by shock waves is still controversial. Cavitation is detected around the stone and hyperbaric pressure suppresses fragmentation; yet major cracks are formed early before cavitation bubble collapse is observed. The latter has been regarded as evidence for a direct shock wave effect.

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“…The choice of the animal was based in objections made by several authors regarding the discrepancy between the size of the shock wave focus and the kidney size (5,6,14). Studies conducted in small animals such as rats, for example, would have a pro- portionally larger area of the renal parenchyma that is affected by the shock wave when compared to humans.…”

Section: Discussionmentioning

confidence: 99%

Effect of shock wave reapplication on urinary n-acetyl-beta-glucosaminidase in canine kidney

et al. 2004

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Objective: Renal tubular damage can be assessed with the aid of urinary dosing of N-acetylbeta-glucosaminidase (NAG) and it is possible to demonstrate a significant correlation between shock wave and damage to renal parenchyma. The objective of this study was to assess the effect of shock wave reapplication over urinary NAG in canine kidney.Materials and Methods: The authors submitted 10 crossbred dogs to 2 applications of 2000 shock waves in a 24-hour interval in order to assess urinary NAG values after 12, 24, 36 and 48 hours.Results: Twelve hours following the first shockwave application there was an increase in NAG of 6.47 ± 5.44 u/g creatinine (p < 0.05). Twelve hours and 24 h following the second application there was no increase in the urinary enzyme, -2.56 ± -7.36 u/g creatinine and 2.89 ± -7.27 u/g creatinine, respectively (p > 0.05).Conclusion: Shock wave reapplication with a 24-hour interval did not cause any increase in urinary NAG.

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Dose-Dependent Influence on Canine Renal Morphology After Application of Extracorporeal Shock Waves with Wolf Piezolith

Cited by 19 publications

References 7 publications

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

Medical applications and bioeffects of extracorporeal shock waves

Effect of shock wave reapplication on urinary n-acetyl-beta-glucosaminidase in canine kidney

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