Gallstone dissolution with methyltert-butyl ether in 120 patients?Efficacy and safety

Leuschner, U.; Hellstern, A; Schmidt, Klaus D.; Fischer, H; Güldütuna, S.; Hübner, K.; Leuschner, M.

doi:10.1007/bf01300756

Cited by 62 publications

(20 citation statements)

References 17 publications

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“…Results of Leuschner et al (1991) on MTBE in blood, urine, and breast milk after use of MTBE for dissolution of gallstones suggested somewhat slower, though still relatively rapid, clearance of MTBE. The amount of MTBE used for treatment was unspecified, but varied among patients (n = 26), as did duration of treatment, which averaged 5.1 h. Concentration in blood averaged 400 µg/L just after treatment and fell by half in 5 h. Since some absorption of MTBE may have continued after therapy, these data may underestimate the true rate of elimination.…”

Section: Pharmacokinetic Studymentioning

confidence: 99%

Acute Exposure to Low-Level Methyl Tertiary-Butyl Ether (MTBE): Human Reactions and Pharmacokinetic Response

Cain

Leaderer

Ginsberg

et al. 1996

Inhalation Toxicology

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This two-part investigation assessed the effects of 1-h exposures to methyl tertiary-butyl ether (MTBE) at an ambient concentration of 1.7 ppm on healthy adults. In one part, four subjects participated in a pharmacokinetic study of blood levels of MTBE. Concentration in blood rose 20-fold from baseline to 17 µg/L by the end of exposure and declined to one half that level at 40 min after exposure. In another part, 43 subjects participated in a double-blind study of reactions to exposures to MTBE (1.7 ppm), to a mixture of 17 volatile organic compounds (VOCs) (7.1 ppm), and to air. Subjects rated symptoms (e.g., irritation, headache, mental fatigue), their mood, and various environmental attributes (e.g., odor, air quality, temperature), and also took computerized performance tests during exposures. Measures of eye irritation (e.g., tear-film breakup, eye redness) and nasal inflammation (i.e., measurement of polymorphonuclear neutrophilic leukocytes, PMNs) were taken before and after exposure as objective correlates of symptoms. Although subjects could perceive differences among the exposures via odor and air quality, they showed no increase in symptoms in response to MTBE and VOCs over those to air. The only significant objective effect comprised a time-by-agent interaction in number PMNs due principally to an increase in PMNs after exposure to VOCs. The level was higher 18-24 h after exposure than immediately after lt. Because the subjects' ratings replicated effects found previously (e.g., time dependence in irritation judgments, effect of gender on rated odor intensity and pleasantness, and thermal comfort), it would appear that the absence of differential effects of MTBE on symptoms can be accepted at face value.

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Section: Pharmacokinetic Studymentioning

confidence: 99%

Acute Exposure to Low-Level Methyl Tertiary-Butyl Ether (MTBE): Human Reactions and Pharmacokinetic Response

Cain

Leaderer

Ginsberg

et al. 1996

Inhalation Toxicology

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“…Theoretically, fragmentation of the stones facilitates passage of insoluble material and solubilized cholesterol along the biliary tree, through the gallbladder catheter or both (6). In addition, dissolution is enhanced, especially for mixed stones (16).…”

Section: Discussionmentioning

confidence: 99%

Combination of extracorporeal shock-wave lithotripsy and dissolution of gallbladder stones with methyl tert-butyl ether: A randomized study

et al. 1994

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We conducted a prospective randomized study in gallstone patients to determine whether a combination of extracorporeal shock-wave lithotripsy and subsequent dissolution with methyl tert-butyl ether increases the success rate of methyl tert-butyl ether dissolution and shortens treatment time compared with monotherapy with methyl tert-butyl ether. Fifty patients were randomized into two groups. Twenty-five patients underwent extracorporeal shock-wave lithotripsy before contact dissolution with methyl tert-butyl ether, and 25 patients were treated with methyl tert-butyl ether alone. All patients had at least three stones or stones larger than 30 mm that were radiolucent on x-ray and had densities of less than 140 Hounsfield Units (HU) on computed tomography. Overall, the combined approach neither shortened the treatment time significantly vs. monotherapy with methyl tert-butyl ether nor reduced the time of hospitalization. The success rate was slightly but not significantly increased compared with that of methyl tert-butyl ether therapy alone. The recurrence rate was similar in the two groups after a median follow-up of 1 yr. However, when subgroups of patients with at least one stone larger than 15 mm or with stones with densities of more than 60 HU were analyzed, the clearance rate after 5 mo was significantly higher (p < 0.005 and p < 0.025, respectively) in patients subjected to a combination of extracorporeal shock-wave lithotripsy and methyl tert-butyl ether dissolution. Extracorporeal shock-wave lithotripsy and methyl tert-butyl ether did not expose patients to more adverse effects than did treatment with methyl tert-butyl ether alone.

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“…If the absorption from the gallbladder and subsequent metabolism of ethyl propionate and methyl tert-butyl ether in human beings are similar to those of the piglet, side effects attributable to increased blood levels will be fewer if ethyl propionate is used than if methyl tert-butyl ether is used for contact dissolution of Methyl tert-butyl ether (MTBE) has been explored rather widely for contact dissolution of cholesterol gallstones in the gallbladder or bile ducts in patients for whom other procedures such as surgery or endoscopy are more hazardous or are refused. The solvent, developed by the Atlantic Richfield Co. as an octane enhancer to replace tetraethyl lead in gasoline, dissolves cholesterol gallstones rapidly in uitro and in uiuo and does not appear to cause major injury to the human gallbladder mucosa (1)(2)(3). In contrast to diethyl ether, which was used as the first contact dissolution solvent for gallstones a century ago (41, MTBE boils at 55" C, well above body temperature (5).…”

Section: W F Hofmann~mentioning

confidence: 99%

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

et al. 1993

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We performed experiments in anesthetized piglets with two cholesterol gallstone solvents, methyl tert-butyl ether and ethyl propionate, to determine whether blood levels of either solvent would increase during gallbladder instillation of these solvents under conditions simulating gallstone dissolution. The solvent was oscillated rapidly in and out of the gallbladder with a computer-controlled syringe pump; intraluminal pressure was set below the leakage pressure, and oscillating volume was set below the leakage volume to decrease loss of solvent into the intestine. Blood levels were measured with gas chromatography. Six piglets received methyl tert-butyl ether, and six piglets received ethyl propionate. During 2 hr of instillation with methyl tert-butyl ether, blood levels increased steadily to concentrations averaging 0.3 ml/L blood at 2 hr; during a 6-hr period of instillation, blood levels rose to above 0.4 ml/L blood. Replacement of methyl tert-butyl ether with saline solution in the gallbladder caused blood levels to decline gradually; plasma levels decreased by half in 90 min. In contrast, when ethyl propionate was infused for 2 or 6 hr, blood levels remained below the detection limit, probably because of high first-pass hepatic extraction. We conclude that, under conditions simulating those likely present in patients undergoing contact dissolution of gallbladder stones, the two solvents differ: Ethyl propionate is removed so rapidly from blood that its levels remain undetectable, whereas methyl tert-butyl ether levels in blood (and, presumably, peripheral tissues) increase continuously.(ABSTRACT TRUNCATED AT 250 WORDS)

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Gallstone dissolution with methyltert-butyl ether in 120 patients?Efficacy and safety

Cited by 62 publications

References 17 publications

Acute Exposure to Low-Level Methyl Tertiary-Butyl Ether (MTBE): Human Reactions and Pharmacokinetic Response

Acute Exposure to Low-Level Methyl Tertiary-Butyl Ether (MTBE): Human Reactions and Pharmacokinetic Response

Combination of extracorporeal shock-wave lithotripsy and dissolution of gallbladder stones with methyl tert-butyl ether: A randomized study

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

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