Gallstone fragmentation during biliary lithotripsy: effect of stone composition and structure.

Zeman, Robert K.; Marchand, Tiffany; Davros, William J.; Garra, Brian S.; Glass-Royal, M; Soloway, Roger D.

doi:10.2214/ajr.156.3.1899743

Cited by 10 publications

(2 citation statements)

References 8 publications

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“…Confusing results have been obtained when the cholesterol content was related to fragmentation. Two negative (Schachler et al 1988;Schulte and Baron 1990) contrast to two positive reports (Zeman et al 1991;Nitsche et al 1993) which state however the contrary that stones with a high cholesterol need more or less shocks.…”

Section: Chemical Propertiesmentioning

confidence: 81%

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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Section: Chemical Propertiesmentioning

confidence: 81%

Medical applications and bioeffects of extracorporeal shock waves

Delius¹

1994

Shock Waves

163

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“…Beside the total stone volume the composition of the stone addition ally determines the success of fragmentation [14][15][16][17][18][19]. Dif ferent modes of fragmentation have been observed in dif ferent gallstones [18,19]. Mechanical properties of gall stones have also been tested [20] and correlated with lithotripsy [21],…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Lithotripsy of Gallstones in Different Biles and Water in vitro

Nitsche¹,

Amelsberg²,

Berg

et al. 1994

Digestion

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Twenty-four gallstones were fragmented by extracorporeal shock wave lithotripsy (ESWL) to compare the influence of three different biles (bovine bile, human bile, synthetic bile) and water on the rapidity of fragmentation. Four groups of comparable stones were used for lithotripsy in vitro. The stones were collected from 6 patients, four nearly identical ‘sister’ stones from each patient. The number of shock waves required for adequate fragmentation (fragments ≤ 4 mm) was measured for comparison. Overall highly significant differences were found for the four different ‘biles’ with regard to the number of shock waves required for adequate fragmentation. Using synthetic bile, which was artificially composed according to a textbook on hepatology, significantly more shock waves were necessary for fragmentation compared to the use of water, bovine bile or human bile. On the other hand, no significant difference between water and human bile could be registered. We conclude that the number of shock waves required for adequate lithotripsy is influenced by the composition of bile in which the stone is fragmented. Possibly results of ESWL can be improved by manipulation of the bile.

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The Effects of a Soft Tissue Mimicking Medium and Increased Power Settings on the Location and Magnitude of Lithotripter Peak Positive Pressure

et al. 1993

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In vitro experiments showed that a tissue mimicking medium alters the peak positive pressure (p+), focal zone properties and frequency content of shockwaves compared with their behavior in water. The reduction in (p+) ranged from 5% at 10 kV. to 19% at 18.1 kV., when measured at the geometric focus with the tissue mimicking medium present. As power settings were increased, the relative gain in pressure was damped by attenuation. A 2 mm. shift in the acoustic focus was seen both axially and laterally with the tissue mimicking medium. While the former is probably not significant, the latter may be clinically significant given the narrow lateral beam width at the acoustic focus. These attenuation experiments suggest that clinical targeting through tissue may not be as precise or result in as high peak pressures as the clinician expects. Especially at high power settings, the depth of tissue traversed should be minimized to limit attenuation effects.

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Gallstone fragmentation during biliary lithotripsy: effect of stone composition and structure.

Cited by 10 publications

References 8 publications

Medical applications and bioeffects of extracorporeal shock waves

Medical applications and bioeffects of extracorporeal shock waves

Extracorporeal Shock Wave Lithotripsy of Gallstones in Different Biles and Water in vitro

The Effects of a Soft Tissue Mimicking Medium and Increased Power Settings on the Location and Magnitude of Lithotripter Peak Positive Pressure

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