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In a prospective study carried out to determine spleen size by a rapid and simple ultrasonic method, 45 normal subjects, 20 men and 25 women, average age 54 +/- 17 years (range 17-78) were studied. The three principal dimensions of the spleen, breadth, thickness, and height, were obtained with a compound scan technique; each dimension was measured at its largest point. The values obtained were multiplied by each other and the product arbitrarily divided by 27, which is the cube of the three values. This gave a splenic volumetric index (SVI), which, in 95 per cent of normal subjects, was between 8 and 34. There were no statistically significant differences related to age, sex, or morphotype when endomorphs, ectomorphs, and mesomorphs were examined. This SVI determination, based on standardized measurements, allows the distinction of normal from abnormal spleens in 10 minutes.

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Between November 1988 and July 1992 70 patients with radiolucent gall stones were treated with extracorporeal lithotripsy (ESL) and ursodeoxycholic acid (UDCA; mean (SD) dose 11-2 (1-9) mg/kg/day). Fifty three patients have been followed for one year. One week after lithotripsy, 30-6% had completely eliminated all stone fragments from the gall bladder and one year later 93*9% were free of stones. Three factors were considered important in achieving these results. 'Pulverisation' of the stone -that is, its fragmentation into echogenic dust (crystalline aggregates, some few hundred > in size) or particles similar to grains of sand, smaller than 1 mm in diameter, or both, is required. Secondly, dust and particles were rapidly eliminated, strongly suggesting a mechanical elimination process by physiological gall bladder contractions. Thirdly, there must be chemical dissolution with biliary acids. This therapeutic approach gave excellent results without causing any clinically relevant side effects. The first 20 patients who became free of stones after ESL were given oral bile acid maintenance treatment -300 mg/ day of UDCA at bedtime, for two years. All were asymptomatic and none had suffered a recurrence after two years. In four patients, crystalline aggregates, detected in gall bladder bile by ultrasound, were subsequently dissolved between one and three months after resuming a full dose regimen of UDCA. (Gut 1994; 35: 117-12 Results of studies on extracorporeal lithotripsy (ESL) of gall stones in which patients have been followed up for seven years have often proved to be unsatisfactory and at times discordant. Despite this we believe that ESL is an extremely effective method of treating gall stones and that these negative results may result from the following factors that are unrelated to the procedure: (1) Use of equipment developed for kidney stone dissolution and improperly adapted to gall stone treatment; (2) Use of shock waves that are too low in pressure and too few in number; (3) Therapeutic strategy tending towards stone fragmentation followed by chemical dissolution with bile acids lasting even long periods of time.This trial aimed to determine whether by perfecting the technique of biliary lithotripsy, the procedure would prove to be an effective method of treating gall stones. For this purpose it was necessary to verify:(1) Whether by using shock waves adequate in pressure and in number it would be possible to achieve 'pulverisation' of stones into crystalline aggregates or particles the size of grains of sand, or both.(2) Whether by achieving this pulverisation it would be possible to achieve safer and more rapid elimination of the resulting microfragments.(3) Eliminating stones followed by maintenance treatment while preserving the gall bladder would be sufficient to avoid stone recurrence. Methods PATIENTSBetween November 1988 and July 1992, 70 patients with radiolucent gall stones were treated with a lithotripter equipped with an underwater spark-gap for shock wave generation (Dornier MPL...