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Between May 1985 and September 1990, 291 ureteroscopies were performed either for primary or secondary stone therapy or for diagnostic purposes. Rigid ureteroscopes (12.5 or 9.5 French) were used without dilation of the ureteral orifice. 83 % of the stones could be removed either by direct extraction or electrohydraulic or ultrasound lithotripsy. The highest failure rates (25.6%) occurred in stones located in the upper ureter, the lowest failure rate (9.6%) resulted from treatment of lower ureteral stones. 3.4% complications were observed such as perforation, leakage, stenosis and septicemia. After an average follow-up of 4.5 months, 1 in 70 patients revealed an ureteropelvic stricture which was treated with open surgery. The ureterorenoscopy represents an effective and low-risk primary and secondary method for treatment of ureteral stones in stone centers using extracorporeal lithotriptors which are exclusively equipped with ultrasound detection devices.

To evaluate whether midazolam has analgesic properties in humans after intravenous injection we studied the influence of a subhypnotic dose of midazolam (50 micrograms/kg) on the cumulative alfentanil consumption in 53 patients during extracorporeal shock wave lithotripsy (ESWL) using a patient-controlled analgesia system (PCAS). In a randomised double blind fashion all patients received either midazolam or an equal volume of saline (placebo) prior to ESWL. Heart rate and arterial blood pressure were measured before and during ESWL. Alfentanil consumption was assessed 20 minutes after injection of midazolam or placebo, respectively. All patients received oxygen via face mask. In patients older than 60 years (median: 70 years, range: 61-88 years) pretreatment with midazolam resulted in a significantly lower cumulative alfentanil consumption (0.41 vs 0.97 mg; p = 0.027) compared with patients younger than 60 years after midazolam pretreatment (0.84 vs 0.71 mg; p = 0.27). Mean arterial pressure also was significantly lower in the former compared with the latter group, while heart rate remained unchanged. In contrast, in patients younger than 60 years (median: 47 years, range: 24-56 years) no significant differences were observed between the midazolam and the placebo group. Thus, low dose intravenous midazolam pretreatment led to a significant decrease of alfentanil consumption in patients beyond 60 years of age. We conclude that subhypnotic doses of midazolam are capable of reducing alfentanil demand in elderly but not in younger patients during ESWL.

The performance data of the new fully mechanized coagulation analysis System Hemolab are presented. Hemolab is used for clotting and chromogenic assays. The determination ofthromboplastin time, aPTT, thrombin time, fibrinogen and antithrombin III on Hemolab was compared with the same parameter analyzed on well-introduced Electra 1000 C and coagulometer KC 40. All assay data showed good correlation coefficients between the individual analysis Systems. The precision and quality control studies demonstrated the high level ofaccuracy of Hemolab. Easy handling also favors the new System in comparison with the others examined.