A mechanism of gallstone destruction by extracorporeal shock waves

Delius, Michael; Brendel, W.; Heine, G.

doi:10.1007/bf00735580

Cited by 80 publications

(19 citation statements)

References 6 publications

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“…During shock wave treatment, cavitation might occur in patients and has been discussed in connection with tissue injury (Fischer et al 1988) and stone fragmentation (Delius and Brendel 1988). Only few publications report about evidence for cavitation in vivo: in piglet liver (Delius et al 1990) and in dog kidneys (Kuwahara et al 1990) cavitation bubbles have been traced by ultrasonic imaging; acoustic measurements indicated cavitation events in tumor-bearing rats and mice (Riedlinger et al 1988) as well as in Beagle dogs (Williams et al 1989).…”

Section: Discussionmentioning

confidence: 99%

“…Shock waves also destroy eukaryotic cells in a dose-dependent manner when cells were treated in suspension (Russo et al 1986;B~mmer et al 1989). One of the mechanisms discussed for stone fragmentation and tissue damage is cavitation (Crum 1988;Delius and Brendel 1988), the formation of gas-or vapour-filled bubbles in liquids exposed to tensile stresses and their violent collapse (Coleman et al 1987). The high velocity of this breakdown--as the collapse of the bubble walls exceeds the speed of sound--causes an adiabatic compression of the gas inside the bubble without heat exchange with the surrounding medium.…”

Section: Introductionmentioning

confidence: 99%

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Cavitation-generated free radicals during shock wave exposure: Investigations with cell-free solutions and suspended cells

Suhr

Brümmer

Hülser

1991

Ultrasound in Medicine & Biology

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Abstract--Extracorporeally generated shock waves as used in lithotripsy of urinary and biliary stones exhibit side effects in vivo. Furthermore, these shock waves destroy eukaryotic cells during in vitro treatment in suspension. A possible cause of these damaging effects might be cavitation, the growth and collapse of bubbles in liquids exposed to tensile stresses. During the collapse, temperature inside these cavitation bubbles rises up to several thousand K, leading to the formation of free radicals. We demonstrated the occurrence of cavitation-generated free radicals by direct reaction with fluorescent dyes in solution after shock wave treatment and investigated the resulting cell killing by variation of the cellular antioxidative defense status. We present evidence for the generation of intracellular free radicals during shock wave treatment of suspended cells.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cavitation-generated free radicals during shock wave exposure: Investigations with cell-free solutions and suspended cells

Suhr

Brümmer

Hülser

1991

Ultrasound in Medicine & Biology

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“…The mechanism of gallstone destruction includes at least two components: stress fracture mechanism at the stone and cavitation in the surrounding fluid [22], The neg ative pressure at the end of the shock wave causes bubbles arising in the fluid (cavitation). These bubbles may burst the stone especially if they occur in cracks of the stone.…”

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 soft tissues about the tibiae studied were accoustically similar to the water in the "beach ball" and conductive gel. Thus this energy was coverted into tension waves and mechanical energy only at the site of the osteotomy [1,2,4,5,6,11,14,16,19].…”

Section: Administration Of Shockwavesmentioning

confidence: 99%

The effect of shockwaves on mature and healing cortical bone

Forriol

Solchaga

Moreno

et al. 1994

International Orthopaedics

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SUMMARYIt has been proposed that high energy shockwaves could be used to creare microfractures in cortical bone. This quality might be exploited clinically to perforen closed osteotomies and promote healing in nonunion (15). However; no study has previously documented the effect of shockwaves on cortical bone "in vivo". We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.

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A mechanism of gallstone destruction by extracorporeal shock waves

Cited by 80 publications

References 6 publications

Cavitation-generated free radicals during shock wave exposure: Investigations with cell-free solutions and suspended cells

Cavitation-generated free radicals during shock wave exposure: Investigations with cell-free solutions and suspended cells

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

The effect of shockwaves on mature and healing cortical bone

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