Fragmentation of gallstones using extracorporeal shock waves: An in Vitro study

Schachler, R; Sauerbruch, Tilman; Wosiewitz, U.; Holl, Joseph; Hahn, Dietbert; Denk, R.; Neubrand, Michael; Paumgartner, Gustav

doi:10.1002/hep.1840080437

Cited by 62 publications

(17 citation statements)

References 16 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 Propertiescontrasting

confidence: 55%

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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 Propertiescontrasting

confidence: 55%

“…Two negative (Schachler et al 1988;Arends et al 1990) and a positive (Torres et al 1990) result were found. Impaction of a model stone or just covering of its surface diminished the fragmentation rate (Vakil et al 1991b;Parr et al 1992).…”

Section: Various Target Factorsmentioning

confidence: 90%

Medical applications and bioeffects of extracorporeal shock waves

Delius¹

1994

Shock Waves

163

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“…Clinical experience has shown that total stone volume and stone number are the major determinants of the fragmentation of gallstones [7,9,10]. Commercially available lithotripters can be used with different energy settings.…”

Section: Discussionmentioning

confidence: 99%

In vitro study to elucidate the physical laws concerning the fragmentation of both solitary and multiple artificial stones

Lobentanzer

Neubrand²,

Hermeking

et al. 1993

Clin Investig

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These in vitro studies define the basic physical laws regarding work and energy for the successful fragmentation of human gallstones. For this purpose a standardized stone model was used consisting of plaster and glass microspheres with physical properties similar to those of human gallstones. All experiments were performed using the lithotripter model MPL9000 (Dornier). The acoustic energy passing stones of 10-30 mm ranged between 8 and 90 mJ per pulse depending on the stone size and energy setting. These results represent the basis for the three following investigations. In the first experiment the relationship between fragmentation and shock wave energy was investigated in a basket with 2 mm mesh size. Thus no layer of small fragments could shadow the acoustic energy for further fragmentation of larger fragments. A constant amount of stone material was found to be fragmented per shock-wave pulse irrespective of stone volume. A low energy threshold (2 mJ/cm3) was observed, below which fragmentation did not occur. In the second experiment, the sieve was covered with a membrane, thus simulating the in vivo situation. The presence of a layer of small fragments hindered the further disintegration of the larger fragments. The attenuation depended to a large extent on original stone volume and acoustic energy per pulse. The corresponding attenuation factor increased with the original stone volume. Thus the fragmentation of a stone with a diameter of 30 mm was attenuated twice as much as a stone of 20 mm size. The critical layer thickness at which no further disintegration took place was 2.5 mm at 18 kV, 4.2 mm at 22 kV, and 5.0 mm at 26 kV.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…found necessary for fragmentation [10,12,13]. Beside the total stone volume the composition of the stone addition ally determines the success of fragmentation [14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…The most important factor is the total stone volume [10,11]. The clearance of the gallbladder after lithotripsy depends on the number and the size of the stones before lithotripsy [6].…”

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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Fragmentation of gallstones using extracorporeal shock waves: An in Vitro study

Cited by 62 publications

References 16 publications

Medical applications and bioeffects of extracorporeal shock waves

Medical applications and bioeffects of extracorporeal shock waves

In vitro study to elucidate the physical laws concerning the fragmentation of both solitary and multiple artificial stones

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

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