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Sample records for in-situ extracorporeal shock

  1. paediatric ureteric calculi: in-situ extracorporeal shock wave lithotripsy

    African Journals Online (AJOL)

    Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter ...

  2. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AS ...

    African Journals Online (AJOL)

    Objective To evaluate extracorporeal shock wave lithotripsy (ESWL) as a monotherapy for urolithiasis in patients with solitary kidney and to determine the factors that may affect its results. Patients and Methods Using the Dornier MFL 5000 lithotriptor, 106 patients with solitary kidney (80 men and 26 women) were treated for ...

  3. State of the art extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kandel, L.B. (State Univ. of New York at Stony Brook, Stony Brook, NY (US)); Harrison, L.H.; McCullough, D.L. (Wake Forest Univ. Medical Center, Winston-Salem, NC (US))

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL.

  4. State of the art extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kandel, L.B.; Harrison, L.H.; McCullough, D.L.

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL

  5. Kidney changes after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Yoshioka, Hiroyasu; Shindo, Hiroshi; Mabuchi, Nobuhisa; Kawakami, Akira; Fujii, Koichi; Hamada, Tatsumi; Ishida, Osamu; Umekawa, Toru; Kohri, Kenjiro

    1991-01-01

    MRI was performed before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Of the 40 kidneys studied, 24 showed one or more changes on MRI: loss of the corticomedullary junction (n=15), subcapsular fluid (n=14), subcapsular hematoma (n=1), thickening of bridging septa (n=8), high intensity area in the muscle (n=8). These relatively subtle changes detected on MRI may not be apparent with other imaging techniques. (author)

  6. PAEDIATRIC URETERIC CALCULI: IN-SITU EXTRACORPOREAL ...

    African Journals Online (AJOL)

    Il navait ni obstruction urétérale ni infection urinaire. De légères hématuries et coliques transitoires ont été observées après la lithotripsie. Conclusion Chez lenfant, la lithotripsie extra-corporelle in situ est une procédure efficace dans le traitement des calculs urétéraux quelque soit le siège. Il ny a aucune morbidité liée à la ...

  7. Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

    NARCIS (Netherlands)

    R. den Toom (Rene)

    1993-01-01

    textabstractThe aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible,

  8. Extracorporeal shock wave therapy (ESWT) in urology

    DEFF Research Database (Denmark)

    Fojecki, Grzegorz Lukasz; Thiessen, Stefan; Osther, Palle Jörn Sloth

    2017-01-01

    PURPOSE: The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. METHODS: We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline...... deviation and plaque size were observed. Four studies on erectile dysfunction (ED) including 337 participants were included. Using International Index of Erectile Function (IIEF-EF) and erectile hardness scale (EHS) data suggested a significant positive effect of ESWT in phosphodiesterase-5 inhibitor (PDE-5...

  9. Outcome of Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    B Shrestha

    2010-03-01

    Full Text Available NTRODUCTION: Extracorporeal Shock Wave Lithotripsy is an effective noninvasive method to treat urolithiasis. This study aims to evaluate itsoutcome and determine appropriate management strategies for urolithiasis. METHODS: It was a prospective study which included one hundred patients who underwent ESWL for the management of solitary urolithiasis during a period of eight months (December 2007-August 2008. Status of stone and complications were observed and managed accordingly within a period of six postoperative weeks. RESULTS: Out of 100 patients, 93% had complete clearance of stone by the end of six postoperative weeks. Seven percent of the patients required adjunct invasive intervention including open surgery in 3%. Number of sessions of ESWL was found to increase as the size of stone increased. However, in three patients stones were completely refractory to ESWL even after two consecutive sessions. CONCLUSIONS: ESWL is highly effective noninvasive modality in the management of urolithiasis in appropriately selected patients. Keywords: double J stent, extracorporal shockwave lithotripsy, steinstrasse, ultrasonography, ureterorenoscopy.

  10. Arrhythmia during extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Zeng, Z R; Lindstedt, E; Roijer, A; Olsson, S B

    1993-01-01

    A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.

  11. 21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

    Science.gov (United States)

    2010-04-01

    ..., control console, imaging/localization system, and patient table. Prior to treatment, the urinary stone is targeted using either an integral or stand-alone localization/imaging system. Shock waves are typically... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that...

  12. Extracorporeal shock wave lithotripsy: What is new?

    Science.gov (United States)

    Bach, Christian; Karaolides, Theocharis; Buchholz, Noor

    2012-01-01

    Objectives Thirty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for more than half of all urinary tract stones, but machines and treatment strategies have significantly developed over time. In this review, we summarise the latest knowledge about the clinically important aspects of ESWL. Methods We searched PubMed to identify relevant reports and the latest European Association of Urology guidelines, and standard urological textbooks were consulted. Results New technical developments include: Twin-head and tandem-pulse shock-wave generators; wide-focus, low-pressure systems; optimised coupling; and automated location and acoustic tracking systems. Indications have been refined, making possible the identification of patients in whom ESWL treatment is likely to fail. By lowering the shock-wave rate, improving coupling, applying abdominal compression, power ‘ramping’ and postoperative medical expulsion therapy, treatment protocols have been optimised. Conclusions Promising new technical developments are under development, with the potential to increase the stone-free rate after ESWL. For optimal results, the refined indications need to be respected and optimised treatment protocols should be applied. PMID:26558039

  13. [Extracorporeal shock-wave lithotripsy of gallstones].

    Science.gov (United States)

    Freund, H R; Lebensart, P D; Muggia-Sullam, M; Durst, A L

    1989-08-01

    We performed 16 extracorporeal shock-wave lithotripsies (ESWL) to fragment gallstones in 11 women and 2 men, aged 19 to 57 (mean 41 +/- 10) years, during the past 10 months. Criteria for selection included a history of biliary colic, not more than 3 stones with a total diameter of not more than 30 mm, and a functioning gallbladder. 210 patients were examined, of whom 98 were referred for additional screening by combined ultrasonography and oral cholecystography. This resulted in rejection of another 71 patients due to multiple stones (38%), nonfunctioning gallbladder (22%), calcified stones (12%), stones not visualized in the prone position (9%), excessively large stones (3%) and other reasons (16%). Only 27 patients fulfilled all the criteria. Under epidural or general anesthesia (11 and 2 patients, respectively), we administered 1200-3500 (mean 2250 +/- 750) shock waves at 20-24 KV with the Tripter X1 (Direx, Israel-USA). This is an ultrasound-guided, modular portable, shock-wave generator utilizing underwater high energy spark discharge. Chenodeoxycholic or ursodeoxycholic acid, 10 mg/kg/day, was started 1 week prior to ESWL and continued for 3 months after disappearance of fragments and debris. We encountered skin petechiae in all patients, transient hematuria in 8, mild biliary colic in 1 and a small liver hematoma in 1. To date, 3 patients are free of stones, while in 7 only sludge and tiny fragments are present which we expect to disappear as a result of the litholytic therapy. 3 patients had fragments larger than 5 mm and required a second ESWL. Thus ESWL, which was indicated in only 13% of screened patients, proved to be safe and can be expected to be successful in 75% of selected candidates.

  14. Incidence of cavitation in the fragmentation process of extracorporeal shock wave lithotriptors

    Science.gov (United States)

    Rink, K.; Delacrétaz, G.; Pittomvils, G.; Boving, R.; Lafaut, J. P.

    1994-05-01

    The fragmentation mechanism occurring in extracorporeal shock wave lithotripsy (ESWL) is investigated using a fiber optic stress sensing technique. With our technique, we demonstrate that cavitation is a major cause of fragmentation in ESWL procedures. When a target is placed in the operating area of the lithotriptor, two shock waves are detected. The first detected shock wave corresponds to the incoming shock wave generated by the lithotriptor. The second shock wave, detected some hundreds of microseconds later, is generated in situ. It results from the collapse of a cavitation bubble, formed by the reflection of the incoming shock wave at the target boundary. This cavitation induced shock wave generates the largest stress in the target area according to our stress sensing measurements.

  15. US evaluation in extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Baumgartner, B.R.; Steinberg, H.V.; Ambrose, S.S.; Walton, K.N.; Bernardino, M.E.

    1986-01-01

    Real-time US was performed in 100 consecutive patients the day preceding and/or 24 and 48 hours after extracorporeal shock wave lithotripsy (ESWL) therapy. In the 87 treated kidneys containing three or fewer stones, a total of 111 stones were found; 104 were radiopaque. Pre-ESWL US was not available for six stones. Sixty-eight stones (64.5%) were visualized. Of the 37 stones not seen, 10 (27%) were ≤ 5 mm in diameter, and of the larger stones, 19 (51%) were in the ureter or ureteropelvic junction; only six (16%) were in the calyces, and two (5%) were in the renal pelvis. Comparison of pre-ESWL and post-ESWL in 80 kidneys revealed no change in 37 (46%), more stones or fragments detected in 23 (29%), fewer stones or a change in location of stones in 12 (15%), and decreased size of the original stone in eight (10%). The ability of US to detect renal calculi seems to be related not only to stone size but also to location. Hydronephrosis was detected on pre-ESWL US in 16 kidneys (20%). After ESWL the hydronephrosis did not change in seven, decreased or resolved in eight, and increased in only one. Hydronephrosis was noted to develop after ESWL in 21 (26%) other kidneys. Pre-ESWL and post-ESWL hydronephrosis found on US must be considered in conjunction with the clinical picture and other radiographic studies

  16. [Extracorporeal shock wave therapy in chronic prostatitis].

    Science.gov (United States)

    Kul'chavenya, E V; Shevchenko, S Yu; Brizhatyuk, E V

    2016-04-01

    Chronic prostatitis is a prevalent urologic disease, but treatment outcomes are not always satisfactory. As a rule, chronic prostatitis results in chronic pelvic pain syndrome, significantly reducing the patient's quality of life. Open pilot prospective non-comparative study was conducted to test the effectiveness of extracorporeal shock wave therapy (ESWT) using Aries (Dornier) machine in patients with chronic prostatitis (CP) of IIIb category. A total of 27 patients underwent ESWL as monotherapy, 2 times a week for a course of 6 sessions. Exposure settings: 5-6 energy level (by sensation), the frequency of 5 Hz, 2000 pulses per session; each patient received a total energy up to 12000 mJ. per procedure. Treatment results were evaluated using NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) upon completing the 3 week course of 6 treatments and at 1 month after ESWT. Immediately after the ESWT course positive trend was not significant: pain index decreased from 9.1 to 7.9, urinary symptom score remained almost unchanged (4.2 at baseline, 4.1 after treatment), quality of life index also showed a slight improvement, dropping from 7.2 points to 6.0. Total NIH-CPSI score decreased from 20.5 to 18.0. One month post-treatment pain significantly decreased to 3.2 points, the urinary symptom score fell to 2.7 points, the average quality of life score was 3.9 points. ESWT, performed on Aries (Dornier) machine, is highly effective as monotherapy in patients with category IIIb chronic prostatitis.

  17. Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

    Science.gov (United States)

    Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

    2003-05-01

    To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

  18. Extracorporeal shock wave lithotripsy for urinary stones

    International Nuclear Information System (INIS)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun

    1988-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization was

  19. Extracorporeal shock wave lithotripsy for urinary stones

    Energy Technology Data Exchange (ETDEWEB)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

    1988-06-15

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization

  20. Radiation Protection Practices of Staff during Extra-Corporeal Shock ...

    African Journals Online (AJOL)

    Methodology: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure ...

  1. Kidney changes after extracorporeal shock wave lithotripsy; MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Hiroyasu; Shindo, Hiroshi; Mabuchi, Nobuhisa; Kawakami, Akira; Fujii, Koichi; Hamada, Tatsumi; Ishida, Osamu; Umekawa, Toru; Kohri, Kenjiro (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

    1991-02-01

    MRI was performed before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Of the 40 kidneys studied, 24 showed one or more changes on MRI: loss of the corticomedullary junction (n=15), subcapsular fluid (n=14), subcapsular hematoma (n=1), thickening of bridging septa (n=8), high intensity area in the muscle (n=8). These relatively subtle changes detected on MRI may not be apparent with other imaging techniques. (author).

  2. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    Science.gov (United States)

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  3. Extracorporeal shock wave therapy for treatment of plantar fasciitis

    International Nuclear Information System (INIS)

    Dastgir, N.

    2014-01-01

    Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

  4. [Renal hematomas after extracorporeal shock-wave lithotripsy (ESWL)].

    Science.gov (United States)

    Pastor Navarro, Héctor; Carrión López, Pedro; Martínez Ruiz, Jesús; Pastor Guzmán, José Ma; Martínez Martín, Mariano; Virseda Rodríguez, Julio A

    2009-03-01

    The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It's the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasive treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock-waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirenal hematoma which we followed up and treated. After the urological complications (pain, obstruction and infection) the renal and perirenal hematic collections are the most frequent adverse effects of shock-waves used in lithotripsy, these are related to the power of energy used and patient age. Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%. Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy.

  5. Tandem shock wave cavitation enhancement for extracorporeal lithotripsy

    Science.gov (United States)

    Loske, Achim M.; Prieto, Fernando E.; Fernández, Francisco; van Cauwelaert, Javier

    2002-11-01

    Extracorporeal shock wave lithotripsy (ESWL) has been successful for more than twenty years in treating patients with kidney stones. Hundreds of underwater shock waves are generated outside the patient's body and focused on the kidney stone. Stones fracture mainly due to spalling, cavitation and layer separation. Cavitation bubbles are produced in the vicinity of the stone by the tensile phase of each shock wave. Bubbles expand, stabilize and finally collapse violently, creating stone-damaging secondary shock waves and microjets. Bubble collapse can be intensified by sending a second shock wave a few hundred microseconds after the first. A novel method of generating two piezoelectrically generated shock waves with an adjustable time delay between 50 and 950 µs is described and tested. The objective is to enhance cavitation-induced damage to kidney stones during ESWL in order to reduce treatment time. In vitro kidney stone model fragmentation efficiency and pressure measurements were compared with those for a standard ESWL system. Results indicate that fragmentation efficiency was significantly enhanced at a shock wave delay of about 400 and 250 µs using rectangular and spherical stone phantoms, respectively. The system presented here could be installed in clinical devices at relatively low cost, without the need for a second shock wave generator.

  6. CT evaluation of the kidneys following extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Rubin, J.I.; Arger, P.H.; Pollack, H.M.; Banner, M.P.; Coleman, B.G.; Mintz, M.C.; Van Arsdalen, K.N.

    1986-01-01

    CT scans of the kidneys were obtained iln 50 patients before and after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) and intrarenal hematomas in two (4%) patients. Water-density subcapsular collections were seen in three (6%) patients. Treated kidneys showed a mean increase in renal size of 9%. Perinephric stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae. While most patients undergoing ESWL will show some posttreatment abnormality on CT, the procedure appears to be associated with a low incidence of serious renal trauma

  7. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-07-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation.

  8. Radiation exposure to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Marti, J.M.; Robles, J.E.; Arbizu, J.; Castro, F. de; Berian, J.M.; Richter, J.A.

    1992-01-01

    We analyzed the radiological exposure to patients during Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generator lithotriptor. Stone location is accomplished by fluoroscopy and 'quick pics' or snapshots. A prospective study over 55 patients showed a mean exposure of 32.2 R. The introduction of the ALARA criterion reduced it to 16.1 R in the following 145 patients. Mean radiation exposure to patient varies according to treatment difficulty. A mean increase of radiation exposure of 1.6 between low and high difficulty treatment groups was observed. This variation was about 96% when the physician who performed the treatment was considered. (author)

  9. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-01-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation. (author)

  10. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Science.gov (United States)

    Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K.

    2014-01-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome. PMID:25024562

  11. Extracorporeal shock wave therapy in periodontics: A new paradigm.

    Science.gov (United States)

    Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K

    2014-05-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  12. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Directory of Open Access Journals (Sweden)

    Munivenkatappa Lakshmaiah Venkatesh Prabhuji

    2014-01-01

    Full Text Available The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  13. Radiation exposure to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Van Swearingen, F.L.; McCullough, D.L.; Dyer, R.; Appel, B.

    1987-01-01

    Extracorporeal shock wave lithotripsy is rapidly becoming an accepted treatment of renal calculi. Since fluoroscopy is involved to image the stones it is important to know how much radiation the patient receives during this procedure. Surface radiation exposure to the patient was measured in more than 300 fluoroscopic and radiographic procedures using thermoluminescent dosimeters. Initial results showed an average skin exposure of 10.1 rad per procedure for each x-ray unit, comparing favorably with exposure rates for percutaneous nephrostolithotomy and other routine radiological procedures. Factors influencing exposure levels include stone characteristics (location, size and opacity), physician experience and number of shocks required. Suggestions are given that may result in a 50 per cent reduction of radiation exposure

  14. MR imaging of kidneys following extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Baumgartner, B.R.; Dickey, K.W.; Nelson, R.C.; Ambrose, S.S.; Walton, K.N.; Bernardino, M.E.

    1986-01-01

    MR images were obtained the day after extracorporeal shock wave lithotripsy (ESWL) therapy in 34 patients; the untreated kidneys served as controls. Five patients underwent ESWL of both kidneys before MR imaging. The kidneys were imaged with a spin-echo technique. Multisection coronal, sagittal, and axial images were obtained with T1-weighted pulse sequences. MR imaging studies of 39 kidneys after ESWL showed no abnormality in ten (25%) cases. The other kidneys (75%) had one or more of several findings. Small subcapsular or perinephric fluid collections were noted in ten (25%) patients. Generalized loss of corticomedullary junction (CMJ) was noted in eight (21%) cases and focal loss in 16 (24%). The more pronounced alterations in the CMJ correlated with increased numbers of shock waves received by the kidney

  15. Some health physics implications of extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Henderson, J.E.

    1987-01-01

    Extracorporeal Shock Wave Lithotripsy (ESWL) is a relatively new, noninvasive technique for the destruction of renal calculi (kidney stones) in vivo. X-ray localizing techniques are used to position the stone for shock wave destruction. The combination of radiographic and fluoroscopic exposure contributes significantly to patient dose. This presentation considers alternative techniques for measuring patient exposure during ESWL and details many of the problems attendant to those measurements. Factors that contribute to patient dose are described. Comparisons are made to previous interventions for renal calculi involving radiological considerations. Operator exposures are negligible for this procedure, but skin entrance exposures for patients have been found on the order of 10 R to 17 R. Attempts to quantify gonadal doses during ESWL treatment at the University of Virginia are described. A rationale for continued studies in this area is offered

  16. Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL).

    Science.gov (United States)

    Inoue, Hiromasa; Kamphausen, Thomas; Bajanowski, Thomas; Trübner, Kurt

    2011-01-01

    A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy.

  17. Application of Underwater Shock Wave Focusing to the Development of Extracorporeal Shock Wave Lithotripsy

    Science.gov (United States)

    Takayama, Kazuyoshi

    1993-05-01

    This paper describes a summary of a research project for the development of extracorporeal shock wave lithotripsy (ESWL), which has been carried out, under close collaboration between the Shock Wave Research Center of Tohoku University and the School of Medicine, Tohoku University. The ESWL is a noninvasive clinical treatment of disintegrating human calculi and one of the most peaceful applications of shock waves. Underwater spherical shock waves were generated by explosion of microexplosives. Characteristics of the underwater shock waves and of ultrasound focusing were studied by means of holographic interferometric flow visualization and polyvinyliden-difluoride (PVDF) pressure transducers. These focused pressures, when applied to clinical treatments, could effectively and noninvasively disintegrate urinary tract stones or gallbladder stones. However, despite clincal success, tissue damage occurs during ESWL treatments, and the possible mechanism of tissue damage is briefly described.

  18. Prediction of successful treatment by extracorporeal shock wave lithotripsy based on crystalluriacomposition correlations of urinary calculi

    Directory of Open Access Journals (Sweden)

    Nadia Messaoudi

    2015-12-01

    Full Text Available Objective: To provide correlations between crystalluria and chemical structure of calculi in situ to help making decision in the use of the extracorporeal shock wave lithotripsy (ESWL. Methods: A crystalluria study was carried out on 644 morning urines of 172 nephrolithiasis patients (111 males and 61 females, and 235 of them were in situ stone carriers. After treating by ESWL, the recovered calculi have been analyzed by Fourier transform infrared spectroscopy and their compositions were correlated to the nature of urinary crystals. Results: We obtained successful treatment for 109 patients out of 157 and 63 patients out of 78 with stones had a treatment failure (33.2%. The correlations showed that for the overwhelming crystalluria containing calcium oxalate dihydrate (COD with mixed crystals without calcium oxalate monohydrate, we should have 68% to 88 % success rate. However, the obtained result was 79%. Similarly, for crystalluria with COD + calcium oxalate monohydrate ± carbapatite, the prediction was 11% to 45% and the result was approximately 39%. When the majority of crystalluria was calcium phosphate, the prediction of 50% to 80% was confirmed by 71% success rate. For those majority containing magnesium ammonium phosphate hexahydrate (struvite ± diammonium urate ± COD, we predicted between 80% to 100%, and the result gave a success rate of 84%. Conclusions: The analysis of crystalluria of morning urine can help to know the composition of calculi in situ and can predict the success rate of ESWL for maximum efficiency.

  19. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...... studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  20. Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Wei Chuan Chen; Ying Huei Lee; Ming Tsun Chen; Jong Khing Huang; Luke S Chang (Division of Urology, Dept. of Surgery, National Yang-Ming Medical College and Veterans General Hospital-Taipei, Taiwan (China))

    1991-01-01

    A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation. (au).

  1. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    International Nuclear Information System (INIS)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon; Yoon, Seok Hwan

    2006-01-01

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications

  2. Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Wei Chuan Chen; Ying Huei Lee; Ming Tsun Chen; Jong Khing Huang; Luke S Chang

    1991-01-01

    A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation. (au)

  3. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon [Asan Medical Center, Seoul (Korea, Republic of); Yoon, Seok Hwan [Dongnam Health College, Suwon (Korea, Republic of)

    2006-06-15

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications.

  4. Liver fibrosis after extracorporeal shock-wave lithotripsy of gallbladder stones - A case report

    NARCIS (Netherlands)

    P.W. Plaisier; J.F. Hamming (Jaap); R.L. van der Hul (René); R. den Toom (Rene); H.A. Bruining (Hajo)

    1994-01-01

    textabstractWe encountered significant liver fibrosis in a healthy young patient undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Twelve months prior to cholecystectomy the patient underwent multiple extracorporeal shock-wave lithotripsy (ESWL) sessions with adjuvant oral

  5. Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention

    NARCIS (Netherlands)

    Skolarikos, Andreas; Alivizatos, Gerasimos; de la Rosette, Jean

    2006-01-01

    OBJECTIVE: We review the pathophysiology and possible prevention measures of complications after extracorporeal shock wave lithotripsy (ESWL). METHODS: A literature search was performed with the Medline database on ESWL between 1980 and 2004. RESULTS: ESWL application has been intuitively connected

  6. Bacterial sepsis after extracorporeal shock-wave lithotripsy (ESWL) of calyceal diverticular stone.

    Science.gov (United States)

    Oh, Mi Mi; Kim, Jin Wook; Kim, Jong Wook; Chae, Ji Yun; Yoon, Cheol Yong; Park, Hong Seok; Park, Min Gu; Moon, Du Geon

    2013-02-01

    Most calyceal diverticula are asymptomatic but symptoms occur when there is urinary stasis leading to infection and calculi. Septic shock after ESWL of calyceal stone occurs rarely. A 24-year-old woman had septic shock due to after extracorporeal shock-wave lithotripsy (ESWL) of asymptomatic calyceal diverticular stone.

  7. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

    OpenAIRE

    Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus BM; Schmitz, Christoph

    2014-01-01

    Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predict...

  8. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation.

    Science.gov (United States)

    Kisch, Tobias; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix; Mailänder, Peter; Krämer, Robert

    2015-11-01

    Extracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable. High energy ESWT influences cutaneous microcirculation at body regions remote from application site. Eighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10 J) or placebo shock wave treatment (Group B: 0 impulses, 0 J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry. In Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (p = 0.01). Postcapillary venous filling pressure remained statistically unchanged (p > 0.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (p = 0.220). High energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  9. Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock.

    Science.gov (United States)

    Whitman, Glenn J R

    2017-01-01

    Use of extracorporeal membrane oxygenation (ECMO), one of an increasing variety of mechanical circulatory support strategies, was first used close to 50 years ago. For decades, it was mostly applied to the pediatric population. However, during the past several years, its use has dramatically increased as therapy for pulmonary and cardiac failure in the adult. In particular, ECMO is being used more and more for postcardiotomy shock. Unfortunately, despite its increased application in this setting, improved outcomes have been hard to come by. Improved results must be grounded on an approach that honors the tenets of myocardial recovery, minimizing the work done by the heart during the recovery period. Left ventricular decompression should be a tenet of ECMO support in the setting of postcardiotomy shock, universally applied if we are to see any significant improvement in our results. Furthermore, the point is made that surgeons should play a leadership role in the immediate counseling of patients' families to assure realistic expectations on their part. To address the need for family support during this very difficult time, ECMO centers should design a programmatic approach to care for patients and their families so as to provide them with education, guidance, and emotional support. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  10. Holographic interferometric observation of shock wave focusing to extracorporeal shock wave lithotripsy

    Science.gov (United States)

    Takayama, Kazuyoshi; Obara, Tetsuro; Onodera, Osamu

    1991-04-01

    Underwater shock wave focusing is successfully applied to disintegrate and remove kidney stones or gallbladder stones without using surgical operations. This treatment is one of the most peaceful applications ofshock waves and is named as the Extracorporeal Shock Wave Lithotripsy. Ajoint research project is going on between the Institute ofFluid Science, Tohoku University and the School ofMedicine, Tohoku University. The paper describes a result of the fundamental research on the underwater shock wave focusing applied to the ESWL. Quantitatively to visualize the underwater shock waves, various optical flow visualization techniques were successfully used such as holographic interferometry, and shadowgraphs combined with Ima-Con high speed camera. Double exposure holographic interferometric observation revealed the mechanism of generation, propagation and focusing of underwater shock waves. The result of the present research was already used to manufacture a prototype machine and it has already been applied successfully to ESWL crinical treatments. However, despite of success in the clinical treatments, important fundamental questions still remain unsolved, i.e., effects of underwater shock wave focusing on tissue damage during the treatment. Model experiments were conducted to clarify mechanism of the tissue damage associated with the ESWL. Shock-bubble interactions were found responsible to the tissue damage during the ESWL treatment. In order to interprete experimental findings and to predict shock wave behavior and high pressures, a numerical simulation was carried. The numerical results agreed with the experiments.

  11. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF PEDIATRIC UROLITHIASIS

    Directory of Open Access Journals (Sweden)

    Emilija Golubovic

    2006-04-01

    Full Text Available The paper presents the experiences in the treatment of urinary tract calculosis in 114 children aged 6 months to 14 years by means of extracorporeal shock wave lithotripsy (ESWL.The treatment was performed at the Institute of Radiology and the Clinic for Pediatric Surgery and Orthopedics in Nis, in the period 1988-2000 on Siemens Litostar lithotriptor. The children were treated after clinical, laboratory and radiological preparation, provided that the stone was not greater than 3 cm (measured in native urinary tract graph and that it was not located in the pelvic part of the ureter. In the present study, the success in application of ESWL for treating pediatric patients was 88%. The total clearance of fragments was found in 57% of patients, whereas retention of fragments smaller than 4 mm three months after the last treatment was present in 31% of patients. ESWL treatment failed in 12% of patients since they had retained fragments greater than 4 mm.The authors recommend this method as a method of choice in the treatment of renal and urethral calculi in children.

  12. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes

    Directory of Open Access Journals (Sweden)

    Sean McAdams

    2010-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  13. Does extracorporeal shock wave lithotripsy cause hearing impairment?

    Science.gov (United States)

    Tuncer, Murat; Erdogan, Banu A; Yazici, Ozgur; Sahin, Cahit; Altin, Gokhan; Faydaci, Gokhan; Eryildirim, Bilal; Sarica, Kemal

    2014-07-01

    To evaluate the possible effects of extracorporeal shock wave lithotripsy (ESWL) on the hearing status of the patients in this prospective controlled study. A total of 40 patients with normal hearing function were included to the study. We had 20 patients each in the study group and control group. The treatment parameters were standardized in all 3 sessions in which a total of 3000 shock waves with a rate of 90/min along with a total energy value of 126 J at the fourth energy level have been applied (Dornier Compact Sigma, Medtech, Germany). In addition to the testing of hearing functions and possible cochlear impairment by Transient Evoked Otoacoustic Emissions test at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz frequencies, complications such as ear pain, tinnitus, and hearing loss have been well evaluated in each patient before the procedure and 2 hours and 1 month after the completion of the third session of ESWL in the study group. The same evaluation procedures were performed before the study and after 7-weeks in the control group. Regarding Transient Evoked Otoacoustic Emissions data obtained in study group and control group patients, there was no significant alteration in values obtained after ESWL when compared with the values before the procedure. A well-planned ESWL procedure is a safe and effective treatment in urinary stones and causes no detectable harmful effect on the hearing function of treated patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Gallbladder Dynamics Before and After Extracorporeal Shock Wave Lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Hea; Suk, Jae Dong; Moon, Dae Hyuk; Kim, Myung Hwan; Min, Young Il [Asian Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Extracorporeal shock wave lithotripsy (ESWI.) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, {sup 99m}Tc-DISIDA hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7 mCi of {sup 99m}Tc-DISIDA, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (I frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated, ESWL group were studied before, l day after and 2 weeks after ESWL, and UDCA group were studied before and 2 weeks after starting oral medication Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESlVL group, mean EF and mean ER at 1 day after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recovered to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

  15. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    Science.gov (United States)

    Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

    2007-01-01

    The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment. PMID:18225463

  16. Application of extracorporeal shock wave on bone: preliminary report.

    Science.gov (United States)

    Ikeda, K; Tomita, K; Takayama, K

    1999-11-01

    We have studied the effect of extracorporeal shock waves (ESW) on bone. ESW emitted by the new powerful generator provides three to six times greater energy than a common lithotriptor. Because the ESW causes fracture of rabbit femurs and induces new bone formation, we have called this treatment as ESWIB (ESW-induced bone formation). The purpose of this study is to confirm the effect of ESWIB on a canine model, which is more similar to clinical cases, and to apply ESWIB on nonunion of clinical cases. In our basic research, ESWIB was applied on six canine femurs as follows: group I with 100, 500, 1,000 shots and group II with 100, 500, 1,000 shots. A femur was extracted immediately after ESWIB in group I and 2 months after ESWIB in group II. Blood tests, including blood cell counts and blood chemistry studies, were performed before and after ESWIB in group II. In our clinical research, we applied ESWIB to six patients of delayed or nonunion of the fracture. The sites of the ESWIB application were three tibiae, one radius, one femur, and one humerus. Average age of the patients, the period from the previous surgery, and the period until fusion was achieved were 38.6 years, 14.0 months, and 4.3 months, respectively. In our basic research, group I, 500 or more shots caused periosteum detachment. In addition, small fractures of the inner surface of the cortex were observed. However, gross fracture with displacement was not observed. In group II, 500 or more shots caused callus formation beneath the detached periosteum. Subcutaneous hemorrhage was seen in all dogs, and the degree of bleeding was directly proportional to the number of the shots. The blood was absorbed within a week. The level of serum creatine kinase was significantly high 2 days after ESWIB, but it recovered in a week. In our clinical research, four of the patients achieved union without any complications except mild subcutaneous bleeding. We predict that ESWIB will be one of the tactics for treatment of

  17. THE USE OF NORMOTHERMIC EXTRACORPOREAL PERFUSION IN SITU IN KIDNEY ASYSTOLIC DONORS

    Directory of Open Access Journals (Sweden)

    Y.. A. Shcherbuk

    2010-01-01

    Full Text Available Deficit of donor organs is the limiting factor in organ transplantation. One way of solving this problem is the use of donors with sudden irreversible circulatory arrest. Obtaining organs from this category of donors is pos- sible only through the use of normothermic extracorporal perfusion in situ (NECP with oxygenation and leu- cocyte depletion. The article presents the implementation of NECP in 11 uncontrolled non heart beating donor (uNHBD kidneys (age of 43,1 ± 2,98 years and the results of transplantation in 22 recipients of such transplants in comparison with the results of the 20 recipients of kidney transplants from 20 donors to the death of the brain (age 45,65 ± 1,8 years. Despite the initially high rate of delayed function and more significant number of hemo- dialysis in uNHBD group (group of investigation, serum creatinine at 21st day was the same level as in BDD group (comparison group: 0,198 ± 0,002 mmol/L and 0,151 ± 0,002 mmol/L (p > 0,05. The use of NECP with oxygenation and leucocyte depletion is an effective practice for recovery kidney from donors with a sudden ir- reversible circulatory arrest with warm ischemic time one hour and more before the operation explantation. 

  18. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-03-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients' function.

  19. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified

  20. Role of extracorporeal shock wave lithotripsy in hepato-biliary-pancreatic surgery

    NARCIS (Netherlands)

    R.L. van der Hul (René); P.W. Plaisier; O.T. Terpstra (Onno); H.A. Bruining (Hajo)

    1993-01-01

    textabstractSince the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed

  1. Acoustic wave focusing in an ellipsoidal reflector for extracorporeal shock-wave lithotripsy

    Science.gov (United States)

    Lottati, Itzhak; Eidelman, Shmuel

    1993-07-01

    Simulations of acoustic wave focusing in an ellipsoidal reflector for extracorporeal shock-wave lithotripsy (ESWL) are presented. The simulations are done on a structured/unstructured grid with a modified Tait equation of state for water. The Euler equations are solved by applying a second-order Godunov method. The computed results compare very well with the experimental results.

  2. Fractionated Repetitive Extracorporeal Shock Wave Therapy: A New Standard in Shock Wave Therapy?

    Directory of Open Access Journals (Sweden)

    Tobias Kisch

    2015-01-01

    Full Text Available Background. ESWT has proven clinical benefit in dermatology and plastic surgery. It promotes wound healing and improves tissue regeneration, connective tissue disorders, and inflammatory skin diseases. However, a single treatment session or long intervals between sessions may reduce the therapeutic effect. The present study investigated the effects of fractionated repetitive treatment in skin microcirculation. Methods. 32 rats were randomly assigned to two groups and received either fractionated repetitive high-energy ESWT every ten minutes or placebo shock wave treatment, applied to the dorsal lower leg. Microcirculatory effects were continuously assessed by combined laser Doppler imaging and photospectrometry. Results. In experimental group, cutaneous tissue oxygen saturation was increased 1 minute after the first application and until the end of the measuring period at 80 minutes after the second treatment (P<0.05. The third ESWT application boosted the effect to its highest extent. Cutaneous capillary blood flow showed a significant increase after the second application which was sustained for 20 minutes after the third application (P<0.05. Placebo group showed no statistically significant differences. Conclusions. Fractionated repetitive extracorporeal shock wave therapy (frESWT boosts and prolongs the effects on cutaneous hemodynamics. The results indicate that frESWT may provide greater benefits in the treatment of distinct soft tissue disorders compared with single-session ESWT.

  3. Extracorporeal shock waves lithotripsy of urinary organs in patients with one kidney

    Directory of Open Access Journals (Sweden)

    Zogović Jezdimir

    2002-01-01

    Full Text Available Extracorporeal Shock Waves Lithotripsy (ESWL is a method of choice in the treatment of lithiasis. Surgical treatment is reduced to minimum, which in our case means 1-2%. Contraindications for using this method are: blood coagulation disorders, manifest tuberculosis, pregnancy, over obesity. Thanks to appropriate indications and technique which is used in an adequate way as well as to various endurological manipulations, removal of a stone by this method is safe, trauma is minimised, which is very important for patients with one kidney. During the last three years, usually in hospital conditions, 57 patients were treated in this way. Removal of a stone was performed by Extracorporeal Shock Waves Lithotripsy as mono therapy in 30 (53% patients; Extracorporeal Shock Waves Lithotripsy by using Double-J catheter in 16 (28% patients; Extracorporeal Lithotripsy with urine derivation by percutaneous nephrostome in 11 (19% patients. Endurological methods were used in 27 patients. Disintegration of stone was performed in the proper way. Full success was reached. Two patients had incrustation of ureteral catheter which had to be removed by surgery. In two other patients with inferior function of one kidney, after brief obstruction, hemodialisis was performed. Our results confirm that this method is nonaggressive, tech nically perfect for disintegration of urineorgans stone on all levels followed by small complications which are often solved by endoscopie manipulations.

  4. Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation

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    Amine Tarmiz

    2017-01-01

    Full Text Available Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient’s hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.

  5. Effects of extracorporeal shock wave lithotripsy on the kidney and perinephric tissues: CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Song, Kounn Sik; Kim, Kun Sang; Kim, Sae Chul [College of Medicine, Chung-Ang University, Seoul (Korea, Republic of)

    1987-12-15

    Since the first successful treatment of the patient with renal stone by extracorporeal shock wave lithotripsy at the Institute for Surgical Research, West Germany, on February 7, 1980, extracorporeal shock wave lithotripsy (ESWL) has been a non-invasive technique for the treatment of the renal and ureteral calculi. In spite of the fact that the acoustic energy of the focused shock waves must pass through the soft tissues of back, perinephric tissues and renal parenchyme before reaching calculi, little is known about the effects of ESWL in the renal parenchyme and perinephric soft tissues. So we analyzed a pre and post-ESWL computed tomography scans of the kidneys in 130 patients treated at our hospital during a three month period to evaluate the effects of ESWL on the kidney and perinephric soft tissues.

  6. Effects of extracorporeal shock wave lithotripsy on the kidney and perinephric tissues: CT evaluation

    International Nuclear Information System (INIS)

    Song, Kounn Sik; Kim, Kun Sang; Kim, Sae Chul

    1987-01-01

    Since the first successful treatment of the patient with renal stone by extracorporeal shock wave lithotripsy at the Institute for Surgical Research, West Germany, on February 7, 1980, extracorporeal shock wave lithotripsy (ESWL) has been a non-invasive technique for the treatment of the renal and ureteral calculi. In spite of the fact that the acoustic energy of the focused shock waves must pass through the soft tissues of back, perinephric tissues and renal parenchyme before reaching calculi, little is known about the effects of ESWL in the renal parenchyme and perinephric soft tissues. So we analyzed a pre and post-ESWL computed tomography scans of the kidneys in 130 patients treated at our hospital during a three month period to evaluate the effects of ESWL on the kidney and perinephric soft tissues

  7. Symptomatic gallbladder stones. Cost-effectiveness of treatment with extracorporeal shock-wave lithotripsy, conventional and laparoscopic cholecystectomy

    NARCIS (Netherlands)

    Go, P. M.; Stolk, M. F.; Obertop, H.; Dirksen, C.; van der Elst, D. H.; Ament, A.; van Erpecum, K. J.; van Berge Henegouwen, G. P.; Gouma, D. J.

    1995-01-01

    In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy

  8. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

    Science.gov (United States)

    Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

    2007-07-01

    Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

  9. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

    Science.gov (United States)

    Beyazal, Münevver Serdaroğlu; Devrimsel, Gül

    2015-12-01

    [Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

  10. The efficacy of extracorporeal shock wave lithotripsy on single dense calcified gallstones according to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Takao (Mie Univ., Tsu (Japan). School of Medicine); Shimono, Kazuko; Moriyama, Shigeru; Masuda, Touru; Ikeda, Tetsuya; Umegae, Satoru; Nagata, Norikazu

    1993-05-01

    The efficacy and complications of extracorporeal shock wave lithotripsy (ESWL) for single gallstones were compared between 15 patients with a CT-lucent stone and 18 patients with a dense calcified stone. In all of five patients with a stone smaller than 10 mm in diameter, complete or sufficient clearance was observed, regardless of calcification. However, in 28 patients with a stone larger than 11 mm in diameter, the rates of complete or sufficient clearance were lower in those with a dense calcified stone (64%) than in those with a computed tomography (CT) lucent stone (93%). There was no difference in the rate of complications between patients with a CT-lucent stone and those with a dense calcified stone. These results thus suggest that extracorporeal shock wave lithotripsy may be safely employed for patients with a single calcified gallstone. (author).

  11. Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases

    Directory of Open Access Journals (Sweden)

    Dushyant Nadar

    2000-01-01

    Full Text Available Objective: Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases. Patients and methods: 35 patients received shock wave therapy using Econolith 2000 lithotripter 19 patients had isolated lateral epicondylitis, 12 medical epicondylitis and 4 plantar fascitis. A total of 120 shock waves were given in the first sitting. Each patient received a total of three sittings with a gap of one week between each of them. Results: Based on the patients′ self-assessment, about 75% pain relief was observed in 60% of the patients. Fur-ther, in patients having isolated tendinopathies, the pain relief was better. Conclusion: The study indicated that the application of shock waves is not restricted to the fragmentation of urinary calculi. The shock waves can be effectively used for the pain relief in the common orthopedic diseases. Thus, the urologists can widen the application of lithotripters, in a cost-effective manner, to the other medical speciali-ties.

  12. Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management.

    Science.gov (United States)

    Labanaris, Apostolos P; Kühn, Reinhard; Schott, Günter E; Zugor, Vahudin

    2007-09-17

    Extracorporeal shock wave lithotripsy (ESWL) is nowadays accepted as the treatment of choice for the majority of patients with renal or proximal ureteral calculi. Although, a relatively noninvasive modality with low morbidity, minor or major complications can be noted. A relative severe complication for the patient and confusing for the treating physician is the perirenal hematoma. With review the literature and an example of perirenal hematoma induced by ESWL in a patient treated in our department, we describe its therapeutic management.

  13. Measurements of Pressure of Extracorporeal Shock Wave Lithotripter Using Pressure-Sensitive Papers

    Science.gov (United States)

    Inose, Naoto; Ide, Masao

    1993-05-01

    This paper describes measurements of pressures at the focal region of the extracorporeal shock wave lithotripter (ESWL) using pressure-sensitive papers. At the focal region of ESWL, ordinary hydrophones are quickly damaged, because of very high pressures. Recently, measurements of pressure at the focal region of ESWL using pressure-sensitive paper have been advised. Therefore, we have studied the effectiveness of pressure-sensitive papers in the measurement of high acoustic pressures at the focal region of ESWL.

  14. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    Science.gov (United States)

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  15. Extracorporeal shock-wave lithotripsy as an adjunct to biliary interventional procedures

    International Nuclear Information System (INIS)

    Zeman, R.K.; Garra, B.S.; Matsumoto, A.H.; Teitelbaum, G.P.; Barth, K.H.; Cattau, E.L.; Davros, W.J.; McClennan, B.L.; Picus, D.; Paushter, D.M.

    1989-01-01

    This paper reviews the records of nine patients undergoing extracorporeal shock wave lithotripsy (ESWL) of bile duct stones as an adjunct to other biliary intervention. Lithotripsy was successful in producing fragmentation in seven of nine patients. Keeping the duct mildly distended with contrast medium, distributing the shock waves over the stone(s) by taking advantage of respiratory excursion, and pinning stone fragments with balloon catheters facilitated fragmentation. Six patients underwent duct manipulation (stricture dilation, fragment extraction) within 24 hours of ESWL, suggesting that immediate instrumentation is safe in conjunction with lithotripsy

  16. Morphological alterations of the gall-bladder following extracorporeal shock-wave lithotripsy

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Zoeller, A.; Swobodnik, W.; Janowitz, P.

    1990-01-01

    The present study reports on 51 patients with symptomatic cholecystolithiasis, who accordingly underwent extracorporeal shock-wave lithotripsy (ESWL). In all cases, computed tomography (CT) was performed prior to and after the therapeutic procedure to delineate changes in gall-bladder morphology. Slight edematous thickening of the gall-bladder wall was found in 15 patients. One patient presented a rupture of the gall-bladder with formation of a bilioma in the adjacent liver tissue. In case of calcific concrements, CT revealed a characteristic pattern of fragment distribution following shock-wave treatment, and fragments of various sizes exhibited distinct adhesion to the gall-bladder wall. (orig.) [de

  17. Variation of Pressure Waveforms in Measurements of Extracorporeal Shock Wave Lithotripter

    Science.gov (United States)

    Inose, Naoto; Ide, Masao

    1993-05-01

    In this paper, we describe measurement of variation in pressure waveforms of the acoustic field of an extra-corporeal shock-wave lithotripter (ESWL). Variations in the measured acoustic fields and pressure waveform of an underwater spark-gap-type ESWL with an exhausted spark plug electrode have been reported by researchers using crystal sensors. If the ESWL spark plugs become exhausted, patients feel pain during kidney, biliary stone disintegration. We studied the relationship between exhaustion of electrodes and the variation of pressure waveforms and shock-wave fields of the ESWL using a newly developed hydrophone.

  18. Patient exposure and micronucleus assay during extracorporeal shock wave lithotripsy (ESWL) for kidney stones

    International Nuclear Information System (INIS)

    Shao, M.

    1992-01-01

    This study reports results of radiation exposure to 20 patients with kidney stones during Extracorporeal Shock Wave Lithotripsy (ESWL). A domestically made JT-ESWL-I Lithotripter was used. Data indicated that the amount of radiation exposure is related to the numbers, size, location and radiodensity of the stone, and also the number of shock wave and the time of fluoroscopy exposure given to the patients. The results of the micronucleus frequency of lymphocytes assay in the human peripheral blood are reported. This effect increased with increasing radiation exposure doses. (author). 4 refs., 2 tabs

  19. 3D dynamic simulation of crack propagation in extracorporeal shock wave lithotripsy

    Science.gov (United States)

    Wijerathne, M. L. L.; Hori, Muneo; Sakaguchi, Hide; Oguni, Kenji

    2010-06-01

    Some experimental observations of Shock Wave Lithotripsy(SWL), which include 3D dynamic crack propagation, are simulated with the aim of reproducing fragmentation of kidney stones with SWL. Extracorporeal shock wave lithotripsy (ESWL) is the fragmentation of kidney stones by focusing an ultrasonic pressure pulse onto the stones. 3D models with fine discretization are used to accurately capture the high amplitude shear shock waves. For solving the resulting large scale dynamic crack propagation problem, PDS-FEM is used; it provides numerically efficient failure treatments. With a distributed memory parallel code of PDS-FEM, experimentally observed 3D photoelastic images of transient stress waves and crack patterns in cylindrical samples are successfully reproduced. The numerical crack patterns are in good agreement with the experimental ones, quantitatively. The results shows that the high amplitude shear waves induced in solid, by the lithotriptor generated shock wave, play a dominant role in stone fragmentation.

  20. High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy.

    Science.gov (United States)

    Furia, John P

    2008-03-01

    High-energy extracorporeal shock wave therapy has been shown to be an effective treatment for chronic insertional Achilles tendinopathy. The results of high-energy shock wave therapy for chronic noninsertional Achilles tendinopathy have not been determined. Shock wave therapy is an effective treatment for noninsertional Achilles tendinopathy. Case control study; Level of evidence, 3. Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated with a single dose of high-energy shock wave therapy (shock wave therapy group; 3000 shocks; 0.21 mJ/mm(2); total energy flux density, 604 mJ/mm(2)). Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated not with shock wave therapy but with additional forms of nonoperative therapy (control group). All shock wave therapy procedures were performed using regional anesthesia. Evaluation was by change in visual analog score and by Roles and Maudsley score. One month, 3 months, and 12 months after treatment, the mean visual analog scores for the control and shock wave therapy groups were 8.4 and 4.4 (P wave therapy and control groups were 12 and 0 (P wave therapy group than in the control group (P wave therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.

  1. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009 - a Randomized Trial

    Directory of Open Access Journals (Sweden)

    Joest Beatrice

    2010-10-01

    Full Text Available Abstract Background Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Methods/Design Study design: Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Analysis: Intention-to-treat. Outcome parameters: a Photonumeric severity scale, b Nürnberger Score, c circumference measurements, d capillary blood flow, e tissue oxygen saturation, f postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal strength exercise training. Control group: Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal

  2. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

    Directory of Open Access Journals (Sweden)

    Schlaudraff KU

    2014-05-01

    Full Text Available Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI, weight, and/or height.Methods: Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast® device (Electro Medical Systems, S.A., Nyon, Switzerland. Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right, totaling eight treatments on the selected side. Treatment was performed at 3.5–4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area. Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.Results: The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades. Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0

  3. Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Young Kun Lee

    2015-08-01

    Full Text Available Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN, for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

  4. Lung contusion and cavitation with exudative plural effusion following extracorporeal shock wave lithotripsy in an adult: a case report

    Directory of Open Access Journals (Sweden)

    Nouri-Majalan Nader

    2010-08-01

    Full Text Available Abstract Introduction Among the complications of extracorporeal shock wave lithotripsy are perinephric bleeding and hypertension. Case presentation We describe the case of a 31-year-old Asian man with an unusual case of hemoptysis and lung contusion and cavitation with exudative plural effusion due to pulmonary trauma following false positioning of extracorporeal shock wave lithotripsy. Differential diagnoses included pneumonia and pulmonary emboli, but these diagnoses were ruled out by the uniformly negative results of a lung perfusion scan, Doppler ultrasound, and culture of bronchoalveolar lavage and plural effusion, and because our patient showed spontaneous improvement. Conclusions False positioning of extracorporeal shock wave lithotripsy can cause lung trauma presenting as pulmonary contusion and cavitation with plural effusion.

  5. Extracorporeal shock-wave lithotripsy of bile duct stones

    International Nuclear Information System (INIS)

    Lee, Jong Tae; Kim, Myung Joon; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Moo Sang; Jo, Jang Hwan; Kim, Byung Ro

    1989-01-01

    During the past one and half year, we performed ESWL therapy in 13 patients with common bile duct and intrahepatic duct stones, applying Lithostar-R (Siemens co. West Germany) and analyzed their results. In 13 patients, 9 residual common bile duct stones and 7 intrahepatic duct stones were selected postoperatively. The size of stones were ranged from 0.7 cm to 3.5 cm in diameter. 2 stones were multiple and the remained 14 were single in number. The visualization of stones were done with fluoroscopy after the injection of contrast media via cholangiographic T-tube or ERCP. ESWL were applied continuously until stone disintegration was visible, or upto maximum number of 3500 discharge of shock wave. If not disintegrated upto 3500, patients were underwent second or third lithotripsy session with interval of one week. Our results showed that among 9 common bile duct stones, 4 were completely disintegrated and passed out spontaneously, but 3 partially fragmented and removed by the additional procedure. 2 were failed. Among 7 intrahepatic stones, 3 completely and 2 partially were succeeded. One stone partially fragmented were retained without removal and other one were failed. Skin petechia in all patients were revealed on the entry port of shock wave, but no serous complication was not occurred

  6. Extracorporeal shock-wave lithotripsy of bile duct stones

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kim, Myung Joon; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Moo Sang; Jo, Jang Hwan; Kim, Byung Ro [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    During the past one and half year, we performed ESWL therapy in 13 patients with common bile duct and intrahepatic duct stones, applying Lithostar-R (Siemens co. West Germany) and analyzed their results. In 13 patients, 9 residual common bile duct stones and 7 intrahepatic duct stones were selected postoperatively. The size of stones were ranged from 0.7 cm to 3.5 cm in diameter. 2 stones were multiple and the remained 14 were single in number. The visualization of stones were done with fluoroscopy after the injection of contrast media via cholangiographic T-tube or ERCP. ESWL were applied continuously until stone disintegration was visible, or upto maximum number of 3500 discharge of shock wave. If not disintegrated upto 3500, patients were underwent second or third lithotripsy session with interval of one week. Our results showed that among 9 common bile duct stones, 4 were completely disintegrated and passed out spontaneously, but 3 partially fragmented and removed by the additional procedure. 2 were failed. Among 7 intrahepatic stones, 3 completely and 2 partially were succeeded. One stone partially fragmented were retained without removal and other one were failed. Skin petechia in all patients were revealed on the entry port of shock wave, but no serous complication was not occurred.

  7. Decreased renal function and hypertension are long-term complications of extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Williams, C.M.; Kaude, J.V.; Newman, R.C.; Peterson, J.C.; Thomas, W.C.

    1987-01-01

    Quantitative radionuclide renography performed in 21 patients 17-21 months after extracorporeal shock wave lithotripsy showed a significant decrease in the percentage of effective renal plasma flow (%ERPF) of the treated kidney; in five (24%) patients the %ERPF had decreased by more than 5 percentage units. In seven (8%) of 91 patients sustained hypertension developed that required pharmacologic treatment after lithotripsy. Decreased %ERPF of a treated kidney and hypertension may be related to a Page kidney or similar process resulting from renal trauma and hemorrhage occurring as a side effect of lithotripsy. Hypertension is an important complication of lithotripsy in about 8% of patients

  8. Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae [Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-09-15

    Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL.

  9. Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae

    2015-01-01

    Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL

  10. [Bone and Calcium Research Update 2015. Clinical update of urolithiasis--ESWL (extracorporeal shock wave lithotripsy)].

    Science.gov (United States)

    Iguchi, Taro; Nakatani, Tatsuya

    2015-01-01

    ESWL (extracorporeal shock wave lithotripsy) is widely used for upper urinary stones and successfully treats most patients with uncomplicated kidney stones. ESWL is still of high strategic importance despite ureteroscopy and PNL occupy an essential place in the treatment of urinary stones by technologic advancements. However ESWL is just one of treatment tool and the best procedure should be selected for the patients. Moreover urolithiasis is one of lifestyle-related diseases and should be treated as systemic illness in the daily medical practice.

  11. Usefulness of Early Extracorporeal Shock Wave Lithotripsy in Colic Patients with Ureteral Stones

    OpenAIRE

    Choi, Hyeung Joon; Jung, Jin-Hee; Bae, Jungbum; Cho, Min Chul; Lee, Hae Won; Lee, Kwang Soo

    2012-01-01

    Purpose To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. Materials and Methods A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time betw...

  12. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  13. Computed tomography after extra-corporeal shock wave lithotripsy (ESWL) of the kidneys. Pt. 1

    International Nuclear Information System (INIS)

    Schaub, T.; Kunisch, M.; Stadtbaeumer, M.; Schild, H.; Thelen, M.; Stoerkel, S.; El-Damanhoury, H.; Hennes, H.J.

    1991-01-01

    In an experimentel study on pigs, 28 stone-free kidneys were treated with a second generation lithotripter. Histologically, acute bleeding was seen after ESWL in 23 (82 %) of the 28 treated kidneys. CT studies before and after contrast were correct in 20/28 (74%) cases. It was shown that extracorporeal shock waves cause renal bleeding that is only partially detected by computed tomography. It can be concluded that the CT findings seen in a high percentage of renal stone patients after ESWL represent bleeding. The incidence of renal bleeding after ESWL and thus the possible risk of hypertension has obviously been underestimated so far in clinical studies. (orig.) [de

  14. Surface dose of X rays to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Jiang Qingqi; Weng Zhigeng; Feng Ming; Wang Guomin.

    1990-01-01

    During extracorporeal shock wave lithotripsy (ESWL), the fluoroscopy must be made to show the location and size of the stone thus the patient has to be exposed to X rays. The surface dose to patients during ESWL was measured in an investigation on 134 cases of renal lithiasis admitted in a certain hospital of Shanghai. The results show that the average skin dose equivalent for these patients was 162 mSv and the magnitude of doses was depended upon some factors such as the size and location of the stone

  15. Role of US in the evaluation of patients after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Nadel, S.N.; St Amour, T.E.; McClennan, B.L.; Ling, D.; Clayman, R.V.

    1986-01-01

    Five hundred patients underwent extracorporeal shock wave lithotripsy (ESWL) during a 9-month period and 343 were evaluated afterward with high-resolution realtime US. US examinations were correlated with the clinical course, other imaging studies, and patient outcome. US was as sensitive as but less specific than plain radiography for the detection of fragmented calculi. US successfully graded hydronephrosis, imaged fluid collections, and facilitated placement of percutaneous nephrostomy tubes. The limitations of US included loss of detail secondary to indwelling catheters, ileus, reflections from adjacent bowel, and operator or machine dependence

  16. [EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF A SOLITARY KIDNEY].

    Science.gov (United States)

    Parshenkova, I G; Dutov, V V; Rumjancev, A A; Mamedov, E A

    2015-01-01

    The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (ppre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (pcalculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.

  17. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

    Science.gov (United States)

    Bayram, Korhan; Yesil, Hilal; Dogan, Erdal

    2014-01-01

    Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. Visual analog scale (VAS) scores were significantly lower (plateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.

  18. Extracorporeal shock wave lithotripsy for gallbladder stones - an experimental and clinical study -

    International Nuclear Information System (INIS)

    Kim, Kun Sang; Park, Sil Moo; Lee, Jung Hyo; Kim, Young Goo; Song, Kounn Sik; Lee, Kwan Seh; Lee, Jong Beum; Kim, Sang Joon; Chang, Sun Taik

    1988-01-01

    Although many alternative treatment technics have been proposed recently for gallstone to substitute cholecystectomy, the extracorporeal shock wave lithotripsy (ESWL) for gallbladder stones has rarely been tried. We have carried out a series of experiments to evaluate how effective the ESWL for gallbladder stones in and how safe this procedure is. At first, in vitro shock were application was carried out to 10 gallbladder stones which were obtained from human gallbladder. Secondly, gallbladder stones were implanted to canine gallbladder and treated with shock wave. Lastly, a total of 41 volunteers with confirmed gallbladder stones were treated with shock wave and combined oral administration of ursodeoxycholic acid. In the in vitro experiment, all of the 10 gallstones were fragmented with variable firing rates and duration. In animal experiment, the implanted stones were successfully fragmented and the organs included in the pathway of shock wave were proved to be intact histologically. In human study, complete disappearance of gallstones was noted in 78.6% of patients with single radiolucent gallbladder stones, smaller than 2.5cm in the longest diameter. Two patients underwent cholecystectomy after ESWL due to sudden colic attack. One patient had experienced an episode of mild transient obstructive jaundice. It may be concluded that the ESWL for gallbladder stones is an effective and safe method of treatment of gallbladder stones in the selected cases, for example, small radiolucent stones, and the further study is needed to establish improved technology of the ESWL for gallbladder stones.

  19. Extracorporeal shock wave lithotripsy for gallbladder stones - an experimental and clinical study -

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Sil Moo; Lee, Jung Hyo; Kim, Young Goo; Song, Kounn Sik; Lee, Kwan Seh; Lee, Jong Beum; Kim, Sang Joon; Chang, Sun Taik [Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    1988-08-15

    Although many alternative treatment technics have been proposed recently for gallstone to substitute cholecystectomy, the extracorporeal shock wave lithotripsy (ESWL) for gallbladder stones has rarely been tried. We have carried out a series of experiments to evaluate how effective the ESWL for gallbladder stones in and how safe this procedure is. At first, in vitro shock were application was carried out to 10 gallbladder stones which were obtained from human gallbladder. Secondly, gallbladder stones were implanted to canine gallbladder and treated with shock wave. Lastly, a total of 41 volunteers with confirmed gallbladder stones were treated with shock wave and combined oral administration of ursodeoxycholic acid. In the in vitro experiment, all of the 10 gallstones were fragmented with variable firing rates and duration. In animal experiment, the implanted stones were successfully fragmented and the organs included in the pathway of shock wave were proved to be intact histologically. In human study, complete disappearance of gallstones was noted in 78.6% of patients with single radiolucent gallbladder stones, smaller than 2.5cm in the longest diameter. Two patients underwent cholecystectomy after ESWL due to sudden colic attack. One patient had experienced an episode of mild transient obstructive jaundice. It may be concluded that the ESWL for gallbladder stones is an effective and safe method of treatment of gallbladder stones in the selected cases, for example, small radiolucent stones, and the further study is needed to establish improved technology of the ESWL for gallbladder stones.

  20. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite.

    Science.gov (United States)

    Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus Bm; Schmitz, Christoph

    2014-01-01

    Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height. Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires. The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, Pcellulite grade at baseline, BMI, weight, height, or age. Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight

  1. Unexpected difficulties in randomizing patients in a surgical trial: A prospective study comparing extracorporeal shock wave lithotripsy with open cholecystectomy

    NARCIS (Netherlands)

    P.W. Plaisier; M.Y. Berger (Marjolein); R.L. van der Hul (René); H.G. Nijs (Huub); R. den Toom (Rene); O.T. Terpstra (Onno); H.A. Bruining (Hajo); S.M. Strasberg (S.)

    1994-01-01

    textabstractShortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the

  2. Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

    Science.gov (United States)

    Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

    2013-01-01

    Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

  3. Anti-miss-shot control device for selective stone disintegration in extracorporeal shock wave lithotripsy

    Science.gov (United States)

    Kuwahara, M.; Ioritani, N.; Kambe, K.; Orikasa, S.; Takayama, K.

    1991-06-01

    A new device to prevent erroneously focused shock waves to the renal parenchyma during extracorporeal shock wave lithotripsy (ESWL) has been developed; an anti-miss-shot control device (AMCD) and experiments have been conducted to evaluate its effectiveness. For shock wave generation and stone localization, piezoceramic elements (PSE) and ultrasound localization, respectively were used. After stone localization, probing ultrasounds (PU) were emmitted from the PSE towards the focal region and the reflected sound levels (RSL) were monitored by the PSE which also functioned as a microphone. A direct hit by the PU to the stone or a miss was judged from the RSL, i.e. a high RSL indicates a direct hit and a low RSL indicates a miss. Shock waves were generated only when the RSL exceeded the level which indicated a direct hit. The experimental results showed that the injury to the renal parenchyma was decreased by using the AMCD. Clinical application of the AMCD is expected to increase the safety of ESWL.

  4. Studies of renal parenchymal impairments with extracorporeal shock wave lithotripsy (ESWL) by diagnostic imaging methods

    Energy Technology Data Exchange (ETDEWEB)

    Ohishi, Yukihiko; Machida, Toyohei; Tashiro, Kazuya; Wada, Tetsuro; Mochizuki, Atsushi; Torii, Shinichiro; Yoshigoe, Fukuo; Kawashima, Yoshio; Asano, Koji (Jikei Univ., Tokyo (Japan). School of Medicine)

    1989-05-01

    Renal parenchymal impairments with extracorporeal shock wave lithotripsy (ESWL) were studied by diagnostic imaging methods. The subjects were 25 patients with renal stones, and EDAP LT-01 (piezoelectric system) was used for the equipment of ESWL. The examination by MRI, X-ray CT and /sup 99m/Tc-DMSA scintigraphy using SPECT were performed before and after ESWL. To the 24 kidneys of 12 adult dogs, shock waves were fired in order to examine the experimental renal parenchymal impairments. After the treatment with ESWL, renal abnormal findings were obtained with MRI in 6 patients out of 11 (54.5%), with X-ray CT in 1 patient out of 12 (8.3%), and with the /sup 99m/Tc-DMSA renal scintigraphy in 4 patients out of 6 (66.7%). In the inspections with X-ray CT and renal scintigraphy conducted in 4 weeks, it was noted that the conditions of patients were recovered to the states before ESWL was performed. Using the therapeutic doses of shock wave for humans, the renal parenchymal impairments in the kidney in dogs were normalized in 7 days. Although it has been considered that the degree of renal parenchymal impairments with ESWL treatment may be influenced by the kind of the equipment, frequency of shock waves and their strength, the extent of impairments were rather mild, and it was presumed that the impairments might be recovered on the images in 3 to 4 weeks at the latest. (author).

  5. Studies of renal parenchymal impairments with extracorporeal shock wave lithotripsy (ESWL) by diagnostic imaging methods

    International Nuclear Information System (INIS)

    Ohishi, Yukihiko; Machida, Toyohei; Tashiro, Kazuya; Wada, Tetsuro; Mochizuki, Atsushi; Torii, Shinichiro; Yoshigoe, Fukuo; Kawashima, Yoshio; Asano, Koji

    1989-01-01

    Renal parenchymal impairments with extracorporeal shock wave lithotripsy (ESWL) were studied by diagnostic imaging methods. The subjects were 25 patients with renal stones, and EDAP LT-01 (piezoelectric system) was used for the equipment of ESWL. The examination by MRI, X-ray CT and 99m Tc-DMSA scintigraphy using SPECT were performed before and after ESWL. To the 24 kidneys of 12 adult dogs, shock waves were fired in order to examine the experimental renal parenchymal impairments. After the treatment with ESWL, renal abnormal findings were obtained with MRI in 6 patients out of 11 (54.5%), with X-ray CT in 1 patient out of 12 (8.3%), and with the 99m Tc-DMSA renal scintigraphy in 4 patients out of 6 (66.7%). In the inspections with X-ray CT and renal scintigraphy conducted in 4 weeks, it was noted that the conditions of patients were recovered to the states before ESWL was performed. Using the therapeutic doses of shock wave for humans, the renal parenchymal impairments in the kidney in dogs were normalized in 7 days. Although it has been considered that the degree of renal parenchymal impairments with ESWL treatment may be influenced by the kind of the equipment, frequency of shock waves and their strength, the extent of impairments were rather mild, and it was presumed that the impairments might be recovered on the images in 3 to 4 weeks at the latest. (author)

  6. Development of Extracorporeal Shock Wave Therapy for the Treatment for Ischemic Cardiovascular Diseases

    Science.gov (United States)

    Shimokawa, Hiroaki

    Cardiovascular diseases, such as coronary artery disease and peripheral artery disease, are the major causes of death in developed countries, and the number of elderly patients has been rapidly increasing worldwide. Thus, it is crucial to develop new non-invasive therapeutic strategies for these patients. We found that a low-energy shock wave (SW) (about 10% of the energy density that is used for urolithiasis) effectively increases the expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. Subsequently, we demonstrated that extracorporeal cardiac SW therapy with low-energy SW up-regulates the expression of VEGF, enhances angiogenesis, and improves myocardial ischemia in a pig model of chronic myocardial ischemia without any adverse effects in vivo. Based on these promising results in animal studies, we have subsequently developed a new, non-invasive angiogenic therapy with low-energy SW for cardiovascular diseases. Our extracorporeal cardiac SW therapy improved symptoms and myocardial perfusion evaluated with stress-scintigraphy in patients with severe coronary artery disease without indication of percutaneous coronary intervention or coronary artery bypass surgery. Importantly, no procedural complications or adverse effects were noted. The SW therapy was also effective in ameliorating left ventricular remodeling after acute myocardial infarction in pigs and in enhancing angiogenesis in hindlimb ischemia in animals and patients with coronary artery disease. Furthermore, our recent experimental studies suggest that the SW therapy is also effective for indications other than cardiovascular diseases. Thus, our extracorporeal cardiac SW therapy is an effective, safe, and non-invasive angiogenic strategy for cardiovascular medicine.

  7. Propagation of shock waves in elastic solids caused by cavitation microjet impact. II: Application in extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Zhong, P; Chuong, C J; Preminger, G M

    1993-07-01

    To better understand the mechanism of stone fragmentation during extracorporeal shock wave lithotripsy (ESWL), the model developed in Part I [P. Zhong and C.J. Chuong, J. Acoust. Soc. Am. 94, 19-28 (1993)] is applied to study cavitation microjet impingement and its resultant shock wave propagation in renal calculi. Impact pressure at the stone boundary and stress, strain at the propagating shock fronts in the stone were calculated for typical ESWL loading conditions. At the anterior surface of the stone, the jet induced compressive stress can vary from 0.82 approximately 4 times that of the water hammer pressure depending on the contact angles; whereas the jet-induced shear stress can achieve its maximum, with a magnitude of 30% approximately 54% of the water hammer pressure, near the detachment of the longitudinal (or P) wave in the solid. Comparison of model predictions with material failure strengths of renal calculi suggests that jet impact can lead to stone surface erosion by combined compressive and shear loadings at the jet impacting surface, and spalling failure by tensile forces at the distal surface of the stone. Comparing responses from four different stone types suggests that cystine is the most difficult stone to fragment in ESWL, as observed from clinical experience.

  8. Variables influencing radiation exposure during extracorporeal shock wave lithotripsy. Review of 298 treatments

    International Nuclear Information System (INIS)

    Carter, H.B.; Naeslund, E.B.R.; Riehle, R.A. Jr.

    1987-01-01

    Retrospective review of 298 extracorporeal shock wave lithotripsy (ESWL) treatments was undertaken to determine the factors which influence radiation exposure during ESWL. Fluoroscopy time averaged 160 seconds (3-509), and the average number of spot films taken per patient was 26 (5-68). The average stone burden was 19.3 mm (3-64). Average calculated skin surface radiation exposure was 17.8 R per treatment. Radiation exposure increased with increasing stone burden and patient weight. Stones treated in the ureter resulted in a higher average patient radiation exposure than for renal stones (19 R vs 16 R), even though the average size of these ureteral stones (11.3 mm) was significantly less than the mean. However, type of anesthetic (general or regional) used was not a significant factor. Operator training, experience, and familiarity with radiation physics should significantly decrease the amount of imaging time and consequent patient radiation exposure during ESWL

  9. Can a dual-energy computed tomography predict unsuitable stone components for extracorporeal shock wave lithotripsy?

    Science.gov (United States)

    Ahn, Sung Hoon; Oh, Tae Hoon; Seo, Ill Young

    2015-09-01

    To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (penergy values (p<0.001). DECT improved the characterization of urinary stone components and was a useful method for identifying uric acid and calcium oxalate monohydrate stones, which are unsuitable for ESWL.

  10. Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones

    DEFF Research Database (Denmark)

    Jung, Helene; Nørby, Bettina; Osther, Palle Jörn

    2006-01-01

    OBJECTIVE: The newer flexible ureteroscopes, 150-200-microm holmium YAG laser fibres and superflexible Dormia baskets have made it possible to reach and treat stones in all parts of the kidney. The object of this evaluation was to study the outcome of retrograde intrarenal stone surgery (RIRS......) for extracorporeal shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A total of 38 consecutive patients (18 males, 20 females) participated in the study. All patients had undergone ESWL prior to RIRS without success. In all cases the stones could be reached with the endoscope. Calculi...... ranged in size from 3 to 20 mm (mean 9 mm). In 32 cases the stones were fragmented using a holmium YAG laser and in six the stones could be extracted using zero-tip Dormia baskets without fragmentation. Sixteen patients had lower calyceal calculi and eight had an abnormal anatomy of the upper urinary...

  11. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review

    International Nuclear Information System (INIS)

    Mouzopoulos, G.; Tzurbakis, M.; Stamatakos, M.; Mouzopoulos, D.

    2007-01-01

    The treatment of patients with calcific tendonitis is typically conservative, including physical therapy, iontophoresis, deep friction, local or systemic application of noninflammatory drugs, needle irrigation-aspiration of calcium deposit, and subacromial bursal steroid injection. If the pain becomes chronic or intermittent after several months of conservative treatment, arthroscopic and open procedures are available to curette the calcium deposit, and additional subacromial decompression can be performed if necessary. As an alternative, minimally invasive extracorporeal shock wave therapy (ESWT) has been postulated to be an effective treatment option for treating calcific tendinitis of the shoulder, before surgery. Herein we discuss the indications, mechanism of therapeutic effect, efficacy of treatment, and complications after ESWT application. (orig.)

  12. 99mTc-DTPA renography before and after extracorporeal shock wave lithotripsy for renal calculi

    International Nuclear Information System (INIS)

    Ohtake, Eiji; Murata, Hajime; Kanemura, Mikio; Yokoyama, Masao

    1988-01-01

    This study was undertaken to evaluate 99m Tc-DTPA renography before and after extracorporeal shock wave lithotripsy (ESWL). Twelve patients with renal calculi were examined in this study. In three patients, bilateral kidneys were treated with ESWL. Sequential renal images of the vascular phase, and the functional and excretory phases were taken using a gamma camera (ZLC 7500, Siemens), after intravenous injection of 555 MBq of 99m Tc-DTPA. Renograms were generated using data stored every 10 seconds for a period of 30 minutes by computer (Scintipac-2400, Shimadzu). Some treated kidneys were enlarged and/or showed uniform retention of radioactivity on sequential images, within a week after ESWL. Renogram patterns after ESWL were varied in each patient. The renogram findings after ESWL seemed to be affected by the presence or absence of stone fragments in the urinary tract. (author)

  13. Extracorporeal shock wave lithotripsy: Involvement and impact on radiology at a kidney stone center

    International Nuclear Information System (INIS)

    Cochran, S.T.; Barbaric, Z.L.; Mindell, H.; Chaussy, C.D.; Fuchs, G.J.

    1986-01-01

    Of 1,222 extracorporeal shock wave lithotripsy (ECSW) procedures performed on 925 patients (600 males, 325 females), 85% were unilateral and 35% were bilateral treatments. Treated were 446 calyceal, 345 pelvic, 172 uretral, and 108 staghorn calculi. The impact of this new technology to the radiology department was studied. An average of 6.3 KUB studies and 1.2 renal US studies were performed per treatment session. Six percent of patients required post-ESWL excretory urography of CT; 10% required percutaneous nephrostomy. Patients with treated staghorn calculi required the most radiologic procedures (34% performed for partial staghorn calculi, 56% for complete staghorn calculi). By comparison, 3%, 8%, and 11% of radiologic procedures were performed for calyceal, pelvic, and ureteral stones, respectively. The impact of ESWL on the radiology department can be substantial. When staghorn calculi are treated by ESWL, a radiologist skilled in interventional techniques is essential

  14. Functional estimation of kidneys after extracorporeal shock wave therapy (ESWL) by clearance

    International Nuclear Information System (INIS)

    Sydow, K.; Kirschner, P.; Brien, G.; Buchali, K.; Frenzel, R.

    1991-01-01

    35 patients were scintiscanned with 99m-Tc-DTPA to determine the effects of extracorporeal shock waves used to desintegrate renal concrements may have on the patients renal function. The therapy was conducted using a standard Lithostar unit (Siemens) (20 patients) and an additional overtable module (15 patients). Functional scintigraphy was performed using a gamma camera before lithotripsy, and on the first day after it. Further control investigations were performed one or two weeks later and two till six months later. In both groups most of the patients developed temporary restrictions in renal function, some of them irreversible restrictions. Functional losses were found to be less severe with the use of the overtable module than with the standard Lithostar unit. (orig.) [de

  15. Variables influencing radiation exposure during extracorporeal shock wave lithotripsy. Review of 298 treatments

    Energy Technology Data Exchange (ETDEWEB)

    Carter, H.B.; Naeslund, E.B.R.; Riehle, R.A. Jr.

    1987-12-01

    Retrospective review of 298 extracorporeal shock wave lithotripsy (ESWL) treatments was undertaken to determine the factors which influence radiation exposure during ESWL. Fluoroscopy time averaged 160 seconds (3-509), and the average number of spot films taken per patient was 26 (5-68). The average stone burden was 19.3 mm (3-64). Average calculated skin surface radiation exposure was 17.8 R per treatment. Radiation exposure increased with increasing stone burden and patient weight. Stones treated in the ureter resulted in a higher average patient radiation exposure than for renal stones (19 R vs 16 R), even though the average size of these ureteral stones (11.3 mm) was significantly less than the mean. However, type of anesthetic (general or regional) used was not a significant factor. Operator training, experience, and familiarity with radiation physics should significantly decrease the amount of imaging time and consequent patient radiation exposure during ESWL.

  16. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones

    Directory of Open Access Journals (Sweden)

    Fábio César Miranda Torricelli

    2015-02-01

    Full Text Available The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL. The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.

  17. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis.

    Science.gov (United States)

    Lee, Sang Seok; Kang, Sangkuk; Park, Noh Kyoung; Lee, Chan Woo; Song, Ho Sup; Sohn, Min Kyun; Cho, Kang Hee; Kim, Jung Hwan

    2012-10-01

    To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm(2), 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

  18. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    International Nuclear Information System (INIS)

    Fedele, F; Coleman, A J; Leighton, T G; White, P R; Hurrell, A M

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented

  19. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Fedele, F [Medical Physics Department, Guy' s and St Thomas' NHS Trust, London, SE1 7EH (United Kingdom); Coleman, A J [Medical Physics Department, Guy' s and St Thomas' NHS Trust, London, SE1 7EH (United Kingdom); Leighton, T G [Institute of Sound and Vibration Research, University of Southampton, Southampton, SO17 1BJ (United Kingdom); White, P R [Institute of Sound and Vibration Research, University of Southampton, Southampton, SO17 1BJ (United Kingdom); Hurrell, A M [Precision Acoustics Ltd, Dorchester, DT1 1PY (United Kingdom)

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  20. Experience of extracorporeal shock wave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotripter

    International Nuclear Information System (INIS)

    Wazir, B.G.; Haq, M.I.H.; Faheem-ul-Haq; Nawaz, A.; Nawaz, A.; Ikramullah; Jamil, M.

    2010-01-01

    Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. Methods: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from January 1, 2008 to March 30, 2009 in Institute of Kidney Diseases, Peshawar. Results: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, stein strasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. Conclusion: ESWL is a safe and effective way of treating kidney and upper ureteric stones. (author)

  1. Effects and radiation dose to patients during extracorporeal shock wave lithotripsy for kidney stones

    International Nuclear Information System (INIS)

    Weng Zhigen; Shao Songsheng; Shao Min

    1991-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is rapidly becoming an accepted treatment of renal calculi. Since fluoroscopy is involved in it to image the stones, it is important to know how much radiation and effects the patients receive during ESWL. Surface radiation exposure to 134 patients and medical personnel were measured during the course of ESWL using LiF(Mg, P, Cu) thermoluminescent dosimeters. Initial results showed an average skin exposure of 162 mSv per case, with a wide range of 5 to 2360 mSv. Factors influencing exposure levels include stone characteristics (location, size and opacity), physician's experience and number of shocks required. The monthly radiation dose to personnel working in the ESWL suite averaged 0.07-0.54 mSv. The effects of radiation to patients were observed pre-and post-ESWL by using white blood cell counts, lyphocyte micronucleus assays and chromosome aberration analysis. White blood cell counts rose or reduced to > 1000 cells in 50 per cent of cases and rose in one third of cases. Lymphocyte micronuclei and chromosome aberrations were observed in 20 patients during the cources. The average frequency of micronuclei was 0.5 per mille pre-ESWL and 1 per mille post-ESWL (P < 0.05). The dicentric chromosomes were markedly increased as compared with those of pre-ESWL with statistically significant difference (P < 0.05)

  2. Kidney damage in extracorporeal shock wave lithotripsy: a numerical approach for different shock profiles.

    Science.gov (United States)

    Weinberg, Kerstin; Ortiz, Michael

    2009-08-01

    In shock-wave lithotripsy--a medical procedure to fragment kidney stones--the patient is subjected to hypersonic waves focused at the kidney stone. Although this procedure is widely applied, the physics behind this medical treatment, in particular the question of how the injuries to the surrounding kidney tissue arise, is still under investigation. To contribute to the solution of this problem, two- and three-dimensional numerical simulations of a human kidney under shock-wave loading are presented. For this purpose a constitutive model of the bio-mechanical system kidney is introduced, which is able to map large visco-elastic deformations and, in particular, material damage. The specific phenomena of cavitation induced oscillating bubbles is modeled here as an evolution of spherical pores within the soft kidney tissue. By means of large scale finite element simulations, we study the shock-wave propagation into the kidney tissue, adapt unknown material parameters and analyze the resulting stress states. The simulations predict localized damage in the human kidney in the same regions as observed in animal experiments. Furthermore, the numerical results suggest that in first instance the pressure amplitude of the shock wave impulse (and not so much its exact time-pressure profile) is responsible for damaging the kidney tissue.

  3. PROSPECTIVE STUDY TO COMPARE THE EFFICACY OF ANALGESIC AGENTS USED FOR THE PAIN MANAGEMENT DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

    OpenAIRE

    Abhirudra; Mehul; Sharada Kumar; Vilas; Vikram; Deepak; Sunil; Naveen

    2016-01-01

    BACKGROUND Extracorporeal shock wave lithotripsy (ESWL) is well known for its non-invasiveness, effectiveness and minimal morbidity for the management of renal stones. Some generation of lithotripters were associated with significant pain, needing anaesthesia. In modern lithotripters, pain is insignificant making lithotripsy an outpatient procedure (day care). AIMS The present study is aimed to compare the clinical efficacy between four drugs. METHODS AND MATERIALS This...

  4. Successful extracorporeal shock wave lithotripsy (ESWL) treatment of a symptomatic massive biliary stone proximal to an anastomotic biliary stricture.

    Science.gov (United States)

    Muratori, Rosangela; Mandolesi, Daniele; Galaverni, Maria Cristina; Azzaroli, Francesco

    2017-06-01

    Postoperative benign biliary stricture in the anastomotic site is one of the most common complications of biliary-enteric anastomosis, with a rate of 6.87% after 2-13 years of follow-up. If untreated, biliary strictures can induce other complications such as recurrent cholangitis, intrahepatic stones, pancreatitis and secondary biliary cirrhosis. We report our experience with extracorporeal shock wave lithotripsy (ESWL) in a patient with a massive symptomatic stone proximal to an anastomotic biliary stricture.

  5. Treatment of cystine stones: combined approach using open pyelolithotomy, percutaneous pyelolithotripsy, extracorporeal shock wave lithotripsy and chemolysis

    DEFF Research Database (Denmark)

    Aabech, J; Andersen, J T

    1993-01-01

    Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient...... effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E....

  6. Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Hsi-Lin Hsiao

    2008-10-01

    Full Text Available The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL. A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04 and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045 were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

  7. Low Intensity Extracorporeal Shock Wave Therapy Improves Erectile Function in a Model of Type II Diabetes Independently of NO/cGMP Pathway.

    Science.gov (United States)

    Assaly-Kaddoum, Rana; Giuliano, François; Laurin, Miguel; Gorny, Diane; Kergoat, Micheline; Bernabé, Jacques; Vardi, Yoram; Alexandre, Laurent; Behr-Roussel, Delphine

    2016-09-01

    Erectile dysfunction is highly prevalent in type II diabetes mellitus. Low intensity extracorporeal shock wave therapy improves erectile function in patients with erectile dysfunction of vasculogenic origin, including diabetes. However, its mode of action remains unknown. We investigated the effects of low intensity extracorporeal shock wave therapy compared to or combined with sildenafil on erectile dysfunction in a type II diabetes mellitus model. Our purpose was to test our hypothesis of a mode of action targeting the cavernous nitric oxide/cyclic guanosine monophosphate pathway. GK rats, a validated model of type II diabetes mellitus, and age matched Wistar rats were treated with low intensity extracorporeal shock wave therapy twice weekly for 3 weeks. Treatment was repeated after a 3-week no-treatment interval. The penis was stretched and dipped in a specifically designed water-filled cage. Shock waves were delivered by a calibrated probe yielding a controlled energy flux density (0.09 mJ/mm(2)). The probe was attached to an electrohydraulic unit with a focused shock wave source, allowing for accurate extrapolation to humans. Following a 4-week washout period erectile function was assessed as well as endothelium dependent and independent, and nitrergic relaxations of the corpus cavernosum of GK rats. Low intensity extracorporeal shock wave therapy significantly improved erectile function in GK rats to the same extent as sildenafil. Treatment effects were potentiated when combined with sildenafil. Shock wave effects were not associated with improved cavernous endothelium dependent or independent, or nitrergic reactivity. Low intensity extracorporeal shock wave therapy improved erectile function in GK rats. Unexpectedly, this was not mediated by a nitric oxide/cyclic guanosine monophosphate dependent mechanism. Sildenafil increased shock wave efficacy. This preclinical paradigm to deliver low intensity extracorporeal shock wave therapy to the rat penis should

  8. Embolisation of pheochromocytoma to stabilise and wean a patient in cardiogenic shock from emergency extracorporeal life support

    DEFF Research Database (Denmark)

    Vagner, Helle; Hey, Thomas Morris; Elle, Bo

    2015-01-01

    Pheochromocytoma is a catecholamine-secreting tumour associated with varying symptoms ranging from episodic headache, sweating, paroxysmal hypertension and tachycardia to intractable cardiogenic shock. Cardiogenic shock is rare but well-described and the timing of correct management is crucial si...... since mortality is high. Fifty per cent of pheochromocytomas are diagnosed on autopsy. We report on a case of embolisation of the adrenal artery during ongoing extracorporeal life support (ECLS) in order to stabilise and wean the patient from ECLS as a bridge to final surgery....

  9. Extracorporeal Shock Wave Therapy for Coronary Artery Disease: Relationship of Symptom Amelioration and Ischemia Improvement

    Directory of Open Access Journals (Sweden)

    Youko Takakuwa

    2018-01-01

    Full Text Available Objective(s: The current management of coronary artery disease (CAD relies on three major therapeutic options, namely medication, percutaneous coronary intervention (PCI, and coronary artery bypass grafting (CABG. However, severe CAD that is not indicated for PCI or CABG still bears a poor prognosis due to the lack of effective treatments. In 2006, extracorporeal cardiac shock wave (SW therapy reported on human for the first time. This treatment resulted in better myocardial perfusion as evaluated by dipyridamole stress thallium scintigraphy, angina symptoms, and exercise tolerance. The aim of the present study was to investigate myocardial perfusion images and evaluate the relationship between the ischemia improvement and symptom amelioration by SW therapy. Methods: We treated ten patients (i.e., nine males and one female with cardiac SW therapy who had CAD but not indicated for PCI or CABG and aged 63–89 years old. After the SW therapy, all patients were followed up for three months to evaluate any amelioration of the myocardial ischemia based on symptoms, adenosine stress thallium scintigraphy, transthoracic echocardiography, and blood biochemical examinations. Results: The changes in various parameters were evaluated before and after cardiac SW therapy. The cardiac SW therapy resulted in a significant improvement in the symptoms as evaluated by the Canadian Cardiovascular Society [CCS] class score (P=0.016 and a tendency to improve in summed stress score (SSS (P=0.068. However, no significant improvement was observed in the summed rest score (SRS, summed difference score (SDS, left ventricular wall motion score index (LVWMSI, N-terminal pro-brain natriuretic, and troponin I. The difference of CCS class score (ΔCCS was significantly correlated with those of SSS (ΔSSS and SDS (ΔSDS (r=0.69, P=0.028 and r=0.70, P=0.025, respectively. There was no significant correlation between ΔCCS and other parameters. Furthermore, no significant

  10. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    V. A. Mezentsev

    2005-04-01

    Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

  11. Effects of electrohydraulic extracorporeal shock wave lithotripsy on submandibular gland in the rat: electron microscopic evaluation.

    Science.gov (United States)

    Bayar, Nuray; Kaymaz, F Figen; Apan, Alpaslan; Yilmaz, Erdal; Cakar, A Nur

    2002-05-15

    Extracorporeal shockwave lithotripsy (ESWL) has been applied in sialolithiasis as a new treatment modality. The aim of this experimental study is to investigate the local effects of electrohydraulic ESWL applied to the right submandibular gland of the rats. This prospective study was conveyed in four groups; groups I, II, III and IV; each group consisting of 20, 20, 18 and 9 rats, respectively, with a randomized distribution. Groups I, II, III and IV received 250, 500, 1000 and 2000 shock waves at 14-16 kV (average 15.1 kV), respectively, to the right submandibular glands on the 0th day. In groups I, II, III, right submandibular glands of the rats were removed on the 0th, 1st, 7th and 15th days; in group IV, this procedure could be managed only on the 0th and 7th days. Light and electron microscopic evaluation were assessed. Using the light microscopic changes, severity of damage score of the glands (SDS) was found. Statistical analysis was done using SDSs. Light and electron microscopic observations have shown that the damage produced by the shock waves were confined to focal areas in the acinar cells (AC), granulated convoluted tubule (GCT) cells and blood vessels at all doses applied. Vacuolization in the cytoplasms of the AC and GCT cells, disintegration of membranes, alteration in the cytoplasmic organization, swelling of the mitochondria and loss of the features were observed on electron microscopy. Increase in the secretion rate; stasis and dilatation in the blood vessels; blebbing and loss of features in the cytoplasm of the endothelial cells were observed. According to the result of the statistical analysis using SDSs; at 250 shock wave dose, a statistically significant difference between the SDSs of the days (0th, 1st, 7th and 15th) was found (Pwaves (Pwaves was found to have the lower value than the SDS at the 2000 shock wave. It was observed that produced damage was less prominent by small doses (250, 500 doses) initially (0th day). Electrohydraulic

  12. Part I. Mechanisms of injury associated with extracorporeal shock wave lithotripsy; Part II. Exsolution of volatiles

    Science.gov (United States)

    Howard, Danny Dwayne

    Part I - Shock waves are focused in extracorporeal shock wave lithotripsy (ESWL) machines to strengths sufficient to fracture kidney stones. Substantial side effects-most of them acute-have resulted from this procedure, including injury to soft tissue. The focusing of shock waves through various layers of tissue is a complex process which stimulates many bio-mechano-chemical responses.This thesis presents results of an in vitro study of the initial mechanical stimulus. Planar nitrocellulose membranes of order 10 um thick were used as models of thin tissue structures. Two modes of failure were recorded: Failure due to cavitation collapsing on or near the membranes, and failure induced by altering the structure of shock waves. Tests were done in water at and around F2 to characterize the extent of cavitation damage, and was found to be confined within the focal region, 1.2 cm along the axis of focus.Scattering media were used to simulate the effects of acoustic nonuniformity of tissue and to alter the structure of focusing shock waves. 40 um diameter (average) hollow glass spheres were added to ethylene glycol, glycerine and castor oil to vary the properties of the scattering media. Multiple layer samples of various types of phantom tissue were tested in degassed castor oil to gauge the validity of the scattering media. The scattering media and tissue samples increased the rise time decreased strain rate in a similar fashion. Membranes were damaged by the decreased strain rate and accumulated effects of the altered structure: After about 20 or so shocks immersed in the scattering media and after about 100 shocks behind the tissue samples. The mode of failure was tearing with multiple tears in some cases from about .1 cm to about 3 cm depending of the number of shocks and membrane thickness.Part II - This work examines the exsolution of volatiles-carbon dioxide from water-in a cylindrical test cell under different pressure conditions. Water was supersaturated with

  13. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun [AMC, Seoul (Korea, Republic of); Kim, Seung Kook [Kwang-Ju Health College, Kwang-Ju (Korea, Republic of)

    2001-06-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously.

  14. Extracorporeal shock wave lithotripsy (ESWL) vs. ureterorenoscopic (URS) manipulation in proximal ureteric stone.

    Science.gov (United States)

    Manzoor, Salman; Hashmi, Altaf Hussain; Sohail, Muhammad Ali; Mahar, Feroz; Bhatti, Shahid; Khuhro, Abdul Qayoom

    2013-10-01

    To compare the stone free rate at one week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10 - 15 mm size). Randomized controlled trial. Sindh Institute of Urology and Transplantation (SIUT), Karachi, from August 2010 to February 2011. One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using an 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, retreatment rate, auxiliary procedure and complication rate were compared in each group. Success rate was 49.2% for ESWL and 57.8% for URS (p = 0.008). The re-treatment rate was significantly higher in ESWL group than in URS group (40% vs. 11 and 18% in URS group). Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterorenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed.

  15. Extracorporeal shock wave lithotripsy for renal calculi, experience of first 100 cases at Jinnah Hospital, Lahore

    International Nuclear Information System (INIS)

    Nawaz, A.; Hussain, S.; Tahir, M.M.; Iqbal, N.

    1999-01-01

    Extracorporeal shock wave lithotripsy (ESWL), where available, has become the preferred treatment modality for majority of renal calculi. Nevertheless because of low morbidity and strong patient endorsement there is a natural tendency of over using it. We report the experience of first 100 patients of renal calculi treated at Lithotripsy Center, Jinnah Hospital, Lahore between November 1993 and October 1995.. All patients were treated on an out patients basis. In this prospective study patients were divided into three groups depending upon the initial stone size (Group 1 2.1 to 3 cm). Twenty-eight patients were lost to follow-up. Analysis of data revealed a success rate of 89.5%, 65.8% and 33.3% in Group-I, II and III respectively at the end of 3 months follow-up. Morbidity was directly procedures to stone burden, while success was inversely related to stone burden. Complications requiring auxiliary procedures were seen in none of the patients of Group-I while in 17.1% and 25% of the patients of Group-II and III respectively. Failure of the procedure demanding for an open intervention was seen in none of the patients of Group II and III respectively. We concluded that selection of patients is key to successful management of the renal calculi with ESWL. (author)

  16. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  17. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun; Kim, Seung Kook

    2001-01-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously

  18. Assessment of Extracorporeal Shock Wave Lithotripsy (ESWL) Therapeutic Efficiency in Urolithiasis.

    Science.gov (United States)

    Tomescu, P; Pănuş, A; Mitroi, G; Drăgoescu, O; Stoica, L; Dena, S; Enache, E

    2009-01-01

    Extracorporeal shock wave lithotripsy (ESWL) revolutionized the treatment of urolithiasis and gradually became the favorite treatment option so that today it is considered to be the first line of treatment for more than 75% of the patients with urolithiasis. The purpose of this study was the assessment of the therapeutic efficiency, complications and limitations of ESWL in urolithiasis in the initial experience using a third generation electromagnetic lithotripter.  Between 2007 and 2008 we performed ESWL for 167 patients with urolithiasis. We recorded 92 patients with single stone (55.1%) and 72 with multiple lithiasis (44.9%). Stone size varied between 7 and 24 mm with an average of 12.3±7.1 mm. Radioopac stones were found in 104 patients (62.3%) while radiolucent stones in 63 only (37.6%).    Complete stone disintegration and clearance was achieved in most cases (86.2%). Complications were mostly minor and rare (transitory haematuria, renal colic). Severe complications (renal hematoma, steinstrasse) were diagnosed for a limited number of patients (3.6%) and their management was mostly nonsurgical or minimally invasive (retrograde ureteroscopy). ESWL is therefore the first line of treatment for urolithiasis with stone size smaller than 2.5 cm. It has an efficiency rate above 85%, low procedure time, high safety and good tolerability (new generation lithotripters do not require anesthesia) and minimal complications.

  19. Urinary Beta-2Microglobulin: An Indicator of Renal Tubular Damage after Extracorporeal Shock Wave Lithotripsy.

    Science.gov (United States)

    Nasseh, Hamidreza; Abdi, Sepideh; Roshani, Ali; Kazemnezhad, Ehsan

    2016-12-08

    This study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damageand the affecting factors by measuring urinary beta2microglobulin (β2M) excretion. This is a cross-sectional study conducted on 91 patients with renal stones who underwentESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure foreach patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubularinjury. Mean ± SD urinary beta2-microglobulin values, before and after ESWL were 0.08 ± 0.07 and 0.22 ± 0.71mg/dL respectively, the average difference between which was equal to 0.14 ± 0.07 mg/dL. These figures exhibiteda 166.66% rise in the urinary β2M concentration after ESWL which was statistically significant (P ESWL (P = .02) were predictive factors ofhigher post-ESWL urinary beta2-microglobulin excretion. Urinary excretion of beta2-microglobulin increased significantly immediately after ESWL. Thesechanges could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patientswith hypertension and a previous history of ESWL the likelihood of this injury is higher than others.

  20. Usefulness of Early Extracorporeal Shock Wave Lithotripsy in Colic Patients with Ureteral Stones

    Science.gov (United States)

    Choi, Hyeung Joon; Jung, Jin-Hee; Bae, Jungbum; Cho, Min Chul; Lee, Hae Won

    2012-01-01

    Purpose To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. Materials and Methods A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success. Conclusions Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance. PMID:23301130

  1. Quantitative evaluation of stone fragments in extracorporeal shock wave lithotripsy using a time reversal operator

    Science.gov (United States)

    Wang, Jen-Chieh; Zhou, Yufeng

    2017-03-01

    Extracorporeal shock wave lithotripsy (ESWL) has been used widely in the noninvasive treatment of kidney calculi. The fine fragments less than 2 mm in size can be discharged by urination, which determines the success of ESWL. Although ultrasonic and fluorescent imaging are used to localize the calculi, it's challenging to monitor the stone comminution progress, especially at the late stage of ESWL when fragments spread out as a cloud. The lack of real-time and quantitative evaluation makes this procedure semi-blind, resulting in either under- or over-treatment after the legal number of pulses required by FDA. The time reversal operator (TRO) method has the ability to detect point-like scatterers, and the number of non-zero eigenvalues of TRO is equal to that of the scatterers. In this study, the validation of TRO method to identify stones was illustrated from both numerical and experimental results for one to two stones with various sizes and locations. Furthermore, the parameters affecting the performance of TRO method has also been investigated. Overall, TRO method is effective in identifying the fragments in a stone cluster in real-time. Further development of a detection system and evaluation of its performance both in vitro and in vivo during ESWL is necessary for application.

  2. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

    Science.gov (United States)

    Tandan, Manu; Reddy, D Nageshwar

    2011-01-01

    Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi. PMID:22110261

  3. Extracorporeal Shock Wave Lithotripsy (ESWL) vs. Ureterorenoscopic (URS) Manipulation in Proximal Ureteric Stone

    International Nuclear Information System (INIS)

    Manzoor, S.; Khuhro, A.Q.; Hashmi, A.H.; Sohail, M.A.; Mahar, F.; Bhatti, S.

    2013-01-01

    Objective: To compare the stone free rate at one week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10 - 15 mm size). Study Design: Randomized controlled trial. Place and Duration of Study: Sindh Institute of Urology and Transplantation (SIUT), Karachi, from August 2010 to February 2011. Methodology: One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using an 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, retreatment rate, auxiliary procedure and complication rate were compared in each group. Results: Success rate was 49.2% for ESWL and 57.8% for URS (p = 0.008). The re-treatment rate was significantly higher in ESWL group than in URS group (40% vs. 11 and 18% in URS group). Conclusion: Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterorenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed. (author)

  4. Renal damage after extracorporeal shock-wave lithotripsy detected by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Torii, Shinichiro; Machida, Toyohei; Ooishi, Yukihiko; Tashiro, Kazuya; Mochizuki, Atsushi; Yoshigoe, Fukuo

    1988-08-01

    The acute effects of extracorporeal Shock-wave lithotripsy (ESWL) on morphology of the renal parenchyma were evaluated by Magnetic Resonance Imaging (MRI) in 15 kidneys, before and immediately after (within 24 hours) ESWL in 11 cases. The renal parenchymal damages were observed by MRI as the changes of signal itensity of renal cortex and medulla, perirenal fluid, loss of corticomedullar differentiation, and other renal traumas. Loss of corticomedullar differentiation was seen in 9/11 cases and peripheral fluid of the kidney was seen in 4/11 cases. Irregular and edematous changes of renal capsula were seen in 5/11 cases. Obvious abnormal findings indicated renal trauma were not observed in this study. Several MRI findings may transient and reversible changes and the morpholigic changes detected by MRI may attributed to renal parenchymal obstruction and edema and decreasing of renal capillary flow, such as in renal contusion. It is concluded that MRI is very sensitive and the best technique to detect the effects and clinical trouble of ESWL.

  5. Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children: Predictors of successful outcome.

    Science.gov (United States)

    Alsagheer, G; Abdel-Kader, M S; Hasan, A M; Mahmoud, O; Mohamed, O; Fathi, A; Abass, M; Abolyosr, A

    2017-10-01

    Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi ESWL. A prospective study including 100 children with renal stone burden ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention. Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1 mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  6. Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones.

    Science.gov (United States)

    Al-Ansari, Abdulla; As-Sadiq, Khalid; Al-Said, Sami; Younis, Nagy; Jaleel, Osama A; Shokeir, Ahmed A

    2006-01-01

    To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.

  7. Renal damage after extracorporeal shock-wave lithotripsy detected by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Torii, Shinichiro; Machida, Toyohei; Ooishi, Yukihiko; Tashiro, Kazuya; Mochizuki, Atsushi; Yoshigoe, Fukuo

    1988-01-01

    The acute effects of extracorporeal Shock-wave lithotripsy (ESWL) on morphology of the renal parenchyma were evaluated by Magnetic Resonance Imaging (MRI) in 15 kidneys, before and immediately after (within 24 hours) ESWL in 11 cases. The renal parenchymal damages were observed by MRI as the changes of signal itensity of renal cortex and medulla, perirenal fluid, loss of corticomedullar differentiation, and other renal traumas. Loss of corticomedullar differentiation was seen in 9/11 cases and peripheral fluid of the kidney was seen in 4/11 cases. Irregular and edematous changes of renal capsula were seen in 5/11 cases. Obvious abnormal findings indicated renal trauma were not observed in this study. Several MRI findings may transient and reversible changes and the morpholigic changes detected by MRI may attributed to renal parenchymal obstruction and edema and decreasing of renal capillary flow, such as in renal contusion. It is concluded that MRI is very sensitive and the best technique to detect the effects and clinical trouble of ESWL. (author)

  8. Extracorporeal shock wave therapy for injection site panniculitis in multiple sclerosis patients.

    Science.gov (United States)

    Stieger, Marco; Schmid, Jean-Paul; Yawalkar, Nikhil; Hunziker, Thomas

    2015-01-01

    Painful cutaneous injection site reactions may hamper treatment with interferon β (IFN-β) and glatiramer acetate (GA) in multiple sclerosis (MS) patients. To maintain therapy adherence, efficient therapeutic modalities for these subcutaneous inflammatory lesions are urgently needed. We tested the application of local extracorporeal shock wave therapy (ESWT). We applied 5 sessions of ESWT to 8 patients suffering from MS who had developed painful panniculitis at the injection sites of either IFN-β or GA. Clinical outcomes, i.e. pain reduction and regression of induration, were assessed 3 and 6 months after completion of the ESWT using a visual analogue score. All patients showed both significant pain reduction and reduction of the skin induration in the treated lesions, while in untreated control lesions there was no improvement. ESWT proved to be a non-invasive, safe and efficient physical treatment modality for injection-induced painful cutaneous side effects of disease-modifying drugs in MS. © 2014 S. Karger AG, Basel.

  9. Role of technetium 99-m DTPA scintigraphy in evaluation of patients undergoing extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Rasheed, A.

    1993-01-01

    Pre and post-treatment renography with Tc-99m DTPA was done in 33 patients undergoing Extracorporeal Shock Wave Lithotripsy (ESWL). The parameters studied included time to maximum, GFR and relative function of the treated kidney. Quantitative analysis revealed that in patients who developed obstructive uropathy after ESWL, time to maximum increased significantly in 26% patients at 24 hours, in 31% patients at 1 week and in 26% patients at 3 weeks, while GFR decreased by more 8% in 18% patients at 24 hours, in 35% patients at 1 week and in 47% patients at 3 weeks post ESWL. Patients having outflow obstruct at 24 hours and 1 week after ESWL had significantly decreased GFR at 24 hours when compared with patients who did not have outflow obstruction at these times. In patients who are obstructed before ESWL, time to maximum decreased significantly on the treated side after ESWL indicating immediate functional benefit. No significant change in relative renal function was noticed after ESWL 45% patients developed obstructive uropathy after ESWL, out of which 24% had total and rest had partial obstruction. 6% patients needed percutaneous nephrostomy to relieve obstruction while in the rest of 18% patients obstruction got relieved spontaneously. The incidence of developing outflow obstruction was seen to be directly proportional to the size of calculus. This study indicates that obstructive uropathy after ESWL can be conveniently detected and followed by sequential renal radionuclide studies. Furthermore, time to maximum was found to be a sensitive parameter for early detection of renal outflow obstruction that may occur after ESWL treatment. This study also underscores that obstructive uropathy and shock waves may have a composite effect on renal function after ESWL. (author)

  10. Extracorporeal shock wave treatment of non- or delayed union of proximal metatarsal fractures.

    Science.gov (United States)

    Alvarez, Richard G; Cincere, Brandon; Channappa, Chandra; Langerman, Richard; Schulte, Robert; Jaakkola, Juha; Melancon, Keith; Shereff, Michael; Cross, G Lee

    2011-08-01

    Nonunion or delayed union of fractures in the proximal aspect of metatarsals 1 to 4 and Zone 2 of the fifth metatarsal were treated by high energy extracorporeal shock wave treatment (ESWT) to study the safety and efficacy of this method of treatment in a FDA study of the Ossatron device. In a prospective single-arm, multi-center study, 34 fractures were treated in 32 patients (two subjects had two independent fractures) with ESWT. All fractures were at least 10 (range, 10 to 833) weeks after injury, with a median of 23 weeks. ESWT application was conducted using a protocol totaling 2,000 shocks for a total energy application of approximately 0.22 to 0.51 mJ/mm2 per treatment. The mean ESWT application time for each of the treatments was 24.6 +/- 16.6 minutes, and anesthesia time averaged 27.1 +/- 10.4 minutes. All subjects were followed for 1 year after treatment at intervals of 12 weeks, 6, 9, and 12 months. The overall success rate at the 12-week visit was 71% with low complications, significant pain improvement as well as improvement on the SF-36. The success/fail criteria was evaluated again at the 6- and 12-month followup, showing treatment success rates of 89% (23/26) and 90% (18/20), respectively. The most common adverse event was swelling in the foot, reported by five subjects (15.6%). High-energy ESWT appears to be effective and safe in patients for treatment of nonunion or a delayed healing of a proximal metatarsal, and in fifth metatarsal fractures in Zone 2.

  11. The effect of extracorporeal shock wave lithotripsy in the management of idiopathic gallstones in children

    Science.gov (United States)

    Mousavi, Seyed Abdollah; Karami, Hasan; Barzegarnejad, Ayub

    2014-01-01

    Objective: The most common etiology for gallstones in children is hemolytic diseases; however, the prevalence of nonhemolytic gallstones, which are mostly idiopathic, is increasing. Several studies concerning the treatment of gallstones with respect to the influence of extracorporeal shock wave lithotripsy (ESWL) have been conducted in adults, but not to the same extent in children. Therefore, this study attempted to examine the effects of lithotripsy on idiopathic gallstones in children. Materials and Methods: In this study, 12 children, all of whom were under 12 years of age and diagnosed with idiopathic gallstones, were treated with ESWL. The average age of the children examined in this study was 6.5 years (range 3-11 years). Patients were treated with 2500-3000 shockwaves per session. The number of shockwaves was 90 shocks/min and the impulse intensity ranged from 10 to 12 kV. The final goal was the fragmentation of stones in pieces with less than 3 mm in dimension. Patients were followed up for 6-30 months. Results: A total of 12 patients were treated with ESWL for 14 rounds. In three patients, complete fragmentation occurred within the first trial and was cleared. The nine remaining patients underwent ESWL 10 times in which an acceptable change in the gallstone's condition was not observed. Five of the patients underwent surgery. The chemical composition of the gallstones showed that the dominant element in them was calcium. Conclusions: Our findings show that performing ESWL can be effective in some children. Further studies with larger population are recommended. Furthermore, it seems increasing the voltage intensity and frequency as conducted in adults accompanied with biliary acids prescription can be effective in children. PMID:25336804

  12. Acoustic cavitation bubbles in the kidney induced by focused shock waves in extracorporeal shock wave lithotripsy (ESWL)

    Science.gov (United States)

    Kuwahara, M.; Ioritani, N.; Kambe, K.; Taguchi, K.; Saito, T.; Igarashi, M.; Shirai, S.; Orikasa, S.; Takayama, K.

    1990-07-01

    On an ultrasonic imaging system a hyperechoic region was observed in a focal area of fucused shock waves in the dog kidney. This study was performed to learn whether cavitation bubbles are responsible for this hyperechoic region. The ultrasonic images in water of varying temperatures were not markedly different. In the flowing stream of distilled water, the stream was demonstrated as a hyperechoic region only with a mixture of air bubbles. Streams of 5%-50% glucose solutions were also demonstrated as a hyperechoic region. However, such concentration changes in living tissue, as well as thermal changes, are hardly thought to be induced. The holographic interferometry showed that the cavitation bubbles remained for more than 500 msec. in the focal area in water. This finding indicate that the bubble can remain for longer period than previously supposed. These results support the contentions that cavitation bubbles are responsible for the hyperechoic region in the kidney in situ.

  13. Transforming in-situ observations of CME-driven shock accelerated protons into the shock's reference frame.

    Directory of Open Access Journals (Sweden)

    I. M. Robinson

    2005-07-01

    Full Text Available We examine the solar energetic particle event following solar activity from 14, 15 April 2001 which includes a "bump-on-the-tail" in the proton energy spectra at 0.99 AU from the Sun. We find this population was generated by a CME-driven shock which arrived at 0.99 AU around midnight 18 April. As such this population represents an excellent opportunity to study in isolation, the effects of proton acceleration by the shock. The peak energy of the bump-on-the-tail evolves to progressively lower energies as the shock approaches the observing spacecraft at the inner Lagrange point. Focusing on the evolution of this peak energy we demonstrate a technique which transforms these in-situ spectral observations into a frame of reference co-moving with the shock whilst making allowance for the effects of pitch angle scattering and focusing. The results of this transform suggest the bump-on-the-tail population was not driven by the 15 April activity but was generated or at least modulated by a CME-driven shock which left the Sun on 14 April. The existence of a bump-on-the-tail population is predicted by models in Rice et al. (2003 and Li et al. (2003 which we compare with observations and the results of our analysis in the context of both the 14 April and 15 April CMEs. We find an origin of the bump-on-the-tail at the 14 April CME-driven shock provides better agreement with these modelled predictions although some discrepancy exists as to the shock's ability to accelerate 100 MeV protons.

    Keywords. Solar physics, astrophysics and astronomy (Energetic particles; Flares and mass ejections – Space plasma physics (Transport processes

  14. An in situ Comparison of Electron Acceleration at Collisionless Shocks under Differing Upstream Magnetic Field Orientations

    Energy Technology Data Exchange (ETDEWEB)

    Masters, A.; Dougherty, M. K. [The Blackett Laboratory, Imperial College London, Prince Consort Road, London, SW7 2AZ (United Kingdom); Sulaiman, A. H. [Department of Physics and Astronomy, University of Iowa, Iowa City, IA 52242 (United States); Stawarz, Ł. [Astronomical Observatory, Jagiellonian University, ul. Orla 171, 30-244 Krakow (Poland); Reville, B. [School of Mathematics and Physics, Queens University Belfast, Belfast BT7 1NN (United Kingdom); Sergis, N. [Office of Space Research and Technology, Academy of Athens, Soranou Efesiou 4, 11527 Athens (Greece); Fujimoto, M. [Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo-ku, Sagamihara, Kanagawa 252-5210 (Japan); Burgess, D. [School of Physics and Astronomy, Queen Mary University of London, London E1 4NS (United Kingdom); Coates, A. J., E-mail: a.masters@imperial.ac.uk [Mullard Space Science Laboratory, Department of Space and Climate Physics, University College London, Holmbury St. Mary, Dorking RH5 6NT (United Kingdom)

    2017-07-10

    A leading explanation for the origin of Galactic cosmic rays is acceleration at high-Mach number shock waves in the collisionless plasma surrounding young supernova remnants. Evidence for this is provided by multi-wavelength non-thermal emission thought to be associated with ultrarelativistic electrons at these shocks. However, the dependence of the electron acceleration process on the orientation of the upstream magnetic field with respect to the local normal to the shock front (quasi-parallel/quasi-perpendicular) is debated. Cassini spacecraft observations at Saturn’s bow shock have revealed examples of electron acceleration under quasi-perpendicular conditions, and the first in situ evidence of electron acceleration at a quasi-parallel shock. Here we use Cassini data to make the first comparison between energy spectra of locally accelerated electrons under these differing upstream magnetic field regimes. We present data taken during a quasi-perpendicular shock crossing on 2008 March 8 and during a quasi-parallel shock crossing on 2007 February 3, highlighting that both were associated with electron acceleration to at least MeV energies. The magnetic signature of the quasi-perpendicular crossing has a relatively sharp upstream–downstream transition, and energetic electrons were detected close to the transition and immediately downstream. The magnetic transition at the quasi-parallel crossing is less clear, energetic electrons were encountered upstream and downstream, and the electron energy spectrum is harder above ∼100 keV. We discuss whether the acceleration is consistent with diffusive shock acceleration theory in each case, and suggest that the quasi-parallel spectral break is due to an energy-dependent interaction between the electrons and short, large-amplitude magnetic structures.

  15. Shear Wave Elastographic Alterations in the Kidney After Extracorporeal Shock Wave Lithotripsy.

    Science.gov (United States)

    Turkay, Rustu; Inci, Ercan; Bas, Derya; Atar, Arda

    2018-03-01

    Extracorporeal shock wave lithotripsy (ESWL) is a method used frequently for the treatment of renal stone disease. Although its safety is proven, there are still concerns about its unwanted effects on kidneys. In this prospective study, we aimed to evaluate renal tissue alterations with shear wave elastography (SWE) after ESWL. We also studied the correlation between SWE and resistive index (RI) changes. The study included 59 patients who underwent ESWL treatment for renal stone disease. We performed SWE and color Doppler ultrasonography to calculate SWE and RI values before, 1 hour after, and 1 week after lithotripsy treatment. A binary comparison was performed by the Bonferroni test. The correlation between SWE and RI values was evaluated by a Pearson correlation analysis. The patients included 26 women (44.1%) and 33 men (55.9%). Their ages ranged from 20 to 65 years (mean ± SD, 45.0 ± 1.1 years). Stone diameters ranged from 7 to 19 mm (mean, 13.0 ± 0.5 mm). There was a significant difference in SWE values before and 1 hour after lithotripsy treatment (P = .001; P  .99; P > .05). Resistive index values increased significantly 1 hour after lithotripsy treatment and returned to prelithotripsy values 1 week after treatment. In the correlation analysis, SWE and RI values were not correlated. Measurements of alterations in SWE values after ESWL can provide useful information about renal tissue injury. © 2017 by the American Institute of Ultrasound in Medicine.

  16. Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications.

    Science.gov (United States)

    Telegrafo, Michele; Carluccio, Davide Antonio; Rella, Leonarda; Ianora, Amato Antonio Stabile; Angelelli, Giuseppe; Moschetta, Marco

    2016-01-01

    To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach. A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established. Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1). MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.

  17. Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones.

    Science.gov (United States)

    Deem, Samuel; Defade, Brian; Modak, Asmita; Emmett, Mary; Martinez, Fred; Davalos, Julio

    2011-10-01

    To compare the outcomes of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for moderate sized (1-2 cm) upper and middle pole renal calculi in regards to stone clearance rate, morbidity, and quality of life. All patients diagnosed with moderate sized upper and middle pole kidney stones by computed tomography (CT) were offered enrollment. They were randomized to receive either ESWL or PNL. The SF-8 quality of life survey was administered preoperatively and at 1 week and 3 months postoperatively. Abdominal radiograph at 1 week and CT scan at 3 months were used to determine stone-free status. All complications and outcomes were recorded. PNL established a stone-free status of 95% and 85% at 1 week and 3 months, respectively, whereas ESWL established a stone-free status of 17% and 33% at 1 week and 3 months, respectively. Retreatment in ESWL was required in 67% of cases, with 0% retreatment in PNL. Stone location, stone density, and skin-to-stone distance had no impact on stone-free rates at both visits, irrespective of procedure. Patient-reported outcomes, including overall physical and mental health status, favored a better quality of life for patients who had PNL performed. PNL more often establishes stone-free status, has a more similar complication profile, and has similar reported quality of life at 3 months when compared with ESWL for moderate-sized kidney stones. PNL should be offered as a treatment option to all patients with moderate-sized kidney stones in centers with experienced endourologists. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis.

    Science.gov (United States)

    Vaysse, Thibaut; Boytchev, Isabelle; Antoni, Guillemette; Croix, Damien Sainte; Choury, André Daniel; Laurent, Valérie; Pelletier, Gilles; Buffet, Catherine; Bou-Farah, Rita; Carbonnel, Franck

    2016-11-01

    There is still uncertainty regarding the efficacy and optimal modalities of extracorporeal shock wave lithotripsy (ESWL) in the treatment of chronic pancreatitis. The aims of the present study were to assess the safety and the efficacy of ESWL, either alone or followed by therapeutic endoscopic retrograde cholangiopancreatography (adjuvant ERCP) and to determine predictive factors of efficacy, in a real-life setting. This study included all consecutive patients who underwent an ESWL in a single University Hospital between 2001 and 2012. The indication for ESWL was obstructive stone(s) of the main pancreatic duct resulting in either painful chronic pancreatitis or recurrent acute pancreatitis. Success was defined by resolution of pain, no analgesic treatment, no acute pancreatitis and no surgical treatment for chronic pancreatitis 6 months after the ESWL. One hundred and forty-six patients were studied; 6/146 (4%) had a complication of ESWL. Among the 132 patients in whom follow-up was completed, 91 (69%) had an adjuvant ERCP. After 6 months of follow-up, 100/132 (76%) patients achieved success. In multivariate analysis, the single significant predictive factor of the success of the ESWL treatment was chronic pain (p = 0.03). Patients who had chronic pain and needed opioid treatment had less chance of success than patients without chronic pain (OR 95%CI 0.31 [0.07-1.14]). We found no difference in the success rates between patients who underwent adjuvant ERCP and those who had ESWL only (p = 0.93). This study shows that the ESWL is a safe and effective treatment for patients with chronic pancreatitis and obstructive stones within the main pancreatic duct. Systematic association with therapeutic ERCP appears to provide no additional benefit and is therefore not recommended.

  19. Improvement of adipose tissue-derived cells by low-energy extracorporeal shock wave therapy.

    Science.gov (United States)

    Priglinger, Eleni; Schuh, Christina M A P; Steffenhagen, Carolin; Wurzer, Christoph; Maier, Julia; Nuernberger, Sylvia; Holnthoner, Wolfgang; Fuchs, Christiane; Suessner, Susanne; Rünzler, Dominik; Redl, Heinz; Wolbank, Susanne

    2017-09-01

    Cell-based therapies with autologous adipose tissue-derived cells have shown great potential in several clinical studies in the last decades. The majority of these studies have been using the stromal vascular fraction (SVF), a heterogeneous mixture of fibroblasts, lymphocytes, monocytes/macrophages, endothelial cells, endothelial progenitor cells, pericytes and adipose-derived stromal/stem cells (ASC) among others. Although possible clinical applications of autologous adipose tissue-derived cells are manifold, they are limited by insufficient uniformity in cell identity and regenerative potency. In our experimental set-up, low-energy extracorporeal shock wave therapy (ESWT) was performed on freshly obtained human adipose tissue and isolated adipose tissue SVF cells aiming to equalize and enhance stem cell properties and functionality. After ESWT on adipose tissue we could achieve higher cellular adenosine triphosphate (ATP) levels compared with ESWT on the isolated SVF as well as the control. ESWT on adipose tissue resulted in a significantly higher expression of single mesenchymal and vascular marker compared with untreated control. Analysis of SVF protein secretome revealed a significant enhancement in insulin-like growth factor (IGF)-1 and placental growth factor (PLGF) after ESWT on adipose tissue. Summarizing we could show that ESWT on adipose tissue enhanced the cellular ATP content and modified the expression of single mesenchymal and vascular marker, and thus potentially provides a more regenerative cell population. Because the effectiveness of autologous cell therapy is dependent on the therapeutic potency of the patient's cells, this technology might raise the number of patients eligible for autologous cell transplantation. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  20. [Extracorporeal cardiac shock wave therapy for treatment of coronary artery disease].

    Science.gov (United States)

    Wang, Yu; Guo, Tao; Cai, Hong-Yan; Ma, Tie-Kun; Tao, Si-Ming; Chen, Ming-Qing; Gu, Yun; Pan, Jia-Hua; Xiao, Jian-Ming; Zhao, Ling; Yang, Xi-Yun; Yang, Chao

    2010-08-01

    To evaluate the feasibility and efficiency of extracorporeal cardiac shock wave therapy (CSWT) for treatment of coronary artery disease. Twenty-five patients with 1 - 16 years history of chronic angina pectoris underwent the CSWT. Before and after the treatment, low-dose Dobutamine stress echocardiography and (99)Tc(m)-MIBI myocardial perfusion SPECT were applied to locate the ischemic segments, detect the viable myocardium and evaluate the effect of CSWT. Under the guidance of echocardiography, CSWT was applied in R-wave-triggered manner with low energy (0.09 mJ/mm(2)) at 200 shoots/spot for 9 spots (-1-0-+1 combination). Patients were divided group A and group B. Sixteen patients in group A were applied 9 sessions on 29 segments within 3 month and nine patients in group B were applied 9 sessions on 13 segments within 1 month. Ten chronic angina pectoris patients receiving standard medication served as controls. All patients completed the 9 sessions without procedural complications or adverse effects. CSWT significantly improved symptoms as evaluated by NYHA, Canadian Cardiovascular Society (CCS) class sores, Seattle angina questionnaire (SAQ), 6-min walk and the use of nitroglycerin (P < 0.05). CSWT also improved myocardial perfusion and regional myocardium function as evaluated by rest SPECT and stress peak systolic strain rate (PSSR) (P < 0.01). Myocardial perfusion improvement was more significant in group A compared with group B (1.21 ± 0.86 vs. 0.83 ± 0.80, P < 0.01). All parameters remained unchanged in control group during follow up. These preliminary results indicate that CSWT is safe and effective on ameliorating anginal symptoms for chronic angina pectoris patients.

  1. Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi.

    Science.gov (United States)

    Nabi, G; Downey, P; Keeley, F; Watson, G; McClinton, S

    2007-01-24

    Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Extracorporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the two most commonly offered interventional procedures in these patients. ESWL treatment is less invasive but has some limitations such as a high retreatment rate and lack of availability in many centres. Advances in ureteroscopy over the past decade have increased the success rate and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), reference lists of articles and abstracts from conference proceedings without language restriction. RCTs comparing ESWL with ureteroscopic retrieval of ureteric stones were included. Participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered. Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weighted mean difference (MD) for continuous data with 95% confidence intervals (CI). Six RCTs (833 patients) were included. The stone-free rates were lower in the ESWL group (RR 0.84 95% CI 0.73 to 0.96). The retreatment rates were lower but not significant in the ureteroscopy group (RR 3.34 95% CI 0.82 to 13.62). The rate of complications was lower in the ESWL group (RR 0.48 95% CI 0.26 to 0.91). Length of hospital stay was less for ESWL treatment (MD -2.10 95% CI -2.55 to -1.64). Ureteroscopic removal of ureteral stones achieves a higher stone-free state but with a higher complication rate and a longer hospital stay.

  2. Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy.

    Science.gov (United States)

    Koch, Michael; Schapher, Mirco; Mantsopoulos, Konstantinos; von Scotti, Felix; Goncalves, Miguel; Iro, Heinrich

    2017-12-15

    To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL). Retrospective study in a tertiary referral center. Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis. Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free. These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Predictors for kidney stones recurrence following extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL).

    Science.gov (United States)

    Chongruksut, Wilaiwan; Lojanapiwat, Bannakij; Tawichasri, Chamaiporn; Paichitvichean, Somboon; Euathrongchit, Jantima; Ayudhya, Vorvat Choomsai Na; Patumanond, Jayanton

    2012-03-01

    Stone recurrence after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) are common. Predictors for kidney stones vary among populations and areas. To determine predictors for kidney stones recurrence after ESWL or PCNL. A retrospective cohort study was conducted at a university hospital. The study cohort was patients aged more than 18 years, diagnosed with kidney stones, who were treated with ESWL or PCNL between 2006 and 2009. Medical files were reviewed for clinical profiles, stone characteristics, composition, type of treatment, presence of stone after treatment, stone reappearance, and related laboratory data. Predictors were determined by a multivariable poisson regression and presented as incidence rate ratios (IRRs) with 95% confidence interval. From a cohort of 252 patients, 240 who had at least one follow-up and with complete plain kidney ureters and bladder (KUB) film or intravenous pyelogram (IVP) were included in analysis. At three years, the total incidence rate of recurrence was 46 per 1,000 person-months. After a multivariable poisson regression clustering by type of stone composition, independent predictors for stone recurrence were age ESWL treatment (adjusted IRR = 2.1, 95% CI = 2.1-2.2, p < 0.001), stones located in lower calyx as compared to renal pelvis (adjusted IRR = 8.7, 95% CI = 2.9-25.9, p = 0.001), multiple stones (adjusted IRR = 5.9, 95% CI = 4.8-7.5, p < 0.001), and stone size larger than 20 mm (adjusted IRR = 1.4, 95% CI = 1.2-1.6, p < 0.001). After stone removals, patients with these predictors should closely be followed up for regular clinical evaluations.

  4. [The effiectiveness of extracorporeal shock wave lithotripsy in treating proxima ureteral stones].

    Science.gov (United States)

    Kogan, M I; Belousov, I I; Yassine, A M

    2017-10-01

    Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of -blockers in stimulating residual stone clearance after ESWL. To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance. ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

  5. Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision.

    Science.gov (United States)

    Nakamura, Kogenta; Tobiume, Motoi; Narushima, Masahiro; Yoshizawa, Takahiko; Nishikawa, Genya; Kato, Yoshiharu; Katsuda, Remi; Zennami, Kenji; Aoki, Shigeyuki; Yamada, Yoshiaki; Honda, Nobuaki; Sumitomo, Makoto

    2011-12-12

    The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

  6. Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL Sonolith vision

    Directory of Open Access Journals (Sweden)

    Nakamura Kogenta

    2011-12-01

    Full Text Available Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]. Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

  7. Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

    Directory of Open Access Journals (Sweden)

    Konstantinos N. Stamatiou

    2010-12-01

    Full Text Available PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL. In the first group (26 children, ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7% were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%, brief hematuria (< 24 h resolved with increased fluid intake in 5 (19.2%, while slightly elevated body temperature (< 38°C occurred in 4 (15.3%. Four children (15.3% failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%. Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%, brief hematuria (< 24 h, resolved with increased fluid intake in 4 (21% and slightly elevated body temperature (< 38°C monitored for 48 hours occurred in 6 (31.5%. Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

  8. Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis.

    Science.gov (United States)

    Wang, Dan; Bi, Ya-Wei; Ji, Jun-Tao; Xin, Lei; Pan, Jun; Liao, Zhuan; Du, Ting-Ting; Lin, Jin-Huan; Zhang, Di; Zeng, Xiang-Peng; Ye, Bo; Zou, Wen-Bin; Chen, Hui; Xie, Ting; Li, Bai-Rong; Zheng, Zhao-Hong; Li, Zhao-Shen; Hu, Liang-Hao

    2017-05-01

    Background and aims  Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is recommended as the first-line treatment for pancreatic stones. However, how well P-ESWL performs in pediatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for pediatric patients with chronic pancreatitis. Methods  This prospective observational study was conducted in patients with painful chronic pancreatitis who underwent P-ESWL. Patients aged under 18 years were included in the pediatric group; patients aged over 18 years who underwent P-ESWL in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The primary outcomes were P-ESWL complications and pain relief. The secondary outcomes included: stone clearance, physical and mental health, quality of life score, and growth and developmental state. Results  From March 2011 to March 2015, P-ESWL was performed in 1135 patients (72 in the pediatric group, 1063 in the control group). No significant differences were observed in the occurrence of P-ESWL complications between the two groups (11.1 % vs. 12.8 %; P  = 0.68). Among the 67 pediatric patients (93.1 %) who underwent follow-up for 3.0 years (range 1.3 - 5.2), complete pain relief was achieved in 52 patients (52 /67; 77.6 %); this value was not significantly different from that of the matched controls (55 /69; 79.7 %; P  = 0.94). Conclusions  P-ESWL is safe and effective for pediatric patients with chronic pancreatitis. It can promote significant pain relief and stone clearance, and can benefit growth and development. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action.

    Science.gov (United States)

    Mariotto, Sofia; de Prati, Alessandra Carcereri; Cavalieri, Elisabetta; Amelio, Ernesto; Marlinghaus, Ernst; Suzuki, Hisanori

    2009-01-01

    Shock waves (SW), defined as a sequence of single sonic pulses characterised by high peak pressure (100 MPa), a fast rise in pressure (conveyed by an appropriate generator to a specific target area at an energy density ranging from 0.03 to 0.11 mJ/mm(2). Extracorporeal SW (ESW) therapy was first used on patients in 1980 to break up kidney stones. During the last ten years, this technique has been successfully employed in orthopaedic diseases such as pseudoarthosis, tendinitis, calcarea of the shoulder, epicondylitis, plantar fasciitis and several inflammatory tendon diseases. In particular, treatment of the tendon and muscle tissues was found to induce a long-time tissue regeneration effect in addition to having a more immediate anthalgic and anti-inflammatory outcome. In keeping with this, an increase in neoangiogenesis in the tendons of dogs was observed after 4-8 weeks of ESW treatment. Furthermore, clinical observations indicate an immediate increase in blood flow around the treated area. Nevertheless, the biochemical mechanisms underlying these effects have yet to be fully elucidated. In the present review, we briefly detail the physical properties of ESW and clinical cases treated with this therapy. We then go on to describe the possible molecular mechanism that triggers the anti-inflammatory action of ESW, focusing on the possibility that ESW may modulate endogenous nitric oxide (NO) production either under normal or inflammatory conditions. Data on the rapid enhancement of endothelial NO synthase (eNOS) activity in ESW-treated cells suggest that increased NO levels and the subsequent suppression of NF-kappaB activation may account, at least in part, for the clinically beneficial action on tissue inflammation.

  10. Serious clopidogrel associated renal hematoma in a type 2 diabetic patient with primary hyperparathyroidism after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Bahceci, Mithat; Tuzcu, Alpaslan; Agil, Cuneyt; Akay, Ferruh; Akay, Hatice

    2005-01-01

    Renal hematoma after extracorporeal shock wave lithotripsy SWL is a rare complication. We report a case of a large renal hematoma following SWL that resulted in nephrectomy in a type 2 diabetic patient with primary hyperparathyroidism using clopidogrel due to coronary heart disease CHD. Although it was claimed that preoperative use of clopidogrel was not associated with increased bleeding, all patients who are scheduled for SWL should be interrogated in terms of using of platelet aggregation inhibitors such as clopidogrel, and these drugs should be interrupted appropriately before undergoing SWL. (author)

  11. An exceedingly rare cause of secondary hypertension: bilateral renal artery dissection possibly secondary to extracorporeal shock-wave lithotripsy (ESWL).

    Science.gov (United States)

    Orhan, Ozbek; Kultigin, Turkmen; Osman, Koc; Yalcin, Solak; Melih, Anil; Niyazi, Gormus

    2011-01-01

    Extracorporeal shock-wave lithotripsy (ESWL) is an effective and relatively non-invasive treatment modality for ureteral or renal calculi. Although it has been accepted as a safe procedure, minor and major complications have been reported after ESWL. Spontaneous renal artery dissection (SRAD) is a rare and usually misdiagnosed condition because of non-specific presentation of the patients. Depending on the severity of the extent of the dissection non-operative or surgical treatment modalities could be performed. We represent a patient with complaints of bilateral flank pain, hematuria and hypertensive urgency who was diagnosed as having bilateral SRAD possibly secondary to ESWL and chronic hypertension.

  12. Investigation on the Vibration Effect of Shock Wave in Rock Burst by In Situ Microseismic Monitoring

    Directory of Open Access Journals (Sweden)

    Mingshi Gao

    2018-01-01

    Full Text Available Rock burst is a physical explosion associated with enormous damage at a short time. Due to the complicity of mechanics of rock burst in coal mine roadway, the direct use of traditional investigation method applied in tunnel is inappropriate since the components of surrounding rock are much more complex in underground than that of tunnel. In addition, the reliability of the results obtained through these methods (i.e., physical simulation, theoretical analysis, and monitoring in filed application is still not certain with complex geological conditions. Against this background, present experimental study was first ever conducted at initial site to evaluate the effect of shock wave during the rock burst. TDS-6 microseismic monitoring system was set up in situ to evaluate the propagation of shock wave resulting in microexplosions of roadway surrounding rock. Various parameters including the distance of epicentre and the characteristic of response have been investigated. Detailed test results revealed that (1 the shock wave attenuated exponentially with the increase of the distance to seismic source according to the equation of E=E0e-ηl; particularly, the amplitude decreased significantly after being 20 m apart from explosive resource and then became very weak after being 30 m apart from the seismic source; (2 the response mechanics are characteristic with large scatter based on the real location of surrounding rock despite being at the same section. That is, the surrounding rock of floor experienced serious damage, followed by ribs, the roof, and the humeral angles. This in situ experimental study also demonstrated that microseismic monitoring system can be effectively used in rock burst through careful setup and data investigation. The proposed in situ monitoring method has provided a new way to predict rock burst due to its simple instalment procedure associated with direct and reasonable experimental results.

  13. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary...... analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly....

  14. Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.

    Science.gov (United States)

    Tornese, Davide; Mattei, Enrico; Lucchesi, Giampaolo; Bandi, Marco; Ricci, Gabriele; Melegati, Gianluca

    2008-09-01

    To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. Random assignment to two groups of treatment with two and eight months follow-up. The data were collected in outpatients. Forty-five subjects with a history of at least six months of heel pain were studied. Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 +/- 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 +/- 12.3 years). Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up. Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 +/-18.7; group B 53.5 +/- 20; P>0.05). In both groups there was a significant (Pwave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

  15. Exposure of zebra mussels to extracorporeal shock waves demonstrates formation of new mineralized tissue inside and outside the focus zone.

    Science.gov (United States)

    Sternecker, Katharina; Geist, Juergen; Beggel, Sebastian; Dietz-Laursonn, Kristin; de la Fuente, Matias; Frank, Hans-Georg; Furia, John P; Milz, Stefan; Schmitz, Christoph

    2018-04-03

    The success rate of extracorporeal shock wave therapy (ESWT) for fracture nonunions in human medicine (i.e., radiographic union at six months after ESWT) is only approximately 75%. Detailed knowledge regarding the underlying mechanisms that induce bio-calcification after ESWT is limited. We analyzed the biological response within mineralized tissue of a new invertebrate model organism, the zebra mussel Dreissena polymorpha , after exposure with extracorporeal shock waves (ESWs). Mussels were exposed to ESWs with positive energy density of 0.4 mJ/mm 2 (A) or were sham exposed (B). Detection of newly calcified tissue was performed by exposing the mussels to fluorescent markers. Two weeks later, the A-mussels showed a higher mean fluorescence signal intensity within the shell zone than the B-mussels (pmussels was independent of the size and position of the focal point of the ESWs. These data demonstrate that induction of bio-calcification after ESWT may not be restricted to the region of direct energy transfer of ESWs into calcified tissue. The results of the present study are of relevance for better understanding of the molecular and cellular mechanisms that induce formation of new mineralized tissue after ESWT. © 2018. Published by The Company of Biologists Ltd.

  16. Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Han, Yong; Lee, June-Kyung; Lee, Bong-Yeon; Kee, Hoi-Sung; Jung, Kwang-Ik; Yoon, Seo-Ra

    2016-10-01

    To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm 2 ) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm 2 ). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

  17. Assessment of In Situ Time Resolved Shock Experiments at Synchrotron Light Sources*

    Science.gov (United States)

    Belak, J.; Ilavsky, J.; Hessler, J. P.

    2005-07-01

    Prior to fielding in situ time resolved experiments of shock wave loading at the Advanced Photon Source, we have performed feasibility experiments assessing a single photon bunch. Using single and poly-crystal Al, Ti, V and Cu shock to incipient spallation on the gas gun, samples were prepared from slices normal to the spall plane of thickness 100-500 microns. In addition, single crystal Al of thickness 500 microns was shocked to incipient spallation and soft recovered using the LLNL e-gun mini-flyer system. The e-gun mini-flyer impacts the sample target producing a 10's ns flat-top shock transient. Here, we present results for imaging, small-angle scattering (SAS), and diffraction. In particular, there is little SAS away from the spall plane and significant SAS at the spall plane, demonstrating the presence of sub-micron voids. * Use of the Advanced Photon Source was supported by the U. S. Department of Energy, Office of Science, Office of Basic Energy Sciences, under Contract No. W-31-109-Eng-38 and work performed under the auspices of the U.S. Department of Energy by University of California, Lawrence Livermore National Laboratory under Contract W-7405-Eng-48.

  18. Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

    Science.gov (United States)

    Gündüz, Metin; Sekmenli, Tamer; Ciftci, İlhan; Elmacı, Ahmet Midhat

    2017-01-01

    We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in

  19. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head.

    Science.gov (United States)

    Xie, Kai; Mao, Yuanqing; Qu, Xinhua; Dai, Kerong; Jia, Qingwei; Zhu, Zhenan; Yan, Mengning

    2018-02-02

    Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I-III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI). The mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years. The results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration

  20. Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis.

    Science.gov (United States)

    Lu, Chin-Heng; Kuo, Junne-Yih; Lin, Tzu-Ping; Huang, Yi-Hsiu; Chung, Hsiao-Jen; Huang, William J S; Wu, Howard H H; Chang, Yen-Hwa; Lin, Alex T L; Chen, Kuang-Kuo

    2017-09-01

    Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones. Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while

  1. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study

    Science.gov (United States)

    Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed

    2016-01-01

    Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291

  2. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi.

    Science.gov (United States)

    Aboumarzouk, Omar M; Kata, Slawomir G; Keeley, Francis X; McClinton, Samuel; Nabi, Ghulam

    2012-05-16

    Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0

  3. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial

    NARCIS (Netherlands)

    Kolk, A. van der; Yang, K.G.; Tamminga, R.; Hoeven, H. van der

    2013-01-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were

  4. The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment

    NARCIS (Netherlands)

    Bierkens, A. F.; Hendrikx, A. J.; Ezz el Din, K. E.; de la Rosette, J. J.; Horrevorts, A.; Doesburg, W.; Debruyne, F. M.

    1997-01-01

    There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL

  5. Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness

    NARCIS (Netherlands)

    Bierkens, A. F.; Hendrikx, A. J.; de la Rosette, J. J.; Stultiens, G. N.; Beerlage, H. P.; Arends, A. J.; Debruyne, F. M.

    1998-01-01

    To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients

  6. Successful evacuation of large perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) - step 1 of the IDEAL recommendations of surgical innovation.

    Science.gov (United States)

    Hallmann, Steffen; Petersein, Jan; Ruttloff, Jürgen; Ecke, Thorsten H

    2017-02-01

    Larger perirenal hematomas after extracorporeal shock wave lithotripsy (ESWL) are sometimes related to the loss of renal function due to compression of the normal renal tissue. After computed tomography-guided drainage and locally applied urokinase, the hematoma was fractionally evacuated. This procedure is a save and fast way to recover normal renal function.

  7. Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

    NARCIS (Netherlands)

    Portincasa, P.; van Erpecum, K. J.; van de Meeberg, P. C.; Dallinga-Thie, G. M.; de Bruin, T. W.; van Berge-Henegouwen, G. P.

    1996-01-01

    Extracorporeal shock-wave lithotripsy (ESWL) is an effective treatment in selected gallstone patients, but stone recurrence is a major drawback, Factors potentially influencing gallstone clearance and recurrence were studied in 84 patients in whom stone dissolution was diagnosed after ESWL plus bile

  8. UNEXPECTED DIFFICULTIES IN RANDOMIZING PATIENTS IN A SURGICAL TRIAL - A PROSPECTIVE-STUDY COMPARING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY WITH OPEN CHOLECYSTECTOMY

    NARCIS (Netherlands)

    PLAISIER, PW; BERGER, MY; VANDERHUL, RL; NIJS, HGT; DENTOOM, R; TERPSTRA, OT; BRUINING, HA

    1994-01-01

    Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of

  9. INSITU extracorporeal shock- wave lithotripsy as a primary treatment for ureteral stones

    International Nuclear Information System (INIS)

    Maghraby, Hisham

    2003-01-01

    The aim of the sudy was to evaluate the results ofextracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates ,complications and time to complete stone clearence were recorded. Complete stone clearance was received in 152 patients (91.6%) after an average of 10.2 days ( range1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter , and the difference was statistically significant.However, differences in the final success rate and time to stone clearence were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option. (author)

  10. Finite element modeling of acoustic wave propagation and energy deposition in bone during extracorporeal shock wave treatment

    Science.gov (United States)

    Wang, Xiaofeng; Matula, Thomas J.; Ma, Yong; Liu, Zheng; Tu, Juan; Guo, Xiasheng; Zhang, Dong

    2013-06-01

    It is well known that extracorporeal shock wave treatment is capable of providing a non-surgical and relatively pain free alternative treatment modality for patients suffering from musculoskeletal disorders but do not respond well to conservative treatments. The major objective of current work is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Here, a model of finite element method (FEM) was developed based on linear elasticity and acoustic propagation equations to examine SW propagation and deflection near a mimic musculoskeletal bone. High-speed photography experiments were performed to record cavitation bubbles generated in SW field with the presence of mimic bone. By comparing experimental and simulated results, the effectiveness of FEM model could be verified and strain energy distributions in the bone were also predicted according to numerical simulations. The results show that (1) the SW field will be deflected with the presence of bony structure and varying deflection angles can be observed as the bone shifted up in the z-direction relative to SW geometric focus (F2 focus); (2) SW deflection angels predicted by the FEM model agree well with experimental results obtained from high-speed photographs; and (3) temporal evolutions of strain energy distribution in the bone can also be evaluated based on FEM model, with varied vertical distance between F2 focus and intended target point on the bone surface. The present studies indicate that, by combining MRI/CT scans and FEM modeling work, it is possible to better understand SW propagation characteristics and energy deposition in musculoskeletal structure during extracorporeal shock wave treatment, which is important for standardizing the treatment dosage, optimizing treatment protocols, and even providing patient-specific treatment guidance in clinic.

  11. The effect of high-energy extracorporeal shock waves on hyaline cartilage of adult rats in vivo.

    Science.gov (United States)

    Mayer-Wagner, Susanne; Ernst, Judith; Maier, Markus; Chiquet, Matthias; Joos, Helga; Müller, Peter E; Jansson, Volkmar; Sievers, Birte; Hausdorf, Jörg

    2010-08-01

    The aim of this study was to determine if extracorporeal shock wave therapy (ESWT) in vivo affects the structural integrity of articular cartilage. A single bout of ESWT (1500 shock waves of 0.5 mJ/mm(2)) was applied to femoral heads of 18 adult Sprague-Dawley rats. Two sham-treated animals served as controls. Cartilage of each femoral head was harvested at 1, 4, or 10 weeks after ESWT (n = 6 per treatment group) and scored on safranin-O-stained sections. Expression of tenascin-C and chitinase 3-like protein 1 (Chi3L1) was analyzed by immunohistochemistry. Quantitative real-time polymerase chain reaction (PCR) was used to examine collagen (II)alpha(1) (COL2A1) expression and chondrocyte morphology was investigated by transmission electron microscopy no changes in Mankin scores were observed after ESWT. Positive immunostaining for tenascin-C and Chi3L1 was found up to 10 weeks after ESWT in experimental but not in control cartilage. COL2A1 mRNA was increased in samples 1 and 4 weeks after ESWT. Alterations found on the ultrastructural level showed expansion of the rough-surfaced endoplasmatic reticulum, detachment of the cell membrane and necrotic chondrocytes. Extracorporeal shock waves caused alterations of hyaline cartilage on a molecular and ultrastructural level that were distinctly different from control. Similar changes were described before in the very early phase of osteoarthritis (OA). High-energy ESWT might therefore cause degenerative changes in hyaline cartilage as they are found in initial OA. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Three-dimensional magnetohydrodynamic simulations of in situ shock formation in the coronal streamer belt

    International Nuclear Information System (INIS)

    Zaliznyak, Yu.; Keppens, R.; Goedbloed, J.P.

    2003-01-01

    A numerical study of an idealized magnetohydrodynamic (MHD) configuration consisting of a planar wake flow embedded into a three-dimensional (3D) sheared magnetic field is presented. The simulations investigate the possibility for in situ development of large-scale compressive disturbances at cospatial current sheet-velocity shear regions in the heliosphere. Using a linear MHD solver, the systematical investigation of the destabilized wavenumbers, corresponding growth rates, and physical parameter ranges for dominant 3D sinuous-type instabilities in an equilibrium wake-current sheet system was done. Wakes bounded by sufficiently supersonic (Mach number M s >2.6) flow streams are found to support dominant fully 3D sinuous instabilities when the plasma beta is of order unity. Fully nonlinear, compressible 2.5D and 3D MHD simulations show the self-consistent formation of shock fronts of fast magnetosonic type. They carry density perturbations far away from the wake's center. Shock formation conditions are identified in sonic and Alfvenic Mach number parameter space. Depending on the wake velocity contrast and magnetic field magnitude, as well as on the initial perturbation, the emerging shock patterns can be plane-parallel as well as fully three-dimensionally structured. Similar large-scale transients could therefore originate at distances far above coronal helmet streamers or at the location of the ecliptic current sheet

  13. A Case Report of Churg-Strauss Syndrome Presenting With Cardiogenic Shock Treated With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Cui, Na; Su, Longxiang; Wang, Hao; Long, Yun; Pang, Cheng; Yang, Fei; Liu, Dawei

    2015-10-01

    Churg-Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease.A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm). Laboratory tests revealed that eosinophil was significantly increased (WBC: 34.46 × 10/L, neutrophil: 7.56 × 10/L[21.9%], eosinophil: 23.84 × 10/L[69.2%]), and serum myocardial enzymes was abnormal (CK 1049U/L, CKMB-mass 145.1 μg/L, cTnI 16.24 μg/L). Myocardial injury (tachycardia with ST elevation) and poor heart function (LVEF 31%) were found by electrocardiogram and transthoracic echocardiography. On the next day, cardiogenic shock had been developed as demonstrated by deteriorating the perfusion index.Churg-Strauss Syndrome with cardiogenic shock.A series of conservative therapy with drugs such as corticosteroids, anticoagulant, antiplatelet, nitrates, calcium antagonists, inotrope, and vasopressors were initiated on the day of admission. The treatment was ineffective and a cardiogenic shock developed on the next day. Thus, ECMO was initiated immediately to stabilize circulation and perfusion. At the same time, high-dose corticosteroids combined with immunosuppressive therapy were continuously used.Symptoms of cardiogenic shock were gradually improved after ECMO treatment. Elevated values of cardiac enzymes were decreased and the dose of vasoactive drugs was reduced. Extracorporeal membrane oxygenation was discontinued after 8 days, and the patient was eventually weaned off the ventilator. The patient was discharged after 40 days treatment.Once a CSS develops into a

  14. Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol.

    Science.gov (United States)

    Maffulli, G; Hemmings, S; Maffulli, N

    2014-09-01

    Soft tissue injuries and tendinopathies account for large numbers of chronic musculoskeletal disorders. Extracorporeal shockwave therapy (ESWT) is popular, and effective in the management of chronic tendon conditions in the elbow, shoulder, and pain at and around the heel. Ethical approval was granted from the South East London Research Ethics Committee to implement a database for the Assessment of Effectiveness of Extracorporeal Shock Wave Therapy for Soft Tissue Injuries (ASSERT) to prospectively collect information on the effectiveness of ESWT across the UK. All participants will give informed consent. All clinicians follow a standardised method of administration of the ESWT. The primary outcome measures are validated outcome measures specific to the condition being treated. A Visual Analogue Score for pain and the EuroQol will be completed alongside the condition specific outcome tool at baseline, 3, 6, 12 and 24 months post treatment. The development of the ASSERT database will enable the evaluation of the effectiveness of ESWT for patients suffering from chronic conditions (plantar fasciopathy, tennis elbow, Achilles tendinopathy, greater trochanter pain syndrome and patellar tendinopathy). The results will aid the clinicians in the decision making process when managing these patients.

  15. Shock Melting of Iron Silicide as Determined by In Situ X-ray Diffraction.

    Science.gov (United States)

    Newman, M.; Kraus, R. G.; Wicks, J. K.; Smith, R.; Duffy, T. S.

    2016-12-01

    The equation of state of core alloys at pressures and temperatures near the solid-liquid coexistence curve is important for understanding the dynamics at the inner core boundary of the Earth and super-Earths. Here, we present a series of laser driven shock experiments on textured polycrystalline Fe-15Si. These experiments were conducted at the Omega and Omega EP laser facilities. Particle velocities in the Fe-15Si samples were measured using a line VISAR and were used to infer the thermodynamic state of the shocked samples. In situ x-ray diffraction measurements were used to probe the melting transition and investigate the potential decomposition of Fe-15Si in to hcp and B2 structures. This work examines the kinetic effects of decomposition due to the short time scale of dynamic compression experiments. In addition, the thermodynamic data collected in these experiments adds to a limited body of information regarding the equation of state of Fe-15Si, which is a candidate for the composition in Earth's outer core. Our experimental results show a highly textured solid phase upon shock compression to pressures ranging from 170 to 300 GPa. Below 320 GPa, we observe diffraction peaks consistent with decomposition of the D03 starting material in to an hcp and a cubic (potentially B2) structure. Upon shock compression above 320 GPa, the intense and textured solid diffraction peaks give way to diffuse scattering and loss of texture, consistent with melting along the Hugoniot. When comparing these results to that of pure iron, we can ascertain that addition of 15 wt% silicon increases the equilibrium melting temperature significantly, or that the addition of silicon significantly increases the metastability of the solid phase, relative to the liquid. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  16. /sup 99m/Tc-DTPA renography before and after extracorporeal shock wave lithotripsy for renal calculi

    Energy Technology Data Exchange (ETDEWEB)

    Ohtake, Eiji; Murata, Hajime; Kanemura, Mikio; Yokoyama, Masao

    1988-09-01

    This study was undertaken to evaluate /sup 99m/Tc-DTPA renography before and after extracorporeal shock wave lithotripsy (ESWL). Twelve patients with renal calculi were examined in this study. In three patients, bilateral kidneys were treated with ESWL. Sequential renal images of the vascular phase, and the functional and excretory phases were taken using a gamma camera (ZLC 7500, Siemens), after intravenous injection of 555 MBq of /sup 99m/Tc-DTPA. Renograms were generated using data stored every 10 seconds for a period of 30 minutes by computer (Scintipac-2400, Shimadzu). Some treated kidneys were enlarged and/or showed uniform retention of radioactivity on sequential images, within a week after ESWL. Renogram patterns after ESWL were varied in each patient. The renogram findings after ESWL seemed to be affected by the presence or absence of stone fragments in the urinary tract.

  17. NORMOTHERMIC EXTRACORPOREAL PERFUSION IN SITU IN DECEASED ORGAN DONORS WITH IRREVERSIBLE CARDIAC ARREST AND ONE HOUR OF ASYSTOLE. 5-YEAR OUTCOMES OF KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. E. Skvortsov

    2016-01-01

    Full Text Available Aim. The global shortage of deceased organ donors caused increasing interest to the transplant program based on the use of organs from the donors with sudden irreversible cardiac arrest, or asystolic donors (DCD. Ischemia-reperfusion injury as a result of cardiac arrest remains a key problem that limits the use of organs from DCD. Our clinical study was intended to determine the acceptability of renal transplants derived from the DCD using extracorporeal perfusion in situ after 60 minutes of asystole. Materials and methods. In 2009–2014, St. Petersburg Organ Procurement Organization (OPO obtained kidneys from 29 DCD with critically expanded warm ischemic time (WIT. The design of this study was approved by the Scientifi c Board and Ethics Committee of the State Research Institute for Emergency Medicine (Decision 7/0615/09. Initially, no one of died patients was considered as potential organ donors. In case of failed advanced CPR the death of a patient was declared initiating the protocol of subnormothermic extracorporeal abdominal perfusion with ECMO, thrombolytics (strepokinase 1.5 mln U, and LD. The procedures were established by the authorized OPO team which arrived with perfusion equipment in 30–40 minutes after declaration of donors’ death. Mean WIT was 58.1 (19.39 minutes (Mean (SD. Resuscitated grafts were transplanted into 58 recipients. The outcomes of transplantation of resuscitated kidneys were compared to those of 112 KTx from 115 brain death donors (BDDs. Results. Immediate functioning of kidney grafts was observed in 28 (48.3% of 58 recipients. There were 4 cases of primary graft non-function. By the end of the fi rst post-transplant year there was an acute rejection rate of 12.1% (9 episodes of rejection in the DCD group vs. 23.2% (26 episodes of rejection in the BDD group (p < 0.05. The actuarial 5-year graft survival rate was 82.8% (n = 48 in DCD group, and 87.5% (n = 98 in BDD group (p > 0.05. Creatinine levels at the end

  18. Shock Wave Response of Iron-based In Situ Metallic Glass Matrix Composites.

    Science.gov (United States)

    Khanolkar, Gauri R; Rauls, Michael B; Kelly, James P; Graeve, Olivia A; Hodge, Andrea M; Eliasson, Veronica

    2016-03-02

    The response of amorphous steels to shock wave compression has been explored for the first time. Further, the effect of partial devitrification on the shock response of bulk metallic glasses is examined by conducting experiments on two iron-based in situ metallic glass matrix composites, containing varying amounts of crystalline precipitates, both with initial composition Fe49.7Cr17.7Mn1.9Mo7.4W1.6B15.2C3.8Si2.4. The samples, designated SAM2X5-600 and SAM2X5-630, are X-ray amorphous and partially crystalline, respectively, due to differences in sintering parameters during sample preparation. Shock response is determined by making velocity measurements using interferometry techniques at the rear free surface of the samples, which have been subjected to impact from a high-velocity projectile launched from a powder gun. Experiments have yielded results indicating a Hugoniot Elastic Limit (HEL) to be 8.58 ± 0.53 GPa for SAM2X5-600 and 11.76 ± 1.26 GPa for SAM2X5-630. The latter HEL result is higher than elastic limits for any BMG reported in the literature thus far. SAM2X5-600 catastrophically loses post-yield strength whereas SAM2X5-630, while showing some strain-softening, retains strength beyond the HEL. The presence of crystallinity within the amorphous matrix is thus seen to significantly aid in strengthening the material as well as preserving material strength beyond yielding.

  19. Radiation Dose Assesment And Risk Estimation During Extracorporeal Shock Wave Lithotripsy

    International Nuclear Information System (INIS)

    Sulieman, A.; Ibrahim, A.A.; Osman, H.; Yousef, M.

    2011-01-01

    Extracorporeal shockwave lithotripsy (ESWL) is considered the gold standard for calculi fragmentation. The aims of this study are to measure the entrance surface dose (ESD) using thermo-luminescence dosimeter (TLDs) and to estimate the probability of carcinogenesis during ESWL procedure. The study was carried out at two centers (Group A, 50 patients) and (Group B, 25 patients). The mean ESD and effective doses were 36 mGy and 34 mSv. The results show that the probability of carcinogenesis is a tiny value 100 per million patients) but the main biological effect is occurring due to the accumulative impact of radiation.

  20. A low or high BMI is a risk factor for renal hematoma after extracorporeal shock wave lithotripsy for kidney stones.

    Science.gov (United States)

    Nussberger, Fabio; Roth, Beat; Metzger, Tobias; Kiss, Bernhard; Thalmann, George N; Seiler, Roland

    2017-06-01

    The purpose of this study was to evaluate risk factors for renal hematoma after extracorporeal shock wave lithotripsy (SWL) for kidney stones in a matched case-control analysis of a subgroup of patients recruited from a prospective randomized cohort. Between 06/2010 and 03/2013, 418 patients underwent SWL with the MODULITH ® -SLX-F2-lithotripter for kidney stones. In 39/418 patients (9 %), ultrasound at post-treatment day 1 revealed renal hematomas. For 37 of these patients, a matched group without hematoma could be selected according to the following matching criteria: age, gender, number and energy of shock waves, stone burden and localization. Risk factors for renal hematoma after SWL were compared between the two groups. The rates of diabetes, stopped anticoagulant/antiplatelet medications and arterial hypertension were not different between the two groups (p > 0.2). The skin-kidney distance was virtually the same in both groups (p = 0.5). In the hematoma group, significantly more patients had a high (>30: n = 16) as well as a low (hematomas after SWL. Patients with a high (>30) or low (<21.5) BMI had a higher risk for renal damage after SWL. Therefore, alternative endoscopic treatment options should be considered in these patients.

  1. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial.

    Science.gov (United States)

    Albert, J-D; Meadeb, J; Guggenbuhl, P; Marin, F; Benkalfate, T; Thomazeau, H; Chalès, G

    2007-03-01

    In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score. A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (-20.7 to 47.5) points (p energy group. Total or subtotal resorption of the calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group. High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains unchanged in size in the majority of patients.

  2. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

    Science.gov (United States)

    Yalcin, E; Keskin Akca, A; Selcuk, B; Kurtaran, A; Akyuz, M

    2012-02-01

    Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

  3. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Lu, Zhihua; Lin, Guiting; Reed-Maldonado, Amanda; Wang, Chunxi; Lee, Yung-Chin; Lue, Tom F

    2017-02-01

    As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED. A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality. A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT. There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99-3.00; pwaves per treatment, and duration of LI-ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement. The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients. We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED

  4. Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation.

    Science.gov (United States)

    Kraemer, Robert; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix Hagen; Mailaender, Peter; Kisch, Tobias

    2016-12-01

    Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: -22.1% vs. group C: -5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: -4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen

  5. Effect of Extracorporeal Shock Wave Treatment on Deep Partial-Thickness Burn Injury in Rats: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Gabriel Djedovic

    2014-01-01

    Full Text Available Extracorporeal shock wave therapy (ESWT enhances tissue vascularization and neoangiogenesis. Recent animal studies showed improved soft tissue regeneration using ESWT. In most cases, deep partial-thickness burns require skin grafting; the outcome is often unsatisfactory in function and aesthetic appearance. The aim of this study was to demonstrate the effect of ESWT on skin regeneration after deep partial-thickness burns. Under general anesthesia, two standardized deep partial-thickness burns were induced on the back of 30 male Wistar rats. Immediately after the burn, ESWT was given to rats of group 1 (N=15, but not to group 2 (N=15. On days 5, 10, and 15, five rats of each group were analyzed. Reepithelialization rate was defined, perfusion units were measured, and histological analysis was performed. Digital photography was used for visual documentation. A wound score system was used. ESWT enhanced the percentage of wound closure in group 1 as compared to group 2 (P<0.05. The reepithelialization rate was improved significantly on day 15 (P<0.05. The wound score showed a significant increase in the ESWT group. ESWT improves skin regeneration of deep partial-thickness burns in rats. It may be a suitable and cost effective treatment alternative in this type of burn wounds in the future.

  6. Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

    Science.gov (United States)

    Ercil, Hakan; Alma, Ergun; Bas, Okan; Sener, Nevzat Can; Vuruskan, Ediz; Kuyucu, Faruk; Unal, Umut; Gören, Mehmet Resit; Evliyaoglu, Yalcin

    2016-03-05

    To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

  7. COMPARISON BETWEEN EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AT 120 AND 60 SHOCKWAVES PER MINUTE FOR TREATMENT OF URINARY STONES.

    Science.gov (United States)

    Kashima, Soki; Horikawa, Yohei; Obara, Takashi; Muto, Yumina; Koizumi, Atsushi; Honma, Naoko; Akihama, Susumu; Shimoda, Naotake

    2016-01-01

    (Purpose) It has recently been suggested that a slow delivery rate of shockwaves by extracorporeal shock wave lithotripsy (SWL) improved treatment outcomes for urinary stones. We retrospectively analyzed the treatment outcomes of different shockwave delivery rates at 120 and 60 shockwaves per minute. (Patients and method) A total of 88 patients were treated at a fast delivery rate of 120 shockwaves per minute between July 2010 and April 2012, and 139 patients were treated at a slow delivery rate of 60 shockwaves per minute between May 2012 and May 2014 (n=227) using a Sonolith ® Praktis lithotripter. The treatment outcome of stone-free rate (SFR) after one SWL session was assessed at four weeks. (Result) SWL at 60 shockwaves per minute resulted in a significantly higher SFR compared with SWL at 120 shockwaves per minute (39.8% and 59.0%, respectively, p=0.0047), particularly for upper ureter (U1) stones (53.1% and 72.0%, respectively, p=0.028). Multivariate analysis showed that younger age, stone sizes of 10 mm or less, U1 stones, and slow delivery rate were significant predictors of a stone-free outcome. There were fewer adverse events after the delivery rate of 60 shockwaves per minute (p=0.058). (Conclusion) Our study suggests that SWL at 60 shockwaves per minute should be recommended to successfully treat urinary stones using the Sonolith ® Praktis lithotripter.

  8. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.

    Science.gov (United States)

    Bannuru, Raveendhara R; Flavin, Nina E; Vaysbrot, Elizaveta; Harvey, William; McAlindon, Timothy

    2014-04-15

    Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment. To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013. Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant-Murley score), and resolution of calcifications. Three independent reviewers abstracted data and determined eligibility and quality by consensus. Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis. The number of RCTs was small, and the studies were heterogeneous. High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage. None.

  9. Impact of extracorporeal shock waves on the human skin with cellulite: A case study of an unique instance

    Science.gov (United States)

    Kuhn, Christoph; Angehrn, Fiorenzo; Sonnabend, Ortrud; Voss, Axel

    2008-01-01

    In this case study of an unique instance, effects of medium-energy, high-focused extracorporeal generated shock waves (ESW) onto the skin and the underlying fat tissue of a cellulite afflicted, 50-year-old woman were investigated. The treatment consisted of four ESW applications within 21 days. Diagnostic high-resolution ultrasound (Collagenoson) was performed before and after treatment. Directly after the last ESW application, skin samples were taken for histopathological analysis from the treated and from the contra-lateral untreated area of skin with cellulite. No damage to the treated skin tissue, in particular no mechanical destruction to the subcutaneous fat, could be demonstrated by histopathological analysis. However an astounding induction of neocollageno- and neoelastino-genesis within the scaffolding fabric of the dermis and subcutis was observed. The dermis increased in thickness as well as the scaffolding within the subcutaneous fat-tissue. Optimization of critical application parameters may turn ESW into a noninvasive cellulite therapy. PMID:18488890

  10. Non-Contrast Computed Tomography Scan Based Parameters of Ureteric Stones Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy

    Science.gov (United States)

    Ayaz Khan, Mohammad; Waqas Iqbal, Muhammad; Akbar, Mian Khalid; Saqib, Imad-ud-din; Akhter, Saeed

    2017-01-01

    Objective  To compare the non-contrast computed tomography (NCCT) scan-based parameters of ureteric stones affecting the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and methods We retrospectively evaluated the pre-procedure NCCT of 74 patients who had ESWL for solitary ureteric calculi of 5-20 mm in diameter. We assessed the age, sex, basal metabolic index (BMI), laterality, location, presence of double 'J' (DJ) stent, skin to stone distance (SSD), stone maximum diameter, Hounsfield unit (HU), Hounsfield density (HD), area, and volume. All those who had no stone on follow-up imaging within 30 days were declared successful while those who had residual stone were declared failures. Results The overall success rate was 78% (58/74). Sixty (81.1%) patients were male. The success of ESWL was correlated with lower SSD, Hounsfield units (HU) and Hounsfield density (HD). However, in multivariate analysis, SSD, Hounsfield unit, and stone area showed correlation with success of procedure but Hounsfield density failed to show correlation. The success rate in patients with stone HU 1000 were 93.9%, 69%, and 58.3%, respectively. Patients with lower BMI (30 kg/m2) and higher HD (>76 HU/mm). Conclusion BMI, SSD, stone Hounsfield units and Hounsfield unit density were strong predictors of outcome of ESWL for ureteric stone. PMID:28589076

  11. Power Difference in Spectrum of Sound Radiation before and after Break of Phantom by Piezoelectric Extracorporeal Shock Wave Lithotriptor

    Science.gov (United States)

    Kanai, Hiroshi; Jang, Yun-Seok; Chubachi, Noriyoshi; Tanahashi, Yoshikatsu

    1994-05-01

    This paper investigates the difference in the spectrum of sound radiated before and after the break of a phantom at a focal point of the piezoelectric extracorporeal shock wave lithotriptor (ESWL) in order to identify the break time or to examine whether a calculus exists exactly at the focal point or not. From the preliminary experiments using a piece of chalk as a phantom of a calculus to measure the sound radiated when impact is applied to the chalk by an impact hammer, it is found that the bending vibration component of the vibration is exhibited in the spectrum of sound. However, for small-sized chalk shorter than 3 cm, the peak frequency of the bending vibration is higher than 20 kHz. From the experiments using a piezoeletric ESWL, it is found that there is clear difference in the power spectra among the sound radiated before the break, that radiated just after the break in the breaking process, and that radiated when the chalk does not exist at the focal point of the ESWL. These characteristics will be effective for the examination of the existence of the calculus at the focal point.

  12. Plain radiography, renography, and 99mTc-DMSA renal scintigraphy before and after extracorporeal shock wave lithotripsy for urolithiasis

    International Nuclear Information System (INIS)

    Munck, O.; Gerquari, I.; Moeller, J.T.; Jensen, L.I.; Thomsen, H.S.

    1992-01-01

    Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, 131 I-hippuran probe renography, and 99m Tc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL. (orig.)

  13. Comparison of the Effects of Oral Diclofenac Sodium Versus Acetaminophen Codein on Pain During Extracorporeal Shock Wave Lithotrypsy

    Directory of Open Access Journals (Sweden)

    Karkhanehei B

    2017-09-01

    Full Text Available Introduction: Urinary calculi is the second common chronic renal disease. Todays, the extracorporeal shock wave lithotripsy (ESWL is the most common method of treatment of kidney calculi, though this method was invented 30 years ago. This study was conducted to compare the effects of oral diclofenac sodium versus acetaminophen codein on pain during ESWL. Methods: After signing informed consent, 90 patients with urinary calculi were randomly allocated into three equal groups (n = 30. In this study, one hour before the ESWL, 30 patients received the acetaminophen codeine (acetaminophen 650 mg plus codeine 20 mg orally and 30 patients received diclofenac sodium 50 mg orally and 30 patients did not receive any drug. Severity of pain was assessed by the four-point scale during the procedure. Results: The results of our study showed that there was no statistically significant difference among the three groups regarding gender, weight, age, overall satisfaction, and pain severity during ESWL. Although morphine consumption and pain severity in groups of acetaminophen codeine and diclofenac sodium was lower than in the third group, this different was not statistically significant (P = 0.086. Conclusion: Oral prescription of acetaminophen codeine and diclofenac sodium, one hour before ESWL, has a similar effect on pain management.

  14. Clinical experience with EDAP LT-01+ extracorporeal shock wave lithotripsy for radiolucent stones; a report of 27 cases

    International Nuclear Information System (INIS)

    Rim, Hee Kwan; Kim, Ho Sung; Rim, Joung Sik

    1994-01-01

    Between February 1990 and February 1993, Radiolucent stones of 27 renal units in 22 patients were treated by extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT-01+. Intravenous urography was done in all patients for the diagnosis of radiolucent stones. Retrograde pyelography, ultrasonography and/or computed tomography was done, if needed. The locations of stones were kidney in 11(40.7 %), upper ureter in 8(29.6 %), lower ureter in 6(22.2 %), bladder in 1(3.7 %), ureteropelvic junction in 1(3.7 %). The average stone size was 10.9mm with a range of 5 to 32mm in maximum diameter. The average numbers of treatment were 2.7 sessions and average storage required was 34.8 in one session. The average treatment time was 40.4 minutes. All the patients showed complete removal of all calculous materials. Of 17 urinary stones analysed by chemical method, 8(47.1 %) were composed of uric acid, 5(29.4 %) of uric acid and calcium, 3 of phosphate and 1 of carbonate and phosphate. Therefore, we conclude that ESWL with EDAP LT-01+ lithotriptor is considered to be an effective noninvasive procedure for treatment of radiolucent stones. (Author)

  15. [Analysis of success predictive factors in the treatment of urinary lithiasis by extracorporeal shock wave lithotripsy. patient optimization: ESWL score.

    Science.gov (United States)

    Garrido-Abad, Pablo; Rodríguez-Cabello, Miguel Ángel; Platas-Sancho, Arturo

    2017-10-01

    Extracorporeal shock wave lithotripsy (ESWL) represents one of the most frequently used methods to treat urinary tract calculi. However, sometimes we do not obtain the fragmentation expected. The aim of this study is to evaluate the parameters that may influence ESWL final results, developing a classification for better patient's selection and outcome optimization. 270 patients with renal or ureteral stones were retrospectively reviewed after ESWL treatment, recording both clinical parameters (age, sex, location, laterality, body mass index [BMI]), and CT-Scan parameters (stone size and volume, skin-to-stone distance (SSD), mean and maximal stone density). Cutoff values were determined for each parameter based upon ROC curves, and final score (ESWL score) was calculated based on the number of parameters lower than the cutoff values. Of the 270 patients treated, 186 (68.8%) were considered as ESWL success, without significant differences between success and failure group. Parameters that showed significant difference after multivariate analysis were: size (cut off: 9.3 mm), volume (237.2 mm3), mean density (951 UH), SSD (133 mm) and BMI (26.9 kg/m2). AUC of ROC curve including all of these parameters, was 0.807. Stone free status was 17.6% for score 0, 25% (score 1), 48.8% (score 2), 74.1% (score 3), 86.3% (score 4) and 92.2% for score 5. Patient classification before ESWL treatment seems to allow us better selection, improving treatment success.

  16. Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants.

    Science.gov (United States)

    Younesi Rostami, Mehdi; Taghipour-Gorgikolai, Mehrdad; Sharifian, Rayka

    2012-01-01

    Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

  17. Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Kaynar, Mehmet; Tekinarslan, Erdem; Keskin, Suat; Buldu, İbrahim; Sönmez, Mehmet Giray; Karatag, Tuna; Istanbulluoglu, Mustafa Okan

    2015-01-01

    To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible.

  18. Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children.

    Science.gov (United States)

    Habib, Enmar I; Morsi, Hany A; Elsheemy, Mohammed S; Aboulela, Waseem; Eissa, Mohamed A

    2013-06-01

    To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months. 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  19. Effects and outcome of Tamsulosin more than just stone clearance after extracorporeal shock wave lithotripsy for renal calculi

    International Nuclear Information System (INIS)

    Qadri, S. S. U.; Khalid, S. E.; Mahmud, S. M.

    2014-01-01

    Objective: To determine the effect of Tamsulosin, as adjunctive medical therapy after Extracorporeal Shock Wave Lithotripsy for renal stones on rate of stone clearance, clearance time, pain intensity during stone clearance, steinstrasse formation and auxiliary surgical intervention required. Method: A prospective randomized controlled study was carried out in 120 patients who underwent ESWL for renal stones of 0.5-2.0 cm. They were randomized into study and control group in which Tamsulosin 0.4mg/day was given in former as an adjunctive medical therapy. All patients underwent ESWL every 2 weeks until complete stone clearance for 8 weeks. The parameters assessed were stone clearance, clearance time, pain intensity and effect on steinstrasse. Results: Of the 120 patients 60 were in each group. The stone clearance rate was greater in study than in control group, 58(96.7%) vs. 48(80%) respectively, (p<0.004). The mean stone clearance time was observed earlier in study group as compared to control group with significant statistical difference in stone size between 0.6-1.5 cm. The mean intensity of pain patients experienced according to Visual analogue scale (VAS) was significantly less in study group (p<0.002). The rate of steinstrasse formation was observed to be higher in control than in study group 15(25%) vs 6(10%) respectively(p<0.003), while its spontaneous clearance was higher in study group than in control group 83.3% vs 33.3% (p<0.03). Conclusion: Tamsulosin significantly increases stone clearance after shock wave lithotripsy for renal stones. It also appeared to facilitate earlier stone clearance, reduces severity of pain, reduces the incidence of steinstrasse formation and tends to facilitate its spontaneous clearance. (author)

  20. Does C-reactive protein have a value in early detection of infection after extracorporeal shock wave lithotripsy?

    Directory of Open Access Journals (Sweden)

    Behrouz Ghazimoghadam

    2010-06-01

    Full Text Available Introduction: Extracorporeal shock wave lithotripsy (ESWL has produced a great revolution in the treatment of the urolithiasis. Bacteriemia, bacteriuria, and septic shock are the documented complaints for which early diagnosis and treatment can be vital. C-reactive protein (CRP, an acute phase reactant, serves as a marker of the infection before other measures. In this study, we measured the CRP value in the early detection of bacteriemia and bacteriuria after ESWL.Methods: In 2005, we sought patients who had urolithiasis and were candidates for ESWL, and we recruited such patients for this study. The inclusion criteria were sterile urine and a negative CRP test. The patients who participated in the study were requested to undergo laboratory tests on the third and seventh days after ESWL. After the resulting data were entered into the SPSS-11.5 data analysis software, the analyses were done with Chi squared test.Results: Among the studied subjects, 29 out of 97 (29.9% had a positive CRP test and 16 (15.2% had positive urine cultures. There was no significant statistical relationship between the CRP tests and the urine cultures (P value > 0.05. On the third day, the relationship between CRP and erythrocyte sedimentation rate (ESR was significant (P value < 0.001. The positive predictive values of CRP were 0.087 and 0.214, and the negative predictive values were 0.87 and 0.963. The sensitivity and specificity of CRP were 18.2% and 74.1% (first stage, respectively, and 60% and 82.5% (second stage, respectively.Conclusions: We were unable to determine what the diagnostic value of CRP should be in the early detection of infection after ESWL. Additional studies are needed to provide greater insight into this issue.

  1. Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Teerapuncharoen, Krittika; Sharma, Nirmal S; Barker, Andrew B; Wille, Keith M; Diaz-Guzman, Enrique

    2015-09-01

    Carbon monoxide (CO) is the most common cause of poisoning and poisoning-related death in the United States. It is a tasteless and odorless poisonous gas produced from incomplete combustion of hydrocarbons, such as those produced by cars and heating systems. CO rapidly binds to hemoglobin to form carboxyhemoglobin, leading to tissue hypoxia, multiple-organ failure, and cardiovascular collapse. CO also binds to myocardial myoglobin, preventing oxidative phosphorylation in cardiac mitochondria and resulting in cardiac ischemia or stunning and cardiogenic pulmonary edema. Treatment of CO poisoning is mainly supportive, and supplemental oxygen remains the cornerstone of therapy, whereas hyperbaric oxygen therapy is considered for patients with evidence of neurological and myocardial injury. Extracorporeal membrane oxygenation (ECMO) has been utilized effectively in patients with respiratory failure and hemodynamic instability, but its use has rarely been reported in patients with CO poisoning. We report the successful use of venoarterial ECMO in a patient with severe CO poisoning and multiple-organ failure. Copyright © 2015 by Daedalus Enterprises.

  2. Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    Cahit Sahin

    2015-09-01

    Full Text Available Objectives: To evaluate the quality of life (QoL of the patients after extracorporeal shockwave lithotripsy (ESWL on a treated stone size related basis. Methods: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10mm, Group 2 (n: 28, 11 mm- ≤ 20 mm and Group 3 (n: 32, 20- 25 mm. During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. Results: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. Conclusions: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

  3. Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones.

    Science.gov (United States)

    Nielsen, Tommy Kjærgaard; Jensen, Jørgen Bjerggaard

    2017-07-27

    Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment. During an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated. The success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = -0.2, p ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL. Commercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.

  4. Role of alpha-1 blocker in expulsion of stone fragments after extracorporeal shock wave lithotripsy for renal stones

    International Nuclear Information System (INIS)

    Pirzada, A.J.; Anwar, A.; Javed, A.; Memon, I.; Mohammad, A.

    2011-01-01

    Background: Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL). Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Patients and Methods: This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1-adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.5-1.5 Cm in size (average size 1.2 Cm) were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic (Drotaverine HCl) as required and Proton Pump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p=0.01). The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group (p=0.002). This difference was statistically significant. Conclusion: Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal

  5. Experience with extracorporeal shock wave therapy (ESWT) in the United States

    Science.gov (United States)

    Furia, John P.

    2005-04-01

    The purpose of this presentation is to summarize the literature and to report on single treatment, high-energy ESWT for the treatment of chronic plantar fasciitis and lateral epicondylitis. Fifty-three patients (60 heels) were treated with 3800 shock waves. Sixteen patients (19 heels) were active, 21 (22 heels), were moderately active, and 16 (19 heels) were sedentary. Twelve weeks post treatment, mean visual analog scores (VAS) for the entire group improved from 9.2 to 2.4 (plateral epicondylitis were treated with 3200 shock waves. There were 9 workers compensation and 27 non-workers compensation patients. Twelve weeks post treatment, the mean VAS for the entire group improved from 8.0 to 2.5 (plateral epicondylitis.

  6. Extracorporeal shock wave lithotripsy of intrahepatic stones with piezoelectric lithotriptor: in vitro study

    International Nuclear Information System (INIS)

    Choi, Byung Ihn; Yoon, Chong Hyun; Park, Yong Hyun; Han, Joon Koo; Yoon, Yong Bum; Shin, Yong Moon; Kim, Jin Q; Kim, Chu Wan; Han, Man Chung

    1992-01-01

    This study was designed to investigate effectiveness of fragmentation during lithotripsy using 103 intrahepatic stones collected from 10 patients, who had previously undergone biliary surgery. The size of each stone was measured and sonography was performed for the evaluation of the sonographic type of the stones. In vitro lithotripsy was performed on individual stones using piezoelectric lithotriptor to evaluate the fragmentation rate and average number of shock waves for fragmentation. Chemical analysis of each stone was done to determine chemical composition including calcium, bilirubin, and cholesterol. The size of the stones was from 5 mm to 20 mm in diameter. Sonographic type I (echo of whole stone with posterior acoustic shadow) was 68, and type II (are-like strong surface echo of stone with clear posterior acoustic shadow) was 35 in number. The majority (78%) of stones in group I (5-9 mm in diameter) showed sonographic type I characteristics, and 62% of stones in group 3 (larger than 15 mm in diameter) showed sonographic type II characteristics. There was a positive correlation between the size and sonographic type of stones. Fragmentation rates of stones were 100% in group I, 71.9% in group 2 (10-15 mm in diameter), 43.8% in group 3, respectively. Fragmentation rates of stones with sonographic type I and II were 91.2%, 65.7%, respectively. The average number of shock waves for partial and complete fragmentation was 2753 ± 4937 and 6219 ± 10133, respectively. There was a positive correlation between the number of shock waves for fragmentation and diameter of stones (r = 0.618, ρ < 0.05). There was no correlation between the number of shock waves for fragmentation and chemical composition of stones. In conclusion, the most important variable determining the degree of fragmentation of intrahepatic stones using ESWL is not their chemical composition but their size and sonographic characteristics

  7. Extracorporeal shock wave lithotripsy of intrahepatic stones with piezoelectric lithotriptor: in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byung Ihn; Yoon, Chong Hyun; Park, Yong Hyun; Han, Joon Koo; Yoon, Yong Bum; Shin, Yong Moon; Kim, Jin Q; Kim, Chu Wan; Han, Man Chung [Seoul National University, College of Medicine, Seoul (Korea, Republic of)

    1992-05-15

    This study was designed to investigate effectiveness of fragmentation during lithotripsy using 103 intrahepatic stones collected from 10 patients, who had previously undergone biliary surgery. The size of each stone was measured and sonography was performed for the evaluation of the sonographic type of the stones. In vitro lithotripsy was performed on individual stones using piezoelectric lithotriptor to evaluate the fragmentation rate and average number of shock waves for fragmentation. Chemical analysis of each stone was done to determine chemical composition including calcium, bilirubin, and cholesterol. The size of the stones was from 5 mm to 20 mm in diameter. Sonographic type I (echo of whole stone with posterior acoustic shadow) was 68, and type II (are-like strong surface echo of stone with clear posterior acoustic shadow) was 35 in number. The majority (78%) of stones in group I (5-9 mm in diameter) showed sonographic type I characteristics, and 62% of stones in group 3 (larger than 15 mm in diameter) showed sonographic type II characteristics. There was a positive correlation between the size and sonographic type of stones. Fragmentation rates of stones were 100% in group I, 71.9% in group 2 (10-15 mm in diameter), 43.8% in group 3, respectively. Fragmentation rates of stones with sonographic type I and II were 91.2%, 65.7%, respectively. The average number of shock waves for partial and complete fragmentation was 2753 {+-} 4937 and 6219 {+-} 10133, respectively. There was a positive correlation between the number of shock waves for fragmentation and diameter of stones (r = 0.618, {rho} < 0.05). There was no correlation between the number of shock waves for fragmentation and chemical composition of stones. In conclusion, the most important variable determining the degree of fragmentation of intrahepatic stones using ESWL is not their chemical composition but their size and sonographic characteristics.

  8. Effect of Diuretics on Ureteral Stone Therapy with Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Zomorrodi A

    2008-01-01

    Full Text Available To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL, we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.

  9. Safety and efficacy of extracorporeal shock wave myocardial revascularization therapy for refractory angina pectoris.

    Science.gov (United States)

    Cassar, Andrew; Prasad, Megha; Rodriguez-Porcel, Martin; Reeder, Guy S; Karia, Darshak; DeMaria, Anthony N; Lerman, Amir

    2014-03-01

    To assess the safety and efficacy of extracorporeal shockwave myocardial revascularization (ESMR) therapy in treating patients with refractory angina pectoris. A single-arm multicenter prospective trial to assess safety and efficacy of the ESMR therapy in patients with refractory angina (class III/IV angina) was performed. Screening exercise treadmill tests and pharmacological single-photon emission computed tomography (SPECT) were performed for all patients to assess exercise capacity and ischemic burden. Patients were treated with 9 sessions of ESMR to ischemic areas over 9 weeks. Efficacy end points were exercise capacity by using treadmill test as well as ischemic burden on pharmacological SPECT at 4 months after the last ESMR treatment. Safety measures included electrocardiography, echocardiography, troponin, creatine kinase, and brain natriuretic peptide testing, and pain questionnaires. Fifteen patients with medically refractory angina and no revascularization options were enrolled. There was a statistically significant mean increase of 122.3±156.9 seconds (38% increase compared with baseline; P=.01) in exercise treadmill time from baseline (319.8±157.2 seconds) to last follow-up after the ESMR treatment (422.1±183.3 seconds). There was no improvement in the summed stress perfusion scores after pharmacologically induced stress SPECT at 4 months after the last ESMR treatment in comparison to that at screening; however, SPECT summed stress score revealed that untreated areas had greater progression in ischemic burden vs treated areas (3.69±6.2 vs 0.31±4.5; P=.03). There was no significant change in the mean summed echo score from baseline to posttreatment (0.4±5.1; P=.70). The ESMR therapy was performed safely without any adverse events in electrocardiography, echocardiography, troponins, creatine kinase, or brain natriuretic peptide. Pain during the ESMR treatment was minimal (a score of 0.5±1.2 to 1.1±1.2 out of 10). In this multicenter feasibility

  10. Development of a novel miniature detonation-driven shock tube assembly that uses in situ generated oxyhydrogen mixture

    Energy Technology Data Exchange (ETDEWEB)

    Janardhanraj, S.; Jagadeesh, G., E-mail: jaggie@aero.iisc.ernet.in [Department of Aerospace Engineering, Indian Institute of Science, Bangalore 560012 (India)

    2016-08-15

    A novel concept to generate miniature shockwaves in a safe, repeatable, and controllable manner in laboratory confinements using an in situ oxyhydrogen generator has been proposed and demonstrated. This method proves to be more advantageous than existing methods because there is flexibility to vary strength of the shockwave, there is no need for storage of high pressure gases, and there is minimal waste disposal. The required amount of oxyhydrogen mixture is generated using alkaline electrolysis that produces hydrogen and oxygen gases in stoichiometric quantity. The rate of oxyhydrogen mixture production for the newly designed oxyhydrogen generator is found to be around 8 ml/s experimentally. The oxyhydrogen generator is connected to the driver section of a specially designed 10 mm square miniature shock tube assembly. A numerical code that uses CANTERA software package is used to predict the properties of the driver gas in the miniature shock tube. This prediction along with the 1-D shock tube theory is used to calculate the properties of the generated shockwave and matches reasonably well with the experimentally obtained values for oxyhydrogen mixture fill pressures less than 2.5 bars. The miniature shock tube employs a modified tri-clover clamp assembly to facilitate quick changing of diaphragm and replaces the more cumbersome nut and bolt system of fastening components. The versatile nature of oxyhydrogen detonation-driven miniature shock tube opens up new horizons for shockwave-assisted interdisciplinary applications.

  11. Development of a novel miniature detonation-driven shock tube assembly that uses in situ generated oxyhydrogen mixture

    International Nuclear Information System (INIS)

    Janardhanraj, S.; Jagadeesh, G.

    2016-01-01

    A novel concept to generate miniature shockwaves in a safe, repeatable, and controllable manner in laboratory confinements using an in situ oxyhydrogen generator has been proposed and demonstrated. This method proves to be more advantageous than existing methods because there is flexibility to vary strength of the shockwave, there is no need for storage of high pressure gases, and there is minimal waste disposal. The required amount of oxyhydrogen mixture is generated using alkaline electrolysis that produces hydrogen and oxygen gases in stoichiometric quantity. The rate of oxyhydrogen mixture production for the newly designed oxyhydrogen generator is found to be around 8 ml/s experimentally. The oxyhydrogen generator is connected to the driver section of a specially designed 10 mm square miniature shock tube assembly. A numerical code that uses CANTERA software package is used to predict the properties of the driver gas in the miniature shock tube. This prediction along with the 1-D shock tube theory is used to calculate the properties of the generated shockwave and matches reasonably well with the experimentally obtained values for oxyhydrogen mixture fill pressures less than 2.5 bars. The miniature shock tube employs a modified tri-clover clamp assembly to facilitate quick changing of diaphragm and replaces the more cumbersome nut and bolt system of fastening components. The versatile nature of oxyhydrogen detonation-driven miniature shock tube opens up new horizons for shockwave-assisted interdisciplinary applications.

  12. [The results of the combined application of extracorporeal shock-wave therapy and radon baths during the rehabilitative treatment of the patients presenting with gonarthrosis].

    Science.gov (United States)

    Razumov, A N; Puriga, A O; Yurova, O V

    2015-01-01

    Osteoarthritis (OA) is one of the leading diseases of the musculoskeletal system and the main cause of arthritic joint damage. The objective of the present study was to evaluate the effectiveness of the combined application of radon baths and shock-wave therapy in the patients suffering from knee OA. The study involved 75 patients at the age of 35 to 62 years with the confirmed diagnosis of stage II and III gonarthrosis; they were divided into 3 groups. The patients of the main group received the combined treatment including extracorporeal shock-wave therapy and radon baths The patients comprising the group of comparison were given the course of radon therapy alone while those in the control group were offered the standard treatment including physiotherapy, magnetic therapy, and NSAIDs. The study has demonstrated the high effectiveness of the combined application of the radon baths and extracorporeal shock-wave therapy for the rehabilitation of the patients with deforming arthrosis of the knee that was apparent from the substantial decrease of pain syndrome, the increase of the range of motions in the knee joints, and the overall improvement of the quality of life. These beneficial changes persisted for a period of up to 6 months. The results of the present study give reason to recommend the proposed method of the remedial treatment for the wide practical application as a component in the framework of the medical rehabilitation programs.

  13. Extracorporeal shock wave lithotripsy on pancreatic duck stones in patients with chronic pancreatitis: evaluation of therapeutic results with CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Moon Gyu [Asan Medical Center, Seoul (Korea, Republic of); Lee, Yong Suk [Gunpo Medical Center, Gunpo (Korea, Republic of)

    2003-03-01

    To demonstrate by CT scanning the effect of extracorporeal shock wave lithotripsy (ESWL) on pancreatic duct stones in patients with chronic pancreatitis. Pancreatic duct stones in 11 patients with chronic pancreatitis were subject to ESWL using an electrohydraulic lithotripter. Endoscopic stone removal using a basket had failed in ten patients, and in one, endoscopy was impossible due to a previous Whipple's operation. CT scans obtained before and after ESWL were evaluated by two radiologists: the longest and shortest diameters of the target stone were measured, and according to the degree of fragmentation, determined by comparing the area of the stone before and after ESWL, a grade (1-5) was assigned. In each case, the pre- and post- treatment diameter of the main pancreatic duct, measured at the pancreatic body, was also compared. Disintegration of the target stone was achieved in all patients: grade 1 (over 75% of the area remained, compared with that of the initial stone) was assigned in two patients; grade 2 (51-75% of the original area) in one; grade 3 (26-50%) in four; grade 4 (under 25%) in two; and grade 5 (complete clearance of the target stone) in two. The mean area decreased from 175 mm{sup 2} to 69 mm{sup 2} after ESWL (p<0.05); a decrease of more than 50% was observed in eight patients (73%). The mean diameter of the main pancreatic duct decreased from 7.36 to 4.81 mm (p<0.05). No severe adverse effects or complications were noted, and all patients showed clinical improvement. Follow-up studies indicated that pancreatic duct stones recurred in three patients. ESWL can cause the fragmentation of pancreatic duct stones without significant complications, and should be considered where endoscopic stone removal has failed. CT is a suitable non-invasive and accurate tool for evaluating the therapeutic results of ESWL.

  14. Removal of Kidney Stones by Extracorporeal Shock Wave Lithotripsy Is Associated with Delayed Progression of Chronic Kidney Disease

    Science.gov (United States)

    Yoo, Dong Eun; Han, Seung Hyeok; Oh, Hyung Jung; Kim, Seung Jun; Shin, Dong Ho; Lee, Mi Jung; Yoo, Tae-Hyun; Kang, Shin-Wook

    2012-01-01

    Purpose This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression. Materials and Methods We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL. Results The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75±6.5 vs. -1.63±7.2 mL/min/1.73 m2/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29±6.1 vs. -1.63±7.2 mL/min/1.73 m2/year, pESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01±4.7 vs. -0.05±5.2 mL/min/1.73 m2/year, pESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis. PMID:22665335

  15. Extracorporeal shock wave lithotripsy on pancreatic duck stones in patients with chronic pancreatitis: evaluation of therapeutic results with CT

    International Nuclear Information System (INIS)

    Lee, Moon Gyu; Lee, Yong Suk

    2003-01-01

    To demonstrate by CT scanning the effect of extracorporeal shock wave lithotripsy (ESWL) on pancreatic duct stones in patients with chronic pancreatitis. Pancreatic duct stones in 11 patients with chronic pancreatitis were subject to ESWL using an electrohydraulic lithotripter. Endoscopic stone removal using a basket had failed in ten patients, and in one, endoscopy was impossible due to a previous Whipple's operation. CT scans obtained before and after ESWL were evaluated by two radiologists: the longest and shortest diameters of the target stone were measured, and according to the degree of fragmentation, determined by comparing the area of the stone before and after ESWL, a grade (1-5) was assigned. In each case, the pre- and post- treatment diameter of the main pancreatic duct, measured at the pancreatic body, was also compared. Disintegration of the target stone was achieved in all patients: grade 1 (over 75% of the area remained, compared with that of the initial stone) was assigned in two patients; grade 2 (51-75% of the original area) in one; grade 3 (26-50%) in four; grade 4 (under 25%) in two; and grade 5 (complete clearance of the target stone) in two. The mean area decreased from 175 mm 2 to 69 mm 2 after ESWL (p<0.05); a decrease of more than 50% was observed in eight patients (73%). The mean diameter of the main pancreatic duct decreased from 7.36 to 4.81 mm (p<0.05). No severe adverse effects or complications were noted, and all patients showed clinical improvement. Follow-up studies indicated that pancreatic duct stones recurred in three patients. ESWL can cause the fragmentation of pancreatic duct stones without significant complications, and should be considered where endoscopic stone removal has failed. CT is a suitable non-invasive and accurate tool for evaluating the therapeutic results of ESWL

  16. Radial extracorporeal shock wave therapy improves cerebral blood flow and neurological function in a rat model of cerebral ischemia.

    Science.gov (United States)

    Kang, Nan; Zhang, Jing; Yu, Xiaotong; Ma, Yuewen

    2017-01-01

    We performed middle cerebral artery occlusion (MCAO) in rats to investigate the effect and some of the underlying mechanisms of radial extracorporeal shock wave therapy (rESWT) in cerebral ischemia rats. We measured neurological function and cerebral blood flow (CBF) using a full-field laser perfusion imager and brain infarct volume on days 3, 12, and 30. Immunofluorescence, western blot, and real-time polymerase chain reaction (PCR) techniques were used to detect the expression of vascular endothelial growth factor (VEGF), neuron-specific enolase (NSE), nestin, Wnt3a, and β-catenin in the ischemic hemisphere. The dose of rESWT used on the head revealed remarkable advantages over sham rESWT, as demonstrated by improved neurological function scores, increased CBF, and reduced brain infarct volume. Furthermore, applying rESWT to the head and limbs enhanced short-term neurological function. Our results confirmed that rESWT can induce VEGF expression over an extended period with a profound effect, which may be the primary reason for CBF recovery. High NSE and nestin expression levels suggest that rESWT enhanced the number of neurons and neural stem cells (NSCs). Wnt3a and β-catenin expression were up-regulated in the ischemic hemisphere, indicating that rESWT promoted NSC proliferation and differentiation via the Wnt/β-catenin pathway. Overall, our findings suggest that an appropriate rESWT dose delivered to the head of rats helps restore neurological function and CBF, and additional application of rESWT to the limbs is more effective than treating the head alone.

  17. Veno-arterial extracorporeal membrane oxygenation as a bridge for enabling surgery in a patient under cardiogenic shock due to acute mitral prosthesis dysfunction

    Directory of Open Access Journals (Sweden)

    María Elena Arnáiz-García

    2018-04-01

    Full Text Available A 52-year-old male patient, who underwent mitral replacement with a mechanical prosthesis as a child, sustained a cardiac arrest which was successfully resuscitated. Further investigation showed prosthesis malfunction with significant regurgitation in the context of multi-organ failure. In such a life-threatening condition, veno-arterial extracorporeal membrane oxygenation was considered as a rescue procedure to achieve optimisation of clinical status to allow definitive surgical treatment. An unusual complete fracture of the prosthesis was subsequently identified as the cause of acute dysfunction. Keywords: VA-ECMO, Mitral, Prosthesis, Dysfunction, Cardiogenic shock

  18. PROSPECTIVE STUDY TO COMPARE THE EFFICACY OF ANALGESIC AGENTS USED FOR THE PAIN MANAGEMENT DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

    Directory of Open Access Journals (Sweden)

    Abhirudra

    2016-05-01

    Full Text Available BACKGROUND Extracorporeal shock wave lithotripsy (ESWL is well known for its non-invasiveness, effectiveness and minimal morbidity for the management of renal stones. Some generation of lithotripters were associated with significant pain, needing anaesthesia. In modern lithotripters, pain is insignificant making lithotripsy an outpatient procedure (day care. AIMS The present study is aimed to compare the clinical efficacy between four drugs. METHODS AND MATERIALS This was a prospective study of 1000 patients with normal BMI (25-30 who underwent ESWL in the Year 2012-15 at our institute. All the patients with renal stones were randomly divided into 4 groups. Dornier Compact Sigma lithotripsy machine was used in all the patients. Group A was given IM diclofenac sodium (1 mg/kg, 60 minutes before the procedure. In group B, 10 g of EMLA cream; and in group C, 15 g of diclofenac diethylamine gel; in group D placebo (electrode gel was applied locally. STATISTICAL ANALYSIS Visual analogue scale (VAS was used to assess the severity of pain for initial 5-10 minutes and after the procedure. A P value of less than 0.05 was considered to be statistically significant. Statistical analysis was done using one way ANOVA and results were compared between four groups. RESULTS All four groups were having comparable age, weight, stone size, number of shock waves delivered and maximum voltage used. In group A total 250 patients (M/F: 177/73, group B 250 patients (M/F: 129/121, group C 250 patients (M/F: 158/92, group D 250 patients (M/F: 162/88. With regard to pain scores, the responses were better in group B. According to location of the stones, majority of the stones were located in pelvis (41.5%, followed by upper (30.5% and middle calyx (16.8% and least in the lower calyx (11.2%. Overall stone free rate in our study was 75.5%, with least clearance in lower calyceal stones. 112 patients were stented prior to the procedure. Ureteroscopy and RIRS (Retrograde

  19. Effect of Different Analgesics on Pain Relief During Extracorporeal Shock Wave Lithotripsy

    Science.gov (United States)

    Yesil, S; Polat, F; Ozturk, U; Dede, O; Imamoglu, MA; Bozkirli, I

    2014-01-01

    Background/aim: The aim of this study was  to compare  three drugs for pain relief during shock wave lithotripsy (SWL). Materials and Methods: Seventy six male patients that were treated for renal stones with SWL were included in this study. They were randomized into four groups. A different treatment protocol was used for each group.  Intramuscular (IM) diclofenac 75mg was given in group 1 (n=20), dexketoprofen, 50mg, IM in group 2 (n=20) and hyoscine 10 mg plus paracetamol 500mg, orally in group 3 (n=20). In group 4 (control, n=16) saline solution   was given 30 min before SWL. Pain during SWL was assessed using the 10-score linear visual analogue pain scale (VAS) and was compared among groups. Age, weight, height, body mass index (BMI), stone size, stone location, duration of SWL, total shock waves performed and mean energy level (kV) for each patient were recorded. A p value of <0.05 was considered statistically significant. Results: The mean patients’ age was 45.4 ± 12.9 years. The highest VAS value was observed in Group 4 (8.4 ± 1), and the lowest  in Group 1 (6.25 ± 2.2).  Statistically significant  difference was noted  only when Group 1 and Group 4 were compared. The remaining groups provided similar results and there were no significant statistical differences according to VAS values. Other parameters were similar  in all groups. Conclusion: In conclusion, this study shows that reducing the pain with a single dose injection of intramuscular diclofenac sodium before SWL is superior compared to others. PMID:25336870

  20. A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    Goyal Neeraj

    2010-01-01

    Full Text Available To compare the accuracy of artificial neural network (ANN analysis and multi-variate regression analysis (MVRA for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL. A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC (r2 . For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL.

  1. A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Neeraj K Goyal, Abhay Kumar; Sameer Trivedi

    2010-01-01

    To compare the accuracy of artificial neural network (ANN) analysis and multivariate regression analysis (MVRA) for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL). A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values) were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values) from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC) (r2 ). For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL (Author).

  2. In-situ Raman spectroscopy and high-speed photography of a shocked triaminotrinitrobenzene based explosive

    Energy Technology Data Exchange (ETDEWEB)

    Saint-Amans, C.; Hébert, P., E-mail: philippe.hebert@cea.fr; Doucet, M. [CEA, DAM, Le RIPAULT, F-37620 Monts (France); Resseguier, T. de [Institut P' , UPR CNRS 3346, ENSMA, Université de Poitiers, F-86961 Futuroscope, Chasseneuil (France)

    2015-01-14

    We have developed a single-shot Raman spectroscopy experiment to study at the molecular level the initiation mechanisms that can lead to sustained detonation of a triaminotrinitrobenzene-based explosive. Shocks up to 30 GPa were generated using a two-stage laser-driven flyer plate generator. The samples were confined by an optical window and shock pressure was maintained for at least 30 ns. Photon Doppler Velocimetry measurements were performed at the explosive/window interface to determine the shock pressure profile. Raman spectra were recorded as a function of shock pressure and the shifts of the principal modes were compared to static high-pressure measurements performed in a diamond anvil cell. Our shock data indicate the role of temperature effects. Our Raman spectra also show a progressive extinction of the signal which disappears around 9 GPa. High-speed photography images reveal a simultaneous progressive darkening of the sample surface up to total opacity at 9 GPa. Reflectivity measurements under shock compression show that this opacity is due to a broadening of the absorption spectrum over the entire visible region.

  3. Comparison of extracorporeal shock wave lithotripsy running models between outsourcing cooperation and rental cooperation conducted in Taiwan.

    Science.gov (United States)

    Liu, Chih-Kuang; Ko, Ming-Chung; Chen, Shiou-Sheng; Lee, Wen-Kai; Shia, Ben-Chang; Chiang, Han-Sun

    2015-02-01

    We conducted a retrospective study to compare the cost and effectiveness between two different running models for extracorporeal shock wave lithotripsy (SWL), including the outsourcing cooperation model (OC) and the rental cooperation model (RC). Between January 1999 and December 2005, we implemented OC for the SWL, and from January 2006 to October 2011, RC was utilized. With OC, the cooperative company provided a machine and shared a variable payment with the hospital, according to treatment sessions. With RC, the cooperative company provided a machine and received a fixed rent from the hospital. We calculated the cost of each treatment session, and evaluated the break-even point to estimate the lowest number of treatment sessions to make the balance between revenue and cost every month. Effectiveness parameters, including the stone-free rate, the retreatment rate, the rate of additional procedures and complications, were evaluated. Compared with OC there were significantly less treatment sessions for RC every month (42.6±7.8 vs. 36.8±6.5, p=0.01). The cost of each treatment session was significantly higher for OC than for RC (751.6±20.0 USD vs. 684.7±16.7 USD, p=0.01). The break-even point for the hospital was 27.5 treatment sessions/month for OC, when the hospital obtained 40% of the payment, and it could be reduced if the hospital got a greater percentage. The break-even point for the hospital was 27.3 treatment sessions/month for RC. No significant differences were noticed for the stone-free rate, the retreatment rate, the rate of additional procedures and complications. Our study revealed that RC had a lower cost for every treatment session, and fewer treatment sessions of SWL/month than OC. The study might provide a managerial implication for healthcare organization managers, when they face a situation of high price equipment investment. Copyright © 2012. Published by Elsevier B.V.

  4. Extracorporeal shock wave therapy with low-energy flux density inhibits hypertrophic scar formation in an animal model.

    Science.gov (United States)

    Zhao, Jing-Chun; Zhang, Bo-Ru; Hong, Lei; Shi, Kai; Wu, Wei-Wei; Yu, Jia-Ao

    2018-04-01

    Hypertrophic scar is characterized by excessive deposits of collagen during skin wound healing, which could become a challenge to clinicians. This study assessed the effects of the extracorporeal shock wave therapy (ESWT) on hypertrophic scar formation and the underlying gene regu-lation. A rabbit ear hypertrophic scar model was generated and randomly divided into three groups: L-ESWT group to receive L-ESWT (energy flux density of 0.1 mJ/mm2), H-ESWT (energy flux density of 0.2 mJ/mm2) and sham ESWT group (S-ESWT). Hypertrophic scar tissues were then collected and stained with hematoxylin and eosin (H&E) and Masson's trichrome staining, respectively, to assess scar elevation index (SEI), fibroblast density and collagen fiber arrangement. Expression of cell proliferation marker proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were assessed using RT-PCR and immunohistochemistry in hypertrophic scar tissues. H&E staining sections showed significant reduction of SEI and fibroblast density in both ESWT treatment groups compared to S-ESWT, but there was no dramatic difference between L-ESWT and H-ESWT groups. Masson's trichrome staining showed that collagen fibers were more slender and broader and oriented in parallel to skin surface after administration of ESWT compared to control tissues. At the gene level, PCNA‑positive fibroblasts and α-SMA-positive myofibroblasts were significantly decreased after L-ESWT or H-ESWT compared to the controls. Furthermore, there was no significant difference in expression of PCNA mRNA between L-ESWT or H-ESWT and S-ESWT, whereas expression of α-SMA mRNA significantly decreased in L-ESWT compared to that of H-ESWT and S-ESWT (P=0.002 and P=0.030, respectively). In conclusion, L-ESWT could be effective on suppression of hypertrophic scar formation by inhibition of scar elevation index and fibroblast density as well as α-SMA expression in hypertrophic scar tissues of the rabbit model.

  5. New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

    Science.gov (United States)

    Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

    2017-12-01

    To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The

  6. Total intravenous anesthesia using remifentanil in extracorporeal shock wave lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial.

    Science.gov (United States)

    Cannata, F; Spinoglio, A; Di Marco, P; Luzi, M; Canneti, A; Ricciuti, G; Reale, C

    2014-01-01

    Extracorporeal Shock Wave Lithotripsy is usually performed in day surgery setting, consequently people who undergo to this procedure need a safe and fast recovery. Conscious sedation with remifentanil can relieve from pain and keep patients in touch with anaesthesiologists. Few publications tell about infusion rates administered to perform this procedure7. The aim of this study is to assess which is the most appropriate infusion rate. Patients were randomly assigned to two groups. Two different infusion rates were compared: 0,05 mcg/kg/min, GROUP A (N.=114), vs. 0.1 µg/kg/min, GROUP B (N.=114). Patients' vital signs, additional analgesic requests, PONV (postoperative nausea and vomiting) and other side effects were registered. The deepness of sedation and patient's satisfaction were evaluated referring to Obsever's Assessment of Alertness and Sedation scale (O/ASS) and using a Likert's scale respectively. Pain intensity was assessed with a 11-points VAS (visual analogue scale). Differences between groups were analyzed using Student t test for independent variables. The χ2 test was used to analyze categorical variables. The study enrolled 228 patients and assigned them to two groups (N.=114). No significant differences were found regarding Likert's scale values (P=0.20), additional analgesic request (P=0.30) and mean VAS values (P>0.05) between the two groups. The difference between the two groups about PONV, hypotension, oxygen desaturation and respiratory depression was statistically significant (P<0.05), as a matter of fact in group A these side effects occurred less frequently. The fifth degree of O/ASS was estimated in about 1.61±0.19 min and 2.987±0.20 min in group A and in group B respectively (P<0.05). According with previous results remifentanil at the infusion rate of 0.05 µg/kg/min provides an effective analgesia, causing a lower incidence of side effect than 0.1 µg/kg/min, granting a fast and safe recovery.

  7. Extracorporeal shock wave lithotripsy in the treatment of ureteric stones: Experience from Twam Hospital, United Arab Emirates

    International Nuclear Information System (INIS)

    Ghafoor, M.; Halim, A.

    2002-01-01

    The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of 99 patients, 22 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size and the number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A ( 1 0 mm) and B (11-20 mm). The overall all clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (<-10 mm) stone was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the lower ureteric stones was 69.3%. ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without ant need for anesthesia or any pretreatment intervention. It should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance for small stones (<1 mm) in the lower third of ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low

  8. Development of in situ time-resolved Raman spectroscopy facility for dynamic shock loading in materials

    Science.gov (United States)

    Chaurasia, S.; Rastogi, V.; Rao, U.; Sijoy, C. D.; Mishra, V.; Deo, M. N.

    2017-11-01

    The transient state of excitation and relaxation processes in materials under shock compression can be investigated by coupling the laser driven shock facility with Raman spectroscopy. For this purpose, a time resolved Raman spectroscopy setup has been developed to monitor the physical and the chemical changes such as phase transitions, chemical reactions, molecular kinetics etc., under shock compression with nanosecond time resolution. This system consist of mainly three parts, a 2 J/8 ns Nd:YAG laser system used for generation of pump and probe beams, a Raman spectrometer with temporal and spectral resolution of 1.2 ns and 3 cm-1 respectively and a target holder in confinement geometry assembly. Detailed simulation for the optimization of confinement geometry targets is performed. Time resolved measurement of polytetrafluoroethylene (PTFE) targets at focused laser intensity of 2.2 GW/cm2 has been done. The corresponding pressure in the Aluminum and PTFE are 3.6 and 1.7 GPa respectively. At 1.7 GPa in PTFE, a red shift of 5 cm-1 is observed for the CF2 twisting mode (291 cm-1). Shock velocity in PTFE is calculated by measuring rate of change of ratios of the intensity of Raman lines scattered from shocked volume to total volume of sample in the laser focal spot along the laser axis. The calculated shock velocity in PTFE is found to be 1.64 ± 0.16 km/s at shock pressure of 1.7 GPa, for present experimental conditions.

  9. Efficacy of second generation lithotriptors: a multicenter comparative study of 2,206 extracorporeal shock wave lithotripsy treatments with the Siemens Lithostar, Dornier HM4, Wolf Piezolith 2300, Direx Tripter X-1 and Breakstone lithotriptors

    NARCIS (Netherlands)

    Bierkens, A. F.; Hendrikx, A. J.; de Kort, V. J.; de Reyke, T.; Bruynen, C. A.; Bouve, E. R.; Beek, T. V.; Vos, P.; Berkel, H. V.

    1992-01-01

    Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for urinary calculi. The good results of the first generation Dornier HM3 lithotriptor stimulated the development of second generation machines. A multicenter trial is presented involving the Siemens Lithostar, Dornier

  10. In situ measurement of plasma and shock wave properties inside laser-drilled metal holes

    Science.gov (United States)

    Brajdic, Mihael; Hermans, Martin; Horn, Alexander; Kelbassa, Ingomar

    2008-10-01

    High-speed imaging of shock wave and plasma dynamics is a commonly used diagnostic method for monitoring processes during laser material treatment. It is used for processes such as laser ablation, cutting, keyhole welding and drilling. Diagnosis of laser drilling is typically adopted above the material surface because lateral process monitoring with optical diagnostic methods inside the laser-drilled hole is not possible due to the hole walls. A novel method is presented to investigate plasma and shock wave properties during the laser drilling inside a confined environment such as a laser-drilled hole. With a novel sample preparation and the use of high-speed imaging combined with spectroscopy, a time and spatial resolved monitoring of plasma and shock wave dynamics is realized. Optical emission of plasma and shock waves during drilling of stainless steel with ns-pulsed laser radiation is monitored and analysed. Spatial distributions and velocities of shock waves and of plasma are determined inside the holes. Spectroscopy is accomplished during the expansion of the plasma inside the drilled hole allowing for the determination of electron densities.

  11. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

    Science.gov (United States)

    Srisubat, Attasit; Potisat, Somkiat; Lojanapiwat, Bannakij; Setthawong, Vasun; Laopaiboon, Malinee

    2014-11-24

    Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. This is an update of a review first published in 2009. This review aimed to assess the effectiveness and complications of ESWL for kidney stones compared with PCNL or RIRS. We searched the Cochrane Renal Group's Specialised Register to 3 March 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Five studies (338 patients) were included, four studies compared ESWL to PCNL and one compared ESWL with RIRS. Random sequence generation was reported in three studies and unclear in two. Allocation concealment was not reported in any of the included studies. Blinding of participants and investigators could not be undertaken due to the nature of the interventions; blinding of outcome assessors was not reported. Reporting bias was judged to be low risk in all studies. One study was funded by industry and in one study the number of participants in each group was unbalanced.The success of treatment at three months was significantly

  12. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2012-01-01

    Full Text Available Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm 2 in 3 sessions at weekly intervals or sham therapy (n = 20 in each group. Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients′ pain scores, performed at baseline and 12 weeks after completion of the therapy. Results : The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001, but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03. Both groups showed significant pain improvement over the course of the study (P < 0.001, though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049. Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

  13. Comparison of effect of body position, prone or supine, on the result of extracorporeal shock wave lithotripsy in patients with stones in the proximal ureter

    International Nuclear Information System (INIS)

    Zomorrodi, A.; Elahian, A.; Ghorbani, N.; Tavoosi, A.

    2007-01-01

    The aim of this study was to determine whether positioning of patient, prone or supine, plays a significant role on the treatment of stones in the proximal ureter with extracorporeal shock wave lithotripsy (ESWL). 68 patients with proximal ureteric stones underwent ESWL. The procedure was performed in the supine position in 35 (Group1) and the prone position in 33 patients (Group2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. The mean session number per patient was 1.93+-0.82 in Group 1 and 1.88+-0.79 in Group 2 (P=0.786). The stone free rates, three months after ESWL, were 81.8% in group 1 and 82.9% in Group 2 (P=>0.05). Thus these two parameters were similar in both groups. Also, the number of shocks per session was 3066.1 +- 346.3 in Group 1 and 3148+-621.0 in Group 2. This difference was no significant (P=0.49). Our study suggests that the treatment of proximal ureteric stones with ESWL in the prone position is a safe and effective as when the patient is placed in the supine position. (author)

  14. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial

    Science.gov (United States)

    Lai, Ta-Wei; Ma, Hsiao-Li; Lee, Meng-Shiunn; Chen, Po-Ming; Ku, Ming-Chou

    2018-01-01

    Objectives: Extracorporeal shockwave therapy (ESWT) and corticosteroid injection (CSI) are treatment options for plantar fasciitis. Their clinical outcome comparison remains a debate. Also, the thickness changes of the plantar fascia on objective evaluation under the medium energy ESWT and CSI therapy are elusive. Methods: A total of 97 patients with chronic plantar fasciitis were enrolled in the randomized prospective trial. Forty-seven patients received extracorporeal shock wave therapy (ESWT), and fifty patients received corticosteroid injection (CSI). The thickness of the plantar fascia was evaluated respectively before ESWT and CSI, and at the 4th and 12th week after ESWT and CSI by ultrasonography. Pain level and clinical outcomes were recorded using visual analogue scale (VAS) and 100-points scoring systems. Correlation analysis was performed between the thickness change and clinical outcome. Results: Under ultrasonography, we observed more increase of plantar fascia thickness of ESWT group than CSI group at 4th week (p=0.048). VAS of plantar fasciitis patients receiving ESWT was lower than those who received corticosteroid injection (0.001 and pplantar fascia thickness at 4th week was positively correlated with the decrease of VAS score at 12th week follow-up (R=0.302, P=0.039). Conclusions: At 4th week after treatment, the thickness of plantar fascia increased. Then it decreased gradually, but not to the baseline at 12th week. On the pain level outcome at 12th week, extracorporeal shockwave therapy (ESWT) was more efficient than corticosteroid injection (CSI) on chronic plantar fasciitis. The more change of plantar fascia after ESWT, the more efficient on clinical outcome. PMID:29504578

  15. Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience.

    Science.gov (United States)

    Eze, Kenneth C; Irekpita, E; Salami, T A

    2016-01-01

    The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration, decline of the hospital services

  16. High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsy.

    Science.gov (United States)

    Canty, D J; Dhara, S S

    2009-12-01

    High frequency jet ventilation has been shown to be beneficial during extra-corporeal shock wave lithotripsy as it reduces urinary calculus movement which increases lithotripsy efficiency with better utilisation of shockwave energy and less patient exposure to tissue trauma. In all reports, sub-glottic high frequency jet ventilation was delivered through a tracheal tube or a jet catheter requiring paralysis and direct laryngoscopy. In this study, a simple method using supraglottic jet ventilation through a laryngeal mask attached to a circle absorber anaesthetic breathing system is described. The technique avoids the need for dense neuromuscular blockade for laryngoscopy and the potential complications associated with sub-glottic instrumentation and sub-glottic jet ventilation. The technique was successfully employed in a series of patients undergoing lithotripsy under general anaesthesia as an outpatient procedure.

  17. Catastrophic complication following injection and extracorporeal shock wave therapy of a medial femoral condyle subchondral cystic lesion in a 14 year old Arabian mare

    Directory of Open Access Journals (Sweden)

    Darla K. Moser

    2017-05-01

    Full Text Available This report describes fibrous cyst lining injection and extracorporeal shock wave therapy (ESWT of a medial femoral condyle (MFC subchondral cystic lesion (SCL resulting in catastrophic MFC fracture in an Arabian mare. The mare was presented for evaluation of a severe hind limb lameness of approximately 4 months duration. On presentation, a non-weight bearing lameness of the left hind limb with severe effusion and soft tissue swelling of the stifle region was noted. Radiographic evaluation of the stifle revealed a large SCL of the MFC with associated osteoarthritis. Arthroscopic guided intra-lesional injection of the SCL with corticosteroids and autologous bone marrow concentrate was performed followed by ESWT of the MFC. The mare was discharged walking comfortably 48-hours post-operatively. An acute increase in lameness was noted 14 days post-operatively. Imaging revealed catastrophic fracture of the left MFC. Possible mechanisms leading to failure of the MFC secondary to the described treatment are discussed.

  18. Functional estimation of kidneys after extracorporeal shock wave therapy (ESWL) by clearance. Funktionsbeurteilung der Nieren nach extrakorporaler Stosswellenlithotripsie (ESWL) mittels Nieren-Clearance

    Energy Technology Data Exchange (ETDEWEB)

    Sydow, K.; Kirschner, P.; Brien, G.; Buchali, K.; Frenzel, R. (Humboldt-Universitaet, Berlin (Germany). Medizinische Fakultaet)

    1991-10-01

    35 patients were scintiscanned with 99m-Tc-DTPA to determine the effects of extracorporeal shock waves used to desintegrate renal concrements may have on the patients renal function. The therapy was conducted using a standard Lithostar unit (Siemens) (20 patients) and an additional overtable module (15 patients). Functional scintigraphy was performed using a gamma camera before lithotripsy, and on the first day after it. Further control investigations were performed one or two weeks later and two till six months later. In both groups most of the patients developed temporary restrictions in renal function, some of them irreversible restrictions. Functional losses were found to be less severe with the use of the overtable module than with the standard Lithostar unit. (orig.).

  19. Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis.

    Science.gov (United States)

    Mi, Yuanyuan; Ren, Kewei; Pan, Haiyan; Zhu, Lijie; Wu, Sheng; You, Xiaoming; Shao, Hongbao; Dai, Feng; Peng, Tao; Qin, Feng; Wang, Jian; Huang, Yi

    2016-08-01

    The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

  20. Impact on the Quality of Erections after Completing a Low-Intensity Extracorporeal Shock Wave Treatment Cycle on a Group of 710 Patients

    Directory of Open Access Journals (Sweden)

    Héctor A. Corredor Ayala

    2017-01-01

    Full Text Available Objective. The aim of this study is to evaluate the response to low-intensity extracorporeal shock wave therapy in a group of patients with organic vascular erectile dysfunction. Materials and Methods. This is an observational retrospective study. The researchers reviewed 710 patients with a clinical diagnosis of organic vascular erectile dysfunction (ED of more than 3-month duration from male sexual health clinics of the Boston Medical Group from 12 cities in Spain and 4 in Mexico. Patients received 5 outpatient shock wave therapy sessions. They were evaluated with the erection hardness score (EHS before the first session (n = 710, at the end of the last session (n = 710, and one month after the last session (n = 412. Results. In the first examination, the EHS improved in 43.1% (306/710 of subjects compared to the baseline measurement and ability to penetrate increased from 26.8% to 44% (p<0.0001. In the second examination, the ability to penetrate was 37.9%, lower than in the first (p=0.042 but higher than the baseline (p=0.0001. Conclusions. The results suggest that the shock wave therapy with or without concomitant treatments improved the quality of erections in patients with erectile dysfunction treated in specialised male sexual health clinics. This trial is registered with NCT03237143.

  1. In-situ spinelization and thermal shock performance of refractory castables

    OpenAIRE

    Cintra, G. B.; Braulio, M. A. L.; Brito, M. A. M.; Bittencourt, L. R. M.; Pandolfelli, V. C.

    2008-01-01

    O desempenho de uma panela siderúrgica está atrelado ao seu revestimento refratário. Devido à elevada agressividade da escória presente no aço fundido, é fundamental a utilização de revestimentos de alta resistência à corrosão. Concretos refratários aluminosos contendo espinélio são amplamente utilizados em tal aplicação por apresentarem esta característica. Neste contexto, destacam-se os concretos refratários do sistema alumina-magnésia, uma vez que a formação de espinélio in-situ é benéfica...

  2. Development of in-situ laser based cutting technique for shock absorber rear nut in pressurized heavy water reactors. CP-2.1

    International Nuclear Information System (INIS)

    Vishwakarma, S.C.; Jain, R.K.; Upadhyaya, B.N.; Choubey, Ambar; Agrawal, D.K.; Oak, S.M.

    2007-01-01

    We have developed a laser based cutting technique for shock absorber rear nuts in pressurized heavy water reactors (PHWRs). This technique has been successfully used for in-situ laser cutting at RAPS-3 reactor. The technique consists of a motorized compact fixture, which holds a fiber optic beam delivery cutting nozzle and can be operated remotely

  3. Extracorporeal Shock Wave Therapy for Achilles and Patellar Tendinopathy: Meta-Analysis and a Systematic Review of the Literature

    OpenAIRE

    Punnoose, Anuj; Norrish, Alan; Pak, Katie

    2017-01-01

    Background: Sports related injuries such as lower limb tendinopathies can result in long-standing impairment of athletic performance. In recent years, treatment interventions like eccentric exercises, Platelet Rich Plasma (PRP) injections and Extracorporeal Shockwave Therapy (ESWT) have gained popularity among Physiotherapists and sports clinicians, but the evidence of their effectiveness is very limited. Purpose: To investigate the effectiveness of ESWT on Achilles and Patellar tendinopathy....

  4. [The Feasibility of CT Attenuation Value to Predict the Composition of Upper Urinary Calculi and Success Rate of Extracorporeal Shock Wave Lithotripsy].

    Science.gov (United States)

    Fan, Yu; Liu, Zhen-Hua; Wei, Qiang; Tang, Zhuang; Liu, Liang-Ren; Ren, Bi-Hua; Li, Xiang; Bao, Yi-Ge; Yang, Lu

    2017-09-01

    To explore the feasibility of CT attenuation value (CTvalue) to predict the composition of upper urinary calculi and the number of shock waves (NSW) and success rate (SR) of extracorporeal shock wave lithotripsy (ESWL). A total of 146 patients with upper urinary calculi treated by ESWL were included. CT scan was performed before ESWL. Upper urinary calculi with the maximum diameters of less than or equal to 2 cm were included. Infrared spectroscopy was used to analyze the composition of calculi. The effect of ESWL was estimated at 1 month followup. The factors that influence NSW and SR of ESWL were analyzed by correlation analysis. The CTvalue of calcium calculi were larger than that of noncalcium calculi ( P ESWL and CTvalues of calculi between the patients with different ages,skintostone distances and genders were not statistically significant. The partial correlation analysis found that CTvalue and long diameter of calculi were positively correlated with the NSW ( P ESWL ( P ESWL in subgroup analysis. The power of CTvalue to predict upper urinary calculi composition is insufficient. Higher CTvalue suggests more NSW in ESWL,but CTvalue is not suitable to predict SR of ESWL.

  5. Is quantitative diffusion-weighted MRI a valuable technique for the detection of changes in kidneys after extracorporeal shock wave lithotripsy?

    Science.gov (United States)

    Hocaoglu, Elif; Inci, Ercan; Aydin, Sibel; Cesme, Dilek Hacer; Kalfazade, Nadir

    2015-01-01

    Objective The aim of this study was to evaluate the capability and the reliability of diffusion-weighted imaging (DWI) in the changes of kidneys occurring after extracorporeal shock wave lithotripsy (ESWL) treatment for renal stones. Materials and Methods A total of 32 patients who underwent ESWL treatment for renal stone disease between June and December 2011 were enrolled in this prospective study. Color Doppler ultrasonography (CDUS) and DWI were performed before and within 24 hours after ESWL. DWI was obtained with b factors of 0, 500 and 1000 s/mm2 at 1.5 T MRI. Each of Resistive index (RI) and ADC values were calculated from the three regions of renal upper, middle and lower zones for both of the affected and contralateral kidneys. Paired sample t test was used for statistical analyses. Results After ESWL, the treated kidneys had statistically significant lower ADC values in all different regions compared with previous renal images. The best discriminative parameter was signal intensity with a b value of 1000 s/mm2. The changes of DWI after ESWL were noteworthy in the middle of the treated kidney (pESWL (p>0.05). Conclusion DWI is a valuable technique enables the detection of changes in DWI after ESWL treatment that may provide useful information in prediction of renal damage by shock waves, even CDUS is normal. PMID:25928520

  6. Extracorporeal shock wave lithotripsy (ESWL) of a renal calculus in a liver transplant recipient: report of a severe complication--a case report.

    Science.gov (United States)

    Friedersdorff, F; Buckendahl, J; Fuller, T F; Cash, H

    2010-11-01

    Extracorporeal shock wave lithotripsy (ESWL) has evolved as a standard treatment modality for calculi of the upper urinary tract. Noninvasive ESWL shows rare life-threatening complications. Herein we have reported the case of a liver transplant recipient who developed severe renal hemorrhage after ESWL of a renal calculus. Transfusion of erythrocytes and platelets led to anaphylactic shock with acute renal failure requiring intensive care. The patient fully recovered shortly thereafter and was discharged home with a residual left kidney stone measuring 8 mm. A 55-year-old man with a single left kidney underwent ESWL due to symptomatic left nephrolithiasis. He had undergone successful liver transplantation 11 years earlier. At the time of ESWL his liver functions were normal and his serum creatinine level was 1.3 mg/dL. Two weeks before the treatment a double pigtail ureteral stent was inserted because of a symptomatic left hydronephrosis. Several hours after ESWL treatment the patient complained of left-sided flank pain. An ultrasound revealed a large subcapsular hematoma of the left kidney, which was confirmed using abdominal computed tomography (CT). With the patient being hemodynamically stable, we opted for conservative management. Despite postinterventional complications, the patient made a fast recovery. ESWL is a noninvasive, safe, and efficient method to treat renal calculi. Patients who are at risk for hemorrhage should undergo close postinterventional monitoring, including red blood cell count and renal ultrasound. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Treatment of distal ureteric stones-comparative efficacy of transureteral pneumatic lithotripsy and extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Wazir, B.G.; Nawaz, A.; Orakzai, A.N.

    2015-01-01

    Ureteric stones greater than 6mm require intervention. Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) with intra-corporeal lithotripsy (ICL) are two least invasive therapies. Both show acceptable stone clearance. What should be the first line of treatment in distal ureteric stones. We conducted this study to compare the efficacy of ESWL and pneumatic ICL in order to develop clear cut treatment guidelines. Methods: This randomized control trial was conducted at Institute of Kidney Diseases, Peshawar from June 2011 to June 2012. Two hundred and twenty-four patients with distal ureteric stones 6-12 mm in size were included. Patients were randomized into two groups. Group-A patients were treated with URS plus ICL and Group-B with ESWL. Patients were evaluated for stone clearance after 2 weeks, with X-ray KUB and ultrasound. All the data were recorded in a proforma and analysed in SPSS 10. Fisher's exact test was applied to compare the efficacy and a p-value of 0.05 was considered significant. Results: Out of 112 patients in Group-A, 75 (67%) were males and 37 (33%) were females while in Group-B 79 (70.5%) were males and 33 (29.5%) were females. The mean age in Group-A was, 48.73 ± 16.23 years whereas it was 6 ± 14.58 years in Group-B. Overall, mean age was 47.36 ± 15.4 years. Mean stone size was 9.18 ± 1.6 mm. At follow up (2 weeks post-operative) URS with ICL was successful in 101 (90.2%) patients while ESWL was successful in 75 (67%) patients (p-value=0.0001). Conclusion: Extracorporeal shockwave lithotripsy shows acceptable stone clearance but ureteroscopy with intra-corporeal lithotripsy shows superior results in distal ureteric stones. (author)

  8. Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

    Directory of Open Access Journals (Sweden)

    Catalin Pricop

    2014-10-01

    Full Text Available The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS and extracorporeal shock waves lithotripsy (ESWL for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2, calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI, waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm2 was 509 (SD=180, while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201. In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2 was 892 (SD=436, while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429. The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones.

  9. The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

    Science.gov (United States)

    Hanada, M.; Takahashi, M.; Matsuyama, Y.

    2017-12-01

    In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (Pplantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

  10. Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

    Science.gov (United States)

    Argüelles-Salido, E; Campoy-Martínez, P; Aguilar-García, J; Podio-Lora, V; Medina-López, R

    2014-03-01

    To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  11. Capsulotomy for treatment of compartment syndrome in patients with post extracorporeal shock wave lithotripsy renal hematomas: safe and effective, but also advisable?

    Science.gov (United States)

    Al Ghazal, Andreas; Schnoeller, Thomas J; Baechle, Christian; Steinestel, Julie; Jentzmik, Florian; Steffens, Sandra; Hirning, Christian; Schrader, Mark; Schrader, Andres J

    2014-07-08

    To examine whether surgical decompression of hematomas by capsulotomy can help to improve long-term renal function following extracorporeal shock wave lithotripsy (SWL). This study retrospectively identified 7 patients who underwent capsulotomy for post SWL renal hematomas between 2008 and 2012. The control group comprised 8 conservatively treated patients. The median follow-up time was 22 months. The two groups were comparable in age, gender, body mass index, risk factors for developing hematomas (renal failure, urinary flow impairment, indwelling ureteral stent and diabetes mellitus) and the selected SWL modalities. Hematoma size was also similar. However, significantly more patients in the surgical group had purely intracapsular hematomas (85.7% vs. 37.5%) without a potentially pressure-relieving capsular rupture. There were no significant differences in the post-interventional drop in hemoglobin, rise in retention parameters or drop in glomerular filtration rate (GFR). No capsulotomy-related complications were observed, but surgery required a significantly longer hospital stay than conservative management (median, 9 days vs. 5 days). The two groups also showed comparable recovery of renal function at long-term follow-up (median change in GFR from baseline, 97.1% and 97.8%, respectively). Since renal function did not differ between the two treatment groups, the conservative management remains the standard treatment for post-SWL renal hematoma.

  12. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.

    Science.gov (United States)

    Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

    2013-11-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ≤ 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment.

  13. Effects of Focused Extracorporeal Shock Waves on Bone Marrow Mesenchymal Stem Cells in Patients with Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Zhai, Lei; Sun, Nan; Zhang, Bo; Liu, Shui-Tao; Zhao, Zhe; Jin, Hai-Chao; Ma, Xin-Long; Xing, Geng-Yan

    2016-03-01

    To observe the effect of extracorporeal shock waves (ESWs) on bone marrow mesenchymal stem cells (MSCs) in patients with avascular necrosis of the femoral head, we collected bone marrow donated by patients and then cultivated and passaged MSCs in vitro using density gradient centrifugation combined with adherence screening methods. The P3 generation MSCs were divided into the ESW group and the control group. The cell counting kit for MSCs detected some proliferation differences. Cytochemistry, alkaline phosphatase staining and Alizarin red staining were used to determine alkaline phosphatase content. Simultaneously, real-time polymerase factor α1, osteocalcin and peroxisome proliferator-activated receptor γ. Together, the results of our study first indicate that moderate ESW intensity, which is instrumental in enhancing MSC proliferation, inducing conversion of MSCs into osteoblasts, and inhibiting differentiation of MSCs into adipocytes from MSCs, is one of the effective mechanisms for treating avascular necrosis of the femoral head. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  14. [Ureteral stricture after extracorporeal shock wave lithotripsy. Case report and overview of the spectrum of rare side effects of modern ESWL treatment].

    Science.gov (United States)

    Finter, F; Rinnab, L; Simon, J; Volkmer, B; Hautmann, R; Kuefer, R

    2007-07-01

    Extracorporeal shock wave lithotripsy (ESWL) is considered a very safe and noninvasive procedure for the treatment of urolithiasis. Achievements in the technical development of recent decades resulted in a continuous reduction of side effects. One of our patients, a woman with cystinuria, developed a temporary ureteral stricture after several sessions of ESWL. Encouraged by this observation we set out to explore--based on a MEDLINE literature search--published reports of more severe side effects observed in modern ESWL therapy. Besides hydronephrosis and renal colic the most common side effects were renal and perirenal hematomas in up to 4% in the larger series. Uncommon extrarenal complications are described mostly in case reports, which are also outlined in this report. The injury of visceral organs (liver, spleen, gut, pancreas) was published most frequently. A rupture or dissection of an abdominal aortic aneurysm as an outstanding serious complication was also reported several times. Taking obvious and well-known contraindications into consideration and carefully preparing the patients for the therapy (i.e., checking hemostasis, drug history), ESWL is a very safe procedure with a low risk of serious complications. Yet, postoperative clinical and ultrasound monitoring seems to be essential especially with respect to the increasing numbers of outpatient procedures.

  15. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

    International Nuclear Information System (INIS)

    Wang, Li-Jen; Wong, Yon-Cheong; Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen; See, Lai-Chu

    2005-01-01

    The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P 3 (P 3 (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

  16. The success of extracorporeal shock-wave lithotripsy based on the stone-attenuation value from non-contrast computed tomography

    Science.gov (United States)

    Massoud, Amr M.; Abdelbary, Ahmed M.; Al-Dessoukey, Ahmad A.; Moussa, Ayman S.; Zayed, Ahmed S.; Mahmmoud, Osama

    2014-01-01

    Objective To determine the utility of the urinary stone-attenuation value (SAV, in Hounsfield units, HU) from non-contrast computed tomography (NCCT) for predicting the success of extracorporeal shock-wave lithotripsy (ESWL). Patients and methods The study included 305 patients with renal calculi of ⩽30 mm and upper ureteric calculi of ⩽20 mm. The SAV was measured using NCCT. Numerical variables were compared using a one-way analysis of variance with posthoc multiple two-group comparisons. Univariate and multivariate regression analysis models were used to test the preferential effect of the independent variable(s) on the success of ESWL. Results Patients were grouped according to the SAV as group 1 (⩽500 HU, 81 patients), group 2 (501–1000 HU, 141 patients) and group 3 (>1000 HU, 83 patients). ESWL was successful in 253 patients (83%). The rate of stone clearance was 100% in group 1, 95.7% (135/141) in group 2 and 44.6% (37/83) in group 3 (P = 0.001). Conclusions The SAV value is an independent predictor of the success of ESWL and a useful tool for planning stone treatment. Patients with a SAV ⩾956 HU are not ideal candidates for ESWL. The inclusion criteria for ESWL of stones with a SAV 30 kg/m2 and a lower calyceal location make them less ideal for ESWL. PMID:26019941

  17. Plain radiography, renography, and [sup 99m]Tc-DMSA renal scintigraphy before and after extracorporeal shock wave lithotripsy for urolithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Munck, O.; Gerquari, I.; Moeller, J.T.; Jensen, L.I.; Thomsen, H.S. (Dept. of Clinical Physiology, Dept. of Nuclear Medicine, Dept. of Diagnostic Radiology, Herlev Hospital, Copenhagen Univ. (Denmark))

    1992-11-01

    Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, [sup 131]I-hippuran probe renography, and [sup 99m]Tc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL. (orig.).

  18. A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function.

    Science.gov (United States)

    Reznik, J E; Biros, E; Sacher, Y; Kibrik, O; Milanese, S; Gordon, S; Galea, M P

    2017-01-01

    Neurogenic heterotopic ossification (NHO) occurs as a complication of traumatic brain injury (TBI). Management of clinically significant NHO remains variable. Complications of mature NHO include limitation of mobility. The effect of the extracorporeal shock wave therapy (ESWT) on range of motion at hip and knee, and function in patients with TBI with chronic NHO was investigated. A series of single-case studies applying ESWT to chronic NHO at the hip or knee of 11 patients with TBI were undertaken at a rehabilitation hospital. Participants received four applications of high-energy EWST delivered to the affected hip or knee over a period of 8 weeks. Two-weekly follow- up assessments were carried out; final assessments were made 3 and 6 months post-intervention. Range of motion (ROM) and Functional Reach (FR) or Modified Functional Reach (MFR) were measured. Application of high-energy ESWT was associated with significant improvement in ROM (flexion) of the NHO-affected knee (Tau = 0.833, 95% CI 0.391-1.276, p = 0.002) and significant improvement of FR (Overall Tau 0.486, 95% CI 0.141-0.832, p = 0.006); no significant improvement in hip ROM or MFR. ESWT may improve mobility and balance of patients with TBI who have chronic NHO.

  19. Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

    Science.gov (United States)

    Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

    2016-01-01

    JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

  20. Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

    Science.gov (United States)

    Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

    2014-01-01

    Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

  1. Outcomes in Cardiogenic Shock Patients with Extracorporeal Membrane Oxygenation Use: A Matched Cohort Study in Hospitals across the United States

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    Rayan El Sibai

    2018-01-01

    Full Text Available Background. ECMO is increasingly used for patients with critical illnesses. This study examines ECMO use in patients with cardiogenic shock in US hospitals and associated outcomes (mortality, hospital length of stay, and total hospital charges. Methods. A matched cohort retrospective study was conducted using the 2013 Nationwide Emergency Department Sample. Cardiogenic shock visits were matched (1 : 1 and compared based on ECMO use. Results. Patients with ECMO (N=802 were compared to patients without ECMO (N=805. Mortality was higher in the ECMO group (48.9% versus 4.0%, p < 0.001. Visits with ECMO use also had higher average hospital charges ($580,065.8 versus $156,436.5, p < 0.001 and average hospital LOS (21.3 versus 11.6 days, p < 0.001. After adjusting for confounders, mortality (OR = 8.52 (95% CI: 2.84–25.58 and charges (OR = 1.03 (95% CI: 1.02–1.05 remained higher in the ECMO group, while LOS was similar (OR = 1.01 (95% CI: 0.99–1.02. Conclusions. Patients with cardiogenic shock who underwent ECMO had increased mortality and higher cost of care without significant increase in LOS when compared to patients with cardiogenic shock without ECMO use. Prospective evaluation of this observed association is needed to improve outcomes and resources’ utilization further.

  2. Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi.

    Science.gov (United States)

    Yang, Teng-Kai; Yang, Hung-Ju; Lee, Liang-Min; Liao, Chun-Hou

    2013-07-01

    Effective stone disintegration by extracorporeal shockwave lithotripsy (ESWL) may depend on patient- and stone-related factors. We investigated predictors of disintegration failure in ESWL for a solitary ureteral calculus. From July 2008 to May 2010, 203 patients who underwent ESWL for a solitary ureteral calculus were enrolled. Clinical and radiologic data were collected, and factors related to ESWL failure were analyzed. Fifty-two patients (25.6%) showed ESWL failure, with a mean follow-up of 41 days. Forty patients (19.7%) required retreatment, including 12 who underwent repeat ESWL and 28 who underwent curative ureteroscopy. Patients with ESWL failure had significantly higher body weight, body mass index (BMI), and buttock circumference (BC) than patients for whom ESWL was successful. Univariate analysis showed that stone burden (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.06) and BC (OR, 1.06; 95% CI, 1.01-1.11) were predictors of ESWL failure, while BMI was a potential predictor with borderline significance (OR, 1.09; 95% CI, 0.99-1.20). Multivariate analysis showed that stone burden (OR, 1.04; 95% CI, 1.03-1.06) was a significant predictor for all patients. On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor (OR, 1.35; 95% CI, 1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI (OR, 1.47; 95% CI, 1.13-1.91) for upper ureteral calculi. Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi, respectively. Copyright © 2012. Published by Elsevier B.V.

  3. High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

    Science.gov (United States)

    Verstraelen, F U; In den Kleef, N J H M; Jansen, L; Morrenhof, J W

    2014-09-01

    There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. Level I, therapeutic study

  4. Low-Intensity Extracorporeal Shock Wave Therapy Enhances Brain-Derived Neurotrophic Factor Expression through PERK/ATF4 Signaling Pathway

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    Bohan Wang

    2017-02-01

    Full Text Available Low-intensity extracorporeal shock wave therapy (Li-ESWT is used in the treatment of erectile dysfunction, but its mechanisms are not well understood. Previously, we found that Li-ESWT increased the expression of brain-derived neurotrophic factor (BDNF. Here we assessed the underlying signaling pathways in Schwann cells in vitro and in penis tissue in vivo after nerve injury. The result indicated that BDNF were significantly increased by the Li-ESWT after nerve injury, as well as the expression of BDNF in Schwann cells (SCs, RT4-D6P2T in vitro. Li-ESWT activated the protein kinase RNA-like endoplasmic reticulum (ER kinase (PERK pathway by increasing the phosphorylation levels of PERK and eukaryotic initiation factor 2a (eIF2α, and enhanced activating transcription factor 4 (ATF4 in an energy-dependent manner. In addition, GSK2656157—an inhibitor of PERK—effectively inhibited the effect of Li-ESWT on the phosphorylation of PERK, eIF2α, and the expression of ATF4. Furthermore, silencing ATF4 dramatically attenuated the effect of Li-ESWT on the expression of BDNF, but had no effect on hypoxia-inducible factor (HIF1α or glial cell-derived neurotrophic factor (GDNF in Schwann cells. In conclusion, our findings shed new light on the underlying mechanisms by which Li-ESWT may stimulate the expression of BDNF through activation of PERK/ATF4 signaling pathway. This information may help to refine the use of Li-ESWT to further improve its clinical efficacy.

  5. Investigating the Effect of Extracorporeal Shock Wave Therapy on reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial

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    Saeid Khosrawi

    2017-01-01

    Full Text Available Background: Knee pain, is one of the most common causes of patients' referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months, who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT. Pain scores of all patients were measured using the Visual Analog Scale (VAS and McGill Pain Questionnaire (MPQ (total and present pain indexes [TPIs and PPIs] before intervention, immediately after intervention (3rd week, and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week: P=0.02, P= 0.04 respectively; and 8 weeks after the end of treatment: P=0.01, P= 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001. Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB.

  6. Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    Capan, Nalan; Esmaeilzadeh, Sina; Oral, Aydan; Basoglu, Ceyhun; Karan, Ayse; Sindel, Dilsad

    2016-07-01

    The aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. A double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. Both rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. The rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

  7. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis.

    Science.gov (United States)

    Trentini, R; Mangano, T; Repetto, I; Cerruti, P; Kuqi, E; Trompetto, C; Franchin, F

    2015-09-01

    Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.

  8. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Li; Fu, Xiao-Bing; Chen, Shuo; Zhao, Zhan-Bo; Schmitz, Christoph; Weng, Chang-Shui

    2018-04-19

    This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English-language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration's "risk of bias" tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow-up duration were extracted. The fixed or random-effects model was used to calculate the pooled effect sizes according to studies' heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta-analysis. The meta-analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73-fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30-6.04, P SMD) = 30.45; 95% CI: 23.79-37.12; P SMD = -2.86, 95% CI:-3.78 to -1.95, P SMD = -19.11, 95% CI: -23.74 to -14.47, P infection by 53% (OR = 0.47, 95% CI: 0.24-0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher-quality and well-controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds. © 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  9. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach.

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    Kang Su Cho

    Full Text Available To investigate whether skin-to-stone distance (SSD, which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL in patients with upper ureter stones.We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4-20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU, and SSD were determined on pretreatment non-contrast computed tomography (NCCT. For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile.In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032. The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL.Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL.

  10. Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones

    Science.gov (United States)

    Tao, Tao; Zhang, Ming; Zhang, Qi-Jie; Li, Liang; Li, Tao; Zhu, Xiao; Li, Ming-Dong; Li, Gui-Hua; Sun, Shu-Xia

    2017-01-01

    AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs ERCP only for problematic and large common bile duct (CBD) stones. METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups, an “ESWL + ERCP group” and an “ERCP-only” group. For ESWL + ERCP cases, ESWL was performed prior to ERCP. Clearance of the CBD, complications related to the ESWL/ERCP procedure, frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups. RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session (74.2% vs 71.0%, P = 0.135), but a higher clearance rate within the second treatment session (84.4% vs 51.6%, P = 0.018) and total stone clearance (96.0% vs 86.0%, P = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min vs 59 ± 28 min, P = 0.034) and the rate of mechanical lithotripsy use (20% vs 30%, P = 0.025), but also raised the clearance rate of extremely large stones (80.0% vs 40.0%, P = 0.016). Post-ERCP complications were similar for the two groups. CONCLUSION Based on the higher rate of successful stone removal and minimal complications, ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones. PMID:28785149

  11. Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

    Science.gov (United States)

    Jeong, U-Seok; Lee, Sinwoo; Kang, Junghun; Han, Deok Hyun; Park, Kwan Hyun

    2013-01-01

    Purpose Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. Materials and Methods A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. Results The final analysis was for 42 boys and 22 girls (mean age, 9.2±5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. Conclusions Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation. PMID:23878689

  12. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

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    Mingchao Li

    Full Text Available Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL, the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31, significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53, significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04, significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39. Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77, anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99 and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72 in the α-blocker group was associated with a higher incidence.Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

  13. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

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    Wang, Li-Jen; Wong, Yon-Cheong [Chang Gung University, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei (Taiwan); Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen [Chang Gung University, Department of Urology, Chang Gung Memorial Hospital, Taipei (Taiwan); See, Lai-Chu [Chang Gung University, Department of Biostatistics Center, Chang Gung Memorial Hospital, Taipei (Taiwan)

    2005-11-01

    The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P<0.0001), a stone burden of more than 700 mm{sup 3} (P<0.0001), a maximal stone density of more than 900 HU (P=0.0008) and nonround/oval stones (P=0.0007) were associated with ESWL failure outcomes. Multivariate analysis demonstrated that a stone burden of more than 700 mm{sup 3} (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

  14. Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for renal calculi between 20-30 mm: a multivariate analysis model.

    Science.gov (United States)

    El-Assmy, Ahmed; El-Nahas, Ahmed R; Abo-Elghar, Mohamed E; Eraky, Ibrahim; El-Kenawy, Mahmoud R; Sheir, Khaled Z

    2006-03-23

    The first-line management of renal stones between 20-30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20-30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis. Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%. Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20-30 mm. High probability of stone clearance is obtained with single stone ESWL in such controversial groups and can define patients who would need other treatment modality.

  15. Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.

    Science.gov (United States)

    Iqbal, Nadeem; Malik, Yashfeen; Nadeem, Utbah; Khalid, Maham; Pirzada, Amna; Majeed, Mehr; Malik, Hajra Arshad; Akhter, Saeed

    2018-05-01

    To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3 rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.

  16. An Evaluation of Electroacupuncture at the Weizhong Acupoint (BL-40 as a Means of Relieving Pain Induced by Extracorporeal Shock Wave Lithotripsy

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    Wei-Ta Chen

    2014-01-01

    Full Text Available Background. Extracorporeal shock wave lithotripsy (ESWL is the preferred option for urolithiasis treatment. However, intensities of pain may be induced and the sedative anesthetic or analgesics were usually needed. The aim of this study was to develop an improved acupuncture-assisted anesthesia approach in pain relief. Methods. We conducted a single-blind, randomized controlled study in China Medical University Hospital. Patients treated by ESWL due to upper urolithiasis were randomly divided into control group, sham-EA group, and 100 Hz EA group. The high frequency electroacupuncture (EA was applied at the Weizhong acupoint (100 Hz EA group for 20 minutes prior to the ESWL. In the sham-EA group, the same procedures were performed as those of 100 Hz EA group but no electric current was given to stimulate the acupoints. In the control group, no action was taken before operation. The information including the numbers and dosage of analgesic requirements, pain score, vital signs, and the satisfaction of procedure was collected. Results. A total of 74 subjects were recruited and we found that the interval to the first request analgesic, the number/total dosage of additional analgesic, recovery time from anesthesia, and the satisfaction were all better in both the 100 Hz EA and the sham-EA group. The 100 Hz EA also showed better relief of painful sensations by delaying the onset of pain. Conclusions. The 100 Hz EA and the sham-EA can effectively relieve pain due to ESWL as well as reducing the dosage of opium analgesic used.

  17. Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function.

    Science.gov (United States)

    Wang, Lei; Jiang, Yuquan; Jiang, Zheng; Han, Lizhang

    2016-01-01

    Latest studies show that low-energy extracorporeal shock wave therapy (ESWT) can upregulate levels of vascular endothelial growth factor (VEGF). VEGF can ease nervous tissue harm after spinal cord injury (SCI). This study aims to explore whether low-energy ESWT can promote expression of VEGF, protect nervous tissue after SCI, and improve motor function. Ninety adult female rats were divided into the following groups: Group A (simple laminectomy), Group B (laminectomy and low-energy ESWT), Group C (spinal cord injury), and Group D (spinal cord injury and low-energy ESWT). Impinger was used to cause thoracic spinal cord injury. Low-energy ESWT was applied as treatment after injury three times a week, for 3 weeks. After SCI, the Basso, Beattie, and Bresnahan (BBB) scale was used to evaluate motor function over a period of 42 days at different time points. Hematoxylin and eosin (HE) staining was used to evaluate nerve tissue injury. Neuronal nuclear antigen (NeuN) staining was also used to evaluate loss of neurons. Polymerase chain reaction was used to detect messenger RNA (mRNA) expression of VEGF and its receptor fms-like tyrosine kinase 1 (Flt-1). Immunostaining was used to evaluate VEGF protein expression level in myeloid tissue. BBB scores of Groups A and B showed no significant result related to dyskinesia. HE and NeuN staining indicated that only using low-energy ESWT could not cause damage of nervous tissue in Group B. Recovery of motor function at 7, 35, and 42 days after SCI in Group D was better than that in Group C (Pfunction. It can be regarded as one mode of clinical routine adjunctive therapy for spinal injury.

  18. Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

    Science.gov (United States)

    Sharma, Rakesh; Das, Ranjit Kumar; Basu, Supriya; Dey, Ranjan Kumar; Gupta, Rupesh; Deb, Partha Pratim

    2017-01-01

    Purpose Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients' mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications. Conclusions Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi. PMID:28261679

  19. Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

    Directory of Open Access Journals (Sweden)

    Rakesh Sharma

    2017-03-01

    Full Text Available Purpose: Extracorporeal shock wave lithotripsy (ESWL is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods: The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results: Eighty-eight patients (male, 47; female, 41 were available for analysis. The patients’ mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155 than did group 1 (mean, 3,859; p=0.05 or group 2 (mean, 3,872; p=0.04. The fragmentation rate was similar in group 3 (96.7% and groups 1 (81.5%, p=0.12 and 2 (87.1%, p=0.16. Overall clearance in group 3 was significantly improved (83.3% compared with that in groups 1 (63.0%, p=0.02 and 2 (64.5%, p=0.02 and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21. The analgesic requirement in group 2 was higher than in the other groups (p=0.00. Group 2 patients also had more grade IIIa (2/3 and IIIB (1/2 complications. Conclusions: Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi.

  20. The effect of extracorporeal shock wave lithotripsy on kidney and adjacent tissue detected by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Saiko, Yasushi; Hirose, Tomonobu; Yoshida, Masahiko; Saito, Isao

    1995-01-01

    Etracorporeal shock wave lithotripsy (ESWL) using YACHIYODA SZ1 was performed on 12 patients with renal stones and the effect on the kidney and adjacent tissue was evaluated by magnetic resonance imaging(MRI) before and after treatment. Some changes were seen in 6 of the 12 (50%) patients; perirenal fluid collection in 2 of the 12 (16.7%) patients, subcapsular hematoma in 2 of the 12 (16.7%) patients, renal enlargement in 5 of the 12 (31.3%) patients, increased signal intensity in perirenal tissue in 6 of the 12 (50%) patients, and loss of the corticomedullary junction in 2 out of 9 patients (22%). These findings indicated fewer changes in the kidney after ESWL using YACHIYODA SZ1 than in the other reports. MRI is also concluded to be effective to detect the changes of the kidney after ESWL. (author)

  1. The effect of extracorporeal shock wave lithotripsy on kidney and adjacent tissue detected by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Saiko, Yasushi; Hirose, Tomonobu; Yoshida, Masahiko; Saito, Isao [Tokyo Kyosai Hospital (Japan)

    1995-08-01

    Etracorporeal shock wave lithotripsy (ESWL) using YACHIYODA SZ1 was performed on 12 patients with renal stones and the effect on the kidney and adjacent tissue was evaluated by magnetic resonance imaging(MRI) before and after treatment. Some changes were seen in 6 of the 12 (50%) patients; perirenal fluid collection in 2 of the 12 (16.7%) patients, subcapsular hematoma in 2 of the 12 (16.7%) patients, renal enlargement in 5 of the 12 (31.3%) patients, increased signal intensity in perirenal tissue in 6 of the 12 (50%) patients, and loss of the corticomedullary junction in 2 out of 9 patients (22%). These findings indicated fewer changes in the kidney after ESWL using YACHIYODA SZ1 than in the other reports. MRI is also concluded to be effective to detect the changes of the kidney after ESWL. (author).

  2. Shock initiation sensitivity and Hugoniot-based equation of state of Composition B obtained using in situ electromagnetic gauging

    International Nuclear Information System (INIS)

    Gibson, L L; Bartram, B D; Sheffield, S A; Gustavsen, R L; Brown, G W; Sandstrom, M M; Giambra, A M; Dattelbaum, D M; Handley, C A

    2014-01-01

    A series of gas gun-driven plate impact experiments were performed on vacuum melt-cast Composition B to obtain new Hugoniot states and shock sensitivity (run-distance-to-detonation) information. The Comp B (ρ 0 = 1.713 g/cm 3 ) consisted of 59.5% RDX, 39.5% TNT, and 1% wax, with ∼ 6.5% HMX in the RDX. The measured Hugoniot states were found to be consistent with earlier reports, with the compressibility on the shock adiabat softer than that of a 63% RDX material reported by Marsh.[4] The shock sensitivity was found to be more sensitive (shorter run distance to detonation at a given shock input condition) than earlier reports for Comp B-3 and a lower density (1.68-1.69 g/cm 3 ) Comp B formulation. The reactive flow during the shock-to-detonation transition was marked by heterogeneous, hot spot-driven growth both in and behind the leading shock front.

  3. Litiasis única en vesícula doble tratada con ondas de choque extracorpórea Single lithiasis in double gallblader treated with extracorporeal shock waves

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    Domingo Pérez González

    2004-06-01

    Full Text Available La vesícula biliar doble es una anomalía congénita poco frecuente. Su diagnóstico puede realizarse con ultrasonido y colecistografía. Se presenta una paciente de 27 años de edad, con antecedentes de intolerancia a las grasas y cólicos biliares a repetición, con vesícula duplicada; exteriormente fundida y dos conductos císticos independientes que desembocan en el hepatocolécodo, con un cálculo único, de 12 mm de diámetro, retrotransparente y 0 unidades Houndfield, ubicado en el cuello de la vesícula más desarrollada. Se aplicaron 2 259 ondas de choque extracorpóreas de 20,4 kilovoltios, generadas por el principio electromagnético; en una sesión de litroticia. Se detuvo fragmentación completa del cálculo. El tratamiento fue ambulatorio. La paciente se reincorporó a su vida laboral a las 24 horas. Durante la expulsión de los fragmentos tuvo varias crisis de dolor que cedieron con analgésicos orales. A los 6 meses, la vesícula afectada se encontraba libre de fragmentos y funcional. No existió complicación y hasta el momento se mantiene asintomáticaDouble gall bladder is an uncommon congenital abnormality. It may be diagnosed by ultrasound and cholecystography. It is reported the case of a 27-year-old patient with history of intolerance to fats and repeated biliary cholics, with duplicated gallbladder externally fused, and two independent cystic ducts flowing to the hepatocholedoco with a single calculus of 12 mm of diameter, retrotransparent and 0 Houndfield units, located in the neck of the more developed gallbladder. 2 259 extracorporeal shock waves of 20.4 kilovolts generated by the electromagnetic principle were applied in a lithotripsy session. The complete fragmentation of the calculus was stopped. The treatment was ambulatory. The patient reincorporated to her working life at 24 hours. During the expulsion of the fragments, she had several pain crises that were resolved with oral analgesics. Six months later, the

  4. Low-energy extracorporeal shock wave therapy promotes vascular endothelial growth factor expression and improves locomotor recovery after spinal cord injury.

    Science.gov (United States)

    Yamaya, Seiji; Ozawa, Hiroshi; Kanno, Haruo; Kishimoto, Koshi N; Sekiguchi, Akira; Tateda, Satoshi; Yahata, Kenichiro; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

    2014-12-01

    Extracorporeal shock wave therapy (ESWT) is widely used for the clinical treatment of various human diseases. Recent studies have demonstrated that low-energy ESWT upregulates the expression of vascular endothelial growth factor (VEGF) and promotes angiogenesis and functional recovery in myocardial infarction and peripheral artery disease. Many previous reports suggested that VEGF produces a neuroprotective effect to reduce secondary neural tissue damage after spinal cord injury (SCI). The purpose of the present study was to investigate whether low-energy ESWT promotes VEGF expression and neuroprotection and improves locomotor recovery after SCI. Sixty adult female Sprague-Dawley rats were randomly divided into 4 groups: sham group (laminectomy only), sham-SW group (low-energy ESWT applied after laminectomy), SCI group (SCI only), and SCI-SW group (low-energy ESWT applied after SCI). Thoracic spinal cord contusion injury was inflicted using an impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) Scale (open field locomotor score) at different time points over 42 days after SCI. Hematoxylin and eosin staining was performed to assess neural tissue damage in the spinal cord. Neuronal loss was investigated by immunostaining for NeuN. The mRNA expressions of VEGF and its receptor, Flt-1, in the spinal cord were assessed using real-time polymerase chain reaction. Immunostaining for VEGF was performed to evaluate VEGF protein expression in the spinal cord. In both the sham and sham-SW groups, no animals showed locomotor impairment on BBB scoring. Histological analysis of H & E and NeuN stainings in the sham-SW group confirmed that no neural tissue damage was induced by the low-energy ESWT. Importantly, animals in the SCI-SW group demonstrated significantly better locomotor improvement than those in the SCI group at 7, 35, and 42 days after injury (p

  5. Predictors of Success after Extracorporeal Shock Wave Lithotripsy (ESWL for Renal Calculi Between 20—30 mm: A Multivariate Analysis Model

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    Ahmed El-Assmy

    2006-01-01

    Full Text Available The first-line management of renal stones between 20—30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20—30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis.Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%.Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20—30 mm. High probability of stone clearance is obtained with single stone ≤400 mm2 located in renal pelvis with no congenital anomalies. Our regression model can predict the probability of the success of ESWL in such controversial groups and can define patients who

  6. Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL).

    Science.gov (United States)

    Yuri, Prahara; Hariwibowo, Rinto; Soeroharjo, Indrawarman; Danarto, Raden; Hendri, Ahmad Z; Brodjonegoro, Sakti R; Rasyid, Nur; Birowo, Ponco; Widyahening, Indah S

    2018-01-01

    the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 - 1.55); pESWL (overall risk ratio 1.42 (95% CI 1.30 - 1.55); p=ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 - 1.30; p=0.01 and I2=40%). percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.

  7. Strength of shock-loaded single-crystal tantalum [100] determined using in situ broadband x-ray Laue diffraction.

    Science.gov (United States)

    Comley, A J; Maddox, B R; Rudd, R E; Prisbrey, S T; Hawreliak, J A; Orlikowski, D A; Peterson, S C; Satcher, J H; Elsholz, A J; Park, H-S; Remington, B A; Bazin, N; Foster, J M; Graham, P; Park, N; Rosen, P A; Rothman, S R; Higginbotham, A; Suggit, M; Wark, J S

    2013-03-15

    The strength of shock-loaded single crystal tantalum [100] has been experimentally determined using in situ broadband x-ray Laue diffraction to measure the strain state of the compressed crystal, and elastic constants calculated from first principles. The inferred strength reaches 35 GPa at a shock pressure of 181 GPa and is in excellent agreement with a multiscale strength model [N. R. Barton et al., J. Appl. Phys. 109, 073501 (2011)], which employs a hierarchy of simulation methods over a range of length scales to calculate strength from first principles.

  8. Espinelização in-situ e seu efeito na resistência ao choque térmico de concretos refratários In-situ spinelization and thermal shock performance of refractory castables

    Directory of Open Access Journals (Sweden)

    G. B. Cintra

    2008-09-01

    -magnesia refractory castables, as the in-situ spinel formation leads to a better chemical performance. The steel ladles are also subjected to abrupt temperature changes, due to heating and cooling cycles. Therefore, the thermal shock evaluation is of utmost importance to a proper material selection. The objective of this paper is the analysis of the matrix components and its consequences on the thermal shock damage in order to attain the most suitable thermo mechanical solution coupled with a high corrosion resistance, resulting the increase of the life expectancy of a steel ladle. The results presented show that alumina-spinel castables had better performance than alumina-magnesia castables when there is no constraining. The presence of microssilica increased the thermal shock damage, and this may be related to the testing temperature range.

  9. High Pressure In Situ X-ray Diffraction Study of MnO to 120 GPa and Comparison with Shock Compression Experiment

    Science.gov (United States)

    Yagi, Takehiko; Kondo, Tadashi; Syono, Yasuhiko

    1997-07-01

    In order to clarify the nature of the phase transformation in MnO observed at around 90 GPa by shock compression experiment (Syono et al., this symposium), high pressure in situ x-ray experiments were carried out up to 120 GPa. Powdered sample was directly compressed in Mao-Bell type diamond anvil and x-ray experiments were carried out using angle dispersive technique by combining synchrotron radiation and imaging plate detector. Distortion of the B1 structured phase into hexagonal unit cell was observed from 25-40 GPa, which continues to increase up to 90 GPa. At around 90 GPa, discontinuous change of the diffraction was observed. This new phase cannot be explained by a simple B2 structure and the analysis of this phase is in progress. This high pressure phase has metallic appearance, which reverses to transparent MnO on release of pressure.

  10. Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury.

    Science.gov (United States)

    Yahata, Kenichiro; Kanno, Haruo; Ozawa, Hiroshi; Yamaya, Seiji; Tateda, Satoshi; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

    2016-12-01

    OBJECTIVE Extracorporeal shock wave therapy (ESWT) is widely used to treat various human diseases. Low-energy ESWT increases expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. The VEGF stimulates not only endothelial cells to promote angiogenesis but also neural cells to induce neuroprotective effects. A previous study by these authors demonstrated that low-energy ESWT promoted expression of VEGF in damaged neural tissue and improved locomotor function after spinal cord injury (SCI). However, the neuroprotective mechanisms in the injured spinal cord produced by low-energy ESWT are still unknown. In the present study, the authors investigated the cell specificity of VEGF expression in injured spinal cords and angiogenesis induced by low-energy ESWT. They also examined the neuroprotective effects of low-energy ESWT on cell death, axonal damage, and white matter sparing as well as the therapeutic effect for improvement of sensory function following SCI. METHODS Adult female Sprague-Dawley rats were divided into the SCI group (SCI only) and SCI-SW group (low-energy ESWT applied after SCI). Thoracic SCI was produced using a New York University Impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks after SCI. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan open-field locomotor score for 42 days after SCI. Mechanical and thermal allodynia in the hindpaw were evaluated for 42 days. Double staining for VEGF and various cell-type markers (NeuN, GFAP, and Olig2) was performed at Day 7; TUNEL staining was also performed at Day 7. Immunohistochemical staining for CD31, α-SMA, and 5-HT was performed on spinal cord sections taken 42 days after SCI. Luxol fast blue staining was performed at Day 42. RESULTS Low-energy ESWT significantly improved not only locomotion but also mechanical and thermal allodynia following SCI. In the double staining, expression of VEGF was observed in Neu

  11. In situ detection of a heat-shock regulatory element binding protein using a soluble short synthetic enhancer sequence

    Energy Technology Data Exchange (ETDEWEB)

    Harel-Bellan, A; Brini, A T; Farrar, W L [National Cancer Institute, Frederick, MD (USA); Ferris, D K [Program Resources, Inc., Frederick, MD (USA); Robin, P [Institut Gustave Roussy, Villejuif (France)

    1989-06-12

    In various studies, enhancer binding proteins have been successfully absorbed out by competing sequences inserted into plasmids, resulting in the inhibition of the plasmid expression. Theoretically, such a result could be achieved using synthetic enhancer sequences not inserted into plasmids. In this study, a double stranded DNA sequence corresponding to the human heat shock regulatory element was chemically synthesized. By in vitro retardation assays, the synthetic sequence was shown to bind specifically a protein in extracts from the human T cell line Jurkat. When the synthetic enhancer was electroporated into Jurkat cells, not only the enhancer was shown to remain undegraded into the cells for up to 2 days, but also its was shown to bind intracellularly a protein. The binding was specific and was modulated upon heat shock. Furthermore, the binding protein was shown to be of the expected molecular weight by UV crosslinking. However, when the synthetic enhancer element was co-electroporated with an HSP 70-CAT reporter construct, the expression of the reporter plasmid was consistently enhanced in the presence of the exogenous synthetic enhancer.

  12. Extracorporeal Shockwave Lithotripsy of Primary Intrahepatic Stones

    Science.gov (United States)

    Kim, Myung Hwan; Lee, Sung Koo; Min, Young Il; Lee, Mun Gyu; Sung, Kyu Bo; Cho, Kyung Sik; Lee, Sung Gyu; Min, Pyung Chul

    1992-01-01

    Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainge tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal Shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis. PMID:1477027

  13. High pressure in situ X-ray diffraction study of MnO to 137 GPa and comparison with shock compression experiment

    Science.gov (United States)

    Yagi, T.; Kondo, T.; Syono, Y.

    1998-07-01

    In order to clarify the nature of the phase transformation in MnO observed at around 90 GPa by shock compression experiment, high pressure in situ X-ray observations were carried out up to 137 GPa. Powdered sample was directly compressed in Mao-Bell type diamond anvil cell and X-ray experiments were carried out using angle dispersive technique by combining synchrotron radiation and imaging plate detector. Distortion of the B1 structured phase was observed above about 40 GPa, which continues to increase up to 90 GPa. Two discontinuous changes of the diffraction profiles were observed at around 90 GPa and 120 GPa. The nature of the intermediate phase between 90 GPa and 120 GPa is not clear yet. It is neither cesium chloride (B2) nor nickel arsenide (B8) structure. On the other hand, the diffraction profile above 120 GPa can be reasonably well explained by the B8 structure. High pressure phases above 90 GPa have metallic luster and all the transformations are reversible on release of pressure.

  14. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

    Science.gov (United States)

    Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

    2018-01-01

    Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

  15. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

    Directory of Open Access Journals (Sweden)

    Babak Vahdatpour

    2018-01-01

    Full Text Available Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40 received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS and modified Roles and Maudsley score (RMS at baseline and 1 month and 3 months after intervention. Plantar fascia (PF thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006 and RMS showed better improvement in intervention group (P = 0.026. There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292. Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

  16. Target-controlled infusion of remifentanil with or without flurbiprofen axetil in sedation for extracorporeal shock wave lithotripsy of pancreatic stones: a prospective, open-label, randomized controlled trial.

    Science.gov (United States)

    Yang, Yu-Guang; Hu, Liang-Hao; Chen, Hui; Li, Bo; Fan, Xiao-Hua; Li, Jin-Bao; Wang, Jia-Feng; Deng, Xiao-Ming

    2015-11-07

    Extracorporeal shock wave lithotripsy (ESWL) is an effective therapeutic method used to treat patients with pancreatic stones. However, the anesthesia for this procedure has been underappreciated, with minimal reports of these procedures in certain case series with general or epidural anesthesia. A cohort of 60 patients who elected to undergo ESWL in order to treat pancreatic stones for the first time were randomly selected and divided into two groups. One group of patients received target controlled infusion (TCI) of remifentanil, while the other group of patients received TCI of remifentanil plus a bolus of flurbiprofen axetil (a cyclooxygenase inhibitor) (Rem group and Rem + Flu group, n = 30 for each group). The Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC50) of remifentanil. Visual analogue scales of pain, Ramsay sedation scale, hemodynamic changes, and adverse events were also recorded. The EC50 of remifentanil was calculated to be 4.0 ng/ml (95 % confidential interval: 3.84 ng/ml, 4.16 ng/ml) and 2.76 ng/ml (95 % confidential interval: 2.63 ng/ml, 2.89 ng/ml) in the Rem group and Rem + Flu group respectively (p flurbiprofen axetil provided satisfactory analgesia and sedation for ESWL of pancreatic stones with less adverse events. (Clinicaltrial.gov: NCT01998217 ; registered on November 19, 2013).

  17. Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers.

    Science.gov (United States)

    Aschermann, Ilknur; Noor, Seema; Venturelli, Sascha; Sinnberg, Tobias; Mnich, Christian D; Busch, Christian

    2017-01-01

    Chronic leg ulcers (CLUs) are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT) has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred "from bench to bedside", and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial) were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the treatment of chronic, therapy-refractory ulcers. © 2017 The Author

  18. Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers

    Directory of Open Access Journals (Sweden)

    Ilknur Aschermann

    2017-02-01

    Full Text Available Background/Aims: Chronic leg ulcers (CLUs are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. Methods: We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Results: Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred “from bench to bedside”, and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. Conclusions: The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the

  19. Experiencia en Cuba del tratamiento de la litiasis renoureteral con litotricia extracorpórea por ondas de choque en niños Cuban experience in the treatment of renouretheral lithiasis in children by using extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    María Victoria Labrada Rodríguez

    2012-06-01

    Full Text Available Introducción: la litiasis urinaria en el niño resulta una enfermedad poco frecuente si se compara con su incidencia en el adulto. Objetivos: describir el resultado del tratamiento en Cuba de la litiasis del aparato urinario en niños, mediante la litotricia extracorpórea por ondas de choque, así como validar la eficacia del método. Métodos: la muestra corresponde a 227 niños, tratados en el Centro de Tratamiento de la Litiasis Urinaria del Hospital Clinicoquirúrgico "Hermanos Ameijeiras'' de La Habana, entre abril de 1986 y octubre de 2011, utilizando 3 tipos de litotritores: el HM3 (Dornier, Lithostar Plus (Siemens y Medical Modulith® SLX (Storz. Resultados: las edades límites fueron 2 y 18 años. De manera general resultó similar el total de pacientes tratados del sexo femenino que el masculino (51 %/49 %. El síntoma predominante fue el cólico nefrítico con cálculos renales (81,9 %, y en el uréter (18,1 %. La superficie media fue de 1,20 cm². Se utilizó anestesia general orotraqueal (34,4 % y general intravenosa (65,6 %. Los retratamientos fueron necesarios en 8 casos (3,52 %. Las complicaciones fueron la infección urinaria aguda (3,08 % y el hematoma subcapsular renal (0,88 %. Resultó libre de material litiásico el 96,04 %. Conclusiones: la terapéutica mediante la litotricia extracorpórea por ondas de choque resulta efectiva, con baja tasa de morbilidad y de complicaciones graves, por lo que creemos debe defenderse científicamente como la primera opción terapéutica en la resolución de la litiasis urinaria en estas edades. Debe recordarse que eliminar el cálculo no es suficiente, hay que identificar la enfermedad, su tratamiento de fondo, y evitar las recidivas.Introduction: urinary lithiasis is a rare disease in children if compared with its incidence on the adults. Objectives: to describe the results of the treatment of urinary lithiasis in children in Cuba, by using extracorporeal shock wave lithrotripsy, and to

  20. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study.

    Science.gov (United States)

    Alessio-Mazzola, Mattia; Repetto, Ilaria; Biti, Besmir; Trentini, Roberto; Formica, Matteo; Felli, Lamberto

    2018-01-01

    To compare the efficacy of two independent groups of patients treated with ultrasound (US)-guided extracorporeal shock wave (ESW) therapy and with US-guided injection of platelet-rich plasma (PRP) for chronic lateral epicondylitis (LE) with a minimum of 2-year follow-up. We retrospectively evaluated 63 patients treated for chronic LE (31 patients with autologous US-guided PRP injection and 32 patients with US-guided focal ESW therapy) from 2009 to 2014. All the patients were evaluated by means of Roles-Maudsley (RM) score, quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, visual analogic scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) to retrospectively assess the pain relief, level of activity, the self-reported function and subjective satisfaction at minimum of 2-year follow-up. Both US-guided autologous PRP injection and US-guided focal ESW administration proved effective in chronic LE with significant improvement in the QuickDASH, VAS, RM and PRTEE scores ( p 0.05). The mean time between treatment and symptom resolution was significantly shorter for the PRP treatment ( p = 0.0212); furthermore, the mean time to return to the normal activities was quicker for PRP group ( p = 0.0119). Both PRP injection and ESW therapy are feasible and safe options for the treatment of chronic LE with low risk of complications and with good long-term follow-up results. US-guided PRP injection has quick efficacy when compared with US-guided focal ESW therapy.

  1. The value of the renal resistive index in the measurement of renal perfusion before and after extracorporal shock wave lithotripsy in correlation to the scintigraphy, to the magnetic resonance perfusion imaging and to big-endothelin values

    International Nuclear Information System (INIS)

    Palwein-Prettner, L.

    1999-07-01

    Purpose: the goal of this study was to evaluate effects of extracorporeal shock wave lithotripsy (ESWL) on the renal perfusion using the resistive index (RI), perfusion scintigraphy, magnetic resonance (MR) perfusion imaging and plasma big-endothelin (big-ET-1) values. Method/materials: In 21 patients divided in 3 age-groups the RI was measured before and 1,3,6 and 24 hours after ESWL. Big-ET-1, a potent vasoconstrictor peptid was correlated with the RI values. The RI and Big-ET-1 results was compared to the results of the MR perfusion imaging and the scintigraphy, the gold-standard method. Results: The RI of the treated kidneys increased significantly from 0,64±0,05 to 0,72±0,08 after the ESWL (p<0,001) and in the untreated kidneys from 0,63±0,05 to 0,68±0,09 (p=0,003). The hightest age group shows the most significant increase. The Big-ET-values also increased only in this age group significantly from 0,78±0,24 fmol/l to 1,58±0,52 fmol/l. In the scintigraphy the decrease of the renal plasma flow (RPF) in this age group was most significant. The MR perfusion Imaging shows in all age groups significant decrease (p<0,001). Conclusion: we conclude that the ESWL causes considerable renal parenchymal damage only in the elderly patients. The following changes in renal perfusion were measured very sensitively with the RI which had a good correlation to the results of the perfusion scintigraphy and the MR perfusion imaging. Further studies with larger series have to evaluate these results. (author)

  2. Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy.

    Directory of Open Access Journals (Sweden)

    Paweł Woźniak

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30-240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers.Twelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT, prothrombin time (PT, and thrombin time (TT of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups.No difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL.Oxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates

  3. Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Woźniak, Paweł; Kontek, Bogdan; Różański, Waldemar; Olas, Beata

    2017-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30-240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers. Twelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups. No difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL. Oxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates hemostasis. By

  4. Computed tomography after extra-corporeal shock wave lithotripsy (ESWL) of the kidneys. Pt. 1. Acute findings with histopathological correlation in an animal model. Computertomographie nach extrakorporaler Stosswellen-Lithotripsie (ESWL) der Nieren. T. 1. Korrelation mit akuten histopathologischen Befunden im Tierexperiment

    Energy Technology Data Exchange (ETDEWEB)

    Schaub, T.; Kunisch, M.; Stadtbaeumer, M.; Schild, H.; Thelen, M. (Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde); Stoerkel, S. (Mainz Univ. (Germany, F.R.). Pathologisches Inst.); El-Damanhoury, H. (Mainz Univ. (Germany, F.R.). Urologische Klinik und Poliklinik); Hennes, H.J. (Mainz Univ. (Germany, F.R.). Anaesthesiologische Klinik)

    1991-03-01

    In an experimentel study on pigs, 28 stone-free kidneys were treated with a second generation lithotripter. Histologically, acute bleeding was seen after ESWL in 23 (82 %) of the 28 treated kidneys. CT studies before and after contrast were correct in 20/28 (74%) cases. It was shown that extracorporeal shock waves cause renal bleeding that is only partially detected by computed tomography. It can be concluded that the CT findings seen in a high percentage of renal stone patients after ESWL represent bleeding. The incidence of renal bleeding after ESWL and thus the possible risk of hypertension has obviously been underestimated so far in clinical studies. (orig.).

  5. Litotricia por ondas de choque extracorpóreas como tratamiento de los cálculos del conducto pancreático principal Extracorporeal shock- wave lithotripsy as a treatment of the calculi of the main pancreatic duct

    Directory of Open Access Journals (Sweden)

    Domingo Pérez González

    2004-12-01

    Full Text Available Las ondas de choque extracorpóreas se utilizan desde hace varios años con buenos resultados en la fragmentación de cálculos vesiculares y de las vías biliares en pacientes seleccionados. Cuando los cálculos del conducto pancreático principal no pueden extraerse endoscópicamente está indicada esta variante no quirúrgica. Se presentan 4 pacientes del sexo masculino, entre 41 y 55 años de edad, con antecedentes de alcoholismo y el diagnóstico de pancreatitis crónica con litiasis en el conducto principal, 3 de ellos con más de 1 cálculo, que recibieron ondas de choque generadas por el principio electromagnético. Todos fragmentaron. El paciente con cálculo único eliminó los fragmentos espontáneamente, mientras que en los 3 restantes fue necesario asociar la endoscopia para obtener la limpieza total de Wirsung . Durante el seguimiento de más de 5 años se constató la regresión de los síntomas, fundamentalmente del dolor, sin recidivasThe extracorporeal shock waves have been used for several years with good results in the fragmentation of calculi of the gallbladder and of the biliary tract in selected patients. When the calculi of the main pancreatic duct cannot be endoscopically removed, this non-surgical variant is indicated. 4 male patients aged 41-55 with alcoholism history and the diagnosis of chronic pancreatitis with lithiasis in the main duct are presented. 3 of them with more than a calculus received shock waves generated by electromagnetic principle. All the calculi were fragmented. The patient with only one calculus eliminated the fragments spontaneously, whereas in the other 3 it was necessary to associate endoscopy to obtain Wirsung's total cleaning. During the follow-up of more than 5 years it was proved the regression of the symptoms, mainly pain, without relapses

  6. Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

    Science.gov (United States)

    Mustafa, Mahmoud

    2012-08-01

    We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

  7. A simple objective method to assess the radiopacity of urinary calculi and its use to predict extracorporeal shock wave lithotripsy outcomes.

    Science.gov (United States)

    el-Gamal, Osama; el-Badry, Amr

    2009-07-01

    We describe an objective method to evaluate kidney stone radiopacity for use in selection of cases suitable for ESWL. We recruited 76 adult patients with a solitary 1 to 2 cm renal pelvic stone. All patients underwent routine plain x-ray of the urinary tract but an aluminum step wedge (Gammex) was adapted to the cassette before x-ray exposure. This x-ray was then digitized and analyzed by histogram to calculate the gray level of the stone and of each step of the aluminum step wedge. This allowed radiographic stone density to be expressed in mm aluminum equivalent. All patients also underwent abdominopelvic computerized tomography and then ESWL was started. Stone density on plain x-ray was 1.83 to 5.93 mm aluminum equivalent. There was a positive correlation between these values and stone attenuation values on computerized tomography (r(2) 0.83, p stones of significantly higher density than stones in patients with complete stone fragmentation (mean +/- SD 4.8 +/- 0.74 vs 3.35 +/- 0.88 mm aluminum equivalent, p stone radiopacity in mm aluminum equivalent and the total number of shock waves required to achieve complete fragmentation (r(2) 0.66, p <0.005). The aluminum step wedge with plain x-ray of the urinary tract provides a good reference for objectively assessing the radiopacity of renal calculi.

  8. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

  9. Cavitation phenomena in extracorporeal microexplosion lithotripsy

    Science.gov (United States)

    Tomita, Y.; Obara, T.; Takayama, K.; Kuwahara, M.

    1994-09-01

    An experimental investigation was made of cavitation phenomena induced by underwater shock wave focusing applied to the extracorporeal microexplosion lithotripsy (microexplosion ESWL). Firstly an underwater microexplosion generated by detonation of a 10 mg silver azide pellet was studied and secondly underwater shock focusing and its induced cavitation phenomena were investgated. Underwater shock wave was focused by using a semi-ellipsoidal reflector in which a shock wave generated at the first focal point of the reflector was reflected and focused at the second focal point. It is found that an explosion product gas bubble did not produce any distinct rebound shocks. Meantime cavitation appeared after shock focusing at the second focal point where expansion waves originated at the exit of the reflector were simultaneously collected. A shock/bubble interaction is found to contribute not only to urinary tract stone disintegration but also tissue damage. The cavitation effect associated with the microexplosion ESWL was weaker in comparison with a spark discharge ESWL. The microexplosion ESWL is an effective method which can minimize the number of shock exposures hence decreasing tissue damage by conducting precise positioning of urinary tract stones.

  10. The effects of extracorporeal shock-wave therapy (ESWT versus Mulligan concept of manual therapy in treating lateral epicondylitis = Efektywność terapii zewnątrzustrojową falą uderzeniową versus terapia manualna w koncepcji Mulligana w leczeniu zapalenia nadkłykcia bocznego

    Directory of Open Access Journals (Sweden)

    Janusz Kocjan

    2016-07-01

    SUMMARY Extracorporeal shockwave therapy (ESWT is a conservative treatment in case of many musculoskeletal disorders, including lateral epicondylitis. The aim of the study was the assessment of the efficacy of the shockwave - compare to manual therapy treatment (Mulligan concept in a population of consecutive patients affected by tennis elbow. 26 patients who suffered from chronic persistent tennis elbow were randomly assigned to one of the two treatment groups. Group 1 (n=13, mean age=37,14±10,07 received an extracorporeal shock wave treatment (ESWT; 2,500 shocks, while Group 2 (n=13, mean age= was undergoing manual therapy in Mulligan concept. Visual Analogue Scale (VAS and Patient-Rated Tennis Elbow Evaluation (PRTEE were used. The results of the study presented here shows that ESWT and Mulligan therapy are an effective treatment of lateral epicondylitis. Both groups achieved improvement in all of analysed variables, but in case of Mulligan Concept statistical significant differences were found in 4 from 6 variables. It is concluded that ESWT and Mulligan therapy appears to be a useful non invasive treatment methods that reduces the symptoms of lateral epicondylitis.   Key words: ESWT, mulligan, tennis elbow, lateral epicondylitis.

  11. Extracorporeal treatment for thallium poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S

    2012-01-01

    The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).......The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl)....

  12. Criterios de selección para fragmentación de cálculos vesiculares por ondas de choque extracorpóreas Selection criteria for fragmenting gallstones by extracorporeal shock waves

    Directory of Open Access Journals (Sweden)

    Domingo Pérez González

    2004-06-01

    Full Text Available La fragmentación de cálculos vesiculares por ondas de choque extracorpóreas es otra de las variantes terapéuticas no quirúrgicas a tener en cuenta en esta entidad. Se estudiaron 1 957 pacientes remitidos de todo el país con el diagnóstico de litiasis vesicular en una consulta especializada creada el efecto en el Hospital Clínico Quirúrgico “Hermanos Ameijeiras”. Se seleccionaron 626 (32 % y se siguieron inicialmente los criterios del Grupo de Munich; 479 (76,6 % del sexo femenino y 147 (23,4 % del masculino. En 125 pacientes (20,0 % la edad sobrepasó los 60 años. No se incluyeron 672 por componente litiásico grande (50,4 %; 276 por vesícula excluida en la colecistografía oral (20,8 % y 212 por vaciamiento vesicular insuficiente (16,0 %. La hipertensión arterial (67,0, la diabetes melitus (45,0 % y la cardiopatía isquémica (28,0 % fueron las enfermedades asociadas más frecuentes en los seleccionados; en ellos predominaron los cálculos únicos (71,7 %, de hasta 20 mm de diámetro (65,7 %, radiotransparentes (83 % y con densidades inferiores a las 50 unidades Houndsfield (60,5 %The fragmentation of gallstones by extracorporeal shock waves is other of the nonsurgical threapeutic variants to be taken into account in this entity. 1 957 patients referred from all over the country with the diagnosis of biliary lithiasis were studied in a specialized office established to this end at “Hermanos Ameijeiras” Clinical and Surgical Hospital. 626 (32 % were selected, 479 (76.6 % females and 147 (23.4 % males, and the criteria of the Group of Munich were initially followed. 125 patients (20.0 % were over 60. 672 were not included due to large lithiasic component (50.4 %; 276 due to gallblader excluded in oral cholecistography (20,8 %; and 212 to insufficient gallblader dumping (16,0 %. Arterial hypertension (67,0 %, diabetes melitus (45,0 % and ischemic heart disease (28.0 % were the most frequent associated diseases among the

  13. Factores que influyen en la fragmentación de cálculos vesiculares por ondas de choque extracorpóreas Factors influencing on the fragmentation of gallbladder calculi by extracorporeal shock waves

    Directory of Open Access Journals (Sweden)

    Domingo Pérez González

    2004-12-01

    Full Text Available La litotricia por ondas de choque extracorpóreas es una de las variantes terapéuticas para la litiasis vesicular sintomática. Se aplicaron en 626 pacientes 479 (76,6 % del sexo femenino y 147 (23,4 % del masculino, con más de 40 años de edad en 473 (69,9 %. Los índices de fragmentación completa fueron mayores en los pacientes con cálculos únicos (79,5 %, de menos de 20 mm de diámetro (72,3 %, radiotransparentes (89,2 % y con densidades inferiores a las 50 unidades Houndsfield (72,6 %. Necesitaron 2, 3 y 4 sesiones de tratamiento 215 pacientes (34,3 %, 35 (5,6 % y 11 (1,8 % respectivamente. Finalmente la fragmentación fue completa en 332 (53,0 %, parcial en 241 (38,5 % y solo no fragmentaron 53 (8,5 %, donde se demostró el valor de las características físicas e imagenológicas de los cálculos en este procesoExtracorporeal shock-wave lithotripsy is one of the therapeutic variants for symptomatic gallbladder lithiasis. It was applied to 626 patients, 479 (76.6 % females and 147 (23.4 % males. 473 (69.9 % were over 40. The indexes of complete fragmentation were higher in patients with a single calculus (79.5 % of less than 20 mm of diameter (72.3 %·, radiotransparent (89.2% and with densities under 50 Houndsfield units (72.6 %. 215 patients (34.3 %, 35 (5.6 % and 11 (1.8 % needed 2,3 and 4 treatment sessions, respectively. Finally, the fragmentation was complete in 332 (53.0 %, partial in 241 (38.5 % and only 53 (8.5 % were not fragmented. The value of the physical and imaging characteristics of the calculi in this process was demonstrated

  14. Extracorporeal membrane oxygenation (ECMO)

    African Journals Online (AJOL)

    Extracorporeal membrane oxygenation (ECMO) is not a novel therapy in the true sense of the ... Intention-to-treat analysis showed benefit for ECMO, with a relative risk ... no doubt that VV-ECMO is an advance in medical technology, and that.

  15. Extracorporeal shock wave lithotripsy (ESWL) in orthopaedics

    OpenAIRE

    Tosun, Nihat; Yucel, Mustafa; Brenner, Horst

    2004-01-01

    ESWL gained interest in orthopedics recently, especially in the treatment of tendinitis. Three sessions of ESWL with 1 month intervals were performed to 34 patients including 28 shoulder impingement syndromes, 4 lateral humeral epicondilitis and 2 Achilles tendinitis. Twenty (77%) patients with shoulder impingement, 2 (50%) patients with lateral humeral epicondilitis got benefit. However, it was ineffective in 2 cases (100%) with Achilles tendinitis, 2 cases (50%) with lateral humeral epicond...

  16. Extracorporeal irradiation -Physicist perspective

    International Nuclear Information System (INIS)

    Vijayaprabhu, N.; Saravanan, K.S.; Gunaseelan; Vivekanandam, S.; Reddy, K.S.; Parthasarathy; Mourougan, S.; Elangovan, K.

    2008-01-01

    Extracorporeal irradiation (ECI) involves irradiation of body tissues, particularly malignant bones of the extremities, outside the body. This involves en bloc resection of the tumour, extracorporeal irradiation of the bone segment with a single dose of 50 Gy or more, and reimplantation of the irradiated bone with fixation devices. Bone tumours like Ewing's Sarcoma, Chondrosarcoma and Oesteosarcoma; in the involved sites like femur, tibia, humerus, ilium and sacrum can be treated with ECI. The reimplanted bone simply acts as a framework for appositional bone growth from surrounding healthy bones. The conventional indications for postoperative irradiation are still applied. The major advantages of ECI are the precise anatomic fit of the reimplanted bone segment, preservation of joint mobility and its potential in avoiding the growth discrepancy commonly seen in prosthetic replacement. The use of ECI was first described in 1968 and practiced in Australia since 1996. In our center, we have completed six ECIs

  17. Extracorporeal treatment for acetaminophen poisoning

    DEFF Research Database (Denmark)

    Gosselin, S; Juurlink, D N; Kielstein, J T

    2014-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP). METHODS: After a systematic review of the litera...... of NAC has not been definitively demonstrated....

  18. Extracorporeal Treatment for Lithium Poisoning

    DEFF Research Database (Denmark)

    Decker, Brian S; Goldfarb, David S; Dargan, Paul I

    2015-01-01

    The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxico......The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical...... extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li...... treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity...

  19. Extracorporeal Treatment for Metformin Poisoning

    DEFF Research Database (Denmark)

    Calello, Diane P; Liu, Kathleen D; Wiegand, Timothy J

    2015-01-01

    diverse professions, presents its systematic review and clinical recommendations for extracorporeal treatment in metformin poisoning. METHODS: A systematic literature search was performed, data extracted, findings summarized, and structured voting statements developed. A two-round modified Delphi method...... was used to achieve consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Anonymized votes and opinions were compiled and discussed. A second vote determined the final recommendations. RESULTS: One hundred seventy-five articles were identified, including 63 deaths...... appears to be amenable to extracorporeal treatments. Despite clinical evidence comprised mostly of case reports and suboptimal toxicokinetic data, the workgroup recommended extracorporeal removal in the case of severe metformin poisoning....

  20. em>In vivoem> biological response to extracorporeal shockwave therapy in human tendinopathy

    DEFF Research Database (Denmark)

    Waugh, C. M.; Morrissey, D.; Jones, E.

    2015-01-01

    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment for chronic tendinopathies, however little is known about the in-vivo biological mechanisms of ESWT. Using microdialysis, we examined the real-time biological response of healthy and pathological tendons to ESWT. A single session...

  1. Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

    International Nuclear Information System (INIS)

    Haneya, Assad; Philipp, Alois; Foltan, Maik; Camboni, Daniele; Rupprecht, Leopold; Puehler, Thomas; Hirt, Stephan; Hilker, Michael; Kobuch, Reinhard; Schmid, Christof; Arlt, Matthias; Mueller, Thomas

    2009-01-01

    Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation. From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4. All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO. Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care. (author)

  2. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy : A pilot study

    NARCIS (Netherlands)

    Zwerver, J.; Dekker, F.; Pepping, G.J.

    2010-01-01

    Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be

  3. Patient and personnel exposure during extracorporeal lithotripsy

    International Nuclear Information System (INIS)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-01-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required

  4. Patient and personnel exposure during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) (range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)) which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  5. Extracorporeal Treatment in Phenytoin Poisoning

    DEFF Research Database (Denmark)

    Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A

    2016-01-01

    The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles......) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia...... is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available...

  6. Extracorporeal treatment for barbiturate poisoning

    DEFF Research Database (Denmark)

    Mactier, Robert; Laliberté, Martin; Mardini, Joelle

    2014-01-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all...... treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least......-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory...

  7. Hospital Costs Of Extracorporeal Life Support Therapy

    NARCIS (Netherlands)

    Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.

    Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

  8. In-Situ Simulation

    DEFF Research Database (Denmark)

    Bjerregaard, Anders Thais; Slot, Susanne; Paltved, Charlotte

    2015-01-01

    , and organisational characteristic. Therefore, it might fail to fully mimic real clinical team processes. Though research on in situ simulation in healthcare is in its infancy, literature is abundant on patient safety and team training1. Patient safety reporting systems that identify risks to patients can improve......Introduction: In situ simulation offers on-site training to healthcare professionals. It refers to a training strategy where simulation technology is integrated into the clinical encounter. Training in the simulation laboratory does not easily tap into situational resources, e.g. individual, team...... patient safety if coupled with training and organisational support. This study explored the use of critical incidents and adverse events reports for in situ simulation and short-term observations were used to create learning objectives and training scenarios. Method: This study used an interventional case...

  9. In situ groundwater bioremediation

    Energy Technology Data Exchange (ETDEWEB)

    Hazen, Terry C.

    2009-02-01

    In situ groundwater bioremediation of hydrocarbons has been used for more than 40 years. Most strategies involve biostimulation; however, recently bioaugmentation have been used for dehalorespiration. Aquifer and contaminant profiles are critical to determining the feasibility and strategy for in situ groundwater bioremediation. Hydraulic conductivity and redox conditions, including concentrations of terminal electron acceptors are critical to determine the feasibility and strategy for potential bioremediation applications. Conceptual models followed by characterization and subsequent numerical models are critical for efficient and cost effective bioremediation. Critical research needs in this area include better modeling and integration of remediation strategies with natural attenuation.

  10. Assessment of Safety and Effectiveness of the Extracorporeal Continuous-Flow Ventricular Assist Device (BR16010) Use as a Bridge-to-Decision Therapy for Severe Heart Failure or Refractory Cardiogenic Shock: Study Protocol for Single-Arm Non-randomized, Uncontrolled, and Investigator-Initiated Clinical Trial.

    Science.gov (United States)

    Fukushima, Norihide; Tatsumi, Eisuke; Seguchi, Osamu; Takewa, Yoshiaki; Hamasaki, Toshimitsu; Onda, Kaori; Yamamoto, Haruko; Hayashi, Teruyuki; Fujita, Tomoyuki; Kobayashi, Junjiro

    2018-06-08

    The management of heart failure patients presenting in a moribund state remains challenging, despite significant advances in the field of ventricular assist systems. Bridge to decision involves using temporary devices to stabilize the hemodynamic state of such patients while further assessment is performed and a decision can be made regarding patient management. The purpose of this study (NCVC-BTD_01, National Cerebral and Cardiovascular Center-Bridge to Dicision_01) is to assess the safety and effectiveness of the newly developed extracorporeal continuous-flow ventricular assist system employing a disposable centrifugal pump with a hydrodynamically levitated bearing (BR16010) use as a bridge-to-decision therapy for patients with severe heart failure or refractory cardiogenic shock. NCVC-BTD_01 is a single-center, single-arm, open-label, exploratory, medical device, investigator-initiated clinical study. It is conducted at the National Cerebral and Cardiovascular Center in Japan. A total of nine patients will be enrolled in the study. The study was planned using Simon's minimax two-stage phase design. The primary endpoint is a composite of survival free of device-related serious adverse events and complications during device support. For left ventricular assistance, withdrawal of a trial device due to cardiac function recovery or exchange to other ventricular assist devices (VADs) for the purpose of bridge to transplantation (BTT) during 30 days after implantation will be considered study successes. For right ventricular assistance, withdrawal of tal device due to right ventricular function recovery within 30 days after implantation will be considered a study success. Secondary objectives include changes in brain natriuretic peptide levels (7 days after implantation of a trial device and the day of withdrawal of a trial device), period of mechanical ventricular support, changes in left ventricular ejection fraction (7 days after implantation of a trial device

  11. Application of holographic interferometric studies of underwater shock-wave focusing to medicine

    Science.gov (United States)

    Takayama, Kazuyoshi; Nagoya, H.; Obara, Tetsuro; Kuwahara, M.

    1993-01-01

    Holographic interferometric flow visualization was successfully applied to underwater shock wave focusing and its application to extracorporeal shock wave lithotripsy (ESWL). Real time diffuse holograms revealed the shock wave focusing process in an ellipsoidal reflector made from PMMA and double exposure holographic interferometry also clarified quantitatively the shock focusing process. Disintegration of urinary tract stones and gallbladder stones was observed by high speed photogrammetry. Tissue damage associated with the ESWL treatment is discussed in some detail.

  12. Sex in situ

    DEFF Research Database (Denmark)

    Krøgholt, Ida

    2017-01-01

    Sex er en del af vores sociale praksis og centralt for det, vi hver især er. Men bortset fra pornoindustrien, har vi ikke mange muligheder for at få adgang til billeder af sex. Teater Nordkrafts forestilling Sex in situ vil gøre seksuelle billeder til noget, der kan deles, udveksles og tales om, og...

  13. Extracorporeal Pregnancy as a Feminist Issue

    Directory of Open Access Journals (Sweden)

    Iskra Krstić

    2015-10-01

    Full Text Available Extracorporeal pregnancy (ectogenesis presents perhaps the culmination of reproductive technology (NRT. Second wave feminism welcomed the use of NRT (including extracorporeal pregnancy as a means of women’s liberation. Later on, theories belonging to the third wave pointed out the negative implications of NRT and reclaimed the power of unassisted reproduction. This paper will try to point out some remaining productive potentials of NRT and extracorporeal pregnancy. The author wishes to explore the changes in the conceptualisation of the integrity of the individual in the context of the feminist critique of ectogenesis.

  14. Second generation extracorporeal lithotripsy: Whither American radiologic leadership

    International Nuclear Information System (INIS)

    Pfister, R.C.

    1987-01-01

    Extracorporeal shock wave lithotripsy was developed by Dornier Medical Systems, Inc., and West German urologists. In the United States the marketing, training, and operation of these wet-tub units were limited to urologists. New dry-treatment lithotriptors are being developed in various countries, including the United States (Medstone), and will be marketed to radiologists, among others, once approved by the FDA for clinical use; future applications will include gallstones as well as renal calculi. Some of these new lithotripors are radiologically intensive, requiring US or fluroscopic guidance and radiography. Since the stone pulverization process in an image-controlled procedure, the units should be managed by radiologists; this will require supportive leadership from all current radiology department chiefs. This presentation reviews the lithotriptors available

  15. In situ reactor

    Science.gov (United States)

    Radtke, Corey William; Blackwelder, David Bradley

    2004-01-27

    An in situ reactor for use in a geological strata, is described and which includes a liner defining a centrally disposed passageway and which is placed in a borehole formed in the geological strata; and a sampling conduit is received within the passageway defined by the liner and which receives a geological specimen which is derived from the geological strata, and wherein the sampling conduit is in fluid communication with the passageway defined by the liner.

  16. Highlighting Indication of extracorporeal membrane oxygenation in endocrine emergencies.

    Science.gov (United States)

    Chao, Anne; Wang, Chih-Hsien; You, Hao-Chun; Chou, Nai-Kwoun; Yu, Hsi-Yu; Chi, Nai-Hsin; Huang, Shu-Chien; Wu, I-Hui; Tseng, Li-Jung; Lin, Ming-Hsien; Chen, Yih-Sharng

    2015-08-24

    Extracorporeal membrane oxygenation (ECMO) has been repeatedly used to rescue patients with cardiopulmonary arrest. However, its clinical utility in endocrine emergencies remains unclear. Herein, we describe a case series of 12 patients presenting with refractory shock secondary to endocrine emergencies who were rescued by ECMO support. Patients were identified between 2005 and 2012 from our ECMO registry. The diagnostic distribution was as follows: pheochromocytoma crisis (n = 4), thyroid storm (n = 5), and diabetic ketoacidosis (n = 3). The initial presentation of pheochromocytoma crisis was indistinguishable from acute myocardial infarction (AMI) and frequently accompanied by paroxysmal hypertension and limb ischemia. Thyroid storm was characterized by hyperbilirubinemia and severe gastrointestinal bleeding, whereas neurological symptoms were common in diabetic ketoacidosis. The clinical outcomes of patients with endocrine emergencies were compared with those of 80 cases with AMI who received ECMO because of cardiogenic shock. The cardiac function and the general conditions showed a significantly faster recovery in patients with endocrine emergencies than in those with AMI. We conclude that ECMO support can be clinically useful in endocrine emergencies. The screening of endocrine diseases should be considered during the resuscitation of patients with refractory circulatory shock.

  17. The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup

    DEFF Research Database (Denmark)

    Lavergne, Valéry; Nolin, Thomas D; Hoffman, Robert S

    2012-01-01

    Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from...

  18. Characterization and modification of cavitation pattern in shock wave lithotripsy

    NARCIS (Netherlands)

    Arora, M.; Ohl, C.D.; Liebler, Marko

    2004-01-01

    The temporal and spatial dynamics of cavitation bubble cloud growth and collapse in extracorporeal shock wave lithotripsy (ESWL) is studied experimentally. The first objective is obtaining reproducible cloud patterns experimentally and comparing them with FDTD-calculations. Second, we describe a

  19. Surgical myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2003-05-01

    Full Text Available OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5% of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

  20. CT after renal extracorporeal shock waves lithotripsy (ESWL). Pt. 2

    International Nuclear Information System (INIS)

    Schaub, T.; Kunisch, M.; Stadtbaeumer, M.; Schild, H.; Thelen, M.; Stoerkel, S.; El-Damanhoury, H.; Hennes, H.J.

    1991-01-01

    In a pig model, 13 kidneys were treated with a second generation lithotripter and examined by CT immediately and three weeks after ESWL. 9 (69%) acute traumatic lesions were seen in CT without, and 10 (77%) in CT with contrast in the 13 treated kidneys. After 3 weeks only 1 residual lesion persisted in CT contrast studies. On the histopathologic specimens residuals of bleeding were found in 3 (23%) of the 13 kidneys treated, which could not be seen in CT studies. CT is accurate in monitoring acute traumatic renal lesions after ESWL, but appears less reliable in chronic ones. Three weeks after ESWL traumatic renal lesions show marked regression. (orig.) [de

  1. Extracorporeal Shock Wave Lithotripsy versus Lasertripsy For The ...

    African Journals Online (AJOL)

    Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones. Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric ...

  2. Radiological hazard assessment of extracorporeal shock wave lithotripsy devices

    International Nuclear Information System (INIS)

    Sprague, D.D.; Vermeere, W.R.

    1987-01-01

    With the recent introduction of ESWL to the clinical environment, a new health physics challenge has entered the medical consulting area. The x-ray imaging systems used in the devices are of a conventional design, but in an unusual configuration that is difficult to properly assess. The scope of this paper considers specific evaluation problems, and deals with methods developed during experience with 4 units in California. Pertinent regulations are also covered, along with a synopsis of data obtained and ALARA recommendations

  3. Malignant mesothelioma in situ.

    Science.gov (United States)

    Churg, Andrew; Hwang, Harry; Tan, Larry; Qing, Gefei; Taher, Altaf; Tong, Amy; Bilawich, Ana M; Dacic, Sanja

    2018-05-01

    The existence of malignant mesothelioma in situ (MIS) is often postulated, but there are no accepted morphological criteria for making such a diagnosis. Here we report two cases that appear to be true MIS on the basis of in-situ genomic analysis. In one case the patient had repeated unexplained pleural unilateral effusions. Two thoracoscopies 9 months apart revealed only visually normal pleura. Biopsies from both thoracoscopies showed only a single layer of mildly reactive mesothelial cells. However, these cells had lost BRCA1-associated protein 1 (BAP1) and showed loss of cyclin-dependent kinase inhibitor 2 (CDKN2A) (p16) by fluorescence in-situ hybridisation (FISH). NF2 was not deleted by FISH but 28% of the mesothelial cells showed hyperploidy. Six months after the second biopsy the patient has persisting effusions but no evidence of pleural malignancy on imaging. The second patient presented with ascites and minimal omental thickening on imaging, but no visual evidence of tumour at laparoscopy. Omental biopsy showed a single layer of minimally atypical mesothelial cells with rare tiny foci of superficial invasion of fat. BAP1 immunostain showed loss of nuclear BAP1 in all the surface mesothelial cells and the invasive cells. There was CDKN2A deletion, but no deletion of NF2 by FISH. These cases show that morphologically bland single-layered surface mesothelial proliferations with molecular alterations seen previously only in invasive malignant mesotheliomas exist, and presumably represent malignant MIS. More cases are need to understand the frequency of such changes and the time-course over which invasive tumour develops. © 2018 John Wiley & Sons Ltd.

  4. In situ breast cancer

    International Nuclear Information System (INIS)

    Pacheco, Luis

    2004-01-01

    In situ breast cancer, particularly the ductal type, is increasing in frequency in the developed countries as well as in Ecuador, most probably. These lesions carry a higher risk of developing a subsequent invasive cancer. Treatment has changed recently due to results of randomized studies, from classical mastectomy to conservative surgery associated to radiotherapy. The Van Nuys Prognostic Index is currently the most usual instrument to guide diagnosis and treatment. Tamoxifen seems to decrease significantly the risk of tumor recurrence after initial treatment. (The author)

  5. The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats A repetição de ondas de choque extracorpóreas e a lesão do parênquima renal em ratos normais e diabéticos

    Directory of Open Access Journals (Sweden)

    Vicente Massaji Kira

    2007-08-01

    Full Text Available PURPOSE: To assess the effect of repeated extracorporeal shock waves (ESW on renal parenchyma of normal and diabetic rats. METHODS: 40 normal rats (A and 40 diabetic rats (B were assigned for ESW (Direx Tripter X1® - 14 KVA as follow: A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW; A4/B4 two ESW (4,000 SW in an elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples of renal parenchyma were histological prepared, stained by H&E. For each animal the frequency of hemorrhage focus (HF in the subcapasular, interstitial and glomerulus area was calculated (porcentage on 20 randomly histological sections. RESULTS: No one HF was identified in all normal or diabetic animals without ESW (A1, A3 and B1, B3. In the normal rats the HF frequency was similar to one ESW (subcapsular =15%; interstitial =20% and glomerular =10% or repetead ESW (subcapsular =25%; interstitial =20%; glomerular=10%. In diabetic rats the occurence of HF with repetead ESW was more frequent (subcapsular =40%; interstitial =30% and glomerular =10% than with a single ESW (subcapsular =25%; interstitial =15% and glomerular =15%. CONCLUSION: A single ESW or a repeated ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic rats the repetead ESW may result in an accumulated damage, especially with focus of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.RESUMO OBJETIVO: Avaliar o efeito de repetidas ondas de choque extracorpóreas (OCE sobre o parênquima renal de ratos normais e diabéticos. MÉTODOS: 40 ratos normais e 40 ratos diabéticos foram distribuídos para aplicação de OCE (Direx Tripter X1® - 14 KVA como segue: A1/B1 e A3/B3 sem OCE; A2/B2 uma sessão de OCE (2000 OC; A4/B4 duas sessões de OC (4000 OC num intervalo de 14 dias. Todos os animais foram sacrificados no 3º. dia após a aplicação da OCE e amostras de parênquima renal foram histologicamente preparados e corados em H&E. Para cada animal

  6. Extracorporeal life support in the treatment of colchicine poisoning.

    Science.gov (United States)

    Boisramé-Helms, Julie; Rahmani, Hassène; Stiel, Laure; Tournoud, Christine; Sauder, Philippe

    2015-01-01

    Ingestions of Colchicum autumnale may lead to severe poisoning. It begins with gastrointestinal symptoms and leukocytosis, followed by multi-organ failure with shock and a possible late recovery phase. Mortality is highly dependent on the ingested dose. We report a case of accidental C. autumnale poisoning with refractory cardiogenic shock and eventual survival after extracorporeal life support (ECLS). A 68-year-old woman was admitted to the intensive care unit (ICU) on day 3 after ingestion of C. autumnale in a meal. She first suffered from nausea and vomiting leading to severe dehydration. She then developed multi-organ failure and refractory cardiogenic shock, with a mean arterial pressure nadir of 50 mmHg despite high doses of catecholamines and a left ventricular ejection fraction at 5-10%. Venous-arterial ECLS was therefore started at an initial rate of 3.5 L/min and 3,800 rev/min. Her symptoms also included pancytopenia on day 4 with diffuse bleeding requiring iterative blood product transfusion. Platelet and leukocyte count nadirs were 13 × 10(9)/L (normal range: 150-400 × 10(9)/L) and 0.77 × 10(9)/L (normal range: 4.2-10.7 × 10(9)/L), respectively. ECLS allowed good cardiac contractility recovery within a few days, with complications including bleeding made controllable. Indeed, because of hemostasis disorders, the patient presented hemoptysis and hematuria. She was treated with tranexamic acid and transfused with blood products. She received 15 erythrocyte concentrates, 13 platelet concentrates, and 7 fresh frozen plasma. ECLS was removed by day 10, with subsequent weaning from mechanical ventilation as well as from hemodialysis in the following days. This patient survives after the use of ECLS in Colchicum poisoning, with controllable complications. Thus, ECLS might be indicated to overcome the potentially refractory cardiogenic shock phase.

  7. The Heliospheric Termination Shock

    Science.gov (United States)

    Jokipii, J. R.

    2013-06-01

    The heliospheric termination shock is a vast, spheroidal shock wave marking the transition from the supersonic solar wind to the slower flow in the heliosheath, in response to the pressure of the interstellar medium. It is one of the most-important boundaries in the outer heliosphere. It affects energetic particles strongly and for this reason is a significant factor in the effects of the Sun on Galactic cosmic rays. This paper summarizes the general properties and overall large-scale structure and motions of the termination shock. Observations over the past several years, both in situ and remote, have dramatically revised our understanding of the shock. The consensus now is that the shock is quite blunt, is with the front, blunt side canted at an angle to the flow direction of the local interstellar plasma relative to the Sun, and is dynamical and turbulent. Much of this new understanding has come from remote observations of energetic charged particles interacting with the shock, radio waves and radiation backscattered from interstellar neutral atoms. The observations and the implications are discussed.

  8. In situ zymography.

    Science.gov (United States)

    George, Sarah J; Johnson, Jason L

    2010-01-01

    In situ zymography is a unique laboratory technique that enables the localisation of matrix-degrading metalloproteinase (MMP) activity in histological sections. Frozen sections are placed on glass slides coated with fluorescently labelled matrix proteins. After incubation MMP activity can be observed as black holes in the fluorescent background due to proteolysis of the matrix protein. Alternatively frozen sections can be incubated with matrix proteins conjugated to quenched fluorescein. Proteolysis of the substrate by MMPs leads to the release of fluorescence. This technique can be combined with immunohistochemistry to enable co-location of proteins such as cell type markers or other proteins of interest. Additionally, this technique can be adapted for use with cell cultures, permitting precise location of MMP activity within cells, time-lapse analysis of MMP activity and analysis of MMP activity in migrating cells.

  9. Effects of repeated extracorporeal shock wave in urinary biochemical markers of rats Avaliação dos fatores bioquímicos urinários de risco para nefrolitíase em ratos submetidos à aplicação repetida de ondas de choque eletro-hidráulicas

    Directory of Open Access Journals (Sweden)

    Márcio Carvalho

    2009-12-01

    Full Text Available PURPOSE: To access the effect of repeated extracorporeal shock wave (ESW on urinary biochemical markers METHODS: 20 rats were assigned for ESW (Direx Tripter X1® - 14 KV to one of two groups: G1 (n=10 one ESW; G2 (n=10 two ESWs within a 14-day interval. Within the twenty-four hour period before and after the application of shock waves, the animals were placed in metabolic cages for 24 hour urine collection. The ph, creatinine, sodium, potassium, chlorides, calcium, magnesium, phosphorus, oxalates, alkaline phosphatase and citrates were measured. Twenty-four hours after the material was collected for urinary determination, the animals underwent nephrectomy of the kidney submitted to the ESW applications and were, then, sacrificed. The kidneys were processed for hispatological examination. RESULTS: Small variations in the biochemical markers were found in both groups, with no significant differences between the values obtained either prior to or following the ESW applications, except for citrate and alkaline phosphatase. Citraturia decreased significantly in group 2, following the second ESWL application (24.8 ± 3.0 mg/day after the first ESWL vs. 15.3 ± 2.2 mg/day after the second ESWL; p OBJETIVO: Avaliar os efeitos renais das ondas de choque eletro-hidráulicas (OCEH, utilizando como parâmetros marcadores bioquímicos urinários. MÉTODOS: Foram utilizados 20 ratos machos, EPM - Wistar, distribuídos aleatoriamente em dois grupos: G1 (n=10 Animais submetidos a uma sessão de OCEH. G2 (n=10 Animais submetidos a duas sessões de OCEH separadas por um intervalo de 14 dias. Para coleta da urina os animais foram mantidos em gaiolas metabólicas 24 horas antes e depois da aplicação das OCEH. Foram medidos o pH, a creatinina, sódio, potássio, cloretos, cálcio, magnésio, fósforo, oxalato, fosfatase alcalina e citrato. Vinte e quatro horas após a coleta da urina os animais foram submetidos à nefrectomia do rim envolvido no experimento e, em

  10. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    International Nuclear Information System (INIS)

    Fedele, F; Coleman, A J; Thomas, K; Ryves, S; Phillips, D; Leighton, T G

    2011-01-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  11. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Fedele, F; Coleman, A J [Medical Physics Department, Guy' s and St Thomas NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London (United Kingdom); Thomas, K; Ryves, S; Phillips, D [Urology Department, Guy' s and St Thomas NHS Foundation Trust, Great Maze Pond, SE1 9RT, London (United Kingdom); Leighton, T G, E-mail: fiammetta.fedele@gstt.nhs.uk [Institute of Sound and Vibration Research, University of Southampton, Highfield, S017 1BJ, Southampton (United Kingdom)

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  12. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Science.gov (United States)

    Fedele, F.; Thomas, K.; Leighton, T. G.; Ryves, S.; Phillips, D.; Coleman, A. J.

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p ESWL or if the patient should be sent for surgery.

  13. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Fedele, F; Coleman, A J [Medical Physics Department, Guy' s and St Thomas NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London (United Kingdom); Thomas, K; Ryves, S; Phillips, D [Urology Department, Guy' s and St Thomas NHS Foundation Trust, Great Maze Pond, SE1 9RT, London (United Kingdom); Leighton, T G, E-mail: fiammetta.fedele@gstt.nhs.uk [Institute of Sound and Vibration Research, University of Southampton, Highfield, S017 1BJ, Southampton (United Kingdom)

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  14. Medical and biomedical applications of shock waves

    CERN Document Server

    Loske, Achim M

    2017-01-01

    This book provides current, comprehensive, and clear explanations of the physics behind medical and biomedical applications of shock waves. Extracorporeal shock wave lithotripsy is one of the greatest medical advances of our time, and its techniques and clinical devices are continuously evolving. Further research continues to improve the understanding of calculi fragmentation and tissue-damaging mechanisms. Shock waves are also used in orthopedics and traumatology. Possible applications in oncology, cardiology, dentistry, gene therapy, cell transfection, transformation of fungi and bacteria, as well as the inactivation of microorganisms are promising approaches for clinical treatment, industrial applications and research. Medical and Biomedical Applications of Shock Waves is useful as a guide for students, technicians and researchers working in universities and laboratories. Chemists, biologists, physicians and veterinarians, involved in research or clinical practice will find useful advice, but also engineer...

  15. "Driverless" Shocks in the Interplanetary Medium

    Science.gov (United States)

    Gopalswamy, N.; Kaiser, M. L.; Lara, A.

    1999-01-01

    Many interplanetary shocks have been detected without an obvious driver behind them. These shocks have been thought to be either blast waves from solar flares or shocks due to sudden increase in solar wind speed caused by interactions between large scale open and closed field lines of the Sun. We investigated this problem using a set of interplanetary shock detected {\\it in situ} by the Wind space craft and tracing their solar origins using low frequency radio data obtained by the Wind/WAVES experiment. For each of these "driverless shocks" we could find a unique coronal mass ejections (CME) event observed by the SOHO (Solar and Heliospheric Observatory) coronagraphs. We also found that these CMEs were ejected at large angles from the Sun-Earth line. It appears that the "driverless shocks" are actually driver shocks, but the drivers were not intercepted by the spacecraft. We conclude that the interplanetary shocks are much more extended than the driving CMEs.

  16. Neuroradiology of extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Fitz, C.R.; Taylor, G.A.

    1986-01-01

    Extracorporeal membrane oxygenation (ECMO) is a new method of treating respiratory diseases, especially meconium aspiration, in newborns. It requires continued heparinization of the infant and carries the risk of intracranial bleeding. At the author's institution this risk is monitored with daily US examinations. CT is routinely performed at the end of treatment, or at other times to confirm the presence of any pathology that might require the cessation of ECMO treatment. Of the first 62 newborns receiving ECMO therapy, all underwent daily US examinations; 48 underwent CT. In ten patients (16%) hemorrhages developed that were detected on US; the incidence was evenly distributed between primary intraventricular and parenchymal bleeding. Five of these patients died without CT having been performed. Follow-up CT scans in another five also showed hemorrhage. In five patients CT scans showed definite small punctate areas of bleeding in unusual locations, not visible on US. CT scans in another four patients were suspicious for similar bleeding. One subarachnoid hemorrhage was found. In three infants performed widening of the interhemispheric fissure was seen, and six others had probable abnormal widening of the fissure. Overall, 14 (29%) CT scans were definitely abnormal and 21% probably abnormal. Follow-up has not been significantly long enough to allow evaluation the significance of the smaller bleeding areas and interhemispheric fissure widening seen on CT. At this time, both US and CT have a definite role in the care of newborn infants undergoing ECMO

  17. Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

    Science.gov (United States)

    Mactier, Robert; Laliberté, Martin; Mardini, Joelle; Ghannoum, Marc; Lavergne, Valery; Gosselin, Sophie; Hoffman, Robert S; Nolin, Thomas D

    2014-09-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all articles, extracted data, summarized key findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 617 articles met the search inclusion criteria. Data for 538 patients were abstracted and evaluated. Only case reports, case series, and nonrandomized observational studies were identified, yielding a low quality of evidence for all recommendations. Using established criteria, the workgroup deemed that long-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory depression necessitating mechanical ventilation, shock, persistent toxicity, or increasing or persistently elevated serum barbiturate concentrations despite treatment with multiple-dose activated charcoal. (3) Intermittent hemodialysis is the preferred mode of ECTR, and multiple-dose activated charcoal treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  18. Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

    Directory of Open Access Journals (Sweden)

    Tae Hee Hong

    2015-06-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO.

  19. Extracorporeal Membrane Oxygenation for Complicated Scrub Typhus

    Directory of Open Access Journals (Sweden)

    Eun Sun Kim

    Full Text Available Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.

  20. Modeling in situ vitrification

    International Nuclear Information System (INIS)

    Mecham, D.C.; MacKinnon, R.J.; Murray, P.E.; Johnson, R.W.

    1990-01-01

    In Situ Vitrification (ISV) process is being assessed by the Idaho National Engineering Laboratory (INEL) to determine its applicability to transuranic and mixed wastes buried at INEL'S Subsurface Disposal Area (SDA). This process uses electrical resistance heating to melt waste and contaminated soil in place to produce a durable glasslike material that encapsulates and immobilizes buried wastes. This paper outlines the requirements for the model being developed at the INEL which will provide analytical support for the ISV technology assessment program. The model includes representations of the electric potential field, thermal transport with melting, gas and particulate release, vapor migration, off-gas combustion and process chemistry. The modeling objectives are to help determine the safety of the process by assessing the air and surrounding soil radionuclides and chemical pollution hazards, the nuclear criticality hazard, and the explosion and fire hazards, help determine the suitability of the ISV process for stabilizing the buried wastes involved, and help design laboratory and field tests and interpret results. 3 refs., 2 figs., 1 tab

  1. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

    Directory of Open Access Journals (Sweden)

    Liane Brescovici Nunes

    2014-03-01

    Full Text Available OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1 optimization of extracorporeal membrane oxygenation blood flow; 2 identification of recirculation and cannula repositioning if necessary; 3 optimization of residual lung function and consideration of blood transfusion; 4 diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5 optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.

  2. Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ para el tratamiento de la litiasis ureteral Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ lithotriptor for treatment or ureteral lithiasis

    Directory of Open Access Journals (Sweden)

    María Victoria Labrada

    2010-09-01

    general es posible considerar la LEC como la primera opción terapéutica de la litiasis ureteral.INTRODUCTION. Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL using the MODULITH SLX-MX (STORZ lithotriptor for treatment or ureteral lithiasis. METHODS. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the "Hermanos Ameijeiras" Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ (96, lumbar ureter (LU (263, iliac joint (IJ (40, pelvic joint (PJ (199 analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. RESULTS. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm² in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04% previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6%. After SWEL it was necessary the conversion to other procedure for solution of 4,68% of the cases. The SWEL was effective in the 95,32% with better results in the UP (96,99% and with worse results in the IJ (92,50%. CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ lithotriptor. The better

  3. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  4. Extracorporeal shockwave therapy in musculoskeletal disorders

    OpenAIRE

    Wang, Ching-Jen

    2012-01-01

    Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave ...

  5. Frequency of stone clearance after extracorporeal shockwave ...

    African Journals Online (AJOL)

    Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent ESWL. The indications for ESWL were determined by the ...

  6. Extracorporeal total artificial heart as bailout surgery.

    Science.gov (United States)

    Perrodin, Stéphanie F; Muller, Olivier; Gronchi, Fabrizio; Liaudet, Lucas; Hullin, Roger; Kirsch, Matthias

    2017-03-01

    We report the use of a total extracorporeal heart for uncontrolled bleeding following a proximal left anterior descending artery perforation, using two centrifugal ventricular assist devices after heart explantation. The literature describing similar techniques and patient outcomes for this "bailout" technique are reviewed. © 2017 Wiley Periodicals, Inc.

  7. In-situ uranium leaching

    International Nuclear Information System (INIS)

    Dotson, B.J.

    1986-01-01

    This invention provides a method for improving the recovery of mineral values from ore bodies subjected to in-situ leaching by controlling the flow behaviour of the leaching solution. In particular, the invention relates to an in-situ leaching operation employing a foam for mobility control of the leaching solution. A foam bank is either introduced into the ore bed or developed in-situ in the ore bed. The foam then becomes a diverting agent forcing the leaching fluid through the previously non-contacted regions of the deposit

  8. In situ leaching of uranium

    International Nuclear Information System (INIS)

    Martin, B.

    1980-01-01

    A process is described for the in-situ leaching of uranium-containing ores employing an acidic leach liquor containing peroxymonosulphuric acid. Preferably, additionally, sulphuric acid is present in the leach liquor. (author)

  9. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    Energy Technology Data Exchange (ETDEWEB)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-08-15

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm.

  10. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    International Nuclear Information System (INIS)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung

    1994-01-01

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm

  11. Prolonged Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Wen-Je Ko

    2006-01-01

    Full Text Available When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS have failed, extracorporeal membrane oxygenation (ECMO can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

  12. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  13. Extracorporeal treatment for tricyclic antidepressant poisoning

    DEFF Research Database (Denmark)

    Yates, Christopher; Galvao, Tais; Sowinski, Kevin M

    2014-01-01

    The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined...... methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND...... yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers...

  14. Optimal time for initiating extracorporeal membrane oxygenation.

    Science.gov (United States)

    Haile, Dawit T; Schears, Gregory J

    2009-09-01

    The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. The technology has been validated to improve survival in select patients who would otherwise have 100% mortality. This is by far the most complex life-sustaining technology employed and thus can contribute significant risks such that the decision to institute ECMO requires prompt risk and benefit analysis. Delaying the institution of ECMO may cause irreversible pulmonary and cardiac injuries in addition to other organs. Therefore, the optimal time of initiating ECMO support is crucial to the survival of a critically ill patient.

  15. Extracorporeal shockwave for chronic patellar tendinopathy.

    Science.gov (United States)

    Wang, Ching-Jen; Ko, Jih-Yang; Chan, Yi-Sheng; Weng, Lin-Hsiu; Hsu, Shan-Lin

    2007-06-01

    Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Randomized controlled clinical trial; Level of evidence, 2. This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm(2) energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 +/- 10.22 and 39.25 +/- 10.85, respectively, before treatment (P = .129) and 92.0 +/- 10.17 and 41.04 +/- 10.96, respectively, after treatment (P Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

  16. Nitric oxide : An ally in extracorporeal circulation?

    OpenAIRE

    Melki, Vilyam

    2016-01-01

    Many complications associated with heart surgery are due to the negative effects of extracorporeal circulation (ECC). Some of these complications may be attributed to ECC-induced activation of inflammation and coagulation pathways. The inflammatory reaction may be caused by the interaction of blood components with air and the artificial surfaces of the ECC, from substances produced due to ischaemia-reperfusion injury of the heart and lungs, and from increased release of endotoxin from ischemi...

  17. Extracorporeal photopheresis: Review of technical aspects.

    Science.gov (United States)

    Arora, Satyam; Setia, Rasika

    2017-01-01

    Extracorporeal photochemotherapy (ECP) is considered as an immune modulating therapy majorly targeting the T cells of the Immune system. ECP induces an anti-inflammatory condition with tolerogenic responses without inducing a global immunosuppression state which is a typical feature of other therapeutic options such as steroids. Clinical indication of ECP has grown over time since its initial applications. Our review discusses the technical aspects of the concept of photopheresis with the available methods for its clinical applications.

  18. In Situ TEM Electrical Measurements

    DEFF Research Database (Denmark)

    Canepa, Silvia; Alam, Sardar Bilal; Ngo, Duc-The

    2016-01-01

    understanding of complex physical and chemical interactions in the pursuit to optimize nanostructure function and device performance. Recent developments of sample holder technology for TEM have enabled a new field of research in the study of functional nanomaterials and devices via electrical stimulation...... influence the sample by external stimuli, e.g. through electrical connections, the TEM becomes a powerful laboratory for performing quantitative real time in situ experiments. Such TEM setups enable the characterization of nanostructures and nanodevices under working conditions, thereby providing a deeper...... and measurement of the specimen. Recognizing the benefits of electrical measurements for in situ TEM, many research groups have focused their effort in this field and some of these methods have transferred to ETEM. This chapter will describe recent advances in the in situ TEM investigation of nanostructured...

  19. Triplex in-situ hybridization

    Science.gov (United States)

    Fresco, Jacques R.; Johnson, Marion D.

    2002-01-01

    Disclosed are methods for detecting in situ the presence of a target sequence in a substantially double-stranded nucleic acid segment, which comprises: a) contacting in situ under conditions suitable for hybridization a substantially double-stranded nucleic acid segment with a detectable third strand, said third strand being capable of hybridizing to at least a portion of the target sequence to form a triple-stranded structure, if said target sequence is present; and b) detecting whether hybridization between the third strand and the target sequence has occured.

  20. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction?

    DEFF Research Database (Denmark)

    Olsen, Anne B; Persiani, Marie; Boie, Sidsel

    2015-01-01

    OBJECTIVE: The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. MATERIALS AND METHODS: This prospective, randomized, blinded, placebo-controlled study included 112 ...... are needed. KEYWORDS: Erectile dysfunction; extracorporeal shockwave; penis...

  1. MRI-guided therapeutic ultrasound: Temperature feedback control for extracorporeal and endoluminal applicators

    Science.gov (United States)

    Salomir, Rares

    2005-09-01

    Therapeutic ultrasound is a mini-invasive and promising tool for in situ ablation of non-resectable tumors in uterus, breast, esophagus, kidney, liver, etc. Extracorporeal, endoluminal, and interstitial applicators have been successfully tested to date. Magnetic resonance imaging (MRI) is the only available technique providing non-invasive temperature mapping, together with excellent contrast of soft tissue. Coupling of these two technologies offers the advantage of both: (1) on line spatial guidance to the target region, and (2) thermal dose control during the treatment. This talk will provide an overview of the author's experience with automatic, active feedback control of the temperature evolution in tissues, which has been demonstrated with MRI compatible extracorporeal transducers (focused beam) or endoluminal applicators (plane waves). The feedback loop is based on fast switching capabilities of the driving electronics and real time data transfer out of the MR scanner. Precision of temperature control was typically better than 1°C. This approach is expected to improve the efficacy of the treatment (complete tumor ablation) and the thermal security of the critical regions crossed by the acoustic beam. It also permits one to reach an under-lethal heating regime for local drug delivery using thermosensitive liposomes or gene expression control based on hsp promoters.

  2. Underwater Shock Wave Research Applied to Therapeutic Device Developments

    Science.gov (United States)

    Takayama, K.; Yamamoto, H.; Shimokawa, H.

    2013-07-01

    The chronological development of underwater shock wave research performed at the Shock Wave Research Center of the Institute of Fluid Science at the Tohoku University is presented. Firstly, the generation of planar underwater shock waves in shock tubes and their visualization by using the conventional shadowgraph and schlieren methods are described. Secondly, the generation of spherical underwater shock waves by exploding lead azide pellets weighing from several tens of micrograms to 100 mg, that were ignited by irradiating with a Q-switched laser beam, and their visualization by using double exposure holographic interferometry are presented. The initiation, propagation, reflection, focusing of underwater shock waves, and their interaction with various interfaces, in particular, with air bubbles, are visualized quantitatively. Based on such a fundamental underwater shock wave research, collaboration with the School of Medicine at the Tohoku University was started for developing a shock wave assisted therapeutic device, which was named an extracorporeal shock wave lithotripter (ESWL). Miniature shock waves created by irradiation with Q-switched HO:YAG laser beams are studied, as applied to damaged dysfunctional nerve cells in the myocardium in a precisely controlled manner, and are effectively used to design a catheter for treating arrhythmia.

  3. In situ solution mining technique

    International Nuclear Information System (INIS)

    Learmont, R.P.

    1978-01-01

    A method of in situ solution mining is disclosed in which a primary leaching process employing an array of 5-spot leaching patterns of production and injection wells is converted to a different pattern by converting to injection wells all the production wells in alternate rows

  4. 'In situ' expanded graphite extinguishant

    International Nuclear Information System (INIS)

    Cao Qixin; Shou Yuemei; He Bangrong

    1987-01-01

    This report is concerning the development of the extinguishant for sodium fire and the investigation of its extinguishing property. The experiment result shows that 'in situ' expanded graphite developed by the authors is a kind of extinguishant which extinguishes sodium fire quickly and effectively and has no environment pollution during use and the amount of usage is little

  5. In Situ Cardiovascular Tissue Engineering

    NARCIS (Netherlands)

    Talacua, H

    2016-01-01

    In this thesis, the feasibility of in situ TE for vascular and valvular purposes were tested with the use of different materials, and animal models. First, the feasibility of a decellularized biological scaffold (pSIS-ECM) as pulmonary heart valve prosthesis is examined in sheep (Chapter 2). Next,

  6. Characterization and modification of cavitation pattern in shock wave lithotripsy

    Science.gov (United States)

    Arora, Manish; Ohl, Claus Dieter; Liebler, Marko

    2004-01-01

    The temporal and spatial dynamics of cavitation bubble cloud growth and collapse in extracorporeal shock wave lithotripsy (ESWL) is studied experimentally. The first objective is obtaining reproducible cloud patterns experimentally and comparing them with FDTD-calculations. Second, we describe a method to modify the cavitation pattern by timing two consecutive pressure waves at variable delays. It is found that the spatial and temporal dynamics of the cavitation bubble can be varied in large ranges. The ability to control cavitation dynamics allows discussing strategies for improvement of medical and biological applications of shock waves such as cell membrane poration and stone fragmentation.

  7. New ultrasound stone locking system in extracorporeal lithotripsy: Decreased duration of fluoroscopy and radiation doses

    International Nuclear Information System (INIS)

    Abid, N.; Ravier, E.; Codas, R.; Crouzet, S.; Martin, X.

    2013-01-01

    Extracorporeal shock wave lithotripsy is the most common method of treatment for kidney stones. Both fluoroscopy and ultrasound imaging can be used to locate stones, but fluoroscopy is more frequently employed. Evaluation of a new stereotaxic navigational system: the stone was located using an ultrasound probe, and its 3D location was saved. The table automatically moved to position the stone at the focal point. A real-time follow-up was possible during treatment. Our objective was to demonstrate a decrease in the use of fluoroscopy to locate kidney stones for extracorporeal shock wave lithotripsy through the use of a 3D ultrasound stone locking system. Prospective analysis of the case records of the 20 patients preceding and the 20 patients succeeding the arrival of the ultrasound stone locking system Visio-Track (EDAP-TMS). We used a Student test to compare age, BMI, kidney stone size, number of shock waves and administered energy. Patient characteristics were comparable. The average age was 55 years old and the average kidney stone size was 10.7 mm. Radiation duration was 174.8 seconds in the group without Visio-Track versus 57.1 seconds in the group with it (P < 0.0001). A similar result was observed for radiation doses: 5197.25 mGy.cm 2 for the group without versus 1987.6 mGy.cm 2 for the group with Visio-Track (P ≡ 0.0033). The stone locking system Visio-Track reduced fluoroscopy in our first group of patients, which decreased the patient's individual absorbed irradiation dose. (authors)

  8. Working mechanism of extracorporeal shockwave therapy in non-urological disciplines

    Science.gov (United States)

    Schaden, Wolfgang

    2005-04-01

    For 32 years of extracorporeal shockwave lithotripsy (ESWL) only the mechanical strength of shockwaves were of clinical interest. For use in orthopaedics, the absence of dangerous long term effects (malignant degeneration, etc.) is the only important message. The mechanical model tries to explain the effect of shock waves by the provocation of microleasions in the tissue stimulating repairing processes. First doubts on this mechanical model came up when Schaden (2001) could show, that less energy is more efficient in the treatment of non-unions. Due to the basic research of the last years knowledge increased about the microbiological effects. Under the influence of shock waves the change of permeability of cell membranes and the liberation of free radicals was reported. Also the production of nitric oxide (NO) and different growth factors like vascular endothelial growth factor (VEGF), bone morphogenetic proteins (BMP), transforming growth factor-beta 1 (TGF-b1), insulin-like growth factor-I (IGF-I) etc. was observed. The biological model tries to explain the effect of shock waves by stimulating the ingrowth of blood vessels and liberation of growth factors. Under the influence of shock waves, biological tissues seem to be able to produce important substances to initiate healing processes.

  9. Blood leukocyte responses to extracorporeal circulation. 1. Short term extracorporeal circulation in dogs without and with extracorporeal irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Szemere, P.; Fliedner, T.M. (Ulm Univ. (Germany, F.R.). Abt. Klinische Physiologie)

    1983-01-01

    Short term (1 h) extracorporeal circulation without or with irradiation of blood was performed in two normal dogs in a series of experiments. The granulocyte count was constantly diminished, while the lymphocytes did not show any particular change in their concentration. In the majority of the experiments a decrease of the CFU-C content occurred to less than 70% of the initial level. There was no difference in the results of experiments with or without irradiation. In the 'bag to bag' procedures, no significant change in the blood leukocyte counts including CFU-C, was established.

  10. Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup.

    Science.gov (United States)

    Ghannoum, Marc; Wiegand, Timothy J; Liu, Kathleen D; Calello, Diane P; Godin, Melanie; Lavergne, Valery; Gosselin, Sophie; Nolin, Thomas D; Hoffman, Robert S

    2015-05-01

    The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline. After a systematic review of the literature, a subgroup reviewed articles, extracted data, summarized findings, and proposed structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed. A second vote determined the final recommendations. 141 articles were included: 6 in vitro studies, 4 animal studies, 101 case reports/case series, 7 descriptive cohorts, 4 observational studies, and 19 pharmacokinetic studies, yielding a low-to-very-low quality of evidence for all recommendations. Data on 143 patients were reviewed, including 10 deaths. The workgroup concluded that theophylline is dialyzable (level of evidence = A) and made the following recommendations: ECTR is recommended in severe theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal decontamination cannot be administered (2D). ECTR should be continued until clinical improvement is apparent or the [theophylline] is poisoning is amenable to ECTRs. The workgroup recommended

  11. Shock absorber

    International Nuclear Information System (INIS)

    Nemeth, J.D.

    1981-01-01

    A shock absorber for the support of piping and components in a nuclear power plant is described. It combines a high degree of stiffness under sudden shocks, e.g. seismic disturbances, with the ability to allow for thermal expansion without resistance when so required. (JIW)

  12. Nodular Scleroderma - Successful Treatment With Extracorporeal Photochemotherapy

    Directory of Open Access Journals (Sweden)

    Wollina U

    2001-01-01

    Full Text Available Nodular seleroderma is rare variant of circumscribed scleroderma (morphea. Treatment is often unsatisfactory. This report is on the use of extracorporeal photochemotherapy. A 12 year old girl and a 49 year old woman have been treated once a month on two consecutive days. A complete remission was achieved in one patient after 10 months and an almost complete remission in the young girl after 6 months. The treatment was well-tolerated and no severe side â€" effects occurred. In contrast to previous attempts in treating nodular scleroderma with different modalities, ECP seems to be an effective therapy.

  13. Burst mode trigger of STEREO in situ measurements

    Science.gov (United States)

    Jian, L. K.; Russell, C. T.; Luhmann, J. G.; Curtis, D.; Schroeder, P.

    2013-06-01

    Since the launch of the STEREO spacecraft, the in situ instrument suites have continued to modify their burst mode trigger in order to optimize the collection of high-cadence magnetic field, solar wind, and suprathermal electron data. This report reviews the criteria used for the burst mode trigger and their evolution with time. From 2007 to 2011, the twin STEREO spacecraft observed 236 interplanetary shocks, and 54% of them were captured by the burst mode trigger. The capture rate increased remarkably with time, from 30% in 2007 to 69% in 2011. We evaluate the performance of multiple trigger criteria and investigate why some of the shocks were missed by the trigger. Lessons learned from STEREO are useful for future missions, because the telemetry bandwidth needed to capture the waveforms of high frequency but infrequent events would be unaffordable without an effective burst mode trigger.

  14. Development of a Novel Shock Wave Catheter Ablation System

    Science.gov (United States)

    Yamamoto, H.; Hasebe, Yuhi; Kondo, Masateru; Fukuda, Koji; Takayama, Kazuyoshi; Shimokawa, Hiroaki

    Although radio-frequency catheter ablation (RFCA) is quite effective for the treatment tachyarrhythmias, it possesses two fundamental limitations, including limited efficacy for the treatment of ventricular tachyarrhythmias of epicardial origin and the risk of thromboembolism. Consequently, new method is required, which can eradicate arrhythmia source in deep part of cardiac muscle without heating. On the other hand, for a medical application of shock waves, extracorporeal shock wave lithotripter (ESWL) has been established [1]. It was demonstrated that the underwater shock focusing is one of most efficient method to generate a controlled high pressure in a small region [2]. In order to overcome limitations of existing methods, we aimed to develop a new catheter ablation system with underwater shock waves that can treat myocardium at arbitrary depth without causing heat.

  15. Polyolefin nanocomposites in situ polymerization

    Energy Technology Data Exchange (ETDEWEB)

    Galland, Griselda Barrera; Fim, Fabiana de C.; Milani, Marceo A.; Silva, Silene P. da; Forest, Tadeu; Radaelli, Gislaine, E-mail: griselda.barrera@ufrgs.br [Universidade Federal do Rio Grande de Sul - UFRGS, Porto Alegre, RS (Brazil); Basso, Nara R.S. [Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS (Brazil); Quijada, Raul [Universidad de Chile, Santiago (Chile)

    2011-07-01

    Polyethylene and polypropylene nanocomposites using grapheme nanosheets and treated chrysotile have been synthesized by in situ polymerization using metallocene catalysts. The fillers have been submitted to acid, thermal and/ou ultrasound treatments before to introduce them into the polymerization reactor. A complete characterization of the fillers has been done. The nanocomposites have been characterized by SEM, TEM, DRX and AFM. The thermal, mechanic -dynamic, mechanical and electrical properties of the nanocomposites are discussed. (author)

  16. Polyolefin nanocomposites in situ polymerization

    International Nuclear Information System (INIS)

    Galland, Griselda Barrera; Fim, Fabiana de C.; Milani, Marceo A.; Silva, Silene P. da; Forest, Tadeu; Radaelli, Gislaine; Basso, Nara R.S.; Quijada, Raul

    2011-01-01

    Polyethylene and polypropylene nanocomposites using grapheme nanosheets and treated chrysotile have been synthesized by in situ polymerization using metallocene catalysts. The fillers have been submitted to acid, thermal and/ou ultrasound treatments before to introduce them into the polymerization reactor. A complete characterization of the fillers has been done. The nanocomposites have been characterized by SEM, TEM, DRX and AFM. The thermal, mechanic -dynamic, mechanical and electrical properties of the nanocomposites are discussed. (author)

  17. Collisionless shocks in space plasmas structure and accelerated particles

    CERN Document Server

    Burgess, David

    2015-01-01

    Shock waves are an important feature of solar system plasmas, from the solar corona out to the edge of the heliosphere. This engaging introduction to collisionless shocks in space plasmas presents a comprehensive review of the physics governing different types of shocks and processes of particle acceleration, from fundamental principles to current research. Motivated by observations of planetary bow shocks, interplanetary shocks and the solar wind termination shock, it emphasises the physical theory underlying these shock waves. Readers will develop an understanding of the complex interplay between particle dynamics and the electric and magnetic fields that explains the observations of in situ spacecraft. Written by renowned experts in the field, this up-to-date text is the ideal companion for both graduate students new to heliospheric physics and researchers in astrophysics who wish to apply the lessons of solar system shocks to different astrophysical environments.

  18. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery

    NARCIS (Netherlands)

    Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M. J.; de Geus, Hilde H. R.; Scholten, Evert W.; de Mol, Bas A. J. M.; Ince, Can

    2012-01-01

    OBJECTIVES: To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery

  19. demystifying the shock of shocking

    African Journals Online (AJOL)

    (with a pulse), atrial fibrillation and atrial flutter. The energy dose in cardioversion is less (0.5. - 2 J/kg) than in defibrillation (2 - 4 J/kg). In cardioversion the shock is discharged synchronously with the native R wave of the patient. Without synchronisation,. VF can be induced if a shock is delivered during the refractory period ...

  20. Guidelines on the use of extracorporeal photopheresis.

    Science.gov (United States)

    Knobler, R; Berlin, G; Calzavara-Pinton, P; Greinix, H; Jaksch, P; Laroche, L; Ludvigsson, J; Quaglino, P; Reinisch, W; Scarisbrick, J; Schwarz, T; Wolf, P; Arenberger, P; Assaf, C; Bagot, M; Barr, M; Bohbot, A; Bruckner-Tuderman, L; Dreno, B; Enk, A; French, L; Gniadecki, R; Gollnick, H; Hertl, M; Jantschitsch, C; Jung, A; Just, U; Klemke, C-D; Lippert, U; Luger, T; Papadavid, E; Pehamberger, H; Ranki, A; Stadler, R; Sterry, W; Wolf, I H; Worm, M; Zic, J; Zouboulis, C C; Hillen, U

    2014-01-01

    After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. © 2013 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

  1. Extracorporeal irradiation for malignant bone tumors

    International Nuclear Information System (INIS)

    Hong, Angela; Stevens, Graham; Stalley, Paul; Pendlebury, Susan; Ahern, Verity; Ralston, Anna; Estoesta, Edgar; Barrett, Ian

    2001-01-01

    Purpose: Extracorporeal irradiation (ECI) has been used selectively in the management of primary malignant bone tumors since 1996. We report our techniques for ECI and the short-term oncologic and orthopedic outcomes. Methods and Materials: Sixteen patients with primary malignant bone tumors were treated with ECI from 1996 to 2000. The median age was 14 years. The histologic diagnoses were Ewing's sarcoma (11), osteosarcoma (4) and chondrosarcoma (1). The treated sites were femur (7), tibia (4), humerus (2), ilium (2), and sacrum (1). Following induction chemotherapy in Ewing's sarcomas and osteosarcoma, en bloc resection of the tumor and tumor-bearing bone was performed. A single dose of 50 Gy was delivered to the bone extracorporeally using either a linear accelerator (9 cases) or a blood product irradiator (7 cases). The orthopedic outcome was recorded using a standard functional scale. Results: At a median follow-up of 19.5 months, there were no cases of local recurrence or graft failure. One patient required amputation due to chronic osteomyelitis. For the 10 patients with follow-up greater than 18 months, the functional outcomes were graded good to excellent. Conclusion: The short-term oncologic and orthopedic results are encouraging and suggest that ECI provides a good alternative for reconstruction in limb conservative surgery in selected patients. This technique should only be used in a multidisciplinary setting, where careful follow-up is available to assess the long-term outcomes

  2. Noise canceling in-situ detection

    Science.gov (United States)

    Walsh, David O.

    2014-08-26

    Technologies applicable to noise canceling in-situ NMR detection and imaging are disclosed. An example noise canceling in-situ NMR detection apparatus may comprise one or more of a static magnetic field generator, an alternating magnetic field generator, an in-situ NMR detection device, an auxiliary noise detection device, and a computer.

  3. Central extracorporeal membrane oxygenation requiring pulmonary arterial venting after near-drowning.

    Science.gov (United States)

    Kimura, Mitsutoshi; Kinoshita, Osamu; Fujimoto, Yoshifumi; Murakami, Arata; Shindo, Takahiro; Kashiwa, Koichi; Ono, Minoru

    2014-02-01

    Extracorporeal membrane oxygenation (ECMO) is an effective respiratory and circulatory support in patients in refractory cardiogenic shock or cardiac arrest. Peripheral ECMO sometimes requires left heart drainage; however, few reports state that pulmonary arterial (PA) venting is required during ECMO support. We present a case of a 14-year-old boy who required PA venting during ECMO support after resuscitation from near-drowning in freshwater. A biventricular assist device with an oxygenator implantation was intended on day 1; however, we were unable to proceed because of increasing of pulmonary vascular resistance from the acute lung injury. Central ECMO with PA venting was then performed. On day 13, central ECMO was converted to biventricular assist device with an oxygenator, which was removed on day 16. This case suggests that PA venting during ECMO support may be necessary in some cases of respiratory and circulatory failure with high pulmonary vascular resistance after near-drowning.

  4. Evaluation of the dose to patients during extracorporated lithotripsy treatment (ESWL)

    International Nuclear Information System (INIS)

    Rodriguez, M.F.; Roman, J.R.

    1997-01-01

    Litiasis urinaria is appearing more frequently with approximately 12% of the population with a stone in the urinary system at any moment of their life. The stone produces severe colics causing pain in the transit through the ureter. This is probably one of the worst pains and experiences in human beings. The treatment by extracorporated lithotripsy consists of powdering or smashing into pieces the stones in the kidney and ureter. This has been done with the help of shock waves generated from a canon and which are focused on the stone. The machine used is aimed and the procedure is monitored by way of X rays. The high number of patients treated per year and the doses applied to the patients during the diagnosis, treatment and follow-up led to this study

  5. Hypovolemic shock

    Science.gov (United States)

    ... the person's position unless they are in immediate danger. Do not give fluids by mouth. If person ... the patient with shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  6. Extracorporeal Circulation Using an Extracorporeal Membrane Oxygenation System and an Autotransfusion System

    Directory of Open Access Journals (Sweden)

    Yu. A. Bakhareva

    2010-01-01

    Full Text Available The authors draw attention to the fact that complete cardiopulmonary bypass can be made in the emergency situation in order to perform an extracorporeal membrane oxygenation (ECMO procedure in a 5-year-old boy weighing 15 kg, diagnosed as having Fallot tetrad. By taking into account the technological features of the system for ECMO, there is an additional need for a blood cell separator to be applied.

  7. Shock absorber

    International Nuclear Information System (INIS)

    Housman, J.J.

    1978-01-01

    A shock absorber is described for use in a hostile environment at the end of a blind passage for absorbing impact loads. The shock absorber includes at least one element which occupies the passage and which is comprised of a porous brittle material which is substantially non-degradable in the hostile environment. A void volume is provided in the element to enable the element to absorb a predetermined level of energy upon being crushed due to impact loading

  8. In situ measurement of diffusivity

    International Nuclear Information System (INIS)

    Berne, F.; Pocachard, J.

    2004-01-01

    The mechanism of molecular diffusion controls the migration of contaminants in very low-permeability porous media, like underground facilities for the storage of hazardous waste. Determining of relevant diffusion coefficients is therefore of prime importance. A few techniques exist for in situ measurement of the quantity, but they suffer from many handicaps (duration, complexity and cost of the experiments). We propose here two innovative methods that have some potential to improve the situation. So far, we have found them feasible on the basis of design calculations and laboratory experiments. This work is presently protected by a patent. (author)

  9. In situ measurement of diffusivity

    International Nuclear Information System (INIS)

    Berne, Ph.; Pocachard, J.

    2005-01-01

    The mechanism of molecular diffusion controls the migration of contaminants in very low-permeability porous media, like underground facilities for the storage of hazardous waste. Determining the relevant diffusion coefficients is, therefore, of prime importance. A few techniques exist for the in situ measurement of that quantity, but they suffer from many handicaps (duration, complexity and cost of the experiments). We propose here two innovative methods that have some potential to improve this situation. So far, we have found them feasible on the basis of design calculations and laboratory experiments. This work is presently protected by a patent. (author)

  10. In situ dehydration of yugawaralite

    DEFF Research Database (Denmark)

    Artioli, G.; Ståhl, Kenny; Cruciani, G.

    2001-01-01

    The structural response of the natural zeolite yugawaralite (CaAl2Si6O16. 4H(2)O) upon thermally induced dehydration has been studied by Rietveld analysis of temperature-resolved powder diffraction data collected in situ in the temperature range 315-791 K using synchrotron radiation. The room...... progressively disappearing as the dehydration proceeds. The yugawaralite structure reacts to the release of water molecules with small changes in the Ca-O bond distances and minor distortions of the tetrahedral framework up to about 695 K. Above this temperature the Ca coordination falls below 7 (four framework...

  11. Guidelines for reporting case studies on extracorporeal treatments in poisonings

    DEFF Research Database (Denmark)

    Lavergne, Valéry; Ouellet, Georges; Bouchard, Josée

    2014-01-01

    A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field...... of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen...... reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 were reviewed during the external validation rounds. Twenty-one panelists (20 from the EXTRIP workgroup and an invited expert on pharmacology reporting guidelines) participated in the modified Delphi technique...

  12. Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review.

    NARCIS (Netherlands)

    Mol, A.C. de; Liem, K.D.; Heijst, A.F.J. van

    2013-01-01

    Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral

  13. LEUKOCYTE AND PLATELET ACTIVATION DURING EXTRACORPOREAL-CIRCULATION

    NARCIS (Netherlands)

    VANOEVEREN, W

    1994-01-01

    Extracorporeal circulation of blood has become a routine procedure in plasmapheresis, hemodialysis and cardiopulmonary bypass. Specifically in cardiopulmonary bypass, blood is exposed to a large material surface area, which induces an inflammatory reaction and bleeding disorders. It has been

  14. Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones

    Science.gov (United States)

    Elkholy, Mohamed M.; Ismail, Hassan; Abdelkhalek, Mohamed A.; Badr, Mohamad M.; Elfeky, Mohamed M.

    2014-01-01

    Objective: The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi. Patients and Methods: A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded. Results: Stones were in the abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred. Conclusion: The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major complications. PMID:25371614

  15. Plasmapheresis and other extracorporeal filtration techniques in critical patients.

    Science.gov (United States)

    Daga Ruiz, D; Fonseca San Miguel, F; González de Molina, F J; Úbeda-Iglesias, A; Navas Pérez, A; Jannone Forés, R

    2017-04-01

    Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  16. Extracorporeal respiratory support in adult patients

    Directory of Open Access Journals (Sweden)

    Thiago Gomes Romano

    Full Text Available ABSTRACT In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO, which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.

  17. EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL PADA BATU GINJAL

    Directory of Open Access Journals (Sweden)

    Anak Agung Sri Satyawati

    2014-09-01

    Full Text Available Latar Belakang. Extracorporeal shockwave lithotripsy (ESWL merupakan pilihan terapi yang paling cost effective pada kasus kasus batu ginjal, namun sayangnya modalitas terapi ini belum banyak dipilih karena dianggap mahal dan kurangnya informasi mengenai keuntungan penggunaannya. Kasus. Perempuan usia 65 tahun mengeluh nyeri pinggang yang dirasakan mendadak dan semakin memberat  sejak 2 bulan sebelum masuk rumah sakit, disertai mual dan penurunan nafsu makan. Berdasarkan pemeriksaan foto polos abdomen dan USG Urologi  didapatkan kesan adanya batu renal dekstra ukuran 16mm x 18mm, dengan hidronefrosis derajat I renal dekstra. Kemudian dilakukan tindakan ESWL. Hasil. Setelah dilakukan tindakan ESWL berupa penghantaran gelombang kejut pada permukaan ginjal  kanan selama 20-30 menit, keluar pecahan pecahan kecil batu kalsium. Berdasarkan pemeriksaan radiografi post ESWL tidak ditemukan gambaran radioopak pada kaliks ginjal, ureter maupun kandung kemih. Kesimpulan. Batu kalsium dengan ukuran 16mm x 18mm pada renal dekstra berhasil dikeluarkan total tanpa adanya komplikasi.

  18. Four Models of In Situ Simulation

    DEFF Research Database (Denmark)

    Musaeus, Peter; Krogh, Kristian; Paltved, Charlotte

    2014-01-01

    Introduction In situ simulation is characterized by being situated in the clinical environment as opposed to the simulation laboratory. But in situ simulation bears a family resemblance to other types of on the job training. We explore a typology of in situ simulation and suggest that there are f......Introduction In situ simulation is characterized by being situated in the clinical environment as opposed to the simulation laboratory. But in situ simulation bears a family resemblance to other types of on the job training. We explore a typology of in situ simulation and suggest...... that there are four fruitful approaches to in situ simulation: (1) In situ simulation informed by reported critical incidents and adverse events from emergency departments (ED) in which team training is about to be conducted to write scenarios. (2) In situ simulation through ethnographic studies at the ED. (3) Using...... the following processes: Transition processes, Action processes and Interpersonal processes. Design and purpose This abstract suggests four approaches to in situ simulation. A pilot study will evaluate the different approaches in two emergency departments in the Central Region of Denmark. Methods The typology...

  19. In situ bypass og diabetes

    DEFF Research Database (Denmark)

    Jensen, Leif Panduro; Schroeder, T V; Lorentzen, J E

    1993-01-01

    decreased survival rate was found in diabetics (p useful in the treatment of critical ischaemia of the lower limb in diabetic patients. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non-diabetic......From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p...... = 0.005). Critical limb-ischaemia was more often present in diabetic than non-diabetic patients (DM:57%, NDM:36%, p = 0.0002). Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.00001). There were no differences among diabetic and non-diabetic patients...

  20. In situ treatability test plan

    International Nuclear Information System (INIS)

    1996-08-01

    This document describes the plans for the in situ treatment zone (ISTZ) treatability test for groundwater contaminated with strontium-90. The treatability test is to be conducted at the Hanford Site in Richland, Washington, in a portion of the 100-N Area adjacent to the Columbia River referred to as N-Springs. The purpose of the treatability test is to evaluate the effectiveness of an innovative technology to prevent the discharge of strontium-90 contaminated groundwater into the Columbia River. The ISTZ is a passive technology that consists of placing a treatment agent in the path of the groundwater. The treatment agent must restrict target radioactive contaminants and provide time for the contaminant to decay to acceptable levels. The permeability of the treatment zone must be greater than or equal to that of the surrounding sediments to ensure that the contaminated groundwater flows through the treatment zone agent and not around the agent

  1. DOE In Situ Remediation Integrated Program

    International Nuclear Information System (INIS)

    Yow, J.L. Jr.

    1993-01-01

    The In Situ Remediation Integrated Program (ISRP) supports and manages a balanced portfolio of applied research and development activities in support of DOE environmental restoration and waste management needs. ISRP technologies are being developed in four areas: containment, chemical and physical treatment, in situ bioremediation, and in situ manipulation (including electrokinetics). the focus of containment is to provide mechanisms to stop contaminant migration through the subsurface. In situ bioremediation and chemical and physical treatment both aim to destroy or eliminate contaminants in groundwater and soils. In situ manipulation (ISM) provides mechanisms to access contaminants or introduce treatment agents into the soil, and includes other technologies necessary to support the implementation of ISR methods. Descriptions of each major program area are provided to set the technical context of the ISM subprogram. Typical ISM needs for major areas of in situ remediation research and development are identified

  2. In Situ Hybridization Pada Kanker Payudara

    OpenAIRE

    Diah Witari, Ni Putu

    2014-01-01

    Kesulitan yang dijumpai pada penanganan kanker payudara adalah terjadinya kekambuhan atau relaps. Deteksi status HER2 pada pasien merupakan salah satu upaya untuk mendeteksi terjadinya relaps dan juga untuk menentukan jenis terapi yang ada diberikan. Ekspresi protein HER2 dapat dideteksi dengan immunohistochemistry (IHC), sedangkan mutasi gen HER2 dapat dideteksi dengan teknik in situ hybridization baik berupa fluorescence in situ hybridization (FISH) ataupun chromogenic in situ hy...

  3. Training for teamwork through in situ simulations

    Science.gov (United States)

    Sorensen, Asta; Poehlman, Jon; Bollenbacher, John; Riggan, Scott; Davis, Stan; Miller, Kristi; Ivester, Thomas; Kahwati, Leila

    2015-01-01

    In situ simulations allow healthcare teams to practice teamwork and communication as well as clinical management skills in a team's usual work setting with typically available resources and equipment. The purpose of this video is to demonstrate how to plan and conduct in situ simulation training sessions, with particular emphasis on how such training can be used to improve communication and teamwork. The video features an in situ simulation conducted at a labour and delivery unit in response to postpartum hemorrhage. PMID:26294962

  4. Shock waves: a new physical principle in medicine.

    Science.gov (United States)

    Brendel, W

    1986-01-01

    Shock wave therapy of kidney- and gallstones, i.e. extracorporeal shock wave lithotripsy (ESWL), is a new, noninvasive technique to destroy concrements in the kidney, the gallbladder and in the ductus choledochus. This method was developed by the Dornier Company, Friedrichshafen, FRG, and tested in animal experiments at the Institute for Surgical Research of the University of Munich. In the meantime, kidney lithotripsy has gained world-wide acceptance. More than 60,000 patients suffering from urolithiasis have been treated successfully, what made surgical removal of their kidney stones obsolete. Gallstone lithotripsy is, however, still at the very beginning of clinical trial. Lithotripsy of gallbladder stones will have to be applied in combination with urso- or chenodesoxycholic acid in order to obtain complete dissolution of the fragments. Potential hazards to living tissues are briefly mentioned. Since the lung is particularly susceptible, shock waves must enter the body at an angle which ensures that lung tissue is not affected.

  5. Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.

    Science.gov (United States)

    Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme

    2017-05-01

    Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal

  6. Toxic shock syndrome

    Science.gov (United States)

    Staphylococcal toxic shock syndrome; Toxic shock-like syndrome; TSLS ... Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock- ...

  7. The SENSEI Generic In Situ Interface

    Energy Technology Data Exchange (ETDEWEB)

    Ayachit, Utkarsh [Kitware, Inc., Clifton Park, NY (United States); Whitlock, Brad [Intelligent Light, Rutherford, NJ (United States); Wolf, Matthew [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Loring, Burlen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Geveci, Berk [Kitware, Inc., Clifton Park, NY (United States); Lonie, David [Kitware, Inc., Clifton Park, NY (United States); Bethel, E. Wes [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-04-11

    The SENSEI generic in situ interface is an API that promotes code portability and reusability. From the simulation view, a developer can instrument their code with the SENSEI API and then make make use of any number of in situ infrastructures. From the method view, a developer can write an in situ method using the SENSEI API, then expect it to run in any number of in situ infrastructures, or be invoked directly from a simulation code, with little or no modification. This paper presents the design principles underlying the SENSEI generic interface, along with some simplified coding examples.

  8. Shock Initiation of Damaged Explosives

    Energy Technology Data Exchange (ETDEWEB)

    Chidester, S K; Vandersall, K S; Tarver, C M

    2009-10-22

    Explosive and propellant charges are subjected to various mechanical and thermal insults that can increase their sensitivity over the course of their lifetimes. To quantify this effect, shock initiation experiments were performed on mechanically and thermally damaged LX-04 (85% HMX, 15% Viton by weight) and PBX 9502 (95% TATB, 5% Kel-F by weight) to obtain in-situ manganin pressure gauge data and run distances to detonation at various shock pressures. We report the behavior of the HMX-based explosive LX-04 that was damaged mechanically by applying a compressive load of 600 psi for 20,000 cycles, thus creating many small narrow cracks, or by cutting wedge shaped parts that were then loosely reassembled, thus creating a few large cracks. The thermally damaged LX-04 charges were heated to 190 C for long enough for the beta to delta solid - solid phase transition to occur, and then cooled to ambient temperature. Mechanically damaged LX-04 exhibited only slightly increased shock sensitivity, while thermally damaged LX-04 was much more shock sensitive. Similarly, the insensitive explosive PBX 9502 was mechanically damaged using the same two techniques. Since PBX 9502 does not undergo a solid - solid phase transition but does undergo irreversible or 'rachet' growth when thermally cycled, thermal damage to PBX 9502 was induced by this procedure. As for LX-04, the thermally damaged PBX 9502 demonstrated a greater shock sensitivity than mechanically damaged PBX 9502. The Ignition and Growth reactive flow model calculated the increased sensitivities by igniting more damaged LX-04 and PBX 9502 near the shock front based on the measured densities (porosities) of the damaged charges.

  9. Extracorporeal respiratory support in adult patients.

    Science.gov (United States)

    Romano, Thiago Gomes; Mendes, Pedro Vitale; Park, Marcelo; Costa, Eduardo Leite Vieira

    2017-01-01

    In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation. RESUMO Em pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.

  10. PRINS and in situ PCR protocols

    National Research Council Canada - National Science Library

    Gosden, John R

    1997-01-01

    ... mapping of DNA sequences on chromosomes and location of gene expression followed the invention and refinement of in situ hybridization. Among the most recent technical developments has been the use of oligonucleotide primers to detect and amplify or extend complementary sequences in situ, and it is to this novel field that PRINS and In S...

  11. Technology assessment of in situ uranium mining

    International Nuclear Information System (INIS)

    Cowan, C.E.

    1981-01-01

    The objective of the PNL portion of the Technology Assessment project is to provide a description of the current in situ uranium mining technology; to evaluate, based on available data, the environmental impacts and, in a limited fashion, the health effects; and to explore the impediments to development and deployment of the in situ uranium mining technology

  12. Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function

    Science.gov (United States)

    Akin, Yigit; Yucel, Selcuk

    2014-01-01

    Introduction Extracorporeal shock wave lithotripsy (ESWL) is a well-known and successful treatment modality. In addition, it can be used in premature infants. ESWL is used to treat kidney and ureter stones in children. However, although it is a preferred noninvasive treatment in that setting, there is debate about its long-term effects on growing kidneys in children. Objectives To investigate the long-term effects of pediatric ESWL on renal function in light of updated literature. Methods PubMed and Medline were searched for studies on ESWL in a pediatric population with keywords including efficacy, child, kidney calculi, ureter calculi, lithotripsy, injury, vascular trauma, and shock waves. The research was limited to the English literature during a period from 1980 to 2014. In total, 3,000 articles were evaluated, but only 151 papers were considered. Only the manuscripts directly related to the reviewed subjects were included in the current study. Results However, the acute effects of ESWL in kidney are well-described. Although there are limited studies on the long-term effects of ESWL in children, there is a widespread opinion that ESWL is not affecting renal functions in the long-term. Conclusion ESWL is a safe, effective, and noninvasive treatment option in children. Although ESWL can cause some acute effects in the kidney, there is no long-term effect on the growing kidneys of children. PMID:24892029

  13. The In Situ Vitrification Project

    International Nuclear Information System (INIS)

    Buelt, J.L.

    1988-10-01

    The Columbia Section of the American Society of Civil Engineers (ASCE) is pleased to submit the In Situ Vitrification (ISV) Project to the Pacific Northwest Council for consideration as the Outstanding Civil Engineering Achievement. The ISV process, developed by Battelle-Northwest researchers beginning in 1980, converts contaminated soils and sludges to a glass and crystalline product. In this way it stabilizes hazardous chemical and radioactive wastes and makes them chemically inert. This report describes the process. A square array of four molybdenum electrodes is inserted into the ground to the desired treatment depth. Because soil is not electrically conductive when the moisture has been driven off, a conductive mixture of flaked graphite and glass frit is placed among the electrodes as a starter path. An electrical potential is applied to the electrodes to establish an electric current in the starter path. The resultant power heats the starter path and surrounding soil to 2000/degree/C, well above the initial soil-melting temperature of 1100/degree/C to 1400/degree/C. The graphite starter path is eventually consumed by oxidation, and the current is transferred to the molten soil, which is electrically conductive. As the molten or vitrified zone grows, it incorporates radionuclides and nonvolatile hazardous elements, such as heavy metals, and destroys organic components by pyrolysis. 2 figs

  14. In situ vitrification: A review

    International Nuclear Information System (INIS)

    Cole, L.L.; Fields, D.E.

    1989-11-01

    The in situ vitrification process (ISV) converts contaminated soils and sludges to a glass and crystalline product. The process appears to be ideally suited for on site treatment of both wet and dry wastes. Basically, the system requires four molybdenum electrodes, an electrical power system for vitrifying the soil, a hood to trap gaseous effluents, an off-gas treatment system, an off-gas cooling system, and a process control station. Mounted in three transportable trailers, the ISV process can be moved from site to site. The process has the potential for treating contaminated soils at most 13 m deep. The ISV project has won a number of outstanding achievement awards. The process has also been patented with exclusive worldwide rights being granted to Battelle Memorial Institute for nonradioactive applications. While federal applications still belong to the Department of Energy, Battelle transferred the rights of ISV for non-federal government, chemical hazardous wastes to a separate corporation in 1989 called Geosafe. This report gives a review of the process including current operational behavior and applications

  15. Distillation of shale in situ

    Energy Technology Data Exchange (ETDEWEB)

    de Ganahl, C F

    1922-07-04

    To distill buried shale or other carbon containing compounds in situ, a portion of the shale bed is rendered permeable to gases, and the temperature is raised to the point of distillation. An area in a shale bed is shattered by explosives, so that it is in a relatively finely divided form, and the tunnel is then blocked by a wall, and fuel and air are admitted through pipes until the temperature of the shale is raised to such a point that a portion of the released hydrocarbons will burn. When distillation of the shattered area takes place and the lighter products pass upwardly through uptakes to condensers and scrubbers, liquid oil passes to a tank and gas to a gasometer while heavy unvaporized products in the distillation zone collect in a drain, flow into a sump, and are drawn off through a pipe to a storage tank. In two modifications, methods of working are set out in cases where the shale lies beneath a substantially level surface.

  16. Extracorporeal shockwave therapy in musculoskeletal disorders.

    Science.gov (United States)

    Wang, Ching-Jen

    2012-03-20

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  17. Extracorporeal shockwave therapy in musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Wang Ching-Jen

    2012-03-01

    Full Text Available Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  18. In situ reverse transcription-PCR for monitoring gene expression in individual Methanosarcina mazei S-6 cells

    DEFF Research Database (Denmark)

    Lange, Marianne; Tolker-Nielsen, Tim; Molin, Søren

    2000-01-01

    An in situ reverse transcription-PCR protocol for detecting specific mRNA in Methanosarcina mazei S-6 is described. This method allowed us to detect heat shock-induced increases in the intracellular levels of the transcript of the universal stress gene dnaK. The cell walls of paraformaldehyde...

  19. Production of mullite-zirconia ceramics composites by 'In situ' reaction

    International Nuclear Information System (INIS)

    Melo, F.C.L. de; Cairo, C.A.A.; Piorino Neto, F.; Devezas, T.C.

    1987-01-01

    Mullita-zirconia ceramic composites were produced by 'In situ' reaction of alumina and brazilian zircon. The ideal curve of thermal treatment (reaction + sinterization) was determined for the obtention of composites of maximum mechanical resistence. The retained fraction of tetragonal fase was evaluated by X-ray difraction and correlated with the values of mechanical resistence obtained by different treatment curves. The performance of the developed composites under corrosion and thermal shock was evaluated by glass casting. (Author) [pt

  20. Shock Waves

    CERN Document Server

    Jiang, Z

    2005-01-01

    The International Symposium on Shock Waves (ISSW) is a well established series of conferences held every two years in a different location. A unique feature of the ISSW is the emphasis on bridging the gap between physicists and engineers working in fields as different as gas dynamics, fluid mechanics and materials sciences. The main results presented at these meetings constitute valuable proceedings that offer anyone working in this field an authoritative and comprehensive source of reference.

  1. Neonatal extracorporeal membrane oxygenation: Initial experience of Hospital de São João

    Directory of Open Access Journals (Sweden)

    G. Rocha

    2014-11-01

    Full Text Available The purpose of this series is to report the initial ECMO experience of the Neonatal Intensive Care Unit of Hospital de São João. The first three clinical cases are reported. Case report 1: a 39 weeks gestational age girl with severe lung hypoplasia secondary to a bilateral congenital diaphragmatic hernia. Case report 2: a 39 weeks gestational age girl with a right congenital diaphragmatic hernia and a tracheal stenosis. Case report 3: a 34 weeks gestational age boy, with 61 days of life, with a Bordetella pertussis pneumonia, severe pulmonary hypertension, shock, hyperleukocytosis and seizures. Resumo: O objetivo desta série é apresentar a experiência inicial da Unidade de Cuidados Intensivos Neonatais do Hospital de São João com ECMO no recém-nascido. São apresentados os 3 primeiros casos. Caso 1: recém-nascido de 39 semanas de idade gestacional, com hipoplasia pulmonar severa secundária a hérnia diafragmática congénita bilateral. Caso 2: recém-nascido de 39 semanas de idade gestacional, com hérnia diafragmática congénita direita e estenose traqueal. Caso 3: pré-termo de 34 semanas de idade gestacional, sexo masculino, com 61 dias de vida, com pneumonia por Bordetella pertussis, hipertensão pulmonar severa, choque, hiperleucocitose e convulsões. Keywords: Extracorporeal membrane oxygenation, Newborn, Congenital diaphragmatic hernia, Tracheal stenosis, Bordetella pertussis infection, Palavras-chave: Oxigenação por membrana extracorporal, Recém-nascido, Hérnia diafragmática congénita, Estenose traqueal, Infeção por Bordetella pertussis

  2. Shock-wave lithotripsy of gallstones

    International Nuclear Information System (INIS)

    Torres, W.E.; Baumgartner, B.R.; Nelson, R.C.; Morris, S.J.

    1990-01-01

    This paper evaluates the American Dornier MPL-9000 gallstone study on the effectiveness and safety of biliary extracorporeal shock wave lithotripsy (ESWL) and, in a prospective double blind manner, the need for ursodeoxycholic acid (UDCA). At our institution, 174 symptomatic patients with gallstones (149 with noncalcified stones and 25 with calcified stones) were randomized to receive UDCA or placebo for 6 months. The gallstones were fragmented in 171/174 patients (98%). Evaluation by ultrasound was done at 6 weeks following ESWL; retreatment was done on 42/174 patients for fragments larger than 5 mm. Cholecystectomy was done in 6/174 patients. The 6- and 12- month stone-free rates were noncalcified stones + UDCA, 31% and 41%; noncalcified stones + placebo, 24% and 15%; calcified gallstones, 8% and 8%

  3. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Christos Bakoyiannis

    2012-01-01

    Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  4. Mechanical ventilation during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Schmidt, Matthieu; Pellegrino, Vincent; Combes, Alain; Scheinkestel, Carlos; Cooper, D Jamie; Hodgson, Carol

    2014-01-21

    The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.

  5. Simulation training for extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Roberta Brum

    2015-01-01

    Full Text Available Background: Extracorporeal membrane oxygenation (ECMO is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians. Following the course, 8 (57% gained familiarity in troubleshooting an ECMO circuit, 6 (43% increased their familiarity with the ECMO pump and circuit, 8 (57% perceived an improvement in their communication skills and 7 (50% perceived an improvement in their leadership skills. At the end of the course, 13 (93% delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

  6. Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

    LENUS (Irish Health Repository)

    El-Khuffash, A

    2011-03-01

    Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical

  7. Collateral flow after extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Smith, A.S.; Wiznitzer, M.; Haacke, E.M.

    1990-01-01

    MR angiography was used to evaluate collateral flow after extracorporal membrane oxygenation (ECMO) in patients with permanent ligation of the right common carotid artery (RCCA). One year after ECMO, MR angiography of the cerebral circulation was performed in 11 survivors and MR angiography of the neck in seven. The diameters of the left common carotid (LCCA) and vertebral (Vert) arteries in the neck and of the basilar (Bas) and internal carotid arteries in the head were measured. Ratios of the artery diameters were compared with those of seven children (aged 6 months - 17 years) who had normal MR angiographic and brain MR imaging studies. Compared with carotid artery diameter, the ECMO population had proportionately larger vertebral (RVert/LCCA, -0.82 ± 0.12 vs 0.56 ± 0.20 [<.02], LVert/LCCA, -0.86 ± 0.15 vs 0.67 ± 0.05 [P < .02] and basilar artery diameters (LICA/Bas, -0.91 ± 0.15 vs 1.49 ± 0.48 [p < .003]) than did control subjects. Ratios in five children with enlarged RPComA after ECMO were not significantly different from those in controls. The RICA was present and smaller than the LICA in the ECMO population, but not in control subjects (RICA/LICA, -0.75 ± 0.06 vs 0.91 ± 0.23 [p < .05]). Increased vertebral and basilar artery flow is a response to RCCA ligation in the neonate and is independent of RPComA collateral flow. This suggests the presence of more extensive parenchymal collaterals from posterior cerebral arteries, from the vertebrobasilar circulation to the external carotid artery or other collaterals. Consequently, later abnormalities of vertebrobasilar flow might adversely affect right hemispheric function in this children

  8. Development of an in situ fatigue sensor.

    Science.gov (United States)

    2011-01-01

    A prototype in situ fatigue sensor has been designed, constructed and evaluated experimentally for its ability to monitor the accumulation of fatigue damage in a cyclically loaded steel structure, e.g., highway bridge. The sensor consists of multiple...

  9. In Situ Aerosol Detector, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA is developing new platform systems that have the potential to benefit Earth science research activities, which include in situ instruments for atmospheric...

  10. Past In-Situ Burning Possibilities

    National Research Council Canada - National Science Library

    Yoshioka, Gary

    1999-01-01

    This study evaluated the feasibility of conducting in-situ burning (ISB) using current technology on post 1967 major oil spills over 10,00 barrels in North America and over 50,00 barrels in South America and Europe...

  11. Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome

    Directory of Open Access Journals (Sweden)

    Andrea Berkes

    2017-01-01

    Full Text Available Background. Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. Case Presentation. A 5-year-old girl with Down’s syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. Conclusion. The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed.

  12. [Research on Energy Distribution During Osteoarthritis Treatment Using Shock Wave Lithotripsy].

    Science.gov (United States)

    Zhang, Shinian; Wang, Xiaofeng; Zhang, Dong

    2015-04-01

    Extracorporeal shock wave treatment is capable of providing a non-surgical and effective treatment modality for patients suffering from osteoarthritis. The major objective of current works is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Firstly, a model of finite element method (FEM) was developed based on Comsol software in the present study. Then, high-speed photography experiments were performed to record cavitation bubbles with the presence of mimic bone. On the basis of comparing experimental with simulated results, the effectiveness of FEM model could be verified. Finally, the energy distribution during extracorporeal shock wave treatment was predicted. The results showed that the shock wave field was deflected with the presence of bony structure and varying deflection angles could be observed as the bone shifted up in the z-direction relative to shock wave geometric focus. Combining MRI/CT scans to FEM modeling is helpful for better standardizing the treatment dosage and optimizing treatment protocols in the clinic.

  13. Observatory Magnetometer In-Situ Calibration

    Directory of Open Access Journals (Sweden)

    A Marusenkov

    2011-07-01

    Full Text Available An experimental validation of the in-situ calibration procedure, which allows estimating parameters of observatory magnetometers (scale factors, sensor misalignment without its operation interruption, is presented. In order to control the validity of the procedure, the records provided by two magnetometers calibrated independently in a coil system have been processed. The in-situ estimations of the parameters are in very good agreement with the values provided by the coil system calibration.

  14. In-situ characterization of heterogeneous catalysts

    CERN Document Server

    Rodriguez, Jose A; Chupas, Peter J

    2013-01-01

    Helps researchers develop new catalysts for sustainable fuel and chemical production Reviewing the latest developments in the field, this book explores the in-situ characterization of heterogeneous catalysts, enabling readers to take full advantage of the sophisticated techniques used to study heterogeneous catalysts and reaction mechanisms. In using these techniques, readers can learn to improve the selectivity and the performance of catalysts and how to prepare catalysts as efficiently as possible, with minimum waste. In-situ Characterization of Heterogeneous Catalysts feat

  15. Extracorporeal circuits and autoregulation: effect of albumin coating

    NARCIS (Netherlands)

    Borgdorff, P.; Kok, W. E.; van den Bos, G. C.

    1992-01-01

    Autoregulation of muscle blood flow often is difficult to demonstrate when extracorporeal perfusion is used. This could be caused by contact of blood and foreign material. Accordingly, we tested whether autoregulation is preserved when the system is coated with albumin. Polyurethane tubing between

  16. Nosocomial transmission of Cupriavidus pauculus during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Stovall, S H; Wisdom, C; McKamie, W; Ware, W; Dedman, H; Fiser, R T

    2010-01-01

    Patients undergoing extracorporeal membrane oxygenation (ECMO) are at increased risk of infection. We present the first known report of nosocomial infection with Cupriavidus pauculus attributable to contamination from ECMO equipment and describe the measures taken to halt subsequent infections. A cluster of infections in ECMO patients should prompt team members to consider contamination of equipment with environmental pathogens as a possible cause.

  17. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy

    Directory of Open Access Journals (Sweden)

    Sameh Anwar Kunzman

    2002-01-01

    Full Text Available We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL. To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

  18. Extracorporeal membrane oxygenation after intravenous injection of paraffin oil

    DEFF Research Database (Denmark)

    Pasgaard, Thomas; Huynh, Anh-Nhi Thi; Gjedsted, Jakob

    2016-01-01

    We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve. A...

  19. Shock Prevention

    Science.gov (United States)

    1978-01-01

    The electrician pictured is installing a General Electric Ground Fault Interrupter (GFI), a device which provides protection against electrical shock in the home or in industrial facilities. Shocks due to defective wiring in home appliances or other electrical equipment can cause severe burns, even death. As a result, the National Electrical Code now requires GFIs in all new homes constructed. This particular type of GFI employs a sensing element which derives from technology acquired in space projects by SCI Systems, Inc., Huntsville, Alabama, producer of sensors for GE and other manufacturers of GFI equipment. The sensor is based on the company's experience in developing miniaturized circuitry for space telemetry and other spacecraft electrical systems; this experience enabled SCI to package interruptor circuitry in the extremely limited space available and to produce sensory devices at practicable cost. The tiny sensor measures the strength of the electrical current and detects current differentials that indicate a fault in the functioning of an electrical system. The sensing element then triggers a signal to a disconnect mechanism in the GFI, which cuts off the current in the faulty circuit.

  20. Unintended and in situ amorphisation of pharmaceuticals.

    Science.gov (United States)

    Priemel, P A; Grohganz, H; Rades, T

    2016-05-01

    Amorphisation of poorly water-soluble drugs is one approach that can be applied to improve their solubility and thus their bioavailability. Amorphisation is a process that usually requires deliberate external energy input. However, amorphisation can happen both unintentionally, as in process-induced amorphisation during manufacturing, or in situ during dissolution, vaporisation, or lipolysis. The systems in which unintended and in situ amorphisation has been observed normally contain a drug and a carrier. Common carriers include polymers and mesoporous silica particles. However, the precise mechanisms by which in situ amorphisation occurs are often not fully understood. In situ amorphisation can be exploited and performed before administration of the drug or possibly even within the gastrointestinal tract, as can be inferred from in situ amorphisation observed during in vitro lipolysis. The use of in situ amorphisation can thus confer the advantages of the amorphous form, such as higher apparent solubility and faster dissolution rate, without the disadvantage of its physical instability. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Normothermal or Hypothermal Extracorporeal Circulation Regimens in Patients with Acquired Heart Disease

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2013-01-01

    Full Text Available Background. Hypothermal extracorporeal circulation has been used in cardiosurgery over 50 years. However, recent trials have not shown its predominant effect on the protection of the brain, lung, and myocardium in patients during surgery. We have presumed that when normothermal extracorporeal circulation used in patients with acquired heart disease, its pathophysiological effect on the body is comparable with that of hypothermal extracorporeal circulation. Subjects and methods. One hundred and forty patients who were to undergo acquired heart disease correction were randomized into two equal groups: that using hypothermal or normothermal extracorporeal circulation. Perioperative troponin I and NT-proBNP concentrations, postoperative clinical course, and hospital morbidity and mortality rates were estimated. Results. There were no significant differences in the concentrations of troponin I and NT-proBNP at the study stages. In the normothermal extracorporeal circulation group patients with isolated aortic stenosis, the concentration of troponin I was higher than that in the hypothermal extracorporeal circulation group. Analyzing the postoperative course indicated that the duration of mechanical ventilation was significantly lower in the hypothermal extracorporeal circulation group than in the normothermal extracorporeal circulation group. There were no differences in hospital complications and mortality rates. Conclusion. Hypothermal versus normothermal extracorporeal circulation in the correction of acquired heart diseases has no predominant effect on tro-ponin I and NT-proBNP concentrations, postoperative clinical course, and hospital complications and mortality rates. Key words: extracorporeal circulation, hypothermia, acquired heart disease, troponin I, NT-proBNP.

  2. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P < 0.05). The "SmartECLA" demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  3. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy: A pilot study.

    Science.gov (United States)

    Zwerver, Johannes; Dekker, Femke; Pepping, Gert-Jan

    2010-01-01

    Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p patellar tendinopathy.

  4. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

  5. Fotoferese extracorpórea Extracorporeal photopheresis

    Directory of Open Access Journals (Sweden)

    Márcia M. Silva

    2008-04-01

    Full Text Available Fotoferese extracorpórea é uma modalidade de terapia celular que tem demonstrado eficácia e segurança em pacientes portadores de doenças auto-imunes e mediadas por células T, incluindo esclerodermia, linfoma de células T cutâneo/ Síndrome de Sézary e doença enxerto-contra-hospedeiro após transplante de células-tronco hematopoiéticas. Tem sido empregada, ainda, com o intuito de induzir tolerância em transplantes de órgãos sólidos. O tratamento se baseia no efeito biológico de uma substância fotossensibilizante, o 8-metoxipsoraleno, e da radiação ultravioleta A, nas células mononucleares coletadas por aférese e reinfundidas ao paciente. O mecanismo de ação parece ser devido à indução de imunidade anticlonotípica direcionada a clones patogênicos de células T. O tratamento induz a apoptose de células T patogênicas, e a ativação de células apresentadoras de antígenos desempenha papel importante no processo imunomodulador.Extracorporeal photopheresis is a method of cell therapy that has demonstrated efficacy in autoimmune diseases, cutaneous T-cell lymphoma/Sézary syndrome and graft-versus-host disease after hematopoietic stem-cell transplantation. This technique has also been employed as a treatment strategy to induce tolerance after solid organ transplants. Treatment is based on the biological effect of ultraviolet A radiation and a photosensitizing drug, 8-methoxypsoralen, on mononuclear cells collected by apheresis and reinfused into the patient. The suggested mechanism of action is related to the induction of anticlonotypic immunity directed against pathogenic clones of T lymphocytes. Treatment induces apoptosis of pathogenic T-cells, and it appears that activation of antigen-presenting cells has an important role in this process.

  6. The healing process of intracorporeally and in situ devitalized distal femur by microwave in a dog model and its mechanical properties in vitro.

    Directory of Open Access Journals (Sweden)

    Zhenwei Ji

    Full Text Available BACKGROUND: Limb-salvage surgery has been well recognized as a standard treatment and alternative to amputation for patients with malignant bone tumors. Various limb-sparing techniques have been developed including tumor prosthesis, allograft, autograft and graft-prosthesis composite. However, each of these methods has short- and long-term disadvantages such as nonunion, mechanical failures and poor limb function. The technique of intracorporeal devitalization of tumor-bearing bone segment in situ by microwave-induced hyperthermia after separating it from surrounding normal tissues with a safe margin is a promising limb-salvage method, which may avoid some shortcomings encountered by the above-mentioned conventional techniques. The purpose of this study is to assess the healing process and revitalization potential of the devitalized bone segment by this method in a dog model. In addition, the immediate effect of microwave on the biomechanical properties of bone tissue was also explored in an in vitro experiment. METHODS: We applied the microwave-induced hyperthermia to devitalize the distal femurs of dogs in situ. Using a monopole microwave antenna, we could produce a necrotic bone of nearly 20 mm in length in distal femur. Radiography, bone scintigraphy, microangiography, histology and functional evaluation were performed at 2 weeks and 1, 2, 3, 6, 9 and 12 months postoperatively to assess the healing process. In a biomechanical study, two kinds of bone specimens, 3 and 6 cm in length, were used for compression and three-point bending test respectively immediately after extracorporeally devitalized by microwave. FINDINGS: An in vivo study showed that intracorporeally and in situ devitalized bone segment by microwave had great revitalization potential. An in vitro study revealed that the initial mechanical strength of the extracorporeally devitalized bone specimen may not be affected by microwave. CONCLUSION: Our results suggest that the

  7. In-situ bioremediation via horizontal wells

    International Nuclear Information System (INIS)

    Hazen, T.C.; Looney, B.B.; Enzien, M.; Franck, M.M.; Fliermans, C.B.; Eddy, C.A.

    1993-01-01

    This project is designed to demonstrate in situ bioremediation of groundwater and sediment contaminated with chlorinated solvents. Indigenous microorganisms were stimulated to degrade TCE, PCE and their daughter products in situ by addition of nutrients to the contaminated zone. In situ biodegradation is a highly attractive technology for remediation because contaminants are destroyed, not simply moved to another location or immobilized, thus decreasing costs, risks, and time, while increasing efficiency and public and regulatory acceptability. Bioremediation has been found to be among the least costly technologies in applications where it will work (Radian 1989). Subsurface soils and water adjacent to an abandoned process sewer line at the SRS have been found to have elevated levels of TCE (Marine and Bledsoe 1984). This area of subsurface and groundwater contamination is the focus of a current integrated demonstration of new remediation technologies utilizing horizontal wells. Bioremediation has the potential to enhance the performance of in situ air stripping as well as offering stand-alone remediation of this and other contaminated sites (Looney et al. 1991). Horizontal wells could also be used to enhance the recovery of groundwater contaminants for bioreactor conversions from deep or inaccessible areas (e.g., under buildings) and to enhance the distribution of nutrient or microbe additions in an in situ bioremediation

  8. Efficacy monitoring of in situ fuel bioremediation

    International Nuclear Information System (INIS)

    Mueller, J.; Borchert, S.; Heard, C.

    1996-01-01

    The wide-scale, multiple-purpose use of fossil fuels throughout the industrialized world has resulted in the inadvertent contamination of myriad environments. Given the scope and magnitude of these environmental contamination problems, bioremediation often represents the only practical and economically feasible solution. This is especially true when depth of contamination, magnitude of the problem, and nature of contaminated material preclude other remedial actions, short of the no-response alternative. From the perspective, the effective, safe and scientifically valid use of in situ bioremediation technologies requires cost-efficient and effective implementation strategies in combination with unequivocal approaches for monitoring efficacy of performance. Accordingly, with support from the SERDP program, the authors are field-testing advanced in situ bioremediation strategies and new approaches in efficacy monitoring that employ techniques instable carbon and nitrogen isotope biogeochemistry. One field demonstration has been initiated at the NEX site in Port Hueneme, CA (US Navy's National Test Site). The objectives are: (1) to use stable isotopes as a biogeochemical monitoring tool for in situ bioremediation of refined petroleum (i.e., BTEX), and (2) to use vertical groundwater circulation technology to effect in situ chemical containment and enhanced in situ bioremediation

  9. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    OpenAIRE

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    2017-01-01

    Objective: To review the principles of neonatal‐pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource‐limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly‐indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac res...

  10. Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care.

    Science.gov (United States)

    Lasa, Javier J; Jain, Parag; Raymond, Tia T; Minard, Charles G; Topjian, Alexis; Nadkarni, Vinay; Gaies, Michael; Bembea, Melania; Checchia, Paul A; Shekerdemian, Lara S; Thiagarajan, Ravi

    2018-02-01

    Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorporeal cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. None. Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extracorporeal membrane oxygenation cannulation "most of the time" by 58% of respondents and 94% report using afterload reducing/antihypertensive agents "some" to "most of the time" after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common

  11. Adjunctive Therapies During Extracorporeal Membrane Oxygenation to Enhance Multiple Organ Support in Critically Ill Children

    Directory of Open Access Journals (Sweden)

    Marguerite Orsi Canter

    2018-04-01

    Full Text Available Since the advent of extracorporeal membrane oxygenation (ECMO over 40 years ago, there has been increasing interest in the use of the extracorporeal circuit as a platform for providing multiple organ support. In this review, we will examine the evidence for the use of continuous renal replacement therapy, therapeutic plasma exchange, leukopheresis, adsorptive therapies, and extracorporeal liver support in conjunction with ECMO.

  12. ADVANTAGES/DISADVANTAGES FOR ISCO METHODS IN-SITU FENTON OXIDATION IN-SITU PERMANGANATE OXIDATION

    Science.gov (United States)

    The advantages and disadvantages of in-situ Fenton oxidation and in-situ permanganate oxidation will be presented. This presentation will provide a brief overview of each technology and a detailed analysis of the advantages and disadvantages of each technology. Included in the ...

  13. Collisionless electrostatic shocks

    DEFF Research Database (Denmark)

    Andersen, H.K.; Andersen, S.A.; Jensen, Vagn Orla

    1970-01-01

    An attempt was made in the laboratory to observe the standing collisionless electrostatic shocks in connection with the bow shock of the earth......An attempt was made in the laboratory to observe the standing collisionless electrostatic shocks in connection with the bow shock of the earth...

  14. In situ macromolecular crystallography using microbeams.

    Science.gov (United States)

    Axford, Danny; Owen, Robin L; Aishima, Jun; Foadi, James; Morgan, Ann W; Robinson, James I; Nettleship, Joanne E; Owens, Raymond J; Moraes, Isabel; Fry, Elizabeth E; Grimes, Jonathan M; Harlos, Karl; Kotecha, Abhay; Ren, Jingshan; Sutton, Geoff; Walter, Thomas S; Stuart, David I; Evans, Gwyndaf

    2012-05-01

    Despite significant progress in high-throughput methods in macromolecular crystallography, the production of diffraction-quality crystals remains a major bottleneck. By recording diffraction in situ from crystals in their crystallization plates at room temperature, a number of problems associated with crystal handling and cryoprotection can be side-stepped. Using a dedicated goniometer installed on the microfocus macromolecular crystallography beamline I24 at Diamond Light Source, crystals have been studied in situ with an intense and flexible microfocus beam, allowing weakly diffracting samples to be assessed without a manual crystal-handling step but with good signal to noise, despite the background scatter from the plate. A number of case studies are reported: the structure solution of bovine enterovirus 2, crystallization screening of membrane proteins and complexes, and structure solution from crystallization hits produced via a high-throughput pipeline. These demonstrate the potential for in situ data collection and structure solution with microbeams. © 2012 International Union of Crystallography

  15. Unintended and in situ amorphisation of pharmaceuticals

    DEFF Research Database (Denmark)

    Priemel, P A; Grohganz, H; Rades, T

    2016-01-01

    Amorphisation of poorly water-soluble drugs is one approach that can be applied to improve their solubility and thus their bioavailability. Amorphisation is a process that usually requires deliberate external energy input. However, amorphisation can happen both unintentionally, as in process......-induced amorphisation during manufacturing, or in situ during dissolution, vaporisation, or lipolysis. The systems in which unintended and in situ amorphisation has been observed normally contain a drug and a carrier. Common carriers include polymers and mesoporous silica particles. However, the precise mechanisms...... of in situ amorphisation can thus confer the advantages of the amorphous form, such as higher apparent solubility and faster dissolution rate, without the disadvantage of its physical instability....

  16. In situ vitrification: Application to buried waste

    International Nuclear Information System (INIS)

    Callow, R.A.; Thompson, L.E.

    1991-01-01

    Two in situ vitrification field tests were conducted in June and July 1990 at Idaho National Engineering Laboratory. In situ vitrification is a technology for in-place conversion of contaminated soils into a durable glass and crystalline waste form and is being investigated as a potential remediation technology for buried waste. The overall objective of the two tests was to assess the general suitability of the process to remediate buried waste structures found at Idaho National Engineering Laboratory. In particular, these tests were designed as part of a treatability study to provide essential information on field performance of the process under conditions of significant combustible and metal wastes, and to test a newly developed electrode feed technology. The tests were successfully completed, and the electrode feed technology provided valuable operational control for successfully processing the high metal content waste. The results indicate that in situ vitrification is a feasible technology for application to buried waste. 2 refs., 5 figs., 2 tabs

  17. Oil companies push in-situ recovery

    International Nuclear Information System (INIS)

    McIntyre, H.

    1977-01-01

    Possibly, a third Athabaska tar-sand plant using surface mining will be built in the 1980's, but future development beyond that point will probably depend on in-situ recovery. The discussion of in-situ recovery focusses on the effect it will have on the Canadian chemical industry, for example, the market for sodium hydroxide. To obtain the highest yields of oil from bitumen, an external source of hydrogen is necessary; for example Syncrude imports natural gas to make hydrogen for desulphurization. Gasification of coal is a possible source of hydrogen. Research on hydrocracking is progressing. Use of a prototype CANDU OCR reactor to raise the hot steam necessary for in-situ recovery has been suggested. Venezuela is interested in Canadian upgrading technology. (N.D.H.)

  18. Extracorporeal Life Support Bridge to Ventricular Assist Device: The Double Bridge Strategy.

    Science.gov (United States)

    Marasco, Silvana F; Lo, Casey; Murphy, Deirdre; Summerhayes, Robyn; Quayle, Margaret; Zimmet, Adam; Bailey, Michael

    2016-01-01

    In patients requiring left ventricular assist device (LVAD) support, it can be difficult to ascertain suitability for long-term mechanical support with LVAD and eventual transplantation. LVAD implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support (ECLS) as a bridge-to-bridge support for these critically unwell patients. Here, we reviewed our experience with ECLS double bridging. We hypothesized that ECLS double bridging would stabilize end-organ dysfunction and reduce ventricular assist device (VAD) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous-flow LVAD between January 2010 and December 2013 at The Alfred Hospital, Melbourne, Victoria, Australia. Twenty-three patients required ECLS support pre-LVAD while 35 patients underwent LVAD implantation without an ECLS bridge. Preoperative morbidity in the ECLS bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no ECLS group. ECLS stabilization improved end-organ function pre-VAD implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of ECLS bridge to VAD stabilizes end-organ dysfunction and reduces VAD implant perioperative mortality from that traditionally reported in these "crash and burn" patients. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  19. The neutrophil to lymphocyte ratio in patients supported with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Yost, Gardner; Bhat, Geetha; Pappas, Patroklos; Tatooles, Antone

    2018-04-01

    The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14.2. Survival, the primary outcome, was compared between groups. The study cohort was composed of 64 (60%) males with an average age 53.1 ± 14.9 years. Patients in Group 1 had an average NLR of 7.5 ± 3.5 compared to 27.1 ± 19.9 in Group 2. Additionally, those in Group 2 had significantly higher preoperative blood urea nitrogen (BUN) and age. Survival analysis indicated a thirty-day survival of 56.2%, with significantly worsened mortality in patients with NLR greater than 14.2, p=0.047. Our study shows the NLR has prognostic value in patients undergoing ECMO implantation. Leukocytes are known contributors to myocardial damage and neutrophil infiltration is associated with damage caused by myocardial ischemia.

  20. In situ viscometry by optical trapping interferometry

    DEFF Research Database (Denmark)

    Guzmán, C.; Flyvbjerg, Henrik; Köszali, R.

    2008-01-01

    We demonstrate quantitative in situ viscosity measurements by tracking the thermal fluctuations of an optically trapped microsphere subjected to a small oscillatory flow. The measured power spectral density of the sphere's positions displays a characteristic peak at the driving frequency of the f......We demonstrate quantitative in situ viscosity measurements by tracking the thermal fluctuations of an optically trapped microsphere subjected to a small oscillatory flow. The measured power spectral density of the sphere's positions displays a characteristic peak at the driving frequency...