The use of the Dornier MPL-9000 lithotripter in the treatment of gallbladder and renal stones. Early experience.

The experience of two units (Gastroenterology and Urology) of Clínica La Luz, Madrid, in the treatment of gallbladder and renal lithiasis using the Dornier MPL-9000 lithotripter is reported herein. This lithotriptor has been utilized in the treatment of all cases of gallbladder calculi for which it is indicated and renal calculi localized high up (kidney), and in those cases that are difficult to treat with other lithotriptors such as patients with kyphoscoliosis, radiolucent calculi, elderly patients, children, etc.).

[Extracorporeal biliary lithotripsy: results in 60 cases of single calculus].

The outcome of 60 cases of single biliary stone with a maximum diameter of 25 mm was evaluated. The patients were symptomatic, with functioning gallbladder, and were selected from a group of 180 to evaluate the effects of electrohydraulically generated shockwaves on a priori ideal cases for this procedure. In seven patients fragmentation was not achieved, probably because of the pigmentary character of the stone, that was later verified at cholecystectomy.

Ticlopidine as a hemorrhagic risk factor in coronary surgery.

We retrospectively reviewed the postoperative hemorrhagic risk in patients undergoing surgery for coronary revascularization who had received platelet antiaggregants preoperatively. A significant increase in postoperative hemorrhage and a higher percentage of reoperations for this reason was observed in the patients treated with ticlopidine. However, there were no major differences in the platelet counts among the groups compared.

Hypoglycemic coma after cardiac surgery.

Hypoglycemic coma occurring 5 h after cardiac surgery in a nondiabetic adult patient was primarily triggered by: low cardiac output leading to severe hepatic functional derangement; metabolic acidosis, probably secondary to peripheral hypoperfusion; and possible inhibition of the adrenergic response due to anesthesia with fentanyl. Glucose infused at 8 g/h progressively increased the blood glucose level and paralleled hemodynamic improvement.

Cardiomyopathy and phaeochromocytoma.

A case is presented of phaeochromocytoma with catecholamine-induced cardiomyopathy. The difficulties in the management when left ventricular failure occurred are reported and the importance of monitoring pulmonary artery pressure during the anaesthetic procedure is stressed.

Pulmonary function and tissue oxygenation studies during anesthetic induction with etomidate.

The modifications of pulmonary function and peripheral oxygenation arising during anesthetic induction with Etomidate were studied in 36 unpremedicated patients programmed for elective surgery. The evaluation was carried out through measurement of ventilatory parameters and of the blood gases and oxygen saturation in arterial and mixed venous blood, calculation of the cardiac output, and derivation of data of peripheral oxygenation. A global reduction of the minute volume was observed with a minimal effect on the blood-gas values.