Diagnosis of liver cirrhosis: a comparison of modified ultrasound and laparoscopy in 100 consecutive patients.

Background/goals: Liver cirrhosis, the final stage of chronic liver disease, is characterized by an unfavorable prognosis and an increased risk of hepatocellular carcinoma and also requires an appropriate management. Laparoscopy, the gold standard in the diagnosis of cirrhosis, is hampered by its invasiveness. Therefore, a noninvasive method for diagnosing liver cirrhosis would be of great benefit.

Impact of gallbladder status on the outcome in patients with retained bile duct stones treated with extracorporeal shockwave lithotripsy.

Background And Study Aims: The use of endoscopic therapy in combination with lithotripsy techniques has become increasingly common in patients with complicated common bile duct stones. In many units, although this is controversial, cholecystectomy is then performed, because of possible subsequent cholecystitis and recurrence of choledocholithiasis. The aim of this study was to investigate whether gallbladder status influences the long-term outcome in patients after extracorporeal shockwave lithotripsy (ESWL) of common bile duct stones.

Postprandial blood glucose latency after oatmeal is a valid screening test for diabetic gastropathy in type 1 diabetes, but not in type 2 diabetes.

Disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying time is abnormal in about 50% of diabetic patients and delayed emptying time is known as an important cause for brittle diabetes in type 1 diabetes. We compared the rise in blood glucose after a standardized meal (oatmeal test) as a noninvasive screening test for diabetic gastropathy with the noninvasive measurement of gastric emptying time with ultrasound in type 1 and type 2 diabetic patients.

Treatment of difficult intrahepatic stones by using extracorporeal and intracorporeal lithotripsy techniques: 10 years' experience in 55 patients.

Background: Intrahepatic lithiasis still is a complicated disease and merits special attention during therapeutic intervention. Although resection of the affected liver lobe or segment is the best therapeutic option to completely remove the source of recurrent infection, the need for endoscopic treatment modalities is evident because hepatic resections are combined with a high morbidity and mortality rate.

Methods: Over a 10-year period (1988-1997) 55 patients with intrahepatic stones that were not accessible to routine endoscopic extraction were treated at our department.

Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy.

Background: There have been conflicting reports as to whether pancreatic ductal drainage achieved by endoscopy and lithotripsy improves the clinical outcome of patients with chronic pancreatitis.

Aims: To determine the clinical outcome in patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy (ESWL), and were followed up for two to eight years.

Methods: Eighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric lithotripter between 1989 and 1996.

[Value of ultrasound guided piezoelectric shock wave lithotripsy in the treatment of pancreatic stones].

Aim: Most patients with pancreatic duct stones have been treated with lithotripters that use x-ray for stone targeting. We wanted to evaluate ultrasound guided lithotripsy in clinical use.

Methods: In a prospective clinical study 80 patients (62 men) with symptomatic obstructive chronic pancreatitis were treated with a piezoelectric lithotripter under ultrasound guidance (two in-line 4-MHz-Scanners).

Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones. A prospective randomized trial.

Today, nearly 90% of common bile duct stones are extracted endoscopically. Problems are encountered if there are large stones or a duct stenosis. Extracorporeal piezoelectric lithotripsy (EPL) as well as intracorporeal electrohydraulic lithotripsy (EHL) serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed.

[Ultrasound-guided extracorporeal piezoelectric lithotripsy of bile duct calculi].

Aim: Extracorporeal shock-wave lithotripsy (ESWL) with underwater spark discharge and stone localisation via x-ray has become established in the treatment of difficult bile duct stones. First results with the piezoelectric lithotripter (EPL) in our department have also been promising.

Method: Between 1989 and 1993 we were able to treat 79 patients (mean age 76 years) with problematic bile duct stones with the EPL.

Can aspirin prevent gallstone recurrence after successful extracorporeal shockwave lithotripsy?

Extracorporeal shockwave lithotripsy (ESWL) is a feasible procedure for the treatment of gallbladder stones in humans. Well-selected patients can achieve stone-free rates in a high percentage. With the gallbladder in situ, these patients are at risk of stone recurrence.

ESWL and oral dissolution therapy. What factors influence results?

With the aim of identifying the criteria that have a decisive influence on the success of treatment of gallstones with ESWL and oral dissolution therapy, we investigated, in 117 patients, the stone-free rate as a function of sex, age, weight quotient, number of stones, total stone volume, and gallbladder function. The following inclusion criteria were applied: (1) the Munich criteria, (2) a follow-up period of at least 12 months, or (3) freedom from stones irrespective of the duration of the period of follow-up. Although, owing to the small number of cases involved, no significantly differing results were seen in the parameters investigated, clear tendencies were indeed observed.

Direct dissolution of gallstones with methyl tert-butyl ether by endoscopic cannulation of the gallbladder.

Methyl tert-butyl ether (MTBE) rapidly and effectively dissolves cholesterol gallbladder stones. Due to the invasive nature of transhepatic catheterization, we studied the safety and efficacy of MTBE stone dissolution, delivered by endoscopic, retrograde cannulation of the gallbladder. Extracorporeal shock-wave lithotripsy (ESWL) was employed in patients with multiple stones, to increase contact surface area and facilitate dissolution.

[Extracorporeal piezoelectric lithotripsy of intra- and extrahepatic bile duct stones].

64 patients (27 men, 37 women; mean age 71 [27-90] years) with intra- or extrahepatic biliary stones, which could not be extracted endoscopically, underwent extracorporeal piezoelectric shock-wave lithotripsy (ESWL). The piezoelectric lithotripter which was used localizes the stones sonographically and the shock-waves are produced by a self-focusing sound generator consisting of 3,000 ceramic elements. The sonographic localization of the stones was successful in 57 patients (89%) and complete removal of stones was achieved in 49 (77%), after an average of 7,595 (1,000-30,800) shock-waves per patient.

[Shockwave treatment of gallbladder stones. Current status of therapy].

Aims: Analysis of the results of piezoelectric lithotripsy of gallstones combined with subsequent dissolution therapy using chenodeoxycholic acid and ursodeoxycholic acid.

Design Of Study: Retrospective evaluation after 2 1/2 years application in the department; prospective study for stone recurrence with ASA.

Patients: A total of 246 patients with gallbladder stones selected on the basis of the Munich criteria; 171 patients were followed up for at least 24 months.