Gallstone movement during lithotripsy: mechanisms and effects on fragmentation.

We sought to examine the mechanisms of gallstone movement and its effect on gallstone fragmentation in vitro. Two experiments were performed in four specially constructed phantoms that allowed decreasing degrees of movement during the application of shock waves. Shock waves caused displacement of the stone from the focus, but the stone and its fragments were returned to the focus by streaming movements in the coupling liquid when the volume of surrounding fluid was small. Streaming movements were ineffective in large volumes. Restraining movements of the gallstone did not improve the results of fragmentation. We conclude that radiation force and the streaming motion of the surrounding liquid account for movements of the stone and fragments during lithotripsy. Lithotripsy is more effective when smaller volumes are used because streaming brings fragments back to the focus of the lithotripter. Total immobilization of the stone in the focus of the lithotripter, however, offers no benefit, probably because it inhibits rotational movement of the stone.     

Recurrent Gallstone Ileus

Mechanical small bowel obstructions caused by gallstones account for 1% to 3% of cases. In these patients, 80% to 90% of residual gallstones in these patients will pass through a remaining fistula without consequence. Recurrent gallstone ileus has been reported in 5% of patients. We report the case of a woman, aged 72 years, who presented with mechanical small bowel obstruction caused by gallstone ileus. After successful surgical therapy for gallstone ileus, the patient''s symptoms recurred, and she was diagnosed with recurrent gallstone ileus requiring a repeat operation. While management of gallstone ileus can be achieved through a single-stage operation including enterolithotomy and cholecystectomy with repair of biliary-enteric fistula or by enterolithotomy alone, the literature supports enterolithotomy alone as the treatment of choice for gallstone ileus due to decreased mortality and morbidity. However, the latter approach does not obviate potential recurrence. We present this case of recurrent gallstone ileus to elucidate and review the pathogenesis, presentation, diagnosis, and consensus recommendations regarding management of this disorder.     

胆石性肠梗阻1例

患者女,80岁。上腹阵发性隐痛1个月,伴恶心、呕吐,非喷射性呕吐胆汁样液体,每天2次,每次约50ml,纳差,大便7日未解,小便正常。腹平软,未见胃肠型及蠕动波,剑突下压痛,无反跳痛,肝脾肋下未扪及,移动性浊音阴性,肠鸣音较活跃。既往有胆总管结石病史，无手术及外伤史。CT平扫示胆总管及肝内胆管扩张、积气（图1、2），胆总管最大直径2．8cm，胆囊萎缩，其内见一点状高密度灶，十二指肠水平部见一同心圆状病变，     

高能冲击波束聚焦碎石术后高血压的临床研究

目的探讨体外震波碎石术(ESWL)后出现新的高血压及其可能的原因.方法检测部分患者的血浆肾素(PR)-血管紧张素Ⅱ(AⅡ)系统活性、前列环索(PGI2)和血栓素A2(TXA2)的浓度.结果术后高血压者所接受的震波次数、血浆PR-AII系统活性及TXA2浓度明显高于血压正常者,而其血浆PGI2的浓度则明显低于血压正常者.结论ESWL后新的高血压可能的原因是高能冲击波导致肾脏损伤、缺血,刺激血浆PR-AII系统活性升高,而TXA2合成增多、PGI2合成减少使血管壁对缩血管物质的敏感性增强.     

Ureteroscopic lithotripsy

There is a wide array of endoscopic lithotriptors presently available. Each of these has its own advantages and disadvantages. No single lithotriptor is suitable for all applications and none can meet the goal of fragmenting all calculi while remaining harmless to tissue.     

Gallstone Obstruction of the Small Intestine

Between 7935 and 1951, at the Mayo Clinic, 9 patients with gallstone obstruction of the small intestine have been treated surgically without a death. The case of 1 of these patients, a man 80 years of age, is presented in detail. The interesting roentgenologic findings in such cases are discussed and details of the surgical treatment are considered.     

胆固醇结石患者胆囊动力学的研究

本文用Ｂ超对５４例胆固醇结石患者和２３４例健康人进行胆囊功能的检测，发现胆固醇结石患者存在胆囊绝对收缩体积和胆囊排空率均减小，而空腹胆囊体积未发生改变，证实了胆囊收缩功能降低在胆固醇结石形成中的重要意义。