Visibility of gallstone fragments at US and fluoroscopy: implications for monitoring gallstone lithotripsy

To assess the value of ultrasound (US), fluoroscopy, and spot radiography in the detection, counting, and measurement of gallstone fragments during lithotripsy, in vitro visibility studies were conducted on fragments from 20 stones. Fluoroscopic visibility was evaluated during and after lithotripsy on 185 fragments placed in an anthropomorphic phantom. Three US experiments were performed on the fragments to study the visibility of fragments as a function of size, the accuracy of the count with large numbers of fragments, and the ability of observers to detect and count fragments larger than both 4 mm and 5 mm. With fluoroscopy, fragment detection rates ranged from 20% (fragments larger than 2.5 mm) to 80% (fragments larger than 4.5 mm). With US, all fragments larger than 1.5 mm were detected, and US was significantly better than fluoroscopy and spot radiography for detection of fragments 2.5 mm or smaller. US was also more accurate than fluoroscopy (11% vs 59% error) in the assessment of the number of fragments. When fragments larger than 4 mm or 5 mm were being counted with US, 92% of the fragments were visualized. The results suggest that US is more accurate for monitoring gallstone lithotripsy than fluoroscopy or spot radiography.     

Treatment of stiff thoracic scoliosis by thoracoscopic anterior release combined with posterior instrumentation and fusion

Background  

Thoracoscopic anterior release has been shown that it can effectively improve spinal flexibility in animal and human cadaveric studies, and has been advocated for use in patients with scoliosis. This prospective case series aims to investigate the improvement of the spinal flexibility and the effectiveness in deformity correction by anterior thoracoscopic release and posterior spinal fusion.     

草珊瑚中的一个新倍半萜内酯

草珊瑚为金粟兰科植物Sarcandra glabra(Thumb.)Nakai的全株,又名接骨金粟兰、肿节风、九节风、九节茶、接骨木等。有清热祛风,散瘀接骨之功效,民间用于治疗肺炎、凤湿性关节炎等。近年来做成制剂治疗溃疡病、癌症等。已报导的化学成分有延胡索酸、琥珀酸及异白蜡树定(isofraxidin)等。今从草珊瑚叶中分得一个新的倍半萜内酯,本文鉴定其结构为(—)-istanbulin A。