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  • 1
    ISSN: 1432-1440
    Keywords: Lithotripsy ; Sialolithiasis ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Extracorporeal shock wave lithotripsy has recently been introduced as the first non-operative treatment alternative for patients with sialolithiasis. Using conventional multipurpose lithotripters, however, successful treatment was achieved in only 36%–53% of patients. Therefore we developed an miniaturized lithotripter meeting the special requirements for extracorporeal shock wave treatment in the head and neck region. During a 1-year prospective trial clinical efficacy and safety were compared in 40 patients treated with a conventional electromagnetic lithotripter (group A) to 33 patients treated with the newly developed, miniaturized device (group B). The groups did not differ statistically regarding stone size or number or the proportion of stones located in the submandibular or parotid gland. Successful stone targeting, a prerequisite for shock wave treatment, was achieved by means of in-line ultrasonography in 30 of the 40 patients in group A and in 29 of 33 patients of group B. The number of shock wave impulses administered per session and the maximum shock wave intensities did not differ in the two groups. Significantly more frequent treatments with a longer mean duration of each session were required in group A (2.4 ± 1.0 treatments, 47 ± 11 min) than in group B (1.9 ± 0.7 treatments, 28 ± 9 min; P 〈 0.05). After a 3 month follow-up significantly more patients were free of stones in group B (22/33) than in group A (16/40; P 〈 0.05). Correspondingly, the number of patients free of complaints was significantly higher in group B (27/33) than in group A (22/40; P 〈 0.05). Side effects did not differ between the two types of lithotripters, and they were moderate in intensity, completely reversible, and therefore without influence on the patient's outcome. It is concluded that the new miniaturized lithotripter provides a substantial progress for the feasibility and efficacy of shock wave treatment in sialolithiasis.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 7 (1993), S. 537-538 
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Cholecystectomy ; Laparoscopic cholecystectomy ; Abscess ; Surgery ; Gallstones
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Stones are sometimes spilled at the time of cholecystectomy. Retrieval may be difficult, especially during laparoscopic cholecystectomy. Little is known about the natural history of missed stones which are left behind in the peritoneal cavity. We present a case in which a patient developed an intraabdominal abscess around such a stone. The abscess recurred after drainage and removal of the stone was needed for resolution. This case suggests that care should be taken to avoid stone spillage, and that stones which are spilled into the abdomen should be retrieved.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1435-1803
    Keywords: Blood volume distribution ; splanchnic circulation ; vascular capacitance ; vasopressin ; whole-body scintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In healthy humans, the increase in arterial blood pressure seen in patients with autonomic dysfunction in response to exogenous vasopressin (AVP) is abolished. We tested the hypothesis that redistribution of blood from the intra- to the extrathoracic vascular compartment might contribute to this buffer response. Regional distribution of99mTc labeled autologous red cells was assessed in healthy supine volunteers (n=7) during arginine-vasopressin administration (1 ng·kg−1 bolus i.v. followed by a 14-min infusion of 3 ng·kg−1·min−1), along with arterial and central venous pressures, and heart rate. Exogenous vasopressin increased plasma vasopressin concentration from 4.0±1.4 SEM to 91 pg·ml−1±12. Thoracic counts increased slightly but significantly by 2.2%±0.9, while global abdominal counts remained unchanged. Most surprisingly, counts in the liver markedly increased (+8.1%±1.8, p=0.02), but significantly decreased in the spleen (−3.1%±1.4). Intestinal (−2.5%±2.4) and limb counts did not change significantly. Consistent with the increase in thoracic counts centralvenous pressure increased from 3.6 mm Hg±1 to 4.7±1 (p=0.02), while arterial pressure and heart rate did not change. All changes reversed towards baseline when vasopressin administration ceased. Thus, in humans with an intact autonomic system, vasopressin, at concentrations observed during hypotension, increases liver and, albeit to a small extent, also thoracic blood volume, but decreases splenic blood content. These results 1) are incompatible with the hypothesis that AVP induces a shift of blood from intra- to extrathoracic capacitance vessels, and 2) show that AVP increases rather than decreases central blood volume.
    Type of Medium: Electronic Resource
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