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Sample records for shockwave treatment compared

  1. [Extracorporeal shockwave lithotripsy: experience with 1000 treatments].

    PubMed

    Zehntner, C; Ackermann, D; Zingg, E J

    1987-03-14

    6 1/2 years after the first clinical trials in Munich, extracorporeal shockwave lithotripsy is a well established method for the treatment of urinary tract calculi. The number of open surgical interventions in urolithiasis has therefore markedly diminished. In hospitals with lithotriptors open surgical procedures are less than 1% today. In the first 16 months the Department of Urology at the University of Berne performed 1000 treatments with a kidney stone lithotriptor. The treatment was successful in 93.8%, a result comparable with those of other stone centres. During the last few months the indication for the treatment has been considerably enlarged. The new lithotriptors differ in several respects from the standard model by Dornier, though basically the principle of shockwaves remains unchanged.

  2. The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

    PubMed Central

    2011-01-01

    Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. Methods/design The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave) is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. Discussion The TOPSHOCK study is the

  3. Shockwave treatment of erectile dysfunction.

    PubMed

    Gruenwald, Ilan; Appel, Boaz; Kitrey, Noam D; Vardi, Yoram

    2013-04-01

    Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.

  4. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

    PubMed Central

    Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

    2013-01-01

    OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

  5. [Calcinosis cutis treatment with extracorporeal shockwave therapy].

    PubMed

    Jeppesen, Sune Møller; Yderstræde, Knud Bonnet; Lund, Lars

    2015-05-25

    Calcinosis cutis is a rare disease entity characterized by deposits of calcium in the skin and subcutaneous tissue causing hard-to-heal ulcers. This is a case report on a patient with femoral ulcers in connection with densely mineralized skin caused by ketobemidon injections. Next to surgical excision of calcified tissue the patient received extracorporeal shockwave therapy (ESWT). On the basis of excellent healing, partial skin transplant was feasible. We advocate for randomized trials on ESWT as an adjunctive therapy for complex non-healing wounds.

  6. [Gallstone treatment by electrohydraulic extracorporeal shockwave lithotripsy].

    PubMed

    Janowitz, P; Kratzer, W; Wechsler, J G; Kuhn, K; Janowitz, A; Swobodnik, W; Ditschuneit, H

    1991-08-30

    Extracorporeal shockwave lithotripsy (ESWL) with an electrohydraulic system was performed in 124 patients (33 men, 91 women; mean age 50.1 +/- 12.7 years). Sufficient stone fragmentation was achieved in 122 patients (98.3%). ESWL was repeated in 29 patients (23.3%), twice in 7 patients (5.6%). Average shockwave application per patient was 1,441 +/- 414 impulses, at a mean energy of 20.0 +/- 1.6 kV. Mean stone diameter before ESWL was 16.2 +/- 4.2 (7-30) mm, 7.1 +/- 4.1 (0-19) mm after ESWL. Computed tomography, performed immediately after ESWL in 88 patients demonstrated hypodense thickening (3-10 mm) of the gallbladder wall in 28.4% of patients. This was interpreted as wall oedema, reversible in all. One patient had a covered gallbladder rupture and two had biliary pancreatitis. None of the patients required emergency surgery. 93 patients (74.9%) had no stones 12 months later. A high success rate can be achieved if certain criteria are adhered to and suitable patients are selected.

  7. Shockwave lithotripsy and endourological stone treatment in children.

    PubMed

    Lahme, Sven

    2006-04-01

    Urolithiasis in children is a rare disease in developed countries. Due to the particular anatomical conditions of the infant body, indications and results of the well-known treatment modalities, such as shockwave lithotripsy (SWL), ureteroscopy and PCNL, have to be determined. Experience in active stone treatment in children is very rare and only a limited number of papers are available. SWL can be performed only if focus size and treatment facilities are adapted to the size of the child. Miniaturization of ureteroscopes allows primary access to the infant upper urinary tract. Results, complications and morbidity of the treatment are similar to the results in adults. The main prerequisite for the primary endoscopic approach is the experience of the surgeon. PCNL should be performed as Mini-Perc. Percutaneous procedures show equal results and morbidity compared to the treatment of adults, in experienced hands. As two-thirds of infant stone patients have an underlying metabolic disorder, close cooperation of adult and pediatric urologists, nephrologists and radiologists is necessary in order to achieve good results in the treatment of infant stones.

  8. [Conservative treatment of severe renal trauma after extracorporeal shockwave lithotripsy].

    PubMed

    Marchini, Giovanni Scala; Lopes, Roberto Iglesias; Bruschini, Homero; Torricelli, Fábio; Lopes, Roberto Nicomedes

    2011-01-01

    Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

  9. High-energy v low-energy shockwave lithotripsy in treatment of ureteral calculi.

    PubMed

    Mathes, G L; Mathes, L T

    1997-10-01

    The size of the crater formed in a urinary calculus subjected to shockwave lithotripsy (SWL) is directly proportional to the energy delivered to the stone surface. This study compared the effect of high and low energy levels on the outcomes of ureteral SWL. Ureteral calculi (N = 336) were treated with the conventional low-energy Siemens Lithostar and 62 with the higher-energy (1.02 v 0.5 mJ/mm2) modification of the Lithostar, the Siemens Shock Tube C. Stone locations included all regions of the ureter. The average stone treated with the standard Lithostar measured 8.1 mm in diameter and received 5461 shockwaves (treatment time 45 minutes) at 17.2 kV (range 14.5-19.0 kV). The stone-free rate was 72%, with stents being used in 16% of patients and a retreatment rate of 9%. The typical stone treated with Shock Tube C was 10.4 mm in diameter and received 3528 shockwaves (treatment time 30 minutes) at an average energy setting of 4.1 (range 1.5-8.0). The stone-free rate was 75%, with stents being used in 9.8% of cases, and a retreatment rate of only 1.6% (P < 0.003). In this study, Shock Tube C yielded stone-free rates equivalent to those of the conventional machine. However, the number of shockwaves, treatment time, and retreatment rate were significantly lower with the new shock tube. High-energy lithotripsy is more efficient than low-energy treatment of ureteral calculi.

  10. Molecular and cellular effects of in vitro shockwave treatment on lymphatic endothelial cells.

    PubMed

    Rohringer, Sabrina; Holnthoner, Wolfgang; Hackl, Matthias; Weihs, Anna M; Rünzler, Dominik; Skalicky, Susanna; Karbiener, Michael; Scheideler, Marcel; Pröll, Johannes; Gabriel, Christian; Schweighofer, Bernhard; Gröger, Marion; Spittler, Andreas; Grillari, Johannes; Redl, Heinz

    2014-01-01

    Extracorporeal shockwave treatment was shown to improve orthopaedic diseases and wound healing and to stimulate lymphangiogenesis in vivo. The aim of this study was to investigate in vitro shockwave treatment (IVSWT) effects on lymphatic endothelial cell (LEC) behavior and lymphangiogenesis. We analyzed migration, proliferation, vascular tube forming capability and marker expression changes of LECs after IVSWT compared with HUVECs. Finally, transcriptome- and miRNA analyses were conducted to gain deeper insight into the IVSWT-induced molecular mechanisms in LECs. The results indicate that IVSWT-mediated proliferation changes of LECs are highly energy flux density-dependent and LEC 2D as well as 3D migration was enhanced through IVSWT. IVSWT suppressed HUVEC 3D migration but enhanced vasculogenesis. Furthermore, we identified podoplaninhigh and podoplaninlow cell subpopulations, whose ratios changed upon IVSWT treatment. Transcriptome- and miRNA analyses on these populations showed differences in genes specific for signaling and vascular tissue. Our findings help to understand the cellular and molecular mechanisms underlying shockwave-induced lymphangiogenesis in vivo.

  11. Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

    PubMed

    Cole, R S; Shuttleworth, K E

    1988-12-01

    Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

  12. [Shockwave treatment of therapy refractory soft tissue pain].

    PubMed

    Boxberg, W; Perlick, L; Giebel, G

    1996-11-01

    Extracorporal shock-wave application (ESWA) has been used in the treatment of stones located in the kidneys, bile, pancreas and the glandula parotis. In the last 2 years several studies have shown the benefit of ESWA in the treatment of soft-tissue disorders and tendinosis calcarea. To date, the exact mechanism is unknown. Local hyperemia following damage or afferent inhibition is discussed. The possibilities and indications of ESWA with respect to several syndromes are presented. The results show the benefit of ESWA in the treatment of chronic soft-tissue disorders without severe side effects. Some patients showed small subcutaneous hematomas and erosion of the skin when energies about 20 mJ were used. Forty-seven of 84 of the patients obtained complete relief; 24 patients showed a marked reduction in their complaints. In only 13 of 84 cases was the treatment unsuccessful.

  13. Side effects of high-energy shockwaves in the human kidney: first experience with model comparing two shockwave sources.

    PubMed

    Roessler, W; Wieland, W F; Steinbach, P; Hofstaedter, F; Thüroff, S; Chaussy, C

    1996-12-01

    The side effects of high-energy shockwaves (HESW) from two different sources on kidney parenchyma obtained from 10 patients treated by radical nephrectomy for renal cell carcinoma were examined. Immediately after nephrectomy, the kidneys were perfused with cold HTK solution and kept in hypothermia (8 degrees C) for a maximum of 4 hours. In five cases, the tumor-free parenchyma was treated at the upper or lower renal pole with 2000 shocks, energy output 21 kV, in an experimental electromagnetic shockwave system (Siemens Co., Erlangen). In the other five cases, the upper or lower poles were treated with 2000 shocks, energy output 24 kV, in an electrohydraulic spark gap system (MFL 5000; Dornier Medizintechnik, Germering). The resulting tissue defects were analyzed by histologic examinations. Changes after treatment with the electromagnetic system were found mainly in the tubules and midsized blood vessels in a well-defined focal area. Treatment with the electrohydraulic system was followed by tubular and glomerular lesions combined with vessel defects in a patchy pattern. The model is able to define the side effects of HESW in the human kidney and to test the side effects of different lithotripters.

  14. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature.

    PubMed

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  15. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature☆

    PubMed Central

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  16. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature.

    PubMed

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.

  17. [The value of shockwave therapy in treatment of humero-radial epicondylitis].

    PubMed

    Vogt, W; Dubs, B

    2001-01-01

    Numerous therapies exist for the treatment of radial Epicondylitis. A new treatment, Extracorporal Shock-Wave Therapy (ESWT) has recently been proposed. Based on a review of the medical literature various mechanisms of action are presented. Except for the treatment of conditions of the urinary system, ESWT is controversial. Scientific proof of enhanced efficacy of ESWT compared to other treatments of radial Epicondylitis is still lacking. Prospective, randomized follow-up studies of large patient populations under standardized technical conditions are needed. Based on current knowledge, ESWT of radial Epicondylitis should only be applied if three conditions are fulfilled: 1) the diagnosis of radial Epicondylitis has been ascertained, 2) conservative therapies for at least one year failed, and 3) the only alternative is surgery.

  18. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study.

    PubMed

    Moen, M H; Rayer, S; Schipper, M; Schmikli, S; Weir, A; Tol, J L; Backx, F J G

    2012-03-01

    Objective The purpose of this study was to describe the results of two treatment regimens for medial tibial stress syndrome (MTSS); a graded running programme and the same running programme with additional shockwave therapy (extracorporeal shockwave therapy; ESWT). Design A prospective observational controlled trial. Setting Two different sports medicine departments. Participants 42 athletes with MTSS were included. Intervention Patients from one hospital were treated with a graded running programme, while patients from the other hospital were treated with the same graded running programme and focused ESWT (five sessions in 9 weeks). Main Outcome Measures Time to full recovery (the endpoint was being able to run 18 min consecutively without pain at a fixed intensity). Results The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a graded running programme, respectively 59.7±25.8 and 91.6±43.0 days (p=0.008). Conclusions This prospective observational study showed that MTSS patients may benefit from ESWT in addition to a graded running programme. ESWT as an additional treatment warrants further investigation in a prospective controlled trial with the addition of randomisation and double blinding.

  19. [Extracorporeal shockwave lithotripsy in the treatment of common bile duct calculi].

    PubMed

    Amstrup, J H; Eldrup, J; Wille-Jørgensen, P A

    1995-04-10

    Fifteen patients with stones in the common bile duct, in whom treatment with endoscopic papillotomy and stone-extraction had been unsuccessful were treated with extracorporeal shockwave lithotripsy. Nine patients were stone-free after one or two sessions, and two patients after further endoscopic treatment. One patient achieved partial clearance and palliation. One patient had a choledochoduodenostomy performed due to ineffectiveness of the shockwave lithotripsy. Two patients, who were thought to have a stone, turned out to have neoplasma in the common bile duct. Complications were frequent but temporary and needed no treatment. We conclude that extracorporeal shockwave lithotripsy is a valuable and safe alternative in those cases where conventional endoscopic treatment has failed, and should be considered before operation, especially to old for high-risk patients.

  20. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed Central

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-01-01

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life. PMID:3083922

  1. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-03-29

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.

  2. Effectiveness of electro-acupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy.

    PubMed

    Resim, Sefa; Gumusalan, Yakup; Ekerbicer, Hasan Cetin; Sahin, Mehmet Akif; Sahinkanat, Tayfun

    2005-08-01

    The aim of this study was to compare the clinical efficacy of electro-acupuncture (EA) with the combination of tramadol+midazolam (TM) for pain relief during outpatient extracorporeal shockwave lithotripsy (ESWL). A total of 35 patients (20 men, 15 women) with stones located in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with a third generation lithotriptor (Stone Lith, smart PCK) after receiving either EA (n=17) or TM (n=18) for sedation and analgesia. EA treatment was applied to patients by the same licensed acupuncturist 30 min prior to ESWL in group EA. Tramadol (1.5 mg/kg) 30 min before the start of lithotripsy and midazolam (0.06 mg/kg) 5 min prior to ESWL were given as a sedo-analgesic intravenously to group TM. During ESWL, blood pressure, heart rate, pain and sedation levels were measured at baseline and every 15 min thereafter. The pain intensity perceived during lithotripsy was evaluated using a visual analog scale (VAS). There was no statistical differences in the diameters of the stones and age of the patients between groups (P=0.590; P=0.568, respectively). In the EA group, the median of maximum energy level achieved was 16.0 kV (range 10-23 kV), while it was 18.0 kV (range 10-20 kV) in the TM group. There was no statistically significant difference between the maximum energy levels applied to the patients during ESWL (P=0.613). The median numbers of shockwaves were 2,114 (range 1,100-3,800) and 2,200 (range 1,500-3,200) in the EA and TM groups, respectively. In the TM group, the numbers of shockwaves used were higher than in group EA during ESWL. However, this difference was not significant (P=0.732). VAS scores were consistently lower in the EA group compared with the TM group throughout the ESWL procedure. The median VAS score was 5.0 (range 1-10) in the EA group while it was 8.0 (range 2-10) in the TM group. The patients who underwent EA had lower median scores of VAS than patients who took only

  3. Do renal cysts affect the success of extracorporeal shockwave lithotripsy? A retrospective comparative study.

    PubMed

    Gücük, Adnan; Oztürk, Ufuk; Uyetürk, Uğur; Kemahlı, Eray; Akın, Güven; Imamoğlu, M Abdurrahim; Metin, Ahmet

    2013-01-01

    The aim of this study was to assess the effect of simple renal cysts on extracorporeal shockwave lithotripsy (SWL) in patients with calyceal renal calculi. Patients with simple renal cysts >35 mm and ipsilateral renal calculi <20 mm that were treated with SWL constituted group 1 (cyst + calculi). The control group included patients aged >40 years that had renal calculi <20 mm and no cysts that were treated with SWL. The 2 groups were compared according to age, gender, body mass index, calculi size, localization, and density, the calculi fragmentation rate, and the percentage of stone-free patients. Mean cyst size in group 1 was 44.04 ± 9.08 mm. Mean age in group 1 was 61.4 ± 10.2 years versus 56.9 ± 8.2 years in the control group; the difference was significant (P = 0.045). There were not any other significant differences between the 2 groups, except for the stone-free rate (P > 0.05), which was 33.3% in group 1 and 68.2% in the control group (P = 0.017). The presence of renal cysts in a patient with calculi requires that an individualized treatment plan be devised, so as to provide the patient with the most effective treatment.

  4. [Trigger points - Diagnosis and treatment concepts with special reference to extracorporeal shockwaves].

    PubMed

    Gleitz, M; Hornig, K

    2012-02-01

    The 70-year-old trigger point theory has experienced a growing scientific confirmation and clinical significance as a consequence of recent muscle pain research. The trigger point pain formation is caused by high levels of vasoneuroactive substances. Depending on intensity and duration of the muscle stimulus the central pain processing is modified and leads to characteristic referred pain patterns. The most effective conventional forms of treatment are aimed at a direct mechanical manipulation of the trigger point as are new forms of therapy with focused and radial shockwaves. By using high pressures the focused shockwaves in particular are suitable to provoke local and referred pain and thus simplify the trigger point diagnosis. The empirically found therapeutic effect of shockwaves on muscles is hypothetical and can be explained in analogy with validated reactions of shockwaves in non-muscle tissues. Overall, the shockwave therapy on muscles represents a confirmation and extension of the existing trigger point therapy. It seems to be suitable for treating functional muscular disorders and myofascial pain syndromes within the locomotor system.

  5. Effectiveness of extracorporeal shockwave treatment in 353 patients with chronic plantar fasciitis.

    PubMed

    Norris, Donald M; Eickmeier, Kimberly M; Werber, Bruce R

    2005-01-01

    A 16-question post-treatment survey was sent to 874 patients after extracorporeal shockwave treatment for chronic plantar fasciitis. Of the 377 surveys returned, 353 were used for analysis. These patients were treated by 169 physicians in 19 states using either electrohydraulic or electromagnetic extracorporeal shockwave equipment. Seventy-six percent of the patients underwent treatment after having had continued pain for a year or longer. Seventy percent of patients who rated their pretreatment pain level as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in pain, with a sharp decline considered to be a difference in pain level before and after treatment of 3 or more. In addition, 66% of patients who rated their pretreatment immobility as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in immobility. Of the patients who underwent extracorporeal shockwave treatment, 69% indicated that they would recommend this procedure to someone in a similar situation. If extracorporeal shockwave treatment were not available, 62% of patients indicated that they would have undergone open or invasive surgery, and 41% indicated that they would have continued with additional physician office visits.

  6. Effect of extracorporeal shockwave treatment on the melanogenic activity of cultured melanocytes.

    PubMed

    Huang, Faye; Kuo, Hsi-Kung; Hsieh, Ching-Hua; Wu, Pei-Chang; Wu, Yi-Chan; Wang, Ching-Jen

    2012-02-01

    In addition to the traditional lithotripsy treatment, extracorporeal shockwaves (ESWs) have been shown to be effective in the treatment of certain musculoskeletal disorders and in enhancing skin flap neovascularization. However, relatively little is known about its effect on melanocytes. To investigate its effect on the melanogenic activity of cultured melanocytes, mouse B16F10 melanocytes were treated with defocused ESWs of different energies (15, 21, and 27 kV) and at different doses (300 and 600 impulses). Cell viability was measured 1 and 24 h after treatment. Melanin content was measured and compared against a standard curve generated with fungal melanin. Cellular tyrosinase activity was calculated with the 3,4-dihydroxyphenylalanine (DOPA) oxidase assay. The results demonstrated that ESW treatment reduced cell viability. Our results also indicated that the overall decrease in cell viability lasted for 6 days. After ESW treatment with 300 or 600 impulses at 21 kV, no significant change in melanin content or tyrosinase activity of the B16F10 melanocytes was noted as compared to those of the control. The present study suggests that ESW treatment does not alter the melanogenic activity of the cultured melanocytes.

  7. Current knowledge on evidence-based shockwave treatments for shoulder pathology.

    PubMed

    Moya, Daniel; Ramón, Silvia; Guiloff, Leonardo; Gerdesmeyer, Ludger

    2015-12-01

    Shoulder pain is one of the most common musculoskeletal pathologies. Treatment by ESWT (extracorporeal shockwave therapy) has emerged as an alternative when conservative treatment fails in rotator cuff calcific tendinopathy, prior to invasive procedures. The clinical efficacy of ESWT in non-calcific tendinopathy remains controversial. The good results in the treatment of rotator cuff calcifications, have led to indications of ESWT being expanded to other shoulder pathologies. We review the current state of indications and evidence based practice.

  8. Experience with electrohydraulic shockwave lithotripsy in the treatment of vesical calculi.

    PubMed

    Zhaowu, Z; Xiwen, W; Fenling, Z

    1988-06-01

    Five hundred and two patients with bladder stones have been treated by electrohydraulic shockwave lithotripsy (EHSWL) with the Wolf RIWOLTH-2135 disintegrator. The patients were aged between 18 and 80 years. The largest stone measured 3.6 x 4.8 cm but most were less than 3 cm; 533 stones were disintegrated in the 502 patients. The indications and complications of the treatment are discussed.

  9. Treatment of chronic proximal suspensory desmitis in horses using focused electrohydraulic shockwave therapy.

    PubMed

    Lischer, C J; Ringer, S K; Schnewlin, M; Imboden, I; Fürst, A; Stöckli, M; Auer, J

    2006-10-01

    The objective of the present clinical report was to investigate the short- and long-term outcomes of chronic proximal suspensory desmitis (PSD) treated with Extracorporeal Shockwave Treatment (ESWT). Fifty-two horses with chronic PSD in the forelimb (34 cases) or hindlimb (22 cases) were included in the study. Three horses had lesions in both hindlimbs and one in both forelimbs. The origin of the suspensory ligament was treated every three weeks for a total of three treatments using 2000 impulses applied by a focused ESWT device (Equitron) at an energy flux density of 0.15 mJ/ mm2. This treatment regime was followed by box rest and a controlled exercise program of 12 weeks duration. The horses were assessed 3, 6, 12, 24 weeks and one year after the first treatment. Of the 34 cases with forelimb PSD, 21 (61.8%) had returned to full work by six months after diagnosis and 19 cases (55.9%) were still in full work one year after ESWT. Of the 22 horses with hindlimb PSD, 9 (40.9%) had returned to full work by six months and 4 (18.2%) were still in full work one year after diagnosis. There was no association (chi-square test) between the outcome and the severity of the initial ultrasonographic and/or radiographic findings. Compared with the results of other clinical studies, these findings suggest that in horses with PSD of fore- and hindlimb, the prognosis for returning to full work six months after diagnosis can be improved when ESWT and a controlled exercise program are used. However, a high rate of recurrence occurred in the hindlimb despite treatment.

  10. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed

    Rickford, J K; Speedy, H M; Tytler, J A; Lim, M

    1988-03-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group.

  11. Combination of percutaneous surgery and extracorporeal shockwave lithotripsy for the treatment of large renal calculi.

    PubMed

    Dickinson, I K; Fletcher, M S; Bailey, M J; Coptcoat, M J; McNicholas, T A; Kellett, M J; Whitfield, H N; Wickham, J E

    1986-12-01

    Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.

  12. Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones. A national multicenter study.

    PubMed

    Burnett, D; Ertan, A; Jones, R; O'Leary, J P; Mackie, R; Robinson, J E; Salen, G; Stahlgren, L; Van Thiel, D H; Vassy, L

    1989-07-01

    A prospective multicenter trial was performed to evaluate the use of external shockwave lithotripsy (ESL) and adjuvant medical therapy for the treatment of gallstones. A Medstone STS lithotripter was used together with ursodiol. Two hundred twenty-three patients were treated under general anesthesia (75%) or with intravenous analgesia (25%). Initial treatments were on an inpatient basis, but as centers gained experience, outpatient treatments became more common. Stone fragmentation and clearance were greatest in patients with solitary gallstones less than 2 cm in diameter. In this group of patients, stone fragmentation occurred in 97% of patients, and the cumulative stone-free rates at three and six months were 54% and 90%, respectively. These results indicate that fragmentation of gallstones can be achieved by a dry shock-wave lithotripter and that stone clearance is induced more rapidly by external shock-wave lithotripsy and adjuvant ursodiol therapy than by ursodiol therapy alone.

  13. [Extracorporeal shockwave lithotripsy: an alternative treatment for lithiasis of caliceal diverticula].

    PubMed

    García Reboll, L; Pontones, J; Boronat, F; Vera, C D; Broseta, E; Cuñat, E; Jiménez Cruz, J F

    1992-06-01

    Among all the patients treated in our Lithotrity Unit, 13 of them had lithiasis inside the calyceal diverticulum. They were all treated by extracorporeal shockwaves. In none of the cases complete expulsion of lithiasic mass was achieved. In 3 (23%) cases it was reduced to half. In 2 (15.3%), 75% of the initial mass remained; and in 8 (61.5%) stones were fragmented but none of their debris was eliminated. Out of all the patients who were symptomatic before starting treatment, only 36.6% become asymptomatic. Extracorporeal lithotrity is, therefore, an approach with limited results in the calyceal intradiverticular lithiasis.

  14. [Treatment of a subcapsular renal bleeding after extracorporeal shockwave lithotripsy with recombinant, activated factor VII].

    PubMed

    Langer, H; Strohmaier, W L; Probst, S

    2002-11-01

    We report on a patient who suffered a large subcapsular and perirenal haematoma after extracorporeal shockwave lithotripsy. Despite surgical intervention the bleeding did not stop for 6 days and 10 units of packed red blood cells were transfused. With the treatment of recombinant, activated factor VIII (NovoSeven((R))) an immediate haemostasis could be reached, so that impending nephrectomy could be avoided. This is the first case where FVIIa has been successfully used to stop a trauma-related bleeding in a patient without any obvious accompanying coagulation disorder.

  15. Shockwave lithotripsy-new concepts and optimizing treatment parameters.

    PubMed

    Bhojani, Naeem; Lingeman, James E

    2013-02-01

    The treatment of kidney stone disease has changed dramatically over the past 30 years. This change is due in large part to the arrival of extracorporeal shock wave lithotripsy (ESWL). ESWL along with the advances in ureteroscopic and percutaneous techniques has led to the virtual extinction of open surgical treatments for kidney stone disease. Much research has gone into understanding how ESWL can be made more efficient and safe. This article discusses the parameters that can be used to optimize ESWL outcomes as well as the new concepts that are affecting the efficacy and efficiency of ESWL.

  16. [Extracorporeal shockwave lithotripsy in the treatment of gallstone patients].

    PubMed

    Kolesnikov, B D; Chubenko, S S; Romankova, V A

    1993-04-01

    Stroke-wave lithotripsy (SWL) was used for the treatment of patients with cholelithiasis. Indications and contraindications were strictly observed. This method provides destruction calculi down to a size of 2-3 mm which enables them to enter the intestine without local injury. Subsequent choleritics, exercises, duodenal to reduce time of gallbladder emptying and intake of litholytics.

  17. [Extracorporeal shockwave lithotripsy in the treatment of pediatric urolithiasis].

    PubMed

    Zöller, G; Ludewig, M; Kallerhoff, M; Zappel, H

    1991-11-01

    The 2nd generation lithotripter LITHOSTAR plus was used for extracorporeal shock wave lithotripsy of 9 kidney stones, 2 ureteral calculi and 2 bladder stones in 10 children 15 months to 17 years old. Ultrasonic stone localization was used in 2 children, x-ray guided stone localization in 8 children. General anesthesia was necessary in 6 children. A stone free rate of 60% was achieved after 1 treatment. Except for one 14-year old boy no adjuvant procedures like percutaneous nephrostomy or ureteral stents were applied. No major complications were encountered.

  18. [Extracorporeal shockwave lithotripsy in the treatment of gallbladder lithiasis. The first 109 patients].

    PubMed

    Correia, A P; Ribeiro, L C; Contente, L F; de Moura, M C

    1993-07-01

    The AA report their 15-month experience with extracorporeal shock-wave lithotripsy (ESWL) in the treatment of gallbladder stones (GS). The selection criteria included symptomatic patients, with 1 to 3 radiolucent stones in a functioning gallbladder. All patients were put on adjuvant therapy with 10 mg/Kg weight/day of ursodeoxycholic acid (ursodiol). ESWL sessions were performed in an ambulatory setting, using high-energy shock-waves (mean: 23 Kv) until fragments < or = 4mm were obtained, if possible. By the end of December 1992, 109 patients had completed the ESWL protocol, undergoing a total of 265 sessions (mean: 2.4 sessions per patient, variation 1-5). The stone-free (SF) rates and respective 95% confidence intervals were 31% (22%-43%) at 6 months and 59% (38%-76%) at 1 year of follow-up. For the subset of patients with a single stone < or = 2 cm (n = 59), were 47% (33%-63%) at 6 months and 77% (40%-95%) at 1 year. The most significant complication was acute biliary pancreatitis, of which we report 4 cases (4%). They were always mild and non-complicated. There was no mortality. The AA conclude that ESWL is a safe and effective treatment for selected patients with GS.

  19. [Improvement of extracorporeal shockwave cholelithotripsy in the comprehensive treatment of cholelithiasis].

    PubMed

    Bagaudinov, K G; Saidov, S S; Garilevich, B A; Zubkov, A D; Abdulaev, R A; Ovakimian, G S

    2007-01-01

    The method of shockwave distant lithotripsy (DL) has been used since 1985. However, many facets of this problem have not been solved yet, because large fragments of the stone remain after its destruction, and focused shock waves (FSW) damage the gallbladder (GB). The aim of this study was to determine possibilities of effective distant destruction of gall stones, to reveal negative consequences of the effects of FSW on the gallbladder (GB) and the surrounding tissues, as well as development and perfection of DL technique. The established parameters of FSW were used to develop the new Lithotriptor Compact. By now, 53 patients with cholelithiasis aged 18 to 55 have been treated by DC. The procedure was performed without general anesthesia. A thousand to 3500 shockwave impulses were applied to each stone. All patients had received litholytic therapy and treatment directed towards metabolic normalization, the functional state of the GB, and prevention of recurrent stone formation, prior to DL. In total, 116 DL sessions (2.2 sessions per a patient) were performed. A positive effect as a result of the complex treatment of cholelithiasis using DL method was achieved in 47 (88.7%) of the patients. There were no complications. In 3 patients (5.7%) recurrence of gallstones was found two years after DL sessions. Correctly selected parameters of FSW and DL technology allow for effective destruction of GB stones, while conservative therapy favors their passage through the biliary tract and fast litholysis of remaining stone fragments.

  20. Extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis--a biometrical review.

    PubMed

    Böddeker, R; Schäfer, H; Haake, M

    2001-01-01

    The application of extracorporeal shockwave therapy (ESWT) as a treatment for conservatively unsuccessfully treated plantar fasciitis has experienced a rapid increase over the last years. However, the efficacy of ESWT has not yet been established unequivocally, as published studies have led to inconsistent results. Furthermore, reviews on clinical trials on ESWT are either not up to date, incomplete, or methodologically inadequate. As a consequence, a systematic literature search was conducted which yielded 21 relevant articles on ESWT in the treatment of plantar fasciitis. These were rated according to biometrical criteria for the conduct of therapeutic trials based on international guidelines. None of the rated trials fulfilled all of the criteria, and it is concluded that at this point the efficacy of ESWT can be neither confirmed nor excluded. Randomised and controlled clinical trials are required to adequately estimate the value of ESWT as a treatment for plantar fasciitis.

  1. Extracorporeal shockwave therapy (ESWT)--First choice treatment of fracture non-unions?

    PubMed

    Schaden, Wolfgang; Mittermayr, Rainer; Haffner, Nicolas; Smolen, Daniel; Gerdesmeyer, Ludger; Wang, Ching-Jen

    2015-12-01

    Fracture non-unions are still a challenging problem in orthopedics. The treatment of non-unions remains highly individualized, complex, and demanding. In most countries the surgical approach with debridement of the non-union gap, anatomical reduction and appropriate osteosynthesis along with autologous bone grafting is considered as the standard of care. One of the very first non-urologic applications of extracorporeal shockwave treatment (ESWT) concerned non-healing fractures. Since the early 1990ties the knowledge of the working mechanism has increased enormously. The purpose of this review article is to demonstrate by peer-reviewed literature in conjunction with our own experiences that ESWT can be an efficient, non-invasive, almost complication-free and cost effective alternative to surgical treatment of non-healing fractures.

  2. [Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. A current overview].

    PubMed

    Böddeker, I; Haake, M

    2000-05-01

    In the past, extracorporeal shock-wave therapy (ESWT) has been used increasingly as a treatment for conservatively unsuccessfully treated radiohumeral epicondylitis. However, published reviews of clinical trials on the efficacy of ESWT have led to inconsistent results and are outdated or methodologically inadequate. As a consequence, a systematic literature search was conducted which yielded 20 relevant papers that described trials on the efficacy of ESWT in the treatment of radiohumeral epicondylitis. These were rated according to biometrical criteria for the conduct of therapeutic trials. None of the rated trials fulfilled all of the criteria, and it is concluded that the efficacy of ESWT in the treatment of epidondylitis can presently be neither confirmed nor excluded.

  3. [Treatment of calculi not easily seen with radiology using extracorporeal shockwave lithotripsy. Value of contrast media].

    PubMed

    Lancina Martín, J A; Arrabal Martín, M; Camacho Martínez, E; Gómez Núñez, E; García Pérez, M

    1991-01-01

    Currently, most calculi can be treated with shockwave extracorporeal lithotrity regardless their location within the urinary apparatus or their physico-chemical features. In order to optimize results only medical criteria for patient's selection should be taken into account. Certain type of calculi can obstruct adequate radioscopic viewing by not allowing correct centring for shockwave emission. The problem can be overcome by using echography or other contrast procedures. Of a total 514 patients treated in our Unit with ESWL, execution of contrast procedures was necessary in 18 cases (3.5%) in order to allow adequate viewing of the calculi. Calculi in 10 patients were midly radiopacque, uric acid in 4, and bone-superimposed in the remaining 4. This technical manoeuvre allowed in all cases a good centring of the calculi. After a two months follow-up. lithiasis is absent in 15 patients and only 2 present expellable lithiatic fragments. It can therefore be concluded that the use of contrast procedures, both through i.v. or a catheter, is a simple, safe and well tolerated procedure allowing convenient viewing of those calculi, also followed by good results after ESWL treatment.

  4. The effects of treatment the avascular necrosis of the femoral head with extracorporeal focused shockwave therapy.

    PubMed

    Kusz, Damian; Franek, Andrzej; Wilk, Robert; Dolibog, Paweł; Błaszczak, Edward; Wojciechowski, Piotr; Król, Piotr; Dolibog, Patrycja; Kusz, Błażej

    2012-01-01

    Background.Avascular necrosis of the femoral head continues to represent a major challenge for the orthopaedist and trauma surgeon. A fully effective method of treatment is yet to be introduced. After femoral head collapse, only total hip replacement can help the patient. Our study aims to assess the effects of treatment of avascular necrosis of the femoral head with extra corporeal focused shockwave therapy.Material and methods. A prospective study was carried out in patients with avascular necrosis of the femoral head, ARCO stage I-III, diagnosed by MRI imaging. Shock waves are applied under x-ray guidance. Four points are marked on the skin above the lesion. Each spot receives a dose of 1500 pulses at an energy flux density of 0.4 mJ/mm2 and a frequency of 4 Hz. Each patient undergoes 5 therapy sessions. A posturometric and stabilometric assessment is carried out before and after the therapy. Other examinations include a tensometric evaluation of the strength of the treated limb, and an assessment of pain intensity (VAS scale)and hip function (Harris hip score). Follow-up visits are scheduled at 6 weeks and 3, 6 and 12 months post-treatment.Results. Nine patients were treated with shockwave therapy at the Department of Orthopaedics and Musculoskeletal Traumatology, Medical Faculty, Medical University of Silesia, between 5 May 2011 and 1 June 2012. The patients demonstrated pain reduction and improved mobility of the treated joint (VAS score decreasing from 6.75 +/- 0.71 to 2.5 +/- 1.7; Harris hip score increasing from 55.21 +/- 15.45 to 89.21 +/- 8.26). Tensometric platform testing carried out after the treatment revealed a statistically significant difference between mean velocity of the centre of pressure (CoP) movement when walking with eyes open and closed (p<0.05) and mean CoP movement along the x (walking with eyes closed) and y (free standing with eyes closed) axes.Conclusions. 1. Extracorporeal focused shockwave therapy resulted in considerable

  5. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial.

    PubMed

    Malay, D Scot; Pressman, Martin M; Assili, Amir; Kline, Jason T; York, Shane; Buren, Ben; Heyman, Eugene R; Borowsky, Pam; LeMay, Carley

    2006-01-01

    Extracorporeal shockwave therapy (ESWT) has demonstrated efficacy in the treatment of recalcitrant proximal plantar fasciitis. The objective of this investigation was to compare the outcomes of participants treated with a new ESWT device with those treated with placebo. A total of 172 volunteer participants were randomized in a 2:1 active-to-placebo ratio in this prospective, double-blind, multicenter trial conducted between October 2003 and December 2004. ESWT (n=115) or placebo control (n=57) was administered on a single occasion without local or systemic anesthesia or sedation, after which follow-up was undertaken. The primary outcomes were the blind assessor's objective, and the participant's subjective assessments of heel pain during the first 3 months of follow-up. Participants were also followed up to 1 year to identify any adverse outcomes that may have been related to the shockwave device. On the visual analog scale, the blind assessor's objective assessment of heel pain displayed a mean reduction of 2.51 in the shockwave group and 1.57 in the placebo group; this difference was statistically significant (P=.045). On the visual analog scale, the participant's self-assessment of heel pain displayed a mean reduction of 3.39 in the shockwave group and 1.78 in the placebo group; this difference was statistically significant (P<.001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment.

  6. Extracorporeal shockwave treatment of osteonecrosis of the femoral head in systemic lupus erythematosis.

    PubMed

    Lin, Po-Chun; Wang, Ching-Jen; Yang, Kuender D; Wang, Feng-Sheng; Ko, Jih-Yang; Huang, Chung-Cheng

    2006-09-01

    This article reported a case of systemic lupus erythematosis (SLE) with osteonecrosis of the femoral heads (ONFH-3) successfully treated with a novel extracorporeal shockwave treatment (ESWT). The follow-up at 3 years showed that both hips had no pain on activities for daily living. Magnetic resonance image (MRI) showed substantial reduction in bone marrow edema and no further collapse of the lesions. Radiographs and MRIs showed no change in the staging of the disease. ESWT provided beneficial effects for hips affected by ONFH in patients with SLE. This novel treatment modality resulted in significant pain relief and functional improvement of the hip and reduction in bone marrow edema in our patient. It appeared that ESWT might have the potential to curtail the progression of the disease and to delay the need for total hip arthroplasty in the very young patients contracted with SLE.

  7. Ultrasonic imaging for extracorporeal shockwave lithotripsy: analysis of factors in successful treatment.

    PubMed

    Kiely, E A; Madigan, D; Ryan, P C; Butler, M R

    1990-08-01

    The emergence of real-time ultrasonic imaging for extracorporeal shockwave lithotripsy poses questions regarding the factors and techniques which facilitate stone imaging for clinicians with no previous practical experience in ultrasonography. The ability of these clinicians to assess when stone disintegration has been achieved also needs to be confirmed. A wide range of data was recorded from each of 2688 lithotripsy treatments performed over a 2-year period using the EDAP LT.01 ultrasound-imaged piezoelectric lithotriptor. An analysis of these data was performed using a comprehensive microcomputer-based statistics package. The mean time taken for stone imaging and positioning was reduced from 11.2 to 7.5 min over the 2-year period. Obese patients and those with renal pelvic stones were best imaged in a lateral position. Overall there was no difference in percentage stone disintegration or clearance between treatments in the supine or lateral positions, but a significant reduction in the clearance of small caliceal stones resulted when the lateral position was used. Factors associated with a significantly greater percentage of stone disintegration and clearance included pain experienced by the patient during fine adjustment of the processing head during treatment, acoustic focus attenuation and widening and acoustic shadow widening as detected by the urologist at the end of treatment. Among the factors not associated with significant alterations in the percentage of stone disintegration or clearance were the lithotriptor operator, the side or site of the calculus, obesity and shockwave frequency or power. This study confirmed the ability of urologists to develop expertise in ultrasonography for renal stone imaging and to interpret successfully the subtle signs of stone disintegration.

  8. [Biliary extracorporeal shockwave lithotripsy in the surgical treatment concept of cholelithiasis].

    PubMed

    Meiser, G; Heinerman, M; Boeckl, O

    1990-05-01

    Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm. 14% had more than 3 stones, another 12% had solitary stones with a small rim calcification. In 99 patients all stones could be disintegrated. In 90% we achieved a fragment size smaller than 5 mm, in 10% smaller than 8 mm. 68 patients were treated in a single session, in 32% a 2nd or 3rd treatment was necessary. In the average 4100 +/- 2200 shock-waves with energy level 9 (650 bar) were applied. During treatment 15 patients suffered from slight right kidney pain. In the following 48 hours after BESWL we observed a transitory significant elevation of transaminases (32%), urinary amylases without clinical symptoms (31%), bilirubin (31%) and white blood cells (71%). A microhematuria was seen in 33%, a macrohematuria in 2%. Post-BESWL sonographically we found a transitory edema of the gallbladder wall in 18%, in 15% a hydrops, in 10% a dilatation of the common bile duct and in 4% free fluid surrounding the gallbladder. After dismission 31% of the patients suffered from slight colicky pain. In 3 patients acute biliary pancreatitis was observed 4 and 8 weeks after BESWL which could be treated by EPT and endoscopic stone removal.

  9. Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction

    PubMed Central

    Ruffo, A.; Capece, M.; Prezioso, D.; Romeo, G.; Illiano, E.; Romis, L.; Lauro, G. Di; Iacono, F.

    2015-01-01

    ABSTRACT The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA. Materials and Methods: 31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Results: At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Conclusion: In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified. PMID:26689523

  10. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.

    PubMed

    Ramon, Silvia; Gleitz, Markus; Hernandez, Leonor; Romero, Luis David

    2015-12-01

    Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes in the absence of evident local nociception such as myogelosis, muscle hardening, myalgia, muscular rheumatism, fibrositis or myofascial trigger point with or without referred pain. If it persists over six months or more, it often becomes therapy resistant and frequently results in chronic generalized pain, characterized by a high degree of subjective suffering. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibers, known as myofascial trigger points (MTP), and fascial constrictions. Fibromyalgia (FM) is a chronic condition that involves both central and peripheral sensitization and for which no curative treatment is available at the present time. Fibromyalgia shares some of the features of MPS, such as hyperirritability. Many treatments options have been described for muscle pain syndrome, with differing evidence of efficacy. Extracorporeal Shockwave Treatment (ESWT) offers a new and promising treatment for muscular disorders. We will review the existing bibliography on the evidence of the efficacy of ESWT for MPS, paying particular attention to MTP (Myofascial Trigger Point) and Fibromyalgia (FM).

  11. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.

    PubMed

    Ramon, Silvia; Gleitz, Markus; Hernandez, Leonor; Romero, Luis David

    2015-12-01

    Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes in the absence of evident local nociception such as myogelosis, muscle hardening, myalgia, muscular rheumatism, fibrositis or myofascial trigger point with or without referred pain. If it persists over six months or more, it often becomes therapy resistant and frequently results in chronic generalized pain, characterized by a high degree of subjective suffering. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibers, known as myofascial trigger points (MTP), and fascial constrictions. Fibromyalgia (FM) is a chronic condition that involves both central and peripheral sensitization and for which no curative treatment is available at the present time. Fibromyalgia shares some of the features of MPS, such as hyperirritability. Many treatments options have been described for muscle pain syndrome, with differing evidence of efficacy. Extracorporeal Shockwave Treatment (ESWT) offers a new and promising treatment for muscular disorders. We will review the existing bibliography on the evidence of the efficacy of ESWT for MPS, paying particular attention to MTP (Myofascial Trigger Point) and Fibromyalgia (FM). PMID:26363497

  12. SHOCK-WAVE THERAPY APPLICATION IN CLINICAL PRACTICE (REVIEW).

    PubMed

    Sheveleva, N; Minbayeva, L; Belyayeva, Y

    2016-03-01

    The article presents literature review on the use of extracorporeal shock-wave therapy in physiotherapeutic practice. The basic mechanisms of shock waves influence on the organism are spotlighted. Studies proving high efficacy of the method in treatment of wide variety of inflammatory diseases and traumatic genesis are presented. The data on comparative assessment of shock-wave therapy efficacy, and results of researches on possibility of extracorporeal shock-wave therapy effect potentiating in combination with other therapeutic methods are reflected. Recent years, the range of indications for shock-wave therapy application had been significantly widened. However, further study of the method is still relevant because mechanisms of action of the factor are studied insufficiently; methods of therapy parameters selection (energy flux density, number of pulses per treatment, duration of a course) are either advisory or empirical.

  13. Osteogenesis induced by extracorporeal shockwave in treatment of delayed osteotendinous junction healing.

    PubMed

    Qin, Ling; Wang, Lin; Wong, Margaret Wan-nar; Wen, Chunyi; Wang, Gang; Zhang, Ge; Chan, Kai-ming; Cheung, Wing-hoi; Leung, Kwok-sui

    2010-01-01

    Healing at the osteotendinous junction (OTJ) is challenging in orthopedic surgery. The present study aimed to test extracorporeal shockwave (ESW) in treatment of a delayed OTJ healing. Twenty-eight rabbits were used for establishing a delayed healing (DH) model at patella-patellar-tendon (PPT) complex after partial patellectomy for 4 weeks and then were divided into DH and ESW groups. In the ESW group, a single ESW treatment was given at postoperative week 6 to the PPT healing complex. The samples were harvested at week 8 and 12 for radiographic and histological evaluations with seven samples for each group at each time point. Micro-CT results showed that new bone volume was 1.18 +/- 0.61 mm(3) in the ESW group with no measurable new bone in the DH group at postoperative week 8. Scar tissue formed at the OTJ healing interface of the DH group, whereas ESW triggered high expression of VEGF in hypertrophic chondrocytes at week 8 and regeneration of the fibrocartilage zone at week 12 postoperatively. The accelerated osteogenesis could be explained by acceleration of endochondral ossification. In conclusion, ESW was able to induce osteogenesis at OTJ with delayed healing with enhanced endochondral ossification process and regeneration of fibrocartilage zone. These findings formed a scientific basis to potential clinical application of ESW for treatment of delayed OTJ healing.

  14. Laser induced shockwaves on flexible polymers for treatment of bacterial biofilms.

    PubMed

    Navarro, Artemio; Taylor, Zachary D; Beenhouwer, David; Haake, David A; Gupta, Vijay; Grundfest, Warren S

    2011-01-01

    Bacterial biofilm-related infections are a burden on the healthcare industry. The effect of laser generated shockwaves through polycarbonate, a flexible polymer, is explored for its ability to generate high peak stresses, and also for its ability to conform to complex wound surfaces. Shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 60 MPa was measured which should provide sufficient pressure to kill bacteria.

  15. [Low energy extracorporeal shockwave therapy (ESWT) for treatment of myogelosis of the masseter muscle].

    PubMed

    Kraus, M; Reinhart, E; Krause, H; Reuther, J

    1999-01-01

    Patients with functional disorders of the temporomandibular apparatus often show painful myogelosis, especially of the masseter muscle. The cause is hypertonia of the affected muscle. The aim of the presented single-blinded clinical trial was to analyze the effects of low-energy extracorporeal shock waves on patients with pain sensitivity in this region. Participating in the trial were 50 patients with painful, palpable and sonographically evident myogelosis of the masseter muscle. Half of the patients received a single application of 250 impulses of 0.04 mJ/mm2. The second half received an equivalent placebo treatment with the shock-wave impact being inhibited by a neopren insert. It was shown that in 64% of the patients significant alleviation of pain with palpable and sonographically evident softening of the myogelosis could be achieved. In 40% of the patients the therapeutic result could be conserved over a period of 2 weeks. The difference from the placebo group was statistically highly significant. ESWT is thus an easy-to-use, non-invasive method of initial pain therapy for patients with functional disorders. To preserve the long-term therapeutic result, additional functional therapy is nevertheless necessary.

  16. Shockwave lithotripsy: anecdotes and insights.

    PubMed

    Lingeman, James E; Kim, Samuel C; Kuo, Ramsay L; McAteer, James A; Evan, Andrew P

    2003-11-01

    Shockwave lithotripters have evolved considerably since the introduction of the Dornier HM3 machine 20 years ago. Although shockwave lithotripsy (SWL) remains the preferred treatment for the majority of symptomatic upper urinary-tract calculi, newer lithotripters are not as effective and may have a higher risk of side effects. Lack of progress in lithotripter evolution is attributable to inadequate understanding of how and why shockwaves produce effects on stone and tissue. Current knowledge suggests that stones fragment by the mechanisms of compression fracture, spallation, squeezing, and acoustic cavitation, while tissue damage from shockwaves is secondary to cavitation and non-cavitational forces such as sheer stress. It appears likely that most tissue damage from shockwaves is caused by cavitation. As the understanding of SWL matures, new lithotripter designs may emerge that truly represent an improvement on the original Dornier HM3 machine.

  17. A passive acoustic device for real-time monitoring of the efficacy of shockwave lithotripsy treatment.

    PubMed

    Leighton, T G; Fedele, F; Coleman, A J; McCarthy, C; Ryves, S; Hurrell, A M; De Stefano, A; White, P R

    2008-10-01

    Extracorporeal shockwave lithotripsy (ESWL) is the preferred modality for the treatment of renal and ureteric stone disease. Currently X-ray or ultrasound B-scan imaging are used to locate the stone and to check that it remains targeted at the focus of the lithotripter during treatment. Neither imaging modality is particularly effective in allowing the efficacy of treatment to be judged during the treatment session. A new device is described that, when placed on the patient's skin, can passively monitor the acoustic signals that propagate through the body after each lithotripter shock, and which can provide useful information on the effectiveness of targeting. These acoustic time histories are analyzed in real time to extract the two main characteristic peak amplitudes (m(1) and m(2)) and the time between these peaks (t(c)). A set of rules based on the acoustic parameters was developed during a clinical study in which a complete set of acoustic and clinical data was obtained for 30 of the 118 subjects recruited. The rules, which complied with earlier computational fluid dynamics (CFD) modeling and in vitro tests, allow each shock to be classified as "effective" or "ineffective." These clinically-derived rules were then applied in a second clinical study in which complete datasets were obtained for 49 of the 85 subjects recruited. This second clinical study demonstrated almost perfect agreement (kappa = 0.94) between the number of successful treatments, defined as >50% fragmentation as determined by X-ray at the follow-up appointment, and a device-derived global treatment score, TS(0), a figure derived from the total number of effective shocks in any treatment. The acoustic system is shown to provide a test of the success of the treatment that has a sensitivity of 91.7% and a specificity of 100%. In addition to the predictive capability, the device provides valuable real-time feedback to the lithotripter operator by indicating the effectiveness of each shock, plus

  18. Original hypothesis: Extracorporeal shockwaves as a homeostatic autoimmune restorative treatment (HART) for Type 1 diabetes mellitus.

    PubMed

    Craig, Kenneth; d'Agostino, Cristina; Poratt, Daniel; Walker, Marjorie

    2014-09-01

    Mononuclear invasion of Langerhans islet and the ensuing insulitis triggers signal-transduction for the autoimmune mediated pancreatic beta-cell (β-cell) apoptosis that severely disrupts insulin production resulting in hyperglycemia associated with Type-1 diabetes (T1DM). Today extensive global research is being conducted to eliminate the need for insulin, and even prevent or find a cure for T1DM. The multifactorial combination of autoimmune dysfunction, Langerhans islet hypoxia, and bio-chemical disruption are seen to be contributory factors for β-cell destruction and the consequential disruption to insulin production. Regeneration of β-cells back to physiological levels may restore homeostatic insulin levels, reversing T1DM. Evidence suggests that there are still functioning pancreatic β-cells even in long standing T1DM providing the potential for their regeneration. Although the exact mechanism of extracorporeal shockwaves (ESW) is yet to be fully elucidated, it is seen to influence a complex spectrum of bio-chemical, cellular and neuronal functions (i.e. suppression of pro-inflammatory immune response, improved tissue hemodynamics, anti-microbial properties, and the induction of progenitor cell expression including proangiogenic factors and nitric oxide syntheses). The rationale for the use of ESW as a therapeutic modality in this instance is attributed to its restorative properties and safety profile demonstrated in urology, cardiology, chronic wounds, osteogenesis, complex pain syndromes, and tendinopathies. ESW may restore autoimmune homeostasis creating a suitable environment for pancreatic β-cell proliferation which in-turn may significantly increase or normalize endogenous insulin secretion reducing or totally eliminating dependency of exogenous insulin. The devastating complications, morbidity and mortality associated with T1DM warrants the exploration of homeostatic autoimmune restorative treatment (HART) modalities that may partially or fully

  19. Slightly focused high-energy shockwave therapy: a potential adjuvant treatment for osteoporotic fracture.

    PubMed

    Chen, Xiao-Feng; Huang, Hai-Ming; Li, Xiao-Lin; Liu, Ge-Jun; Zhang, Hui

    2015-01-01

    Slightly focused high-energy shockwave (HESW) therapy is characterized by a wide focal area, a large therapy zone, easy positioning and less pain during treatment. The objective of this study was to perform for the first time an in vivo test of the slightly focused HESWs for osteoporotic fractures. Bilateral proximal tibial osteotomies were made in 30 ovariectomized (OVX) Sprague-Dawley rats and secured with internal fixation. The osteotomy site in the left tibia was subsequently treated with slightly focused HESWs with the energy flux density of 0.26 mj/mm(2), shock repetition frequency of 1 Hz and 2000 shocks (OVX + HESW group). The contralateral right tibia was not treated and served as the control (OVX group). Roentgenographic examination 2, 4, 6, and 8 weeks after osteotomy showed that HESW treatment accelerated tibia fracture healing in osteoporotic rats. Histological examination 2, 4, and 8 weeks after HESW treatment showed a greater inflammatory reaction in the OVX + HESW group, with more mature collagen and trabeculae than in the OVX group. Micro computer tomography (Micro-CT) scanning after 4 and 8 weeks showed that bone volume (BV), bone volume/tissue volume (BV/TV), mean trabecular thickness (Tb.Th), and mean trabecular number (Tb.N) were about 45.0% and 33.1%, 18.4% and 20.1%, 38.2% and 20.9%, 26.7% and 28.4%, respectively, higher in the treatment group than in the control group (P < 0.05); and the mean trabecular separation (Tb.Sp) was about 16.7% and 27.3% lower in the treatment group (P < 0.05). Four and eight weeks after HESW treatment, the maximum compressive callus endurance was about 72.3% and 25.5%, respectively, higher in the treatment group than in the control group (P < 0.05). These results show that slightly focused HESW therapy has a beneficial effect on osteoporotic tibial fracture healing. Slightly focused HESWs could increase callus endurance, induce bone formation, and improve trabecular bone microarchitecture and biomechanical

  20. [Shockwave lithotripsy in sialolithiasis patients].

    PubMed

    Abdusalamov, M R; Afanas'ev, V V; Gamataev, I I

    2014-01-01

    Shockwave lithotripsy was performed by various appliances in sialolithiasis patients. The best results were obtained by means of miniature appliances. Lithotripsy proved to be useful safe alternative for sialolithiasis treatment.

  1. Initial experience with linear focused shockwave treatment for erectile dysfunction: a 6-month follow-up pilot study.

    PubMed

    Reisman, Y; Hind, A; Varaneckas, A; Motil, I

    2015-01-01

    Low-intensity shockwaves (LISW) are known to produce revascularization and have been in evaluation and in use to treat erectile dysfunction (ED). The present single-arm pilot study is aimed to assess the safety and efficacy of a dedicated shockwave device (Renova) on vasculogenic ED patients. Fifty-eight patients with mild to severe ED were treated by LISW and their erectile function was evaluated by the International Index of Erectile Function-Erectile Function Domain (IIEF-EF), Sexual Encounter Profile and Global Assessment Questions questionnaires, at baseline and at 1, 3 and 6 months post treatment. The average IIEF-EF increased significantly from 14.78 at baseline to 21.93 at 3 months post treatment and stabilized at 22.26 at 6 months post treatment. Out of 58 patients, 47 (81%) had a successful treatment. No adverse events were reported during the treatment and the follow-up duration. In conclusion, it suggests that the performance of LISW could add a new advanced treatment for ED.

  2. [The application of extracorporeal shock-wave lithotripsy in the treatment of choledocholithiasis].

    PubMed

    Nichitaĭlo, M E; Ogorodnik, P V; Goĭda, S M; Diachenko, V V; Goĭda, M S; Sobchinskiĭ, S A; Voĭtseshin, V V; Gul'ko, O N

    2001-10-01

    The method of extracorporal shockwave biliary lithotripsy was introduced in the clinic since 1993 yr in patients with residual choledocholithiasis. The method was applied in 25 patients. Cholecystectomy with external drainage of common biliary duct was performed in all patients beforehand. Positive result was noted in 16 observations. All patients are alive.

  3. Can Shockwave Therapy Improve Tendon Metabolism?

    PubMed

    Zwerver, Johannes; Waugh, Charlotte; van der Worp, Henk; Scott, Alex

    2016-01-01

    Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and mechanotransduction-initiated tissue regeneration and remodeling of the tendon are considered to be the most important working mechanisms. The heterogeneity of systems (focussed shockwave therapy vs. radial pressurewave therapy), treatment protocols and study populations, and the fact that there seem to be responders and non-responders, continue to make it difficult to give firm recommendations with regard to the most optimal shockwave therapy approach. Specific knowledge with regard to the effects of shockwave therapy in patients with metabolic tendon disorders is not available. Further fundamental and clinical research is required to determine the value of shockwave therapy in the management of tendinopathy.

  4. Can Shockwave Therapy Improve Tendon Metabolism?

    PubMed

    Zwerver, Johannes; Waugh, Charlotte; van der Worp, Henk; Scott, Alex

    2016-01-01

    Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and mechanotransduction-initiated tissue regeneration and remodeling of the tendon are considered to be the most important working mechanisms. The heterogeneity of systems (focussed shockwave therapy vs. radial pressurewave therapy), treatment protocols and study populations, and the fact that there seem to be responders and non-responders, continue to make it difficult to give firm recommendations with regard to the most optimal shockwave therapy approach. Specific knowledge with regard to the effects of shockwave therapy in patients with metabolic tendon disorders is not available. Further fundamental and clinical research is required to determine the value of shockwave therapy in the management of tendinopathy. PMID:27535269

  5. [Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy for ureteral stones. A comparative study].

    PubMed

    Xue, Z Y

    1991-04-01

    From June 1987 to December 1988, 212 cases of ureteral calculi were treated with ESWL and ureteroscopic lithotripsy (URSL) respectively. The lithotriptic success rates of ESWL for upper, mid and distal ureteric stones were 100.0%, 100.0% and 93.4% respectively as compared with 62.5%, 85.7% and 93.7% of URSL. ESWL for upper and mid ureteral stones was obviously superior to URSL (P less than 0.001). The incidence rate of complications of ESWL was lower than that of URSL (P less than 0.05). In the 212 cases, urinary extravasation caused by ureteral injury occurred in 4 cases treated by URSL. We suggest that ESWL should be the first treatment of choice for ureteral calculi and URSL is not recommended for the treatment of upper ureteral calculi, but it may be used as an adjunctive method.

  6. [Ambulatory treatment without anesthesia of urinary lithiasis by extracorporeal shock-wave lithotripsy: 7,000 cases].

    PubMed

    Torrecilla, C; Contreras, J; Tesedo, X; López-Costea, M; Pérez-Céspedes, M; Serrallach, N

    1993-01-01

    Exposition of results and complications in 7,162 consecutive sessions with Shockwave Extracorporeal Lithotripsy (SWEL) applied to 3,950 lithiasis located at all levels of the urinary tract. These procedures have been performed without sedation or anaesthesia. Diuresis was not forced during or after treatment with serotherapy, mannitol, or diuretics. Treatment was conducted in an outpatients clinic in all cases. The treatment/lithiasis ratio in this initial series was 1.7. Following therapy, 7.09% of patients treated attended the emergency unit due to colic pain/fever. 3.60% of patients treated required hospitalization due to major complications: subcapsular-retroperitoneal haematoma, 9 cases; ureteral obstruction, 120 cases; septicemia, 22 cases; renal function annulment, 11 cases and death, 2 cases.

  7. Combined ultrasound-guided extracorporeal shockwave lithotripsy and MTBE instillation in the treatment of common bile duct stones.

    PubMed

    Darzi, A; Monson, J R; Keeling, P W; O'Morain, C; Tanner, W A; Keane, F B

    1991-02-01

    We report on our initial experience in the treatment of 4 patients with common bile duct stones with extracorporeal shockwave lithotripsy, either alone or in combination with methyl-tert-butyl ether. In four patients, common bile duct stones were successfully fragmented employing a second-generation ultrasound-guided piezoelectric lithotripter (EDAP LT-01). In two of these patients direct application of methyl-tert-butyl ether to the gallstone was utilized to assist in dissolution. There was no mortality or morbidity attributable to either treatment modality. In this first report of this combination of treatments we conclude that ESWL probably has a complementary role to play in the management of patients with common bile duct stones.

  8. Does respiratory gating improve extracorporeal shockwave lithotripsy results?

    PubMed

    Sade, M; Guler, C; Esen, A A; Kirkali, Z

    1994-10-01

    The reliability and efficacy of extracorporeal shockwave lithotripsy (SWL) has been established in urinary stone disease. Its combination with respiratory gating might be a useful method to increase the effectiveness of treatment and reduce the number of shocks required. For this purpose, the results of SWL combined with respiratory gating were compared with those of SWL without gating. There was no difference in the stone-free rates of the two groups or in the complication rate. It is concluded that this method neither decreases the number of shockwaves needed nor increases the effectiveness of SWL.

  9. Extracorporeal shockwave lithotripsy for treatment of intrahepatic stones: in vitro and in vivo studies.

    PubMed

    Ker, C G; Hwang, C H; Chen, J S; Lee, K T; Sheen, P C

    1993-04-01

    In vitro, bile duct stones, mostly comprising calcium bilirubinate, are readily fragmented by extracorporeal shockwave lithotripsy (ESWL). In the case of intrahepatic stones, ESWL is effective if the stones float freely in the bile, but if the stones completely fill, or are impacted within, the hepatic duct or bile duct, attempts at fragmentation will end in failure. Three patients with intrahepatic stones were treated with ESWL, and effectively fragmented. The stone fragments passed out spontaneously through T-tube sinus tract, PTDC sinus tract and the sphincter of Oddi as shown in the second cholangiogram. No specific complication was noted in our experimental and clinical experience. We believe that ESWL for fragmentation of biliary stones is technically reliable. The problem of the passage of these fragmented stones is considered; if necessary, it can be overcome by endoscopic means.

  10. Experience with 395 extracorporeal shockwave lithotripsy in the treatment of renal and ureteric calculi.

    PubMed

    Tan, H M; Cheung, H S

    1990-06-01

    Three hundred and ninety five cases in 358 consecutive patients (male-232, female-126) with renal and ureteric stones were treated with extracorporeal shockwave lithotripsy (ESWL) from March to November 1988. They either had ESWL alone, or in combination with stone manipulation or debulking percutaneous nephrolithotripsy (PCNL). Seventy five percent of the stones were found in the pelvicalyceal system and 25% in the ureter. Seventy-six percent of the stones were less than 25mm size. Two hundred and ninety (79%) cases were followed up to three months. Two hundred and forty nine (85.9%) cases were stone free and 36 (12.4%) had residual sand less than 3mm size. Five (1.7%) cases failed to fragment with ESWL monotherapy and were salvaged by either percutaneous or ureteroscopic intervention. None of the cases required any open surgery intervention.

  11. The use of low-energy radial shockwave in the treatment of entrapment neuropathy of the medial calcaneal nerve: a pilot study.

    PubMed

    Barrett, Stephen L; Reese, Matthew M; Tassone, John; Buitrago, Maria

    2008-08-01

    Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

  12. Extracorporeal shockwave therapy in diabetic foot ulcers.

    PubMed

    Wang, Ching-Jen; Cheng, Jai-Hong; Kuo, Yur-Ren; Schaden, Wolfgang; Mittermayr, Rainer

    2015-12-01

    Diabetic foot ulcers (DFUs) are among the most common foot disorders with ulceration, infection, and gangrene that may ultimately lead to lower extremity amputation. The goals of treatment include the control of diabetes and proper shoe wear. An effective therapy and appropriate foot care are important in wound healing in DFUs. Recently, extracorporeal shockwave therapy (ESWT) was reported to significantly promote and accelerate the healing of complex soft tissue wounds as compared to the standard methods of treatment in DFUs. ESWT showed positive results in short-term and long-term outcomes in diabetic patients suffering from foot ulcers. In this article, we review the clinical results of ESWT in DFUs.

  13. Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

    PubMed

    Kudo, Patricia; Dainty, Katie; Clarfield, Michael; Coughlin, Larry; Lavoie, Pauline; Lebrun, Constance

    2006-02-01

    Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.

  14. Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones.

    PubMed

    Bigum, Lene Hyldgaard; Ulriksen, Peter Sommer; Omar, Omar Salah

    2016-10-01

    This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients.

  15. Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones.

    PubMed

    Bigum, Lene Hyldgaard; Ulriksen, Peter Sommer; Omar, Omar Salah

    2016-10-01

    This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients. PMID:26914829

  16. The effect of shockwaves on mature and healing cortical bone.

    PubMed

    Forriol, F; Solchaga, L; Moreno, J L; Canãdell, J

    1994-10-01

    It has been proposed that high energy shockwaves could be used to create microfractures in cortical bone. This quality might be exploited clinically to perform closed osteotomies and promote healing in nonunion (15). However, no study has previously documented the effect of shockwaves on cortical bone "in vivo". We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.

  17. Extracorporeal shock-wave lithotripsy with MPL9000 for the treatment of urinary stones in pediatric patients.

    PubMed

    Zanetti, G; Montanari, E; Guarneri, A; Seveso, M; Trinchieri, A; Rovera, F; Austoni, E; Pisani, E

    1993-12-01

    Extracorporeal shock-wave lithotripsy (ESWL) is now applied as the treatment of choice in most cases of urinary stones. Its acceptance in pediatry, however has been only gradual despite numerous positive studies. We report on fourteen young patients (mean age: 9.7 years) who were all treated by ESWL with the MPL9000 lithotriptor for renal stones. Each patient received an average of 1440 shocks with generator energy set at 14.4 Kv. Six of these patients required either analgosedation or anesthesia. No observable complications of treatment occurred. At one-month follow up, the kidneys of twelve patients were found to be stone-free, while two still presented fragments that could pass spontaneously. At three-month follow-up, thirteen patients were stone-free and a single patient retained some fragments. From this data we infer that ESWL with the MPL9000 lithotriptor may be used safety and efficiently to treat urolithiasis in younger patients. PMID:8312950

  18. Ureteroscopic treatment of ureteral stones: only an auxiliary measure of extracorporeal shockwave lithotripsy or a primary therapeutic option?

    PubMed

    Osti, A H; Hofmockel, G; Frohmüller, H

    1997-01-01

    Both extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy are well-established methods in stone treatment; however, the therapeutic procedure in ureteral calculi, especially in the distal third of the ureter, is still controversially discussed. The aim of the present study was to examine the role of ureteroscopy as an auxiliary measure after ESWL and its importance as an alternative therapeutic option in the treatment of distal ureteral stones. Between 1991 and 1994, 115 ureteroscopic procedures in 104 patients with ureteral stones or stone fragments were carried out at our institution. During the same period of time, 1,595 patients with ureteral calculi (in the proximal two thirds of the ureter: n = 956; in the distal third of the ureter: n = 639) were treated with a Dornier HM-3 lithotriptor. In 77 of those 104 patients treated by ureteroscopy, this procedure was indicated as an auxiliary measure after failure of ESWL including 34 out of the 639 patients (5.3%) with stones in the distal part of the ureter. The overall direct success rate during the ureteroscopic stone treatment (including 11 cases with a second procedure) in the proximal, middle and distal third of the ureter was 74, 81 and 92%, respectively. The success rate of primary ureteroscopic removal of distal-third ureteral stones alone was 100% in 27 of these 104 patients. After 3 months the overall stone-free rate of all patients treated with ureteroscopy was 94%. Ureteroscopy appears to be a safe and effective treatment modality, if used as an auxiliary measure after failure of ESWL as well as a primary treatment modality in the case of stones in the distal third of the ureter. On the other hand, ESWL alone is a noninvasive and also successful procedure in treating stones situated in the distal part of the ureter.

  19. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: experimental study in a rat model.

    PubMed

    Inanmaz, Mustafa Erkan; Uslu, Mustafa; Isik, Cengiz; Kaya, Ertugrul; Tas, Tekin; Bayram, Recep

    2014-06-01

    Implant-related chronic osteomyelitis is a serious complication of orthopedic surgery requiring implant removal and radical debridement. Extracorporeal shockwave (ESW) have demonstrated significant bactericidal effectiveness in vitro and effectiveness and safety were evaluated in an animal model of osteomyelitis. In this experimental study, we aimed to test our hypothesis that the use of ESW together with systemic antibiotic treatment will provide synergy for the treatment of implant-related chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). The proximal tibia of 32 rats was contaminated with (10) 8 CFU/ml methicillin-sensitive S. aureus (MSSA-ATCC 29213) and Kirschner-wires were placed into the medulla of the tibia. After 4 weeks, Kirschner-wires were removed and the rats were randomly divided into four groups: group I, untreated contaminated control group; group II, receiving only ESW therapy; group III, receiving only systemic teicoplanin; group IV, treated with a combination of ESW and systemic teicoplanin. ESW was applied twice to the infected limbs and all rats were sacrificed at the end of 8th week. The degree of tibial osteomyelitis was assessed by quantitative culture analysis. Bacterial counts in groups III and IV were significantly reduced relative to the control (p=0.002 and 0.001, respectively). The decrease in bacterial counts was more pronounced and significant in group IV compared to group III (p=0.024). In group II, bacterial counts also decreased, but the differences were in significant (p=0.068). Our experimental model suggests that ESW provides significant synergy for systemic antibiotic treatment. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of implant-related chronic osteomyelitis in rats.

  20. Extracorporeal shockwave lithotripsy of primary intrahepatic stones.

    PubMed

    Kim, M H; Lee, S K; Min, Y I; Lee, M G; Sung, K B; Cho, K S; Lee, S G; Min, P C

    1992-01-01

    Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainage tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis.

  1. Halide based shock-wave treatment of fluid-rich natural phases

    NASA Astrophysics Data System (ADS)

    Schlothauer, T.; Schimpf, C.; Brendler, E.; Keller, K.; Kroke, E.; Heide, G.

    2015-11-01

    For the synthesis of high pressure phases from natural minerals and the shock wave treatment of fluid bearing phases a halide based method was developed. The experiments were performed in the pressure range between 25 and 162 GPa with a success rate for the new method of 100% for the new method. Based on the Impedance Corrected Sample Recovery Capsule under avoiding the adiabatic decompression a direct comparison between different loading paths and sample holder geometries is possible. The recovered samples show neither indications of melting in the case of kaolinite and very limited degassing in the case of carbonates. The recovery of amorphous water bearing Al-Si-phases with Aluminum in four-, five- and six-fold coordination was possible. The samples were analyzed with scanning electron microscopy, x-ray diffraction, nuclear-magnetic-resonance- and infra-red-spectroscopy and the results were directly compared.

  2. Mobile extracorporeal shockwave lithotripsy.

    PubMed

    Rajagopal, V; Bailey, M J

    1991-01-01

    During the last 18 months, extracorporeal shockwave lithotripsy (ESWL) has been provided at Epsom District Hospital using a mobile unit containing a Dornier HM4 lithotriptor. Patients with upper ureteric and renal stones were selected for treatment, which was performed without anaesthesia or sedation as a day-case procedure; 83 patients were treated, 5 of them with bilateral stones. Seventy patients required 1 treatment session, 17 required 2 and 1 patient required 3. There were no serious complications but 3 patients needed ureteroscopy to remove obstructing stones. The overall success rate was 86%. The cost to treat each NHS patient was 253 pounds. Mobile lithotripsy as a day-case procedure is a safe and cost-effective means of treating urolithiasis and can be performed in a District General Hospital.

  3. [Electrohydraulic shockwave lithotripsy with ventral shockwave exposure--technic, indications and initial clinical results].

    PubMed

    Miller, K; Bachor, R; Hautmann, R

    1988-05-01

    Shockwave lithotripsy of ureteral or calyceal calculi covered by the bony pelvis and of anteriorly located stones, such as calculi in horseshoe kidneys or the common bile duct, requires ventral introduction of the shockwave into the body. Eleven patients underwent ESWL in the prone position for the aforementioned indications. All treatments were performed with the Dornier HM3 lithotripter, which allows prone positioning of the patient without technical modification of the stretcher. ESWL was successful in all patients, one requiring a second session for complete stone disintegration. Thus, the possibility of shockwave lithotripsy with the patient in the prone position allows further extension of the indications for noninvasive treatment of calculi.

  4. Ultrasonography and biliary extracorporeal shock-wave lithotripsy.

    PubMed

    Jakobeit, C; Greiner, L

    1993-05-01

    The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones.

  5. [Initial experiences with extracorporeal shockwave lithotripsy (ESWL) in treatment of tendinosis calcarea of the shoulder].

    PubMed

    Loew, M; Jurgowski, W

    1993-01-01

    In a prospective investigation the use of high energetic shock waves for treatment of chronical painful calcareous tendinitis of the shoulder was examined in a pilot group of 5 patients. The deposits were localized by sonography. Immediately after treatment 1 patient felt complete release of pain, the calcium deposit had disappeared on the x-ray control one day after treatment. In 3 cases pain release and elimination of the calcification appeared during 6 weeks after treatment. One patient showed only radiological disintegration of the calcification with no release of pain.

  6. [Experience from the first year of treatment of renal calculi with extracorporeal piezoelectric shockwave lithotripsy].

    PubMed

    Jensen, F S; Dørflinger, T; Jensen, K E; Krarup, T; Walter, S

    1991-06-10

    The experience of the first year with piezoelectric extracorporeal lithotripsy is described. One hundred and eighty-eight patients commenced treatment of 194 renoureteric stone units (a total of 328 stones). Twelve per cent required analgesics during therapy. The median number of treatments was two (1-6) and median number of shock waves 4,200 (450-24,606). One hundred and twenty-three stone units had concluded treatment and control schedules at the follow up end date. After six months, 59% of the stone units were stone-free, while 17% had residual fragments up to 2 mm, and additional 15% had residual fragments between 2 and 6 mm. Only few and insignificant complications were observed. Extracorporeal shock wave lithotripsy by the Wolf Piezolith 2300 is a well-tolerated, effective, relative painless and not complicated treatment of renal stones, and an important part of modern treatment of staghorn- and ureteric stones.

  7. The treatment of ureteric calculi before and after the introduction of extracorporeal shockwave lithotripsy.

    PubMed

    Gade, J; Holtveg, H; Nielsen, O S; Rasmussen, O V

    1995-09-01

    Indications and treatment results of ureteric calculi one year before and one year after the introduction of ESWL were analysed in 169 consecutive patients. Sex, age, former stone operation, stone localisation and stone size were not significantly different in the two groups. Before ESW1 47% of the patients received treatment against 54% after the introduction (p > 0.3). There was no tendency towards treatment of smaller calculi. Expectedly, the number of endoscopies and ureterolithotomies was significantly reduced (p < 0.05). The treatment period (from first contact till final control) was longer with ESWL, but not significantly. Judged from the length of the hospital stay there was no major economic benefit from ESWL. In conclusion, ESWL with a second generation lithotriptor is suitable for in situ treatment of ureteric calculi. It should be first choice for ureteric calculi.

  8. Extracorporeal shockwave lithotripsy in pediatrics.

    PubMed

    D'Addessi, Alessandro; Bongiovanni, Luca; Sasso, Francesco; Gulino, Gaetano; Falabella, Roberto; Bassi, Pierfrancesco

    2008-01-01

    Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all

  9. [Treatment of kidney lithiasis with extracorporeal shockwave lithotripsy in horseshoe kidney].

    PubMed

    Iglesias, J I; Mancebo, J M; Massarra, J; Pérez-Castro, E

    1989-01-01

    Following a brief overview of the general features of the horseshoe kidney, we report on ten patients diagnosed as having this anomaly and renal calculi. One patient had bilateral renal calculi. The clinical cases are described and treatment with extracorporeal shock wave lithotripsy (ESWL1) and its advantages and disadvantages relative to other treatment modalities (PCN, open surgery) are discussed. Although we do not advocate the use of a single therapeutic approach, our results show the usefulness of ESWL1 in the treatment of this frequently recurring condition.

  10. The treatment of the reno-ureteral calculi by extracorporeal shockwave lithotripsy (ESWL).

    PubMed

    Ceban, E

    2012-06-12

    Urolithiasis has an important role in the structure of urological pathology, due to its high incidence, frequency of recurrence and complications it might cause. There are many methods of treatment for kidney stones described in the scientific literature as conservative, surgical, laparoscopic, endoscopic, and ESWL. In this study, we have analyzed the ESWL method of treatment of reno-ureteral stones.There are still many controversies about the effectiveness of different models of lithotripters but the lithotripter type Modulith SLK Storz Medical (Germany) used in our clinic has proved to be very effective. ESWL is currently the first-line treatment for the majority of kidney and ureteral stones, which are up to 20 mm in diameter.

  11. [Current status and future developments in noninvasive treatment of urinary calculi with extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Hofbauer, J; Ludvik, G; Grbovic, M; Marberger, M

    1995-01-01

    Being a highly effective and minimally invasive treatment modality, extracorporeal shock wave lithotriopsy (ESWL) has come to be the therapy of choice in more than 80% of urinary stones. Apart from pregnancy and untreated coagulopathy as contraindications, generally accepted limiting factors are a stone size of > 2.5 cm and the presence of anatomical draining barriers. In such cases endourological procedures are indicated from the outset. Modern urinary stone therapy requires both extracorporeal and intracorporeal procedures of lithotripsy as indispensable complementary techniques. Third-generation lithotriptors are characterized by a dual stone location system (ultrasound and X-ray) and painless treatment without any need for analgesia. The current rapid development of lithotriptors is mainly driven by economic aspects and market requirements like multipurpose or mobile applicability. The "ideal" lithotriptor enabling even more effective, safer, and more comfortable treatment has yet to be developed.

  12. [Value of extracorporeal shockwave lithotripsy in the treatment of urinary lithiasis in children].

    PubMed

    Charbit, L; Terdjman, S; Gendreau, M C; Guérin, D; Quentel, P; Cukier, J

    1989-01-01

    We report our experience with extracorporeal lithotripsy (Dornier HM3) in a series of 26 children with a mean age of 11.6 years, treated for 3 1/2 years. 12 children (46%) had a previous history of calculi and 7 (27%) had already undergone surgery on the same side. Treatment requires two transducer investigations before lithotripsy. With the exception of minor modifications the technique is the same as in the adult. Three (9.7%) postlithotripsy complications were noted, requiring 2 drainage procedures to be carried out on the urinary tract. At 3 months, the success rate (no residual calculi on the plain abdominal film) was 60.7%. This study confirms the efficacy of lithotripsy in the treatment of urinary lithiasis in children.

  13. [Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter].

    PubMed

    Ishii, Nobuyuki; Yoshinaga, Atsushi; Ohno, Rena; Chiba, Koji; Hayashi, Tetsuo; Kamata, Shigeyoshi; Watanabe, Toru; Yamada, Takumi

    2004-06-01

    Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter.

  14. [Role of extracorporeal shockwave lithotripsy without anesthesia in the treatment of ureteral calculi].

    PubMed

    Miller, K; Sauter, T; Bachor, R; Hautmann, R

    1989-01-01

    With anesthesia-free lithotripsy recently being available, the discussion upon the treatment of choice of ureteral calculi has been renewed: is a preliminary retrograde manipulation still preferable for proximal calculi? Is ureteroscopy the better treatment for stones in the lower ureter? The retrospective evaluation of our patients with ureteral calculi (January-August 1988) failed to reveal a significantly compromised efficiency with the modified HM-3 lithotripter (40 nF. generator, 17 cm. ellipsoid): 70% (including 11% with repeated sessions) of the patients with proximal stones and 90% (including 28% with repeated sessions) of the patients with distal calculi were successfully treated in situ without the need for anesthesia, auxiliary measures, or ureteroscopy. These results do not substantially differ from those obtained with the old HM-3 in 1987, and confirm, that the majority of patients with ureteral calculi can bypass the discomfort of retrograde manipulation or the risks of ureteroscopy.

  15. [Treatment of distal ureteral calculi with extracorporeal shockwave lithotripsy: experiences with 310 cases].

    PubMed

    Zehntner, C; Lux, O; Casanova, G A; Marth, D; Zingg, E J

    1989-07-01

    Distal ureteral calculi are approached by ureterorenoscopy by most authors. With increasing experience ESWL of distal ureteral calculi gained in importance. The success rate of 96.2% in a large series of 310 consecutive patients treated in this manner, confirmed the results of other authors. Excluding women of child-bearing age and very large calculi (greater than 2 cm) the ESWL is a suitable treatment modality of distal ureteral calculi.

  16. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  17. [Percutaneous nephrolitholapaxy combined with extracorporeal shockwave lithotripsy in the treatment of staghorn lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Castillo Rodríguez, M; Hernández Silverio, D; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1990-05-01

    From December, 1988 to July, 1989, 41 patients with renal or juxtapyelic ureteral calculi were submitted to percutaneous litholapaxy (PCN) at the Stone Center of the Hermanos Amerijeiras Hospital in Havana. This series comprise our early experience utilizing this procedure. PCN was initially limited to pelvic and juxtapyelic ureteric calculi with dilated renal cavities. It was subsequently used in combination with extracorporeal lithotripsy (ESWL) in the treatment of staghorn stones. The present study analyzed the results achieved with PCN in 30 patients with staghorn calculi; 21 (70%) incomplete staghorns and 9 (30%) complete staghorns. Posteriorly, 6 additional borderline staghorns were completely removed by PCN and are not included in the present study. PCN was performed to reduce stone mass and for placement of a large renal drain to permit subsequent ESWL. At two months following treatment, 86.6% of the patients were completely stone-free. The remaining 13.4% with stone remnants presented anatomic and functional renal conditions that allow us to predict complete elimination within a short period of time. Since 6 months had not elapsed in these cases, these were not considered as residual fragments. One patient presented massive absorption of fluids. This was the only observed major and non-lethal complication. Episodes of fever were observed in 23% post-PCN. No patient presented severe sepsis. In our view, PCN combined with ESWL is one of the currently available therapeutic options in the treatment of staghorn calculi. This approach permits adequate resolution of cases that would have otherwise required surgery.

  18. Shockwave treatment of ureteric stones in situ with second-generation lithotriptor.

    PubMed

    Simon, J; Vanden Bossche, M; Schulman, C C

    1990-01-01

    During a 17-month period we treated in situ 334 patients with ureteric stones with a second-generation electromagnetic lithotriptor. Anxiety and discomfort were relieved with diazepam and pethidine chloride only. Ureteral stenting was used in 8.1% of upper, 36.4% of mid- and 5.7% of lower ureteric stones. The retreatment rate was 15%, but no patient had more than 3 sessions. The success rate of the treatment at 3 months was 88% for upper, 65% for mid- and 83% for lower ureteric stones. Open surgery had to be performed in 5 cases and ureteroscopies in 6 cases.

  19. [Cost comparison of laparoscopic cholecystectomy and extracorporeal shockwave lithotripsy in the treatment of gallstones].

    PubMed

    Sonnenberg, A; Benninger, J; Ell, C

    1994-11-11

    To aid in the choice between laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy for the treatment of gallstones the costs of the two methods were investigated. A decision tree was constructed so as to set out the initial procedure costs of both techniques and possible subsequent costs due to treatment failure or complications. The computations were based on figures from the University Clinic, Erlangen, in 1993. The direct (medical) costs of laparoscopic cholecystectomy amounted to DM 3556, to which must be added further indirect costs of DM 3152 arising from loss of working capacity and premature death. The direct expenses for lithotripsy including outpatient aftercare were DM 6708 and the indirect expenses DM 1858. The overall costs per patient for lithotripsy are hence DM 1858 higher than those of laparoscopic cholecystectomy. This cost difference remained substantially unaltered even when the success rates of the two techniques were varied over a wide range. When lithotripsy is performed entirely as an outpatient procedure and inpatient costs hence disappear, the expected overall cost drops from DM 8567 to DM 6381. Omission of the lump sum charge for lithotripsy effects a similar drop in overall costs to DM 6379. Laparoscopic cholecystectomy is hence cheaper than lithotripsy. Only if lithotripsy can be performed at very low cost can it compete with laparoscopic cholecystectomy.

  20. [Treatment with extracorporeal shockwave (ESWL) in lithiasis of the common bile duct].

    PubMed

    Magnanini, F L; Peralta, C G; Olmos, M A; Zalar, A E; Gorzelewsky, A; Nadales, A; Currás, A

    1992-01-01

    During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66%), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.

  1. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5.

    PubMed

    Hausdorf, Jörg; Lemmens, Marijke A M; Kaplan, Suleyman; Marangoz, Cafer; Milz, Stefan; Odaci, Ersan; Korr, Hubert; Schmitz, Christoph; Maier, Markus

    2008-05-01

    Application of extracorporeal shockwaves to the musculoskeletal system can induce long-term analgesia in the treatment of chronic painful diseases such as calcifying tendonitis of the shoulder, tennis elbow and chronic plantar fasciitis. However, the molecular and cellular mechanisms underlying this phenomenon are largely unknown. Recently it was shown that application of extracorporeal shockwaves to the distal femur of rabbits can lead to reduced concentration of substance P in the shockwaves' focal zone. In the present study we investigated the impact of extracorporeal shockwaves on the production of substance P within dorsal root ganglia in vivo. High-energy shockwaves were applied to the ventral side of the right distal femur of rabbits. After six weeks, the dorsal root ganglia L5 to L7 were investigated with high-precision design-based stereology. The application of extracorporeal shockwaves caused a statistically significant decrease in the mean number of neurons immunoreactive for substance P within the dorsal root ganglion L5 of the treated side compared with the untreated side, without affecting the total number of neurons within this dorsal root ganglion. No effect was observed in the dorsal root ganglia L6 and L7, respectively. These data might further contribute to our understanding of the molecular and cellular mechanisms in the induction of long-term analgesia by extracorporeal shockwave application to the musculoskeletal system.

  2. [Gallstone treatment using extracorporeal shockwave lithotripsy and adjuvant oral lysis: status and perspective].

    PubMed

    Staritz, M

    1990-03-27

    Three years of clinical experience and the results of the "First International Symposium of Biliary Lithotripsy" showed that extracorporeal shock waves disintegrate cholesterol, pigment and calcified stones into fragments of 1 to 8 mm in diameter. Since spontaneous passage of fragments through the bile ducts is not possible, the therapeutic goal must be achieved with adjuvant oral lysis of the fragments. Therefore, only cholesterol stones are suitable, and a contractile gallbladder as well as a limited stone volume are prerequisites. After one year of treatment, in 45 to 80% of patients complete clearance of stone fragments from the gallbladder is observed. During this period one third of the patients experiences occasional colics. Further severe complications have not been reported.

  3. [Ureteroscopy versus in situ extracorporeal shockwave lithotripsy in the treatment of calculi of the distal ureter].

    PubMed

    Leblanc, B; Paquin, J M; Valiquette, L; Perreault, J P; Faucher, R; Mauffette, F; Benard, F

    1996-01-01

    In a retrospective study from a unique center (St. Luc Hospital, Montreal) stone clearance of 88 consecutive distal ureteral calculi (below pelvic brim) treated by extracorporeal shock wave lithotripsy in situ were compared to a group of 94 distal ureteral calculi treated by ureteroscopy during the same period. Our results show 84% success rate for ureteroscopy which is clearly superior than 58% stone clearance rate at 3 month follow-up for ESWL Success rate was influenced by stone size in the ESWL group but not in the ureteroscopy group. This study reveals similar success rate for calculi smaller than 6 mm but for larger calculi, success rate of ureteroscopy is significantly superior.

  4. [Extracorporeal shockwave lithotripsy. Current status in treatment of kidney calculus disease].

    PubMed

    Rassweiler, J; Eisenberger, F; Bub, P; Schmidt, A

    1989-08-10

    The introduction of extracorporal shock wave lithotripsy has led to a revolution in stone management. After five years of clinical experience with increasing use of second generation lithotripters, the following conclusions can be drawn: There is an increasing tendency to employ ESWL for ureteral calculi, although only 60% of those can be located by ultrasound. In the case of staghorn stones, a differentiated approach is adopted (ESWL-, PCNL-monotherapy or a combination of the two) depending on stone size, localisation, chemical composition, radiodensity, and the state of the collecting system. With almost all second generation lithotripters, ESWL can be performed under i.v.-analgesia. Some machines with a large-aperture shock wave source (i.e. Wolf Piezolith, Edap LT 01, Dornier MPL 9000) even permit painfree treatment without the need for analgesia. However, this is associated with a 30% increase in retreatment rate. Further development of low-cost lithotripters and increasing use of ESWL for biliary stones make it necessary for ever more hospitals to face the question of installing such a machine. In this situation, the choice must be based on the local situation (i.e. number of patients, interdisciplinary use of ESWL).

  5. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  6. Improving the antioxidant functionality of Citrus junos Tanaka (yuzu) fruit juice by underwater shockwave pretreatment.

    PubMed

    Kuraya, Eisuke; Nakada, Shina; Touyama, Akiko; Itoh, Shigeru

    2017-02-01

    Citrus junos Tanaka (yuzu) has a strong characteristic aroma, and hence, yuzu juice is used in a number of Japanese foods. We herein evaluated the functional compounds of yuzu juice to investigate whether underwater shockwave pretreatment affects its functionality. Employing the shockwave pretreatment at an increased discharge and energy of 3.5kV and 4.9kJ, respectively, resulted in an increase in the flavanone glycoside content and oxygen radical absorbance capacity (ORAC). The ORAC value of yuzu juice cultivated in Rikuzentakata increased approximately 1.7 times upon underwater shockwave pretreatment. The treatment method proposed herein exhibited reliable and good performance for the extraction of functional and antioxidant chemicals in yuzu fruits, and was comparable with traditional squeezing methods. The high applicability and reliability of this technique for improving the antioxidant functionality of yuzu fruit juice was demonstrated, confirming the potential for application to a wide range of food extraction processes.

  7. Improving the antioxidant functionality of Citrus junos Tanaka (yuzu) fruit juice by underwater shockwave pretreatment.

    PubMed

    Kuraya, Eisuke; Nakada, Shina; Touyama, Akiko; Itoh, Shigeru

    2017-02-01

    Citrus junos Tanaka (yuzu) has a strong characteristic aroma, and hence, yuzu juice is used in a number of Japanese foods. We herein evaluated the functional compounds of yuzu juice to investigate whether underwater shockwave pretreatment affects its functionality. Employing the shockwave pretreatment at an increased discharge and energy of 3.5kV and 4.9kJ, respectively, resulted in an increase in the flavanone glycoside content and oxygen radical absorbance capacity (ORAC). The ORAC value of yuzu juice cultivated in Rikuzentakata increased approximately 1.7 times upon underwater shockwave pretreatment. The treatment method proposed herein exhibited reliable and good performance for the extraction of functional and antioxidant chemicals in yuzu fruits, and was comparable with traditional squeezing methods. The high applicability and reliability of this technique for improving the antioxidant functionality of yuzu fruit juice was demonstrated, confirming the potential for application to a wide range of food extraction processes. PMID:27596400

  8. Extracorporeal shockwave therapy in musculoskeletal disorders.

    PubMed

    Wang, Ching-Jen

    2012-01-01

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  9. Outcome of extracorporeal shockwave lithotripsy monotherapy for large renal calculi: effect of stone and collecting system surface areas and cost-effectiveness of treatment.

    PubMed

    Murray, M J; Chandhoke, P S; Berman, C J; Sankey, N E

    1995-02-01

    The treatment options for large renal calculi are controversial. We report on our experience with 65 treatments of renal calculi > 3 cm using extracorporeal shockwave lithotripsy (SWL) monotherapy. We stratified our results according to stone and collecting system surface areas (measured by computer image analyses), stone location, and stone type. The overall success rate of SWL monotherapy was 27% at 3 months. The best stone-free rate (60%) was obtained for stones < 500 mm2 and located primarily within the renal pelvis. The stone-free rate for stones with surface areas > 1000 mm2 was only 8%. None of the cystine stones was treated successfully, whereas 80% of patients with uric acid stones became stone free. We estimated an average cost of $67,048 to render a patient with a large renal calculus stone free using SWL monotherapy. We recommend that other treatment options, such as percutaneous nephrolithotomy, be considered as first-line therapy for large renal calculi.

  10. Detection of tissue injury after extracorporeal shockwave lithotripsy of gallstones.

    PubMed

    Brody, J M; Siebert, W F; Cattau, E L; al-Kawas, F; Goldberg, J A; Zeman, R K

    1991-06-01

    We evaluated seven patients undergoing gallstone lithotripsy for evidence of hepatic or renal trauma after each of 10 lithotripsy treatments. Postlithotripsy magnetic resonance imaging (MRI) and sonography showed no evidence of hepatic or renal injury as compared with baseline studies. Four treatments resulted in sonographic evidence of gaseous hepatic microbubbles (analogous to "the bends") due to cavitation effects of the shockwaves. Three of these four treatments produced serum glutamicoxaloacetic transaminase and -pyruvic transaminase elevation. One patient had microscopic hematuria. Minimal tissue damage results from gallstone lithotripsy. MRI and ultrasound, performed after lithotripsy, appear to be less sensitive than transaminasemia in detecting this low-grade injury.

  11. Effect of electrohydraulic shockwave treatment on tenderness, muscle cathepsin and peptidase activities and microstructure of beef loin steaks from Holstein young bulls.

    PubMed

    Bolumar, Tomas; Bindrich, Utte; Toepfl, Stefan; Toldrá, Fidel; Heinz, Volker

    2014-12-01

    Hydrodynamic pressure processing (HDP) or shockwave treatment improved tenderness (18% reduction in Warner-Bratzler shear force (WBSF) of beef loin steaks. Endogenous muscle proteolyic activities (cathepsins and peptidases) and protein fragmentation of sarcoplasmic and myofibrillar proteins detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were not influenced by HDP. However, microstructure changes were clearly detected using confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Specifically a disruption of the structure at the muscle fiber bundles and an increased endomysium space were observed. The present paper supports the evidence of physical disruption of the muscle fibers as a cause behind the tenderness improvement. The paper discusses the possible mechanisms responsible for the meat tenderisation induced by HDP treatment.

  12. Bacterial biofilm disruption using laser generated shockwaves.

    PubMed

    Taylor, Zachary D; Navarro, Artemio; Kealey, Colin P; Beenhouwer, David; Haake, David A; Grundfest, Warren S; Gupta, Vijay

    2010-01-01

    A system was built to test the efficacy of bacterial biofilm disruption using laser generated shockwaves. The system is based on a Q-switched, ND:YAG pulsed laser operating at a rep rate of 10 Hz with 1500 mJ pulses centered at 1064 nm. The laser pulses were used to create shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 50 MPa was measured. These stress pulses were coupled to bacteria grown to confluence on agar plates and cell death as a result of shockwave stress was assessed. The results show a 55% reduction in the number living bacteria between shocked and control samples. This type of biofilm disruption method could prove useful in the treatment of infected wounds where standard treatment methods such as debridement and topical antibiotics have proven to be ineffectual or harmful.

  13. Current role of extracorporeal shockwave therapy in surgery.

    PubMed

    Plaisier, P W; van der Hul, R L; Terpstra, O T; Bruining, H A

    1994-02-01

    In urology the introduction of extracorporeal shockwave therapy brought a revolutionary change to the management of urinary calculi. This inspired the introduction of shockwave therapy in several fields of surgery; it has been applied as a potential alternative to several operative procedures but is still experimental. So far, the major application of shockwave therapy has been lithotripsy of stones in the gallbladder, common bile duct, pancreatic duct and salivary gland ducts. Other applications are in the non-operative management of bone healing disturbances and in the inhibition of tumour growth. Steps towards selective thrombus ablation and pretreatment of heavily calcified arteries have also been made. In this review, the applications of extracorporeal shockwave therapy in several areas of surgery are discussed. It is concluded that, for selected patients, shockwave treatment may serve as a useful addition to the surgical armamentarium.

  14. Quantitative Assessment of Shockwave Lithotripsy Accuracy and the Effect of Respiratory Motion*

    PubMed Central

    Bailey, Michael R.; Shah, Anup R.; Hsi, Ryan S.; Paun, Marla; Harper, Jonathan D.

    2012-01-01

    Abstract Background and Purpose Effective stone comminution during shockwave lithotripsy (SWL) is dependent on precise three-dimensional targeting of the shockwave. Respiratory motion, imprecise targeting or shockwave alignment, and stone movement may compromise treatment efficacy. The purpose of this study was to evaluate the accuracy of shockwave targeting during SWL treatment and the effect of motion from respiration. Patients and Methods Ten patients underwent SWL for the treatment of 13 renal stones. Stones were targeted fluoroscopically using a Healthtronics Lithotron (five cases) or Dornier Compact Delta II (five cases) shockwave lithotripter. Shocks were delivered at a rate of 1 to 2 Hz with ramping shockwave energy settings of 14 to 26 kV or level 1 to 5. After the low energy pretreatment and protective pause, a commercial diagnostic ultrasound (US) imaging system was used to record images of the stone during active SWL treatment. Shockwave accuracy, defined as the proportion of shockwaves that resulted in stone motion with shockwave delivery, and respiratory stone motion were determined by two independent observers who reviewed the ultrasonographic videos. Results Mean age was 51±15 years with 60% men, and mean stone size was 10.5±3.7 mm (range 5–18 mm). A mean of 2675±303 shocks was delivered. Shockwave-induced stone motion was observed with every stone. Accurate targeting of the stone occurred in 60%±15% of shockwaves. Conclusions US imaging during SWL revealed that 40% of shockwaves miss the stone and contribute solely to tissue injury, primarily from movement with respiration. These data support the need for a device to deliver shockwaves only when the stone is in target. US imaging provides real-time assessment of stone targeting and accuracy of shockwave delivery. PMID:22471349

  15. Extracorporeal shockwave therapy: a review.

    PubMed

    Chung, Bryan; Wiley, J Preston

    2002-01-01

    Extracorporeal shockwave therapy (ESWT) has been in use for the treatment of tendinopathies since the early 1990s. The exact mechanism by which ESWT relieves tendon-associated pain is not known; however, there is an increasing body of literature that suggests that it can be an effective therapy for patients who have had repeated nonsurgical treatment failures. The highest strength of evidence is shown in randomised controlled trials, of which there are a small number. Reported results for tendinopathies of the shoulder, elbow and heel have shown consistent positive results in favour of ESWT over placebo ESWT in individuals who have failed conservative therapy. These studies provide strong evidence for ESWT as an effective therapy for the treatment of chronic treatment-resistant tendinopathies. There is still much debate over several issues surrounding ESWT that have not been adequately addressed by the literature: high- versus low-energy ESWT, shockwave dosage and number of sessions required for a therapeutic effect. Further research is needed to ascertain the most beneficial protocol for patient care.

  16. Stepwise shockwave velocity determinator

    NASA Technical Reports Server (NTRS)

    Roth, Timothy E.; Beeson, Harold

    1992-01-01

    To provide an uncomplicated and inexpensive method for measuring the far-field velocity of a surface shockwave produced by an explosion, a stepwise shockwave velocity determinator (SSVD) was developed. The velocity determinator is constructed of readily available materials and works on the principle of breaking discrete sensors composed of aluminum foil contacts. The discrete sensors have an average breaking threshold of approximately 7 kPa. An incremental output step of 250 mV is created with each foil contact breakage and is logged by analog-to-digital instrumentation. Velocity data obtained from the SSVD is within approximately 11 percent of the calculated surface shockwave velocity of a muzzle blast from a 30.06 rifle.

  17. [Sonography and biliary extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Jakobeit, C; Greiner, L; Rebensburg, S; Spelter, M; Schumacher, R; Frenzel, F; Pumplün, B

    1992-12-01

    Ultrasound is an indispensable tool for preliminary diagnosis ("filter function"), during treatment ("monitoring function") and in the follow-up examinations ("follow-up function") after shock-wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which present-day experience has shown to be rare.

  18. [Extracorporeal shockwave lithotripsy of pancreatic calculi].

    PubMed

    Neuhaus, H; Hagenmüller, F; Classen, M

    1990-08-01

    Extracorporeal shock-wave fragmentation of pancreatic stones is a complementary non-surgical treatment in selected patients with chronic pancreatitis. The procedure has proven to be safe and technically effective. Preliminary clinical results indicate therapeutic success rates in terms of pain disappearance or reduction in more than 90% of the patients. The indication should be taken into consideration before surgical intervention.

  19. The Chelyabinsk airburst shockwave

    NASA Astrophysics Data System (ADS)

    Popova, O.; Shuvalov, V.; Rybnov, Y.; Jenniskens, P.; Kharlamov, V.; Usoltseva, O.; Glazachev, D.; Podobnaya, E.; Dyagilev, R.; Trubetskaya, I.

    2014-07-01

    The Chelyabinsk airburst of 15 February 2013 was exceptional because of the large kinetic energy of the impacting body and because the airburst that was generated created significant damage and injuries in a densely populated area. The butterfly-shape of the damaged area (Popova et al., 2013) is explained from the fact that the energy was deposited over a range of altitudes. Some uncertainty remains about the source energy of the airburst, because it is not known precisely at what pressure glass is expected to break. Reasonable results were obtained for energies of 300--520 kt TNT and over pressures of 500--1000 Pa, assuming that the time dependence of the energy release followed the meteor lightcurve (Popova et al. 2013). Additional information about the airburst characteristics may be extracted from the arrival times of the shockwave at various locations and from pressure records. Arrival times of the shock wave were derived from video observations. From the analysis of these shock wave arrival times, a range of altitudes of energy deposition was derived (Popova et al. 2013). The observed arrival times were compared with model estimates, taking into account the real wind and atmospheric conditions. Results of the numerical simulations were compared with recorded sound signals, which were often quite complex. Borovicka et al. (2013) suggested that subsequent acoustic arrivals corresponded to separate fragmentation events. This hypothesis is tested. There were no instrumental records of overpressure in the damaged area. However, seismic records exist from locations surrounding a coal mine at Korkino, situated in the damage area close to the meteoroid trajectory, almost immediately below the region of highest energy deposition. Its seismic control system to monitor land slides recorded the blast wave from the meteoroid entry indirectly due to coupling to the ground. This is the only instrumental record of the airburst close to the meteoroid trajectory. An analysis

  20. Short-term bioeffects of extracorporeal shockwave lithotripsy.

    PubMed

    Akdaş, A; Türkeri, L N; Ilker, Y; Simşek, F; Emerk, K

    1994-06-01

    Safety guidelines for shockwave delivery during extracorporeal shockwave lithotripsy (SWL) are not yet clear. Renal functions were assessed by using urinary N-acetyl-beta-D-glucosaminidase (NAG), lactate dehydrogenase (LDH), alanine aminotransferase (ALT; EC.2.6.1.2), aspartate aminotransferase (AST; EC. 2.6.1.1), and gamma-glutamyltransferase (GGT) as well as sodium, potassium, and calcium concentrations in respect to tubular functions after SWL with the Dornier MFL 5000 unit in 32 patients. In order to monitor glomerular function, we determined microalbuminuria. Transient glomerular and tubular damage occurs in SWL-treated kidneys. The minimum interval between two shockwave treatments should be at least 7 days.

  1. Superior mesenteric artery dissection after extracorporeal shockwave lithotripsy.

    PubMed

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  2. Gallbladder stones: shockwave therapy.

    PubMed

    Sackmann, M

    1992-11-01

    Within the past 7 years, gallbladder lithotripsy by shockwaves has been proven to be a safe and effective non-invasive therapy for selected patients with gallstone disease. While regulatory decisions prevent shockwave therapy from being used more frequently in the USA, the number of patients treated in Europe and Asia is increasing constantly. At our institution, a relatively constant number of about 250 new patients per year have been treated since 1988 (Figure 4). About 20% of patients with gallstones are suitable for shockwave therapy according to present criteria. The rate of evacuation of all fragments is determined by the initial stone number and stone size, the success at stone fragmentation, adjuvant bile acid dissolution therapy, and gallbladder contractility. In contrast to laparoscopic cholecystectomy (Dubois et al, 1989; Perissat et al, 1989; Southern Surgeons Club, 1991), shockwave therapy does not require general anaesthesia. And in contrast to direct contact dissolution therapy of gallbladder stones using MTBE (Thistle et al, 1989), lithotripsy is non-invasive. In the majority of patients, complete fragment disappearance takes several months. Preliminary analyses of the cost-effectiveness of lithotripsy have revealed that lithotripsy, including retreatments and bile acid medication for recurrent stones, costs about as much as open cholecystectomy (Rothschild et al, 1990; Bass et al, 1991). The ideal patient for gallbladder lithotripsy has a single radiolucent stone < or = 20-25 mm in diameter in a functioning gallbladder (Figure 1). In patients with such stones, nearly all studies have confirmed a favourable outcome with rapid clearance of all fragments and a relatively low rate of stone recurrence. For carefully selected patients, extracorporeal shockwave lithotripsy is therefore an attractive non-invasive therapy.

  3. [Current status of extracorporeal shockwave lithotripsy].

    PubMed

    Wilbert, D M; Jocham, D; Eisenberger, F; Chaussy, C

    1994-11-01

    Extracorporeal shockwave lithotripsy has become an established standard procedure for the treatment of nephrolithiasis. Almost 100 lithotripters are installed in large and medium-sized urological departments in Germany. The number of treatments per year averages 660 ESWL sessions per hospital. Multifunctional use and non-urological ESWL therapy ensure maximum utilization of the lithotripter units. In additional hospitals mobile lithotripsy is provided. At present there is a trend toward ambulatory ESWL treatment.

  4. Shockwave lithotripsy of salivary duct stones.

    PubMed

    Iro, H; Schneider, H T; Födra, C; Waitz, G; Nitsche, N; Heinritz, H H; Benninger, J; Ell, C

    1992-05-30

    Surgical extirpation of the affected gland has been necessary for cases of sialolithiasis in which the stone cannot be removed by dilatation or dissection of the salivary duct. The ability of the piezoelectric lithotripter to deliver shockwaves to a small focus makes extracorporeal shockwave lithotripsy of salivary gland stones potentially safe. Its safety and efficacy have been assessed in 51 patients with symptomatic solitary salivary stones that could not be removed by conservative measures. The stones had a median diameter of 8 (range 4-18) mm and were located in the submandibular gland in 69% of patients and in the parotid gland in 31%. A total of 72 shockwave treatment sessions (maximum 3 per patient) were given under continuous sonographic monitoring. In 45 patients (88%) complete fragmentation (fragments less than or equal to 3 mm) of the concrements was achieved. No patient needed anaesthesia, sedatives, or analgesics. The only untoward effects were localised petechial haemorrhages after 10 (13%) out of 72 treatments and transient swelling of the gland immediately after delivery of shockwave in 2/72 (3%) sessions. 20 weeks after the first session 90% (46/51) of patients were free of discomfort, and 53% (27/51) were stone free. Stone-clearance rate was higher among patients with stones in the parotid gland (81%) than among those with stones of the submandibular gland (40%). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients with stones in the submandibular gland (20%). No long-term damage to the treated salivary gland or to adjacent tissue structures was noted during the median follow-up of 9 (1-24) months. Extracorporeal piezoelectric shockwave therapy seems likely to be safe, comfortable, and effective minimally-invasive, non-surgical treatment for salivary stones.

  5. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy

    PubMed Central

    Francis, Nathan C.; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S.; Taylor, Zach D.

    2015-01-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications. PMID:25798307

  6. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy.

    PubMed

    Francis, Nathan C; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S; Taylor, Zach D

    2015-03-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications.

  7. In situ extracorporeal shockwave lithotripsy for ureteral calculi: investigation of factors influencing stone fragmentation and appropriate number of sessions for changing treatment modality.

    PubMed

    Kim, H H; Lee, J H; Park, M S; Lee, S E; Kim, S W

    1996-12-01

    To determine the factors influencing stone fragmentation and to suggest when to change treatment modality for ureteral calculi refractory to repetitive in situ extracorporeal shockwave lithotripsy (SWL), we analyzed 369 patients treated primarily by the second-generation lithotripter, Siemens Lithostar, from March 1989 to December 1993. Three hundred forty-two (92.7%) of the patients were ultimately free of stones after repetitive in situ SWL. The cumulative stone-free rates of the first, second, and third session were 64%, 81%, and 88%, respectively, and the increment in the cumulative stone-free rate thereafter with further repeated in situ SWL was minimal (p < 0.01). The cumulative stone-free rate at the third session was 89%, 87%, and 86% for proximal, middle, and lower ureteral stones, respectively (p > 0.05). The cumulative stone-free rate at the third session was 100%, 90%, 87%, 70%, 67%, and 50% for stones <5 mm, 6 to 10 mm, 11 to 15 mm, 16 to 20 mm, 21 to 25 mm, and >25 mm, respectively (p < 0.001). According to the radiopacity of the stone, the cumulative stone-free rate at the third session was 96% for stones with minimal opacity, 94% for those with moderate opacity, and 70% for highly opaque stones (p < 0.001). The cumulative stone-free rate at the second session was 100% without ureteral obstruction; 80% with mild, 57% with moderate, and 67% with severe obstruction; and 50% in patients with nonappearance of the kidney (p < 0.05). From these observations, it could be concluded that the factors influencing fragmentation were the size and radiopacity of the calculi and the degree of ureteral obstruction, whereas the location of the calculi did not influence the cumulative stone-free rate of repetitive in situ SWL. It is preferable to restrict in situ SWL to three sessions in patients with ureteral calculi refractory to shockwaves. An early change of treatment modality either to ureteroscopic manipulation or to open surgery would be recommended if there

  8. [Shockwave therapy of gallstones].

    PubMed

    Sackmann, M; Holl, J; Klüppelberg, U; von Ritter, C

    1993-09-01

    Extracorporeal shock-wave lithotripsy (ESWL) is a helpful adjunct for those bile duct stones which cannot be extracted by routine endoscopic measures including mechanical lithotripsy. For very large or impacted stones in the bile duct or stones in the intrahepatic biliary tree, and also for stones located in proximity to a bile duct stenosis, shock-wave therapy has proven to be safe and successful. More than 85% of the patients become free of stones after this therapy; they otherwise would have had to undergo high-risk open bile duct surgery. For gallbladder calculi, the pivotal factor for complete fragment disappearance after shock-wave therapy is sufficient stone disintegration. Only if fragments not larger than 3 mm are achieved, complete expulsion and/or dissolution of these fragments may be expected in a high percentage of the patients. Optimal candidates include patients with a single, radiolucent stone in a well-contracting gallbladder. For this group, ESWL is a safe and effective noninvasive therapeutic alternative.

  9. Extracorporeal shockwave lithotripsy using ultrasonic imaging: urologists' experience.

    PubMed

    Kiely, E A; Ryan, P C; McDermott, T E; Butler, M R

    1989-07-01

    The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography. A total of 406 calculi (359 renal and 47 ureteric) in 317 patients were treated. Analgesia or sedation was not routinely used and 59% of all treatments were performed as outpatient procedures. The clearance rate of renal calculi smaller than 1 cm was 81%, while that of calculi larger than 3 cm was 80% (mean clearance 77.5%). Lithotripsy of ureteric calculi following retrograde manipulation to a renal site resulted in 94.4% clearance compared with 39% for those treated at a ureteric site; 93% of 684 lithotripsy treatments were either painless or caused only mild pain. Our experience with imaging and treating urinary calculi with the EDAP LT.01 lithotripter has been excellent. Patients are treated effectively and inexpensively as out-patients without analgesia or sedation.

  10. Current concepts of shockwave therapy in stress fractures.

    PubMed

    Leal, Carlos; D'Agostino, Cristina; Gomez Garcia, Santiago; Fernandez, Arnold

    2015-12-01

    Stress fractures are common painful conditions in athletes, usually associated to biomechanical overloads. Low risk stress fractures usually respond well to conservative treatments, but up to one third of the athletes may not respond, and evolve into high-risk stress fractures. Surgical stabilization may be the final treatment, but it is a highly invasive procedure with known complications. Shockwave treatments (ESWT), based upon the stimulation of bone turnover, osteoblast stimulation and neovascularization by mechanotransduction, have been successfully used to treat delayed unions and avascular necrosis. Since 1999 it has also been proposed in the treatment of stress fractures with excellent results and no complications. We have used focused shockwave treatments in professional athletes and military personnel with a high rate of recovery, return to competition and pain control. We present the current concepts of shockwave treatments for stress fractures, and recommend it as the primary standard of care in low risk patients with poor response to conventional treatments.

  11. Vertebral fracture associated with shockwave lithotripsy in a patient with granulomatous spondylitis.

    PubMed

    Kazimoğlu, H; Mungan, M U; Kirkali, Z

    2001-09-01

    Extracorporeal shockwave lithotripsy (SWL) is an accepted treatment modality in the treatment of urinary stone disease. Many complications have been reported secondary to high-energy shockwaves, but the effects of SWL on the skeletal system have rarely been investigated. We represent the first case of a burst-type vertebral fracture after SWL in an elderly osteoporotic patient with granulomatous spondylitis.

  12. [Extracorporeal shockwave lithotripsy and lymph node calcification].

    PubMed

    Higashihara, E; Fujime, M; Niijima, T

    1987-05-01

    A female patient with calculi in the left kidney and calcified lymph nodes in the vicinity of the left renal pelvis was treated successfully with extracorporeal shock wave lithotripsy. The simultaneous action of the shock waves on the calcified lymph nodes did not cause any alteration of the lymph node structure. Thus a shock-wave treatment can be carried out even in the presence of a calcified lymph node without complications.

  13. Case report: scrotal ecchymosis after shockwave lithotripsy.

    PubMed

    Aydur, Emin; Göktas, Serdar; Kibar, Yusuf; Irkilata, Hasan Cem; Ors, Fatih; Peker, A Fuat

    2006-12-01

    Shockwave lithotripsy (SWL) is the treatment of choice for most renal calculi because it is highly effective and relatively noninvasive. Although complications of SWL are relatively few, one that occurs more frequently is perirenal hematoma, usually diagnosed by radiologic procedures. We present an interesting case of scrotal ecchymosis as an unusual presentation of perirenal hematoma causing ipsilateral spermatic-vein thrombosis after SWL for a left renal stone. To our knowledge, this condition has not been reported previously.

  14. [Use of extracorporeal shockwave therapy (ESWT)in sports orthopedics].

    PubMed

    Steinacker, T; Steuer, M

    2001-06-01

    From 11/97 to 10/99 409 patients have been treated with the extracorporal shockwave therapy (ESWT) in the sport orthopaedic ambulance. An ultrasound controlled treatment was applied in the low and middle energy range, using energy densities of 0.09 to 0.36 mJ/mm2. The ESWT came into application as an operation avoiding procedure after exhausting the conventional conservative therapy measures. Among the 409 patients, 65 persons were competitive sportsmen. Besides the established indications for the application of the shock wave therapy, this method also has been applied with specific sport orthopaedic indications like achillodynia, patella-top-syndrome, medial shin-syndrome, morbus Schlatter or tendinosis of the shoulder. The results were collected three months after the application of the ESWT using a standardized questionnaire. The performed examination exhibits that for conservatively treated tendinoses of the competitive sportsmen, similarly good therapy results concerning the application of ESWT can be reached compared with the classical orthopaedic shockwave therapy. Therefore, for the treatment of a tendinosis, a shock wave therapy should always be taken into account to avoid long exercise and competition breaks due to operative interventions.

  15. Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children.

    PubMed

    Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut

    2009-04-01

    In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the

  16. Pathophysiologic effects of biliary shockwave lithotripsy in a canine model.

    PubMed

    Chapman, W C; Parish, K L; Kaufman, A J; Stephens, W H; Anderson, S; Woodward, S; Williams, L F

    1991-01-01

    At least 10 extracorporeal shockwave lithotripters are under investigation in the United States for treatment of biliary stone disease. Few reports, however, have documented the potential side effects of this new treatment method. In this study, we performed a series of acute and chronic studies in dogs exposed to varying numbers of shockwaves directed at the gallbladder wall via a transthoracic or transabdominal targeting approach. When shockwaves were directed transthoracically, pulmonary hemorrhagic contusions were found which were sometimes large in size. When a transabdominal approach was used, however, only focal areas of hemorrhage were found in the gallbladder wall and adjacent liver with no alterations in postlithotripsy pancreatic or liver enzymes, and normal cholecystokinin-octapeptide stimulated oral cholecystograms were obtained 6 days after treatment. Biliary shockwaves appear to cause few side effects under normal conditions but should be used with caution in patients with potential bleeding disorders. Until further studies are performed, lung tissue should be avoided in the shockwave beam path during treatment. PMID:1796795

  17. Pathophysiologic effects of biliary shockwave lithotripsy in a canine model.

    PubMed

    Chapman, W C; Parish, K L; Kaufman, A J; Stephens, W H; Anderson, S; Woodward, S; Williams, L F

    1991-01-01

    At least 10 extracorporeal shockwave lithotripters are under investigation in the United States for treatment of biliary stone disease. Few reports, however, have documented the potential side effects of this new treatment method. In this study, we performed a series of acute and chronic studies in dogs exposed to varying numbers of shockwaves directed at the gallbladder wall via a transthoracic or transabdominal targeting approach. When shockwaves were directed transthoracically, pulmonary hemorrhagic contusions were found which were sometimes large in size. When a transabdominal approach was used, however, only focal areas of hemorrhage were found in the gallbladder wall and adjacent liver with no alterations in postlithotripsy pancreatic or liver enzymes, and normal cholecystokinin-octapeptide stimulated oral cholecystograms were obtained 6 days after treatment. Biliary shockwaves appear to cause few side effects under normal conditions but should be used with caution in patients with potential bleeding disorders. Until further studies are performed, lung tissue should be avoided in the shockwave beam path during treatment.

  18. International Shock-Wave Database: Current Status

    NASA Astrophysics Data System (ADS)

    Levashov, Pavel

    2013-06-01

    speed in the Hugoniot state, and time-dependent free-surface or window-interface velocity profiles. Users are able to search the information in the database and obtain the experimental points in tabular or plain text formats directly via the Internet using common browsers. It is also possible to plot the experimental points for comparison with different approximations and results of equation-of-state calculations. The user can present the results of calculations in text or graphical forms and compare them with any experimental data available in the database. A short history of the shock-wave database will be presented and current possibilities of ISWdb will be demonstrated. Web-site of the project: http://iswdb.info. This work is supported by SNL contracts # 1143875, 1196352.

  19. Extracorporeal shockwave lithotripsy: role of the radiologist.

    PubMed

    Barth, K H; Pahira, J J; Elliott, L P

    1985-06-01

    Extracorporeal shockwave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary calculi. ESWL may be applied to the majority of patients requiring stone removal and is expected to replace, to a large degree, percutaneous stone removal (PSR), now practiced jointly by interventional radiologists and endourologists in most institutions. In a number of cases, ESWL and PSR will be complementary procedures. Technically, ESWL can be considered a radiologic procedure; thus far, radiologists are not participating in its use. In the authors' opinion, ESWL should be a combined urologic radiologic procedure analogous to PSR; this will allow the most rational and effective treatment.

  20. [Extracorporeal shockwave nephro-uretero-lithotripsy].

    PubMed

    Lopatkin, N A; Martov, A G; Beshliev, L A

    1992-01-01

    Extracorporeal shock-wave lithotripsy (ESWL) has been widely introduced in the treatment of nephro-uretero-lithiasis during the last decade as it provides a noninvasive removal of the stones from the upper urinary tracts. The paper covers the history, techniques, indications, contraindications, anesthesia, complications and results of the method. Positive and negative characteristics of ESWL equipment (lithotriptors) are considered. The experience with 5000 lithotripsies led the authors to the conclusion that ESWL does not solve all the problems in the treatment of nephro-uretero-lithiasis and should be introduced only in large clinics practicing actively x-ray endoscopy and equipped with modern endoscopic and ultrasonic urologic units.

  1. [3D-navigated high energy shockwave therapy and axis correction after failed distraction treatment of congenital tibial pseudarthrosis].

    PubMed

    Schatz, K D; Nehrer, S; Dorotka, R; Kotz, R

    2002-07-01

    The treatment of congenital tibial pseudarthrosis using a distraction procedure as described by Ilizarov is a standard surgical intervention. Nevertheless, there are problems in achieving bony stability in about 10% of cases even after repeated surgery as reported by Lammens et al. (2000). Traub et al. (1999) found a rate of 50% amputations in 33 cases treated since 1927. To prevent an Ilizarov procedure from resulting in a delayed union or nonunion, Paley et al. (1992) recommended autografting immediately after distraction. Based on the good results in the stimulation of osteogenesis in adults, we started to treat delayed bone union following distraction treatment with high-energy shock wave therapy also in children. In patients suffering from congenital tibial pseudarthrosis with a deviation of the bony axis, we combine this surgery-substituting therapy with fixation of a Taylor spatial frame in order to correct the axis. Using this new method of treatment, we were able to achieve stability in four children who previously had had nonunion even after multiple surgical interventions.

  2. Effect of shockwave therapy on plantar fasciopathy. A biomechanical prospective.

    PubMed

    Hsu, W-H; Lai, L-J; Chang, H-Y; Hsu, R W-W

    2013-08-01

    It has been suggested that extracorporeal shockwave therapy is a safe and effective treatment for pain relief from recalcitrant plantar fasciopathy (PF). However, the changes in gait and associated biomechanical parameters have not been well characterised. We recruited 12 female patients with recalcitrant PF who had a mean age of 59 years (50 to 70) and mean body mass index of 25 kg/m(2) (22 to 30). The patients reported a mean duration of symptoms of 9.3 months (6 to 15). Shockwave therapy consisting of 1500 impulses (energy flux density 0.26 mJ/mm(2)) was applied for three sessions, each three weeks apart. A pain visual analogue scale (VAS) rating, plantar pressure assessment and motion analysis were carried out before and nine weeks after first shock wave therapy. It was demonstrated that patients increased their walking velocity and cadence as well indicating a decrease in pain after shockwave therapy. In the symptomatic foot, the peak contact pressure over the forefoot increased and the contact area over the digits decreased. The total foot impulse also decreased as did stance duration. The duration the centre of pressure remained in the hindfoot increased in the symptomatic foot after shockwave therapy. The differences in centre of pressure trajectory at baseline decreased at final follow-up. In conclusion, shockwave therapy not only decreased the pain VAS rating but also improved the gait parameters of the symptomatic foot in PF patients.

  3. The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions.

    PubMed

    Wang, Ching-Jen; Yang, Kunder D; Ko, Jih-Yang; Huang, Chung-Cheng; Huang, Hsuan-Ying; Wang, Feng-Sheng

    2009-06-01

    This study investigated the effects of extracorporeal shockwave treatment (ESWT) on bone healing and the systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Forty-two patients with 42 established non-unions of the femur and tibia were enrolled in this study. Each long bone non-union was treated with 6000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood were obtained for measurements of serum NO level and osteogenic growth factors including TGF-beta1, VEGF and BMP-2; serum levels of calcium, alkaline phosphatase, calcitonin and parathyroid hormone before treatment and at 1 day, 1, 3 and 6 months after treatment. The evaluations for bone healing included clinical assessments and serial radiographic examinations. At 6 months, bony union was radiographically confirmed in 78.6%, and persistent non-union in 21.4%. Patients with bony union showed significantly higher serum NO level, TGF-beta1, VEGF and BMP-2 at 1 month after treatment as compared to patients with persistent non-union. Shockwave-promoted bone healing was associated with significant increases in serum NO level and osteogenic growth factors. The elevations of systemic concentration of NO level and the osteogenic factors may reflect a local stimulation of shockwave in bone healing in long bone non-unions.

  4. [The treatment of calculi in the iliac segment of the ureter by extracorporeal high-energy shockwave lithotripsy].

    PubMed

    Nikolov, S; Patrashkov, T; Mikhaĭlov, P

    1991-01-01

    Experience is recorded with the treatment of calculi in the iliac segment of the ureter by extracorporal lithotripsy with high-energy stroke waves with lithotriptor of the firm "Dornier", model HM-3. For a period of 2 1/2 years 18 patients at mean age 38 years have been treated. Retrograde catheterization was always performed before lithotripsy. Successful reposition was achieved in 6 patients. In all others lithotripsy was performed in prone position. Special supporting cushions were manufactured and used; they helped for a more stable position of the patient on the stand, facilitate calculus positioning, the load to the knee joints is reduced, the fluoroscopic time is shortened, thus reducing the radiation load to patient and attending personnel. All patients received antibacterial and spasmolytic therapy. The mean length of stay in the clinic was 3.2 days. The results were good in 94.1 per cent of the cases. No early or late complications of urologic or other nature were observed.

  5. [Extracorporeal shockwave lithotripsy of gallstones. Retrospective view and perspectives].

    PubMed

    Adamek, H E; Riemann, J F

    1992-07-01

    Extracorporeal shock-wave lithotripsy (ESWL) is a non-invasive technique in gallstone management, which has been in clinical use since many years now. Exact patient selection provides considerable stone-free rates within a year. Side effects and complications are rare. The stone-recurrence rate is about 15% after two years, and thus lower compared to that after oral dissolution therapy alone. Until now, there is no reasonable medical therapy to prevent stone recurrence. Furthermore, ESWL is a suitable therapy for retained common bile duct stones. Although laparoscopic cholecystectomy has become established as a new, minimally invasive surgical method, ESWL will continue to be a successful technique for the treatment of thoroughly selected gallstone patients, who are looking for a non-invasive way to get rid of their biliary pain, but not of their gall bladder.

  6. Perinephric abscess following extracorporeal shockwave lithotripsy.

    PubMed

    Pautler, Stephen E.; Vallely, John F.; Denstedt, John D.

    1998-10-01

    Since the introduction and widespread use of extracorporeal shockwave lithotripsy (SWL), various complications have been noted. Perinephric hematoma and ureteral obstruction may be anticipated by urologists as potential problems. We report the first case of perinephric abscess encountered after 17 895 SWL treatments at our institution. A 65 year old woman presented 4 months following a second SWL procedure with a perinephric abscess and was successfully treated with percutaneous drainage. A review of the English literature revealed only 3 other cases of perinephric abscess following SWL. This diagnosis should be considered in early and late presentations of flank pain following SWL.

  7. [Extracorporeal shockwave lithotripsy in sedation-analgesia].

    PubMed

    Berger, M; Brandstetter, A; Chowanetz, E; Gasser, G; Mossig, H; Schmidt, P

    1988-03-01

    The aim of the present study was to examine the effects of combined sedation and analgesia during extracorporeal shockwave lithotripsy using the Dornier lithotriptor HM III. We used a combination of a benzodiazepin derivatives with an opioid. We tested the dosage of drugs needed in relation to the length of treatment, the size of the stone and the overall energy output of the lithotriptor. In addition, continuous records were made of the patient's blood pressure and the oxygen saturation in the blood, with and without oxygen insufflation. Our results show that sedation combined with analgesia is a reasonable and useable alternative to general or regional anaesthesia for extracorporeal lithotripsy.

  8. A Supernova's Shockwaves

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Supernovae are the explosive deaths of the universe's most massive stars. In death, these volatile creatures blast tons of energetic waves into the cosmos, destroying much of the dust surrounding them.

    This false-color composite from NASA's Spitzer Space Telescope and NASA's Chandra X-ray Observatory shows the remnant of one such explosion. The remnant, called N132D, is the wispy pink shell of gas at the center of this image. The pinkish color reveals a clash between the explosion's high-energy shockwaves and surrounding dust grains.

    In the background, small organic molecules called polycyclic aromatic hydrocarbons are shown as tints of green. The blue spots represent stars in our galaxy along this line of sight.

    N132D is located 163,000 light-years away in a neighboring galaxy called, the Large Magellanic Cloud.

    In this image, infrared light at 4.5 microns is mapped to blue, 8.0 microns to green and 24 microns to red. Broadband X-ray light is mapped purple. The infrared data were taken by Spitzer's infrared array camera and multiband imaging photometer, while the X-ray data were captured by Chandra.

  9. [Methods optimizing the efficiency of the extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Bonev, K; Panchev, P; Simeonov, P

    2007-01-01

    The medicine science is in a progressive mode. One of the ever discussed problems is the stone kidney disease and the optimizing methods of its treatment. In this article the authors announced a new method of applying jelly, thus improving the efficiency of the Extracorporeal Shockwave Lithotripsy (ESWL).

  10. Laser-induced shockwave chromatography: a separation and analysis method for nanometer-sized particles and molecules.

    PubMed

    Nagahara, Tetsuhiko; Ichinose, Nobuyuki; Nakamura, Shinpei

    2011-04-01

    A microscopic chromatography has been developed where nanometer-size molecules or particles are separated according to their size by the laser-induced shockwave in a water-filled capillary. As the shockwave passed through the mixture of molecules/particles in solution, they move to the direction of the propagation of the shockwave. The distance from the point of shockwave generation depends on the particle size or molecular weight. This technique has some advantages compared to conventional chromatography, in terms of quick analysis of molecular weight and applicability to sticky and adsorbing polymers. Experimental results obtained for proteins, their aggregates, and inorganic nanoparticles are presented.

  11. Interaction of lithotripter shockwaves with single inertial cavitation bubbles.

    PubMed

    Klaseboer, Evert; Fong, Siew Wan; Turangan, Cary K; Khoo, Boo Cheong; Szeri, Andrew J; Calvisi, Michael L; Sankin, Georgy N; Zhong, Pei

    2007-01-01

    The dynamic interaction of a shockwave (modelled as a pressure pulse) with an initially spherically oscillating bubble is investigated. Upon the shockwave impact, the bubble deforms non-spherically and the flow field surrounding the bubble is determined with potential flow theory using the boundary-element method (BEM). The primary advantage of this method is its computational efficiency. The simulation process is repeated until the two opposite sides of the bubble surface collide with each other (i.e. the formation of a jet along the shockwave propagation direction). The collapse time of the bubble, its shape and the velocity of the jet are calculated. Moreover, the impact pressure is estimated based on water-hammer pressure theory. The Kelvin impulse, kinetic energy and bubble displacement (all at the moment of jet impact) are also determined. Overall, the simulated results compare favourably with experimental observations of lithotripter shockwave interaction with single bubbles (using laser-induced bubbles at various oscillation stages). The simulations confirm the experimental observation that the most intense collapse, with the highest jet velocity and impact pressure, occurs for bubbles with intermediate size during the contraction phase when the collapse time of the bubble is approximately equal to the compressive pulse duration of the shock wave. Under this condition, the maximum amount of energy of the incident shockwave is transferred to the collapsing bubble. Further, the effect of the bubble contents (ideal gas with different initial pressures) and the initial conditions of the bubble (initially oscillating vs. non-oscillating) on the dynamics of the shockwave-bubble interaction are discussed.

  12. Developing Multimedia Courseware for the Internet's Java versus Shockwave.

    ERIC Educational Resources Information Center

    Majchrzak, Tina L.

    1996-01-01

    Describes and compares two methods for developing multimedia courseware for use on the Internet: an authoring tool called Shockwave, and an object-oriented language called Java. Topics include vector graphics, browsers, interaction with network protocols, data security, multithreading, and computer languages versus development environments. (LRW)

  13. [Application of extracorporeal shockwave therapy in andrology].

    PubMed

    Qin, Xin; Lu, Yi-Ping

    2012-12-01

    Extracorporeal shockwave therapy (ESWT) has been widely used in various fields ever since it was first introduced for the treatment of urinary stones in 1983. Recent years see a growing application of ESWT to andrology. Studies show that ESWT can relieve pain in 83% of the patients with Peyronie's disease, and has won favorable comments from 66% of the patients. ESWT can significantly improve the sexual life quality of the patients with organic erectile dysfunction, yields good effect in the treatment of chronic nonbacterial prostatitis, especially in pain relief. ESWT has offered new ideas and options for the treatment of andrological diseases. However, its mechanisms have yet to be clarified by more in-depth basic studies and multi-centered, large-sample randomized controlled trials.

  14. Extracorporeal shockwave lithotripsy of distal ureteral calculi.

    PubMed

    Miller, K; Bubeck, J R; Hautmann, R

    1986-01-01

    To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

  15. Extracorporeal shockwave therapy (ESWT) in patients with chronic proximal plantar fasciitis.

    PubMed

    Hammer, Dietrich S; Rupp, Stefan; Kreutz, Andreas; Pape, Dietrich; Kohn, Dieter; Seil, Romain

    2002-04-01

    The aim of this study was to compare the effect of extracorporeal shockwave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections and electrotherapy. Forty-seven patients (49 feet) with a previously unsuccessful conservative treatment of at least six months were randomized to two groups. Treatment of Group 1 (25 heels) started immediately with three sessions of ESWT (3000 shockwaves/session of 0.2 mJ/mm2) at weekly intervals. In the patients of Group 2 (24 heels) treatment was continued for 12 weeks. After this period they were treated using the protocol of Group 1. No significant difference of pain and walking time after further non-ESWT treatment (three months) was seen. Six months after ESWT pain decreased by 64% to 88% on the visual analog scale (VAS) and the comfortable walking time had increased significantly in both groups.

  16. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective.

    PubMed

    Tiselius, Hans-Göran; Chaussy, Christian G

    2012-10-01

    The present review summarizes the most important considerations and steps for an optimal result of extracorporeal shockwave lithotripsy. The relationship between shockwave path, geometry and anatomical conditions is of utmost importance. Selection of appropriate treatment variables in terms of shockwave number, power and frequency, is an important prerequisite for proper disintegration and prevention of complications. Several supportive measures such as inversion therapy, citrate therapy, high diuresis, α-receptor antagonists, chemolysis and recurrence preventive measures are important parts of the management of this group of patients in order to avoid problems with residual fragments and new stone formation. Proper understanding of these factors as well as of the physics of shockwaves is necessary for a successful application of this non-invasive technology treatment concept.

  17. Delayed stimulatory effect of low-intensity shockwaves on human periosteal cells.

    PubMed

    Tam, Kam-Fai; Cheung, Wing-Hoi; Lee, Kwong-Man; Qin, Ling; Leung, Kwok-Sui

    2005-09-01

    We investigated the effect of shockwaves on cells explanted from normal human periosteum to study the potential mechanisms of their responses and to determine suitable treatment settings. The cells were subjected to one shockwave treatment with systematic combinations of energy intensities (range, 0.05-0.5 mJ/mm) and number of shocks (range, 500-2000) whereas control cells received no treatment. The immediate effect on cell viability and the long-lasting effect on proliferation, viable cell number at Day 18, and mineralization at Day 35 were assessed. We observed an immediate dose-dependent destructive effect of shockwaves. Energy intensity and number of shocks contributed equally to viability. Total energy dose (intensity x number of shocks) was a better reference for determining the shockwave effect. We also found a long-term stimulatory effect on proliferation, viable cell number, and calcium deposition of human periosteal cells. At the same total energy dose, low-intensity shockwaves with more shocks (0.12 mJ/mm at 1250 shocks) were more favorable for enhancing cellular activities than high-intensity waves with fewer shocks (0.5 mJ/mm at 300 shocks). These findings document some of the biochemical changes of periosteal cells during shockwave treatments.

  18. [Extracorporeal shockwave lithotripsy of bile duct calculi].

    PubMed

    Greiner, L; Jakobeit, C

    1993-08-01

    Shockwave therapy of bile duct stones is not dependent on difficult preconditions concerning stone-volume and -composition or subsequent lythic therapy. Its main indication is failure of endoscopic sphincterotomy (EST). Shockwave lithotripsy of bile duct stones--which may even be carried out even instead of EST in specific cases--is with a success rate of 80 to 95% as effective as shockwave lithotripsy in urology.

  19. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy.

    PubMed

    Thiele, S; Thiele, R; Gerdesmeyer, L

    2015-12-01

    Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy.

  20. Extracorporeal shockwave lithotripsy in anomalous kidneys.

    PubMed

    Baltaci, S; Sarica, K; Ozdiler, E; Dinçel, C; Küpeli, S; Gögüş, O

    1994-06-01

    Traditionally, stones in anomalous kidneys have been removed by open or percutaneous surgery. Extracorporeal shockwave lithotripsy (SWL) with the Dornier MPL 9000 lithotripter was performed in seven patients with horseshoe kidneys, four with pelvic ectopic kidneys, and six with malrotated kidneys. Twelve patients (71%) needed repeated treatments. A total of 11 patients (65%) in all the groups were stone free, and four patients had asymptomatic residual fragments no more than 5 mm in diameter. In the remaining two patients, no sign of stone disintegration was observed, and they underwent open surgery. Extracorporeal lithotripsy is the treatment of choice for stones in horseshoe or malrotated kidneys but is not useful for stones in most pelvic kidneys.

  1. [Extracorporeal shockwave lithotripsy of the gallbladder: importance of selection criteria].

    PubMed

    Thorens, J; Schnegg, J F; Fasel, J; Deslarzes, C; Duvoisin, B; Schnyder, P; Gonvers, J J; Blum, A L

    1993-04-10

    In recent years, a number of alternatives to surgery for gallstones have been developed. Among them, extracorporeal shock-wave lithotripsy (ESWL) was promising, being non-invasive and risk-free. Nevertheless, its results vary according to the size, number and composition of the stones and according to the bile acids treatment used for fragment dissolution. To better evaluate the importance of these factors, we have widened the selection criteria currently used (1 to 3 non-calcified stones with a diameter below 30 mm) by including patients with large stones (up to 40 mm in diameter), multiple stones (up to 10 stones) and calcified stones. We also compared, for efficacy of fragment dissolution after ESWL, treatment by ursodeoxycholic acid alone as opposed to a mixture with chenodeoxycholic acid. Our results were (1) significant lessening of the fragmentation rate and of the number of gallbladders free of stones 1 year after ESWL when selection criteria are widened; (2) a mixture of ursodeoxycholic and chenodeoxycholic acids may favour fragment dissolution after ESWL compared to treatment by ursodeoxycholic acid alone.

  2. Extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy for lower pole nephrolithiasis?

    PubMed

    Cass, A S

    1996-02-01

    A controversy has arisen as to whether the initial form of therapy for lower pole nephrolithiasis should be extracorporeal shockwave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL). We reviewed our results with 968 single lower pole stones treated by SWL and reviewed publications comparing SWL and PCNL for lower pole nephrolithiasis. In our cases, the stone-free rate was 71.2%, the rate of repeat treatment and post-treatment secondary procedures was 6.4%, the complication rate was 0.5%, and the hospital stay was less than 24 hours in 99.3% of patients. In published series of PCNL for lower pole nephrolithiasis, the stone free rate was 70.5% to 100%, repeat treatment rates were 4% to 62.5%, the complication rates were 13% to 38%, and the hospital stay was 3.1 to 6.1 days. The rates of recurrent stone disease with PCNL were 11% to 22%, similar to the rates after SWL. The percentage of renal urolithiasis patients with lower pole calculi since we started our unit in late 1986 has remained essentially constant at 38%. Although the stone-free rate with PCNL is higher than with SWL, the lower complication rate, lower repeat treatment/secondary procedure rate, the shorter hospital stay, and the similar recurrent stone rate with SWL make SWL more clinically effective as the primary therapy for lower pole calculi less than 2 cm in diameter.

  3. Comparative follow-up of patients with acute and obtuse infundibulum-pelvic angle submitted to extracorporeal shockwave lithotripsy for lower caliceal stones: preliminary report and proposed study design.

    PubMed

    Sampaio, F J; D'Anunciação, A L; Silva, E C

    1997-06-01

    Nowadays, there is a consensus that the poor success rate of extracorporeal shockwave lithotripsy (SWL) is in the treatment of lower caliceal stones. The gravity-dependent position of the lower-pole calices is postulated to be the main factor hindering the spontaneous passage of stone debris that results from SWL. Nevertheless, we proposed that there are some particular features of the inferior-pole collecting system anatomy that could contribute to fragment retention. We studied the influence of the lower infundibulum-pelvic angle on fragment retention, considering 74 patients submitted to SWL for the treatment of lower-pole nephrolithiasis in a Lithostar Plus machine. At a mean follow-up of 9 months, 75% of the patients presenting an angle of greater than 90 degrees between the lower infundibulum where the stone was located and the renal pelvis became stone-free within 3 months. On the other hand, only 23% of the patients presenting an angle smaller than 90 degrees between the lower infundibulum where the stone was located and the renal pelvis became stone-free during the follow-up. Determination of the angle between the renal pelvis and the infundibulum of the inferior pole calix where the stone is located is very important, because the angle will differ in the same kidney, depending on stone location. Although preliminary and based on a small series of patients, our data suggest that an acute pelvic-lower pole infundibular angle hinders the spontaneous discharge of fragments after SWL. Also, use of the proposed technique of pelvic-lower pole infundibular angle measurement will be important for unifying angle evaluation by other investigators.

  4. Verapamil limits shockwave-induced renal tubular damage in vivo.

    PubMed

    Strohmaier, W L; Abelius, A; Billes, I; Grossmann, T; Wilbert, D M; Bichler, K H

    1994-08-01

    Previous investigations on Madin Darby Canine Kidney (MDCK) cells demonstrated the protective effect of verapamil against shockwave-induced tubular dysfunction. In the present study, we investigated whether verapamil is also protective against shockwave-induced damage in vivo. Male rates were randomly assigned to three groups: verapamil (N = 18) (Group I), control (N = 18) (Group II), or sham treatment (N = 4) (Group III). Groups I and II were treated with 500 shockwaves to each kidney with the Dornier MFL 5000 at 18 kV. Animals assigned to Group III received only anesthesics. Verapamil was given to the animals in Group I for 5 days starting 1 day before shockwave exposure. Urine was collected for 8 hours the day before and immediately, 1.7, and 28 days after shockwave exposure (SWE) for measurement of volume, osmolality, hemoglobin, protein, N-acetyl-beta-glucosaminidase (NAG), beta 2-microglobulin (beta 2M), sodium, and creatinine. Kidneys were perfused and removed for histologic study 1, 7, and 28 days after SWE in six animals of Groups I and II. Blood was taken in these rats (Day 1 after SWE) for the determination of creatinine and sodium and the calculation of the creatinine clearance (CCr) and the fractional excretion of sodium (FENa). After SWE, there was strong diuresis and significantly increased excretion of NAG and beta 2M in the controls, while urine osmolality decreased. These changes were significantly less pronounced in the verapamil-treated rats. The CCr was higher and FENa lower than in the latter group.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Extracorporeal shockwave therapy for avascular necrosis of femoral head.

    PubMed

    Wang, Ching-Jen; Cheng, Jai-Hong; Huang, Chung-Cheng; Yip, Han-Kan; Russo, Sergio

    2015-12-01

    The etiology of osteonecrosis of the femoral head (ONFH) is multifactorial. Treatment of ONFH is disease stage dependent. For early stages, femoral head preservation procedures are preferred including core decompression, muscle pedicle grafting and de-rotational osteotomy. Core decompression with bone grafting is considered the gold standard. However, the results are inconsistence and unpredictable. An effective non-invasive method of treatment is imperative. Recently, extracorporeal shockwave therapy (ESWT) has shown beneficial effects in ONFH. ESWT improves pain and function of the hip and regression of the ONFH lesion. ESWT is more effective than core decompression with or without bone grafting, cocktail therapy that combined HBO, ESWT and oral alendronate is shown effective for patients with early osteonecrosis. The purpose of the article is to review, update and summarize the clinical treatment of ONFH using shockwave therapy.

  6. Tissue reactions under piezoelectric shockwave application for the fragmentation of biliary calculi.

    PubMed

    Ell, C; Kerzel, W; Heyder, N; Rödl, W; Langer, H; Mischke, U; Giedl, J; Domschke, W

    1989-05-01

    The tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave applications to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative.

  7. Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study.

    PubMed

    Wang, Ching-Jen; Chen, Han-Shiang; Huang, Ting-Wen

    2002-03-01

    The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fasciitis with one-year follow-up. There were 59 women and 20 men with an average age of 47 (range, 15-75) years. Each patient was treated with 1000 impulses of shockwave at 14 kV to the affected heel. A 100-point scoring system was used for evaluation including 70 points for pain and 30 points for function. The intensity of pain was based on a visual analogue scale from 0 to 10. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fasciitis.

  8. Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete

    PubMed Central

    Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

    2012-01-01

    Summary Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient’s return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. Level of Evidence: II PMID:23738317

  9. [New trends in extracorporeal shockwave lithotripsy].

    PubMed

    Folberth, W

    1992-03-01

    Extracorporeal shock wave lithotripsy has become an established and successful treatment modality for urinary and biliary calculi. However, shock wave technology and corresponding device designs are still at an innovative stage. Three trends are discussed in this paper. In shock wave technology the electromagnetic principle seems to win the race. The demands for successful and tissue-protective stone disintegration require shockwave sources with high dynamic range and optimised focal geometry. Electromagnetic shock wave generators meet all these requirements. For stone localisation an isocentric X-ray targeting system combined with integrated shock wave application is accepted as the "gold standard". In ultrasound localisation in-line targeting is superior to out-of-line targeting.

  10. Deformation behavior and spall fracture of the Hadfield steel under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Gnyusov, S. F.; Rotshtein, V. P.; Polevin, S. D.; Kitsanov, S. A.

    2011-03-01

    Comparative studies of regularities in plastic deformation and fracture of the Hadfield polycrystalline steel upon quasi-static tension, impact failure, and shock-wave loading with rear spall are performed. The SINUS-7 accelerator was used as a shock-wave generator. The electron beam parameters of the accelerator were the following: maximum electron energy was 1.35 MeV, pulse duration at half-maximum was 45 ns, maximum energy density on a target was 3.4·1010 W/cm2, shock-wave amplitude was ~20 GPa, and strain rate was ~106 s-1. It is established that the failure mechanism changes from ductile transgranular to mixed ductile-brittle intergranular one when going from quasi-static tensile and Charpy impact tests to shock-wave loading. It is demonstrated that a reason for the intergranular spallation is the strain localization near the grain boundaries containing a carbide interlayer.

  11. Extracorporeal shockwave therapy as a novel and potential treatment for degenerative cartilage and bone disease: Osteoarthritis. A qualitative analysis of the literature.

    PubMed

    Ji, Qiaodan; Wang, Pu; He, Chengqi

    2016-09-01

    Osteoarthritis (OA) is characterized with pathological changes on articular cartilage and subchondral bone, with clinical symptoms of pain and motor dysfunction in affected joints. A growing number of investigations demonstrated the therapeutic effects of extracorporeal shockwave therapy (ESWT) on joints with OA. While the partial mechanisms of action are based on cellular mechanotransduction through cytoskeleton into nuclei to regulate gene expression and cause biophysical influences, the efficacy and exact mechanisms are still under exploration. At present, a summary of the evidence regarding effectiveness of ESWT on OA is not available. The purpose of this review is thus to offer an overview of ESWT in the management of OA in the aspects of cartilage, subchondral bone, pain sensation and motor function, in hopes of eliciting further multi-disciplinary scientific investigations into this promising application as an adjunct to other modalities or surgery. The optimal frequencies, impulses, energy intensity and protocols of ESWT in the management of OA continue to be elucidated. Further studies are required to reveal its exact mechanisms and biophysical effects on cells, animals and humans prior to the clinical application.

  12. Extracorporeal shockwave therapy as a novel and potential treatment for degenerative cartilage and bone disease: Osteoarthritis. A qualitative analysis of the literature.

    PubMed

    Ji, Qiaodan; Wang, Pu; He, Chengqi

    2016-09-01

    Osteoarthritis (OA) is characterized with pathological changes on articular cartilage and subchondral bone, with clinical symptoms of pain and motor dysfunction in affected joints. A growing number of investigations demonstrated the therapeutic effects of extracorporeal shockwave therapy (ESWT) on joints with OA. While the partial mechanisms of action are based on cellular mechanotransduction through cytoskeleton into nuclei to regulate gene expression and cause biophysical influences, the efficacy and exact mechanisms are still under exploration. At present, a summary of the evidence regarding effectiveness of ESWT on OA is not available. The purpose of this review is thus to offer an overview of ESWT in the management of OA in the aspects of cartilage, subchondral bone, pain sensation and motor function, in hopes of eliciting further multi-disciplinary scientific investigations into this promising application as an adjunct to other modalities or surgery. The optimal frequencies, impulses, energy intensity and protocols of ESWT in the management of OA continue to be elucidated. Further studies are required to reveal its exact mechanisms and biophysical effects on cells, animals and humans prior to the clinical application. PMID:27423987

  13. [A year experience with extracorporeal shockwave lithotripsy of gallstones].

    PubMed

    Rothenbühler, J M; Beglinger, C; Meyer, B; Marx, A; Ackermann, C; Stalder, G A; Harder, F

    1990-04-21

    43 patients with symptomatic gallbladder stones were treated by extracorporeal shockwave lithotripsy and oral bile acids. In all patients the stones were successfully fragmented during the first lithotripsy session. 33 patients underwent 2-4 treatment sessions. In 16 out of 43 patients the stones disappeared within 7.9 months. The rate of stone dissolution was dependent on the number and size of stones. 3 patients required surgery because of frequent colic in one case, cholecystitis in one case and lack of cooperation in one case. No important side effects were noted except mild pancreatitis 3 weeks after lithotripsy in one patient. Results at this center of extracorporeal shockwave lithotripsy combined with oral bile acids indicate that this treatment may become an alternative to cholecystectomy in patients with a small number (less than 3) of stones not exceeding 30 mm in diameter.

  14. Biliary extracorporeal shockwave lithotripsy.

    PubMed

    Rawat, B; Burhenne, H J

    1990-01-01

    Biliary extracorporeal lithotripsy has been considered one of the alternatives to surgery for the treatment of gallstones in the bile ducts and in the gallbladder. Although this technique can fragment almost all gallstones, the clinical effectiveness of this new treatment modality must be measured by successful elimination of all fragments. Some physical principles, stone targeting, patient protocol, complications, and clinical results are presented.

  15. Hydrodynamic shockwave tenderization effects using a cylinder processor on early deboned broiler breasts.

    PubMed

    Claus, J R; Schilling, J K; Marriott, N G; Duncan, S E; Solomon, M B; Wang, H

    2001-07-01

    In separate experiments, chicken broiler breasts were deboned (45 min postmortem, 52 min, respectively) and either exposed to high pressure hydrodynamic shockwaves (HSW) 25 min after deboning (77 min postmortem) or after 24 h of storage (4°C) respectively, and compared to companion control breasts. HSW were produced in a cylindrical HSW processor with 40-g explosive. Warner-Bratzler shear (WBS) values of the HSW breasts treated at 77 min postmortem were not different than the controls. HSW treatment decreased (P<0.05) the WBS values of the stored and cooked breasts by 42.0% as compared to non-treated controls. Cooking losses were not affected by HSW. In general, raw and cooked color characteristics (CIE L*a*b*) were not affected by the HSW. HSW treatment at 25 min after deboning (77 min postmortem) may require a higher pressure front or delayed treatment after postmortem aging to improve tenderness.

  16. Do not treat staghorn calculi by extracorporeal shockwave lithotripsy alone!

    PubMed

    Delaney, C P; Creagh, T A; Smith, J M; Fitzpatrick, J M

    1993-01-01

    A review of 84 patients with triple phosphate (staghorn) calculi treated by extracorporeal shockwave lithotripsy (ESWL) revealed a 67% stone clearance at 6 months. Classification of calculi according to morphology showed a variation in stone clearance from 47 to 82%. A significant number of patients developed complications (25%) or required additional procedures (27%). ESWL monotherapy is not a suitable treatment option for most patients with staghorn calculi.

  17. Ambulatory extracorporeal shockwave lithotripsy.

    PubMed

    Nisonson, I; Witus, W S; Madorsky, M L; Weems, W S

    1986-11-01

    The Kidney Stone Center in Fort Lauderdale, Florida, is an ambulatory ESWL facility where 226 patients have been treated since July, 1985. A total of 258 kidneys were treated over a period of five months with a success rate of 99 per cent. The post-treatment admission rate, both immediate and delayed, was 14.2 per cent. Outpatient ESWL treatment of both renal and ureteral calculi is feasible, medically safe, and cost-effective.

  18. Safety and effectiveness of extracorporeal shockwave therapy: results of a rabbit model of chronic osteomyelitis.

    PubMed

    Gollwitzer, Hans; Roessner, Michaela; Langer, Rupert; Gloeck, Tobias; Diehl, Peter; Horn, Carsten; Stemberger, Axel; von Eiff, Christof; Gerdesmeyer, Ludger

    2009-04-01

    Extracorporeal shockwave therapy (ESWT) is applied successfully in various orthopedic disorders. Since shockwaves have demonstrated significant bactericidal effectiveness in vitro, safety and effectiveness of ESWT in vivo were evaluated in a rabbit model of osteomyelitis. Chronic osteomyelitis was induced by injecting sodium morrhuate and Staphylococcus aureus into the proximal tibia of 12 New Zealand white rabbits. Four and five wk after the initial operation, soft focused ESWT was applied twice to the infected limbs. Clinical parameters and laboratory values were followed and blood samples were taken for culture before and 30 min after ESWT. Following sacrifice after 8 wk, lungs, spleen and kidneys were studied histologically for signs of sepsis and secondary infection. Tibial osteomyelitis was assessed clinically, and by radiologic, microbiologic and histologic procedures. Signs of bacterial spreading were not detectable after ESWT, neither in blood cultures nor in histologic analyses of representative organs. Temperature, body weight, C-reactive protein and white blood cell levels also remained unchanged after ESWT. Of particular interest, histologic scores of osteomyelitis were significantly decreased in the ESWT-group compared to the untreated control (p = 0.019). However, S. aureus was still detectable in tissue samples of all animals. This is the first study investigating the effects of ESWT applied to infected target areas. ESWT of infected bone did neither induce bacterial spreading nor worsening of infection, and the results suggest the reported treatment protocol of ESWT to be beneficial in the treatment of chronic bone infections.

  19. In vitro fragmentation of gallstones: comparison of electrohydraulic, electromagnetic and piezoelectric shockwave lithotripters.

    PubMed

    Schneider, H T; Fromm, M; Ott, R; Janowitz, P; Swobodnik, W; Neuhaus, H; Ell, C

    1991-08-01

    To compare the fragmentation efficiency of three different shockwave systems, 63 human gallstone triplets were disintegrated in vitro using an electrohydraulic (MPL 9000, Dornier), an electromagnetic (Lithostar Plus, Siemens) and a piezoelectric (Piezolith 2300, R. Wolf) lithotripter. Since each stone triplet was obtained from the same gallbladder, the concrements of one such set were identical in physicochemical parameters. According to the maximal diameter, the calculi were divided into group A (6 to 15 mm) and group B (16 to 30 mm). Shockwave application was terminated when residual fragments measured 4 mm or less. Forty-five triplets were fragmented at energy settings mainly used in clinical treatment of patients with gallbladder stones (MPL 9000: 20 kV; Lithostar Plus: setting 9 (maximal); Piezolith 2300: setting 3). The fragmentation endpoint was achieved in group A (n = 3 x 36) with the Piezolith 2300 after median 150 (range = 50 to 500) pulses and with the Lithostar Plus after 150 (50 to 750) pulses compared with 500 (50 to 1,500) pulses using the MPL 9000 (p less than 0.01). In group B (n = 3 x 9) the Lithostar Plus (median = 750, range = 250 to 1,250 pluses) required fewer discharges than the Piezolith 2300 (1,250, 250 to 2,500 pulses; p less than 0.05) and the MPL (1,500, 500 to 1,600 [upper limit] pulses; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder.

    PubMed

    Daecke, W; Kusnierczak, D; Loew, M

    2002-01-01

    Various short-term studies have demonstrated the effectiveness of extracorporeal shockwave therapy in the treatment of calcific tendinitis. To evaluate the long-term effects and any complications, the 4-year outcome was determined in a prospective study of 115 patients. One session (group A, n = 56) or two sessions (group B, n = 59) of high-energy shockwave therapy were administered to each patient. The 6-month results showed that the level of success achieved in pain relief and the Constant score was energy-dependent and that there were significant differences in radiologic changes between the groups. By 4 years after shockwave therapy, 20% of the entire patient population had undergone surgery on the involved shoulder. The effects of extracorporeal shockwave therapy not followed by any other therapy within the first 6 months were evaluated in 59% (n = 68) of the original 115 patients. Subjectively, 78% of patients in group A and 87% in group B thought the shockwave treatment had been successful. The Constant score increased from a mean of 45 before treatment to 88 in group A and 85 in group B after treatment. Radiologic changes were found in 93% of patients in each group. In conclusion, the failure rate after ESWT is high, but for 70% of the patients in this study, the treatment was successful and no long-term complications were seen.

  1. Effects of explosive explosion shockwave pretreatment on sludge dewaterability.

    PubMed

    Chen, Dayong; Yang, Jun

    2012-09-01

    The potential benefits and mechanism of explosive explosion shockwave pretreatment on sludge dewatering treatments were investigated in this study. Water content of sludge cake after centrifugation was used to evaluate sludge dewaterability. Particle size, viscosity, turbidity, and micrograph were determined to explain the observed changes in the pretreatment process. The results indicated that the optimal pretreatment condition, generating the lowest water content of sludge cake, was 25 g explosive and 96.7% original sludge water content. This condition resulted in the reduced particle size and viscosity as well as increased turbidity. Particle size and viscosity significantly contributed to enhance sludge dewaterability. Micrograph investigation indicated that explosive explosion shockwave pretreatment could rupture sludge flocs, release physically bound water, and extracellular substances into the solution, consequently enhancing sludge dewaterability.

  2. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    PubMed

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  3. Laser-induced shockwave propagation from ablation in a cavity

    SciTech Connect

    Zeng Xianzhong; Mao Xianglei; Mao, Samuel S.; Wen, S.-B.; Greif, Ralph; Russo, Richard E.

    2006-02-06

    The propagation of laser-induced shockwaves from ablation inside of cavities was determined from time-resolved shadowgraph images. The temperature and electron number density of the laser-induced plasma was determined from spectroscopic measurements. These properties were compared to those for laser ablation on the flat surface under the same energy and background gas condition. A theoretical model was proposed to determine the amount of energy and vaporized mass stored in the vapor plume based on these measurements.

  4. Lipid peroxidation induced by shockwave lithotripsy.

    PubMed

    Cohen, T D; Durrani, A F; Brown, S A; Ferraro, R; Preminger, G M

    1998-06-01

    To determine the relation between high-energy shockwaves (HESW) and the presence of lipid peroxidation produces, juvenile pigs were subjected to shockwave lithotripsy (SWL). After lithotripsy, both treated and control kidneys were analyzed, along with urine samples collected before, during, and after SWL. Thiobarbituric acid-reactive substance (TBARS) and lipid-conjugated diene (CD) concentrations, used as markers for membrane lipid peroxidation, were determined in the kidney and urine samples. Significantly increased mean TBARS concentrations (146%) were associated with homogenates of lithotripsy-treated kidneys, 77.8 +/- 14.4 (SD) mmol/g v the controls, 31.4 +/- 14.9 mmol/g. Lithotripsy induction of lipid peroxidation products in the cortex, the gross damage site, and the respective medulla were also examined. In HESW-treated cortex samples, increased TBARS concentrations were seen--75.0 +/- 21.3 mmol/g--compared with untreated controls-- 45.2+/- 5.6 mmol/g--while increased CD concentrations (168%) were observed in the medulla of HESW-treated samples. No significant differences were observed in TBARS or CD concentrations in urine samples from control or treated kidneys, yet specific lipid hydroperperoxides were detected in the urine of HESW-treated kidneys. We conclude that HESW lithotripsy of swine kidneys is associated with increased lipid peroxidation products that may cause further cellular damage. Lipid peroxidation induced by SWL may be one of several mechanisms that lead to other potential bioeffects. Finally, analysis of specific lipid hydroperoxides in the urine of HESW-treated kidneys may serve as a noninvasive marker of renal injury after clinical SWL.

  5. Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

    PubMed

    Palfrey, E L; Bultitude, M I; Challah, S; Pemberton, J; Shuttleworth, K E

    1986-12-01

    Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

  6. [Biliary extracorporeal shockwave lithotripsy. Preliminary communication].

    PubMed

    Garnica, E

    1989-01-01

    Shock wave lithotripsy has been successfully used in the treatment of urinary stones. Since 1985, it has also been applied in the management of gallbladder and biliary duct stones. The preliminary experience in Venezuela with the shock wave technology for the treatment of biliary stone disease is presented. The facilities of the Unit for the Treatment of Lithiasis. UNILIT of Venezuela, in Caracas were used. This unit is equipped with a Siemens Lithostar, that operates with an electromagnetic shock wave generator guided by a very accurate computerized biplane fluoroscopic system. Symptomatic gallstones with functioning gallbladder and radiolucid stones smaller than 3 cm, were the most important inclusion criteria. For duct stones, all cases that could not be managed by endoscopy were included. Fifteen cases have been treated from April 1988. Ten with gallstones and 5 with biliary duct stones. Success rate for gallstones, clarifications of gallbladder within a 12 month follow-up, was achieved in 40%. In the cases of biliary duct lithiasis, the aim was to reduce the stone to smaller fragments that could pass spontaneously or be retrieved by endoscopic maneuvers. In all the five cases treated, the stones could be crushed into small fragments and in four, they were easily withdrawn by endoscopic ballooning. Preliminary results and published data suggest that shockwave lithotripsy is a valuable method of treatment for selected cases of gallbladder stones and it is specially useful in the management of biliary duct stones where the endoscopic maneuvers have failed.

  7. Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder

    PubMed Central

    Vahdatpour, Babak; Taheri, Parisa; Zade, Abolghasem Zare; Moradian, Saeed

    2014-01-01

    Background: Frozen shoulder has always been considered important because of the impact on the quality-of-life and long period of illness. Therefore, the use of noninvasive and safe techniques that can speed up the healing process of the disease is important. Methods: This study was a randomized clinical trial study on patients suffering from frozen shoulder who were referred to Isfahan University of Medical Sciences hospitals in 2011 and 2012. A total of 36 patients were enrolled in the study. Eligible patients were allocated into two groups. Intervention group received extracorporeal shockwave therapy (ESWT) once a week for 4 weeks. The control group received sham shockwave therapy once a week for 4 weeks. On the follow-up period, changes in individual performance and the amount of pain and disability were assessed by the Shoulder Pain and Disability Index (SPADI) questionnaire and the range of motion changes were assessed by a goniometer. Data obtained were analyzed using SPSS software. Results: Variance analysis revealed a difference in the mean pain and disability score of the SPADI questionnaire, flexion, extension, and abduction, external rotation of involved shoulder between two groups before and after the shockwave therapy (P < 0.05). Improvement was more satisfactory in the intervention group, but the mean internal rotation did not differ significantly in two groups (P > 0.05). Conclusions: The use of ESWT seems to have positive effects on treatment, quicker return to daily activities, and quality-of-life improvement on frozen shoulder. PMID:25104999

  8. Extracorporeal shockwave for hip necrosis in systemic lupus erythematosus.

    PubMed

    Wang, C J; Ko, J Y; Chan, Y S; Lee, M S; Chen, J M; Wang, F S; Yang, K D; Huang, C C

    2009-10-01

    Patients with systemic lupus erythematosus (SLE) frequently received corticosteroid therapy, resulting in osteonecrosis of the femoral head (ONFH). Prior studies demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) for ONFH.. This study evaluated the effectiveness of ESWT for ONFH in patients with SLE. We studied 39 patients, including 15 patients with SLE (26 hips) and 24 controls (29 hips). To each affected hip we applied ESWT (6000 impulses at 28 kV in a single session). Patients were ambulated with partial weight bearing for 4-6 weeks. The primary endpoint was the need for hip replacement. The secondary endpoints were improvement in hip pain and function and image changes on X-ray and MRI. Patients received total hip replacement in 12% of patients with SLE and in 14% of controls (P = 0.802). There was no statistically significant difference in pain scores (0.86 vs. 0.89; P = 0.467) and function scores (89% vs. 91%; P = 0.194) between patients with SLE and controls. SLE response to ESWT for ONFH is comparable with ONFH in patients without SLE.

  9. A shockwave approach for web-based clinical motion analysis.

    PubMed

    Lemaire, Edward

    2004-01-01

    Advances in Internet connectivity and personal multimedia computing have created opportunities for integrating simple motion analysis into clinical practice. The Macromedia Shockwave environment provides tools for creating media-rich software that runs within a Web browser. For this project, clinical motion analysis software was created using Shockwave that can load digital video clips of a client's motion, step/shuttle/play through the clip, superimpose a grid over the video image, measure relative joint angles, scale to a linear factor, measure distances, and measure average velocities. After installing the Shockwave and Quicktime video plug-ins, the Motion Analysis Tools-Shockwave program runs directly from a Web page hyperlink. Program testing involved comparing angle measurements, linear distances, stride length, and walking speed among six video clips. The first three clips were of a transtibial prosthesis being carried through the field of view (640 x 480, 320 x 240, 320 x 240 enlarged to 640 x 480). The second set of three clips was of a metal square carried through the field of view. Average root mean square errors were 2.0 degrees for angle measures and 1.2 cm for length measures. Stride length standard deviation was 4.6 cm (mean length = 212.1 cm). Average walking speed standard deviation was 0.015 m/s (mean speed = 1.15 m/s). The test results were consistent with video motion analysis results and within an acceptable range for clinical design-making. This Web-based motion analysis approach provides a useful tool for ubiquitous, quantitative, clinical gait analysis.

  10. Comparing extracorporeal shock wave lithotripsy and ureteroscopy for treatment of proximal ureteric calculi: a cost-effectiveness study.

    PubMed

    Izamin, I; Aniza, I; Rizal, A M; Aljunid, S M

    2009-03-01

    Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.

  11. Shockwave Engine: Wave Disk Engine

    SciTech Connect

    2010-01-14

    Broad Funding Opportunity Announcement Project: MSU is developing a new engine for use in hybrid automobiles that could significantly reduce fuel waste and improve engine efficiency. In a traditional internal combustion engine, air and fuel are ignited, creating high-temperature and high-pressure gases which expand rapidly. This expansion of gases forces the engine’s pistons to pump and powers the car. MSU’s engine has no pistons. It uses the combustion of air and fuel to build up pressure within the engine, generating a shockwave that blasts hot gas exhaust into the blades of the engine’s rotors causing them to turn, which generates electricity. MSU’s redesigned engine would be the size of a cooking pot and contain fewer moving parts—reducing the weight of the engine by 30%. It would also enable a vehicle that could use 60% of its fuel for propulsion.

  12. [Extracorporeal shockwave lithotripsy of the ureteral calculus--clinical results with local shockwave lithotripsy].

    PubMed

    Wilbert, D M; Voges, G E; Müller, S C; Alken, P

    1987-11-01

    Second generation local shockwave lithotripsy appliances (Lithostar) were used for the treatment of upper and lower ureteral stones in 199 patients, 145 of whom had upper ureteral stones. In 78 patients the calculi were pushed back and all but one disintegrated. In 33 patients a catheter was inserted past the stone, which resulted of primary disintegration in 66%. In 19 of 34 patients (56%) in whom the stones could not be moved, primary disintegration was achieved. Distal ureteral stones were present in 54 patients and these were treated successfully by ESWL alone in 83.3%. Auxiliary measures (total 10%) included ureteroscopy, percutaneous extraction and ureterolithotomy. The results are discussed under the aspects of 'in situ' versus 'push-and-smash' procedures.

  13. A death due to perirenal hematoma complicating extracorporeal shockwave lithotripsy.

    PubMed

    Uemura, Koichi; Takahashi, Sayuri; Shintani-Ishida, Kaori; Nakajima, Makoto; Saka, Kanju; Yoshida, Ken-ichi

    2008-03-01

    Perirenal hematoma is an occasional complication of extracorporeal shockwave lithotripsy (ESWL) which does not usually require treatment. A 79-year-old woman died 23 h after ESWL. Forensic autopsy was performed to determine whether medical treatment contributed to her death. The cause of death was hemorrhagic shock due to massive hematoma from a ruptured small vein in the perirenal adipose capsule. No injury to other organs was found and the patient had neither coagulation abnormality nor venous disease. Perirenal hematoma can easily be diagnosed with abdominal sonography, if pain or symptoms of anemia develop. Doctors must be aware of the possibilities of severe renal hematomas after ESWL.

  14. Comparing two treatments by decision theory.

    PubMed

    Longford, Nicholas T

    2016-09-01

    Decision theory is applied to the general problem of comparing two treatments in an experiment with subjects assigned to the treatments at random. The inferential agenda covers collection of evidence about superiority, non-inferiority and average bioequivalence of the treatments. The proposed approach requires defining the terms 'small' and 'large' to qualify the magnitude of the treatment effect and specifying the losses (or loss functions) that quantify the consequences of the incorrect conclusions. We argue that any analysis that ignores these two inputs is deficient, and so is any ad hoc way of taking them into account. Sample size calculation for studies intended to be analysed by this approach is also discussed. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27247139

  15. Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

    PubMed

    Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

    2014-05-19

    Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm(2) ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p < 0.001) and control (41 ± 4%, p = 0.012) groups. LVEF markedly improved in shock-wave animals 6 weeks after treatment (62 ± 9%, p = 0.006); no improvement was observed in controls (41 ± 4%, p = 0.36), yielding a significant difference. Quantitative histology revealed significant angiogenesis 6 weeks after treatment (controls 2 ± 0.4 arterioles/high-power field vs treatment group 9 ± 3; p = 0.004). No acute or chronic adverse effects were observed. As a potential mechanism of action in vitro experiments showed stimulation of VEGF receptors after shock-wave treatment in human coronary artery endothelial cells. Epicardial shock-wave treatment in a large animal model of ischaemic heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd.

  16. When should one perform shockwave lithotripsy for lower caliceal stones?

    PubMed

    Ilker, Y; Tarcan, T; Akdas, A

    1995-12-01

    Extracorporal shockwave lithotripsy of lower caliceal stones is often unrewarding because of the difficulty of passing stone fragments. We report our results in SWL of lower pole stones in 219 patients and compare them with the results of SWL of middle (82 patients) and upper pole (85 patients) stones. The stone-free rate of SWL monotherapy was found to be 59%, 77%, and 64% in lower, middle, and upper caliceal stones, respectively. In lower pole stones, SWL was unsuccessful in 41% of the patients, of whom 9% had minimal residual asymptomatic stones (less than 4 mm in greatest diameter). In comparison with the results of percutaneous nephrolithotomy (PCN) of lower pole urolithiasis in the literature, SWL was unsuccessful in large stones, with stone-free rates of 13% and 0 when the stone size was 3 to 4.9 cm2 and > 5 cm2, respectively. A stone-free rate of 82% when the stone burden was < 1 cm2 is similar to the PCN results of other centers, suggesting that SWL may be the first choice of treatment in lower pole stones of this size. We achieved a stone-free rate of 59% when the stone size was between 1 and 3 cm2, which is lower than the stone-free rates of PCN in the literature. In spite of its lower stone-free rates, SWL, with its lower morbidity, may still be considered an acceptable treatment modality in this range of moderate stone burden, especially when there is a patient desire for conservative treatment.

  17. 1D GAS-DYNAMIC SIMULATION OF SHOCK-WAVE PROCESSES VIA INTERNET

    SciTech Connect

    Khishchenko, K. V.; Levashov, P. R.; Povarnitsyn, M. E.; Zakharenkov, A. S.

    2009-12-28

    We present a Web-interface for 1D simulation of different shock-wave experiments. The choosing of initial parameters, the modeling itself and output data treatment can be made directly via the Internet. The interface is based upon the expert system on shock-wave data and equations of state and contains both the Eulerian and Lagrangian Godunov hydrocodes. The availability of equations of state for a broad set of substances makes this system a useful tool for planning and interpretation of shock-wave experiments. As an example of simulation with the system, results of modeling of multistep shock loading of potassium between polytetrafluoroethylene and stainless steel plates are presented in comparison with experimental data from Shakhray et al.(2005).

  18. D Gas-Dynamic Simulation of Shock-Wave Processes via Internet

    NASA Astrophysics Data System (ADS)

    Khishchenko, K. V.; Levashov, P. R.; Povarnitsyn, M. E.; Zakharenkov, A. S.

    2009-12-01

    We present a Web-interface for 1D simulation of different shock-wave experiments. The choosing of initial parameters, the modeling itself and output data treatment can be made directly via the Internet. The interface is based upon the expert system on shock-wave data and equations of state and contains both the Eulerian and Lagrangian Godunov hydrocodes. The availability of equations of state for a broad set of substances makes this system a useful tool for planning and interpretation of shock-wave experiments. As an example of simulation with the system, results of modeling of multistep shock loading of potassium between polytetrafluoroethylene and stainless steel plates are presented in comparison with experimental data from Shakhray et al. (2005).

  19. Intraductal shock-wave lithotripsy in complicated common bile duct stones.

    PubMed

    Riemann, J F; Kohler, B; Weber, J; Schlauch, D

    1992-02-01

    Intracorporeal shockwave lithotripsy was performed in 36 patients with problematic common bile duct stones. All of the patients had undergone unsuccessful mechanical lithotripsy prior to this procedure. In 29 patients (80.6%), the stones were fragmented under cholangioscopic control and subsequently extracted with a Dormia basket. In seven patients, the procedure failed due to stone impaction or failure to intubate the common bile duct with a nasobiliary tube. No complications were observed. Cholangioscopically guided intracorporeal shockwave lithotripsy is a highly effective and safe procedure for the conservative treatment of complicated common bile duct stones.

  20. Shockwave Consolidation of Nanostructured Thermoelectric Materials

    NASA Technical Reports Server (NTRS)

    Prasad, Narasimha S.; Taylor, Patrick; Nemir, David

    2014-01-01

    Nanotechnology based thermoelectric materials are considered attractive for developing highly efficient thermoelectric devices. Nano-structured thermoelectric materials are predicted to offer higher ZT over bulk materials by reducing thermal conductivity and increasing electrical conductivity. Consolidation of nano-structured powders into dense materials without losing nanostructure is essential towards practical device development. Using the gas atomization process, amorphous nano-structured powders were produced. Shockwave consolidation is accomplished by surrounding the nanopowder-containing tube with explosives and then detonating. The resulting shock wave causes rapid fusing of the powders without the melt and subsequent grain growth. We have been successful in generating consolidated nano-structured bismuth telluride alloy powders by using the shockwave technique. Using these consolidated materials, several types of thermoelectric power generating devices have been developed. Shockwave consolidation is anticipated to generate large quantities of nanostructred materials expeditiously and cost effectively. In this paper, the technique of shockwave consolidation will be presented followed by Seebeck Coefficient and thermal conductivity measurements of consolidated materials. Preliminary results indicate a substantial increase in electrical conductivity due to shockwave consolidation technique.

  1. Ulnar Neuropathy After Extracorporeal Shockwave Therapy: A Case Report.

    PubMed

    Shim, Jae Seong; Chung, Sun G; Bang, Hyun; Lee, Hyuk Jin; Kim, Keewon

    2015-06-01

    Currently, extracorporeal shockwave therapy (ESWT) is widely used for treatment of various musculoskeletal disorders. We report a case of ulnar neuropathy secondary to the application of ESWT. A 48-year-old man was diagnosed with medial epicondylitis and underwent 2 sessions of ESWT. Immediately after the second session, he experienced paresthesia and weakness in the right hand. On physical examination, atrophy of the first dorsal interosseus and weakness of the abductor digiti minimi were observed. Electrophysiologic study demonstrated ulnar neuropathy at the elbow with severe partial axonotmesis. Our case report demonstrates that ESWT might cause or contribute to peripheral nerve injury at the site of application.

  2. Extracorporeal shockwave lithotripsy monotherapy for large renal calculi.

    PubMed

    Gleeson, M J; Griffith, D P

    1989-10-01

    Extracorporeal shockwave lithotripsy (ESWL) monotherapy with a Dornier HM3 lithotripter was used to treat 199 large (greater than or equal to 3 cm) renal calculi. Calculi were classified as solitary (29), multiple (152) or staghorn (18) with stone-free rates of 55.2, 39.5 and 55.6% respectively. The stone-free rate was not statistically related to stone size, site or multiplicity. Complications occurred in 24 patients (12.8%) and were more common with solitary and staghorn calculi. ESWL is not recommended as primary treatment for most patients with large renal calculi.

  3. Hypercalciuria and renal stones in a sarcoidosis patient treated by extracorporeal shockwave lithotripsy.

    PubMed

    Sharma, O P; Alfaro, C

    1986-03-01

    A case of chronic pulmonary sarcoidosis and hypercalciuria complicated by bilateral renal stones is reported. Urinary stones were pulverized by extracorporeal shockwave lithotripsy (ESWL) as the patient had declined any surgical procedure. The use of ESWL in conjunction with corticosteroids appears to be the treatment of choice in the management of renal stones secondary to abnormalities of calcium metabolism in sarcoidosis.

  4. [Extracorporeal shockwave lithotripsy in the treatment of urolithiasis--experiences from a center with the Piezolith 2200 and HM3 lithotriptors].

    PubMed

    Zwergel, T; Neisius, D; Zwergel, U; Ziegler, M

    1988-03-01

    The Piezolith 2200 allows not only a qualitatively identical treatment of urolithiasis like the HM-Dornier systems or the Siemens Lithostar, but the application of lithotriptable urinary calculi could be extended to cardiac risk patients, to patients with skeletal deformities and to those with unusual body height and weight. As the piezolithotripsy does not cause pain, treatment is possible without anaesthesia or analgesia. Combined with internal ureteral stenting by self-retaining double-J-ureteral catheter also calculi with larger stone masses can be treated advantageously by exclusive piezolithotripsy as monotherapy. Multiple treatments by the piezolithotriptor are possible because of good focussing of the shock waves and the smaller parenchymal alteration. Lithotripsy of ureteral calculi is performed in the upper and lower part of the ureter. In small calculi the retrograde introduction of an ureteral catheter armed with an "ultrasound mirror" is necessary.

  5. [Shockwave cytotoxicity on neoplastic and non-neoplastic cells].

    PubMed

    Rosell, D; Robles, J E; Abad, J I; Agüera, L G; De Castro, F; Zudaire, J J; Berían, J M

    1993-07-01

    Since initial application of high-energy shockwaves to treat renal lithiasis, their usefulness has been extended within both the clinical and experimental fields. Shockwaves cytotoxic action is determined by means of cell viability methods of vital staining exclusion and nucleoside uptake. Application of shockwaves on cell cultures is carried out by means of an electromagnetic lithotripter. High-energy shockwaves have had cytotoxic action both on non-tumoral and tumoral cells, during "in vitro" experiments. The cytotoxicity produced by the shockwaves, however, is different in tumoral and non-tumoral cells, the viability inhibition being higher in tumoral cells.

  6. Biological mechanism of shockwave in bone.

    PubMed

    Cheng, Jai-Hong; Wang, Ching-Jen

    2015-12-01

    Shockwave is a rapid, short duration acoustic wave that carries energy and can propagate through tissue medium. This kind of physical force can be a mechanical stimulus that induces biological effects in living tissue. Extracorporeal shockwave therapy (ESWT) acts as a mechanical stimulus which promotes biological healing processes through a mechanotransduction. The biological effects of ESWT are reported such as tissue regeneration, wound healing, angiogenesis, bone remodeling, and anti-inflammation. Until now, however, little is known about the basic mechanism of action of this type of therapy. This article describes the molecular mechanism on the current status of ESWT with pre-clinical and clinical applications for treating disorders in bone.

  7. Protective effect of verapamil on renal tissue during shockwave application in rabbit model.

    PubMed

    Yaman, O; Sarica, K; Ozer, G; Soygür, T; Kutsal, O; Yaman, L S; Göŭş, O

    1996-08-01

    Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.

  8. Radiation awareness program for extracorporeal shockwave lithotripsy using Medstone lithotripters.

    PubMed

    Ugarte, R R; Cass, A S

    1998-06-01

    To determine the effectiveness of a radiation awareness program in reducing the radiation exposure to patients treated by a Medstone lithotripter, the exposure was calculated at the end of each extracorporeal shockwave (SWL) treatment using a table of measurements of the estimated entrance exposure rates 70 cm from the X-ray tube port. The results, related to stone size and patient weight, were distributed every month to each radiologic technologist, and a summary was sent regularly to the treating urologists. The doses before and after the introduction of the radiation awareness program were compared to determine the effectiveness of the program, and the chi-square test was used to determine statistical significance. The average calculated radiation exposure before and after introduction of the radiation awareness program was 16.39 rad and 8.26 rad, respectively, for patients with single renal stones; 17.31 rad and 9.02 rad, respectively, with single ureteral stones; 18.45 rad and 9.39 rad, respectively, with multiple renal stones; and 20.59 rad and 11.28 rad, respectively with multiple ureteral stones. These reductions in calculated radiation exposure were statistically significant only with multiple ureteral stones (P = 0.03). The only statistically significant differences in the stone-free rates, retreatment rates, and post-SWL secondary procedure rates before and after the introduction of the radiation awareness program were seen in the stone-free rates with single renal stones: 70% v 65%, respectively (P = 0.02); in the retreatment rates with single ureteral stones: 10% v 6%, respectively ( P < .01); and in the post-SWL secondary procedure rates with single renal stones: 4% v 2%, respectively (P = 0.01), and single ureteral stones: 7% v 4%, respectively (P = 0.05). The radiation awareness program resulted in a 51% reduction in the estimated radiation exposure to patients during SWL using Medstone lithotripters.

  9. Early experience with extracorporeal shockwave Dornier lithotriptor "compact".

    PubMed

    Hamdy, S; Morehouse, D D; Laporte, H; Elhilali, M M

    1995-06-01

    One of the latest developments in extracorporeal shockwave lithotripsy (SWL) is a combination of an electromagnetic energy source with an upgraded parallel online ultrasound imaging for localization. The device is compact, requiring no significant installation or site preparation. Furthermore, it increases the margin of safety of SWL by virtue of the continuous ultrasound monitoring. A hundred sessions of SWL were performed on 88 patients using the Dornier Compact machine. Ninety three renal units having an average of 1.7 stones were treated (two had upper ureteric stones). Of the 135 stones, 2 (1.5%) were radiolucent and 4 (3%) were of faint opacity. Intravenous sedation was used in all patients except one 13-year-old patient, who required general anesthesia. Patients received an average of 2409 shocks per session, and the maximum power setting ranged from 1 to 6 (average 4.7). A plain film was obtained immediately before and after treatment. Early adverse effects were uncommon, and all were mild. Patients were followed by plain films at 2 weeks and 3 months. In 35 sessions (25 solitary and 10 multiple stones), the stones were considered completely fragmented; in 63 sessions, the stones (43 solitary and 20 multiple) were judged to be partial fragmented; and 2 sessions (solitary stones) resulted in poor fragmentation. The mean (+/- SD) stone dimension in the group with complete fragmentation was 9 +/- 4.8 (range 2-24) mm, compared with 11 +/- 6.3 (range 2-38) mm in those with no or partial fragmentation (P = 0.0095). After 2 weeks, 23 of 69 systems (33%) were stone free, while 46 showed residual stones.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. [The use of physical factors in the rehabilitative treatment of patients with stone fragments in the upper urinary tract after extracorporeal shockwave lithotripsy].

    PubMed

    Razumov, A N; Karpukhin, I V; Li, A A

    2000-01-01

    155 patients with fragments of the crushed stones in the upper urinary tract after lithotripsy were divided into 3 groups. 60 patients of group 1 received dynamic amplipulse therapy, oral mineral water, iodobromine baths. Elimination of the fragments was observed in 91.7% of the patients. Group 2 patients (n = 60) were exposed to local vibration, ultrasound and iodobromine baths. The effect occurred in 96.7% of the cases. 35 patients of group 3 were exposed to impulse low-frequency magnetic field and took iodobromine baths. The elimination of the fragments occurred in 62.9% of the cases after a single treatment course.

  11. Shockwaves induce osteogenic differentiation of human mesenchymal stem cells through ATP release and activation of P2X7 receptors.

    PubMed

    Sun, Dahui; Junger, Wolfgang G; Yuan, Changji; Zhang, Wenyan; Bao, Yi; Qin, Daming; Wang, Chengxue; Tan, Lei; Qi, Baochang; Zhu, Dong; Zhang, Xizheng; Yu, Tiecheng

    2013-06-01

    Shockwave treatment promotes bone healing of nonunion fractures. In this study, we investigated whether this effect could be due to adenosine 5'-triphosphate (ATP) release-induced differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells. Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase activity, osteocalcin production, and calcium nodule formation. Expression of P2X7 receptors and c-fos and c-jun mRNA was determined with real-time reverse transcription polymerase chain reaction and Western blotting. P2X7-siRNA, apyrase, P2 receptor antagonists, and p38 MAPK inhibitors were used to evaluate the roles of ATP release, P2X7 receptors, and p38 MAPK signaling in shockwave-induced osteogenic hMSCs differentiation. Shockwave treatment released significant amounts (≈ 7 μM) of ATP from hMSCs. Shockwaves and exogenous ATP induced c-fos and c-jun mRNA transcription, p38 MAPK activation, and hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists, or blockade of p38 MAPK with SB203580 prevented osteogenic differentiation of hMSCs. Our findings indicate that shockwaves release cellular ATP that activates P2X7 receptors and downstream signaling events that caused osteogenic differentiation of hMSCs. We conclude that shockwave therapy promotes bone healing through P2X7 receptor signaling, which contributes to hMSC differentiation.

  12. Shockwaves Induce Osteogenic Differentiation of Human Mesenchymal Stem Cells Through ATP Release and Activation of P2X7 Receptors

    PubMed Central

    Sun, Dahui; Junger, Wolfgang G.; Yuan, Changji; Zhang, Wenyan; Bao, Yi; Qin, Daming; Wang, Chengxue; Tan, Lei; Qi, Baochang; Zhu, Dong; Zhang, Xizheng; Yu, Tiecheng

    2014-01-01

    Shockwave fractures treatment promotes bone healing of nonunion fractures. In this study, we investigated whether this effect could be due to adenosine 5’-triphosphate (ATP) release-induced differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells. Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase activity, osteocalcin production, and calcium nodule formation. Expression of P2X7 receptors and c-fos and c-jun mRNA was determined with real-time reverse transcription polymerase chain reaction and Western blotting. P2X7-siRNA, apyrase, P2 receptor antagonists, and p38 MAPK inhibitors were used to evaluate the roles of ATP release, P2X7 receptors, and p38 MAPK sig naling in shockwave-induced osteogenic hMSCs differentiation. Shockwave treatment released significant amounts (~7 μM) of ATP from hMSCs. Shockwaves and exogenous ATP induced c-fos and c-jun mRNA transcription, p38 MAPK activation, and hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists, or blockade of p38 MAPK with SB203580 prevented osteogenic differentiation of hMSCs. Our findings indicate that shockwaves release cellular ATP that activates P2X7 receptors and downstream signaling events that caused osteogenic differentiation of hMSCs. We conclude that shockwave therapy promotes bone healing through P2X7 receptor signaling, which contributes to hMSC differentiation. PMID:23404811

  13. Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

    PubMed

    Vergunst, H; Terpstra, O T; Brakel, K; Laméris, J S; van Blankenstein, M; Schröder, F H

    1989-11-01

    Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results.

  14. Extracorporeal shockwave therapy for peyronie disease.

    PubMed

    Groth, T; Monga, M

    2003-01-01

    While surgery is the mainstay of therapy for Peyronie disease requiring correction of angulation, interest has grown in the application of extracorporeal shockwave therapy (ESWT) as a minimally invasive approach. This article reviews the current literature reporting the use of ESWT for Peyronie disease.

  15. Extracorporeal shockwave lithotripsy of pancreatic duct stones.

    PubMed

    Rawat, B; Fache, J S; Burhenne, H J

    1992-01-01

    Encouraging results with extracorporeal shockwave lithotripsy (ESWL) for pancreatic duct stones have been reported from Europe. We present our experience with the first two North American patients, treated with excellent results in one and limited clinical improvement in the other patient at 1 year follow-up. Targeting of pancreatic duct stones was achieved with either fluoroscopy or ultrasound.

  16. Severe perinephric hemorrhage after shockwave lithotripsy.

    PubMed

    Antoniou, N K; Karanastasis, D; Stenos, J L

    1995-06-01

    We report a case of a 69-year-old man who, after a second session of shockwave lithotripsy for multiple stones in the right kidney, showed symptoms of severe hemorrhage and flank pain unresponsive to analgesics, with the gradual development of extensive and serious perinephric hematoma. The bleeding necessitated nephrectomy. Unrecognized chronic pyelonephritis may have been a predisposing factor.

  17. Small-bowel perforation after shockwave lithotripsy.

    PubMed

    Rodrigues Netto, Nelson; Ikonomidis, Jean A; Longo, José Antonio; Rodrigues Netto, Mauricio

    2003-11-01

    A 51-year-old woman with a history of stone disease sustained two 3 x 2-mm ileal perforations during SWL (6000 shockwaves; 0.33-0.42 mJ/mm2) for a 14 x 8-mm left-sided midureteral stone. Low energy levels should be applied when ureteral stones are treated by SWL with the patient prone.

  18. Laser-induced shockwave lithotripsy of gallstones.

    PubMed

    Ell, C; Wondrazek, F; Frank, F; Hochberger, J; Lux, G; Demling, L

    1986-05-01

    With the aid of a Q-switched Nd:YAG laser with energy transmission via a flexible glass fiber, it proves possible under laboratory conditions, to destroy gallstones reliably and reproducibly. Lithotripsy is effected mechanically via a laser-induced local shockwave.

  19. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    PubMed

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  20. Use of shock-wave heating for faster and safer ablation of tissue volumes in high intensity focused ultrasound therapy

    NASA Astrophysics Data System (ADS)

    Khokhlova, V.; Yuldashev, P.; Sinilshchikov, I.; Partanen, A.; Khokhlova, T.; Farr, N.; Kreider, W.; Maxwell, A.; Sapozhnikov, O.

    2015-10-01

    Simulation of enhanced heating of clinically relevant tissue volumes using nonlinear ultrasound waves generated by a multi-element HIFU phased array were conducted based on the combined Westervelt and bio-heat equations. A spatial spectral approach using the fast Fourier transform algorithm and a corresponding analytic solution to the bioheat equation were used to optimize temperature modeling in tissue. Localized shock-wave heating within a much larger treated tissue volume and short, single HIFU pulses within a much longer overall exposure time were accounted for in the algorithm. Separation of processes with different time and spatial scales made the calculations faster and more accurate. With the proposed method it was shown that for the same time-average power, the use of high peak power pulsing schemes that produce high-amplitude shocks at the focus result in faster tissue heating compared to harmonic, continuous-wave sonications. Nonlinear effects can significantly accelerate volumetric heating while also permitting greater spatial control to reduce the impact on surrounding tissues. Such studies can be further used to test and optimize various steering trajectories of shock-wave sonications for faster and more controlled treatment of tissue volumes.

  1. [Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

    PubMed

    Weiss, W; Türk, C; Brownstone, E; Hruby, W; Klose, W; Kölbl, C; Marberger, M; Tuchmann, A

    1989-09-29

    Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

  2. Focused extracorporeal shockwave therapy in Dupuytren's disease--a hypothesis.

    PubMed

    Knobloch, Karsten; Kuehn, Marie; Vogt, Peter M

    2011-05-01

    Dupuytren's disease is a progressive disease due to unknown causal agents or genetics. An epidemiological analysis of 566 cases in North Germany estimated that around 1.9 million Germans are suffering from Dupuytren's disease. Beside Dupuytren's disease, there are a number of further less common forms of progressive fibromatosis, such as knuckle pads, plantar fibromatosis or Peyronie's disease. Surgery in plantar fasciectomy yields to a 60% recurrence rate depending on the extent of the plantar fasciectomy. Peyronie's disease of the penis affects middle-aged men between 40 and 60 years with penile pain, curvature during erection and potential erectile dysfunction. In a clinical randomized-controlled trial in Peyronie's disease 2000 focused extracorporeal shock waves reduced pain significantly and improved erectile function and quality of life. We hypothesize that focused extracorporeal shock wave therapy is able to reduce Dupuytren's contracture, a fibromatosis of the palm and improve function. Given the fact that recurrence rate in Dupuytren's disease is high und unpredictable extracorporeal shockwave therapy as a non-invasive tool might be applicable both, in primary and secondary prevention of the progression as well as for treatment. As such we have planned a randomized-controlled trial (ClinicialTrials.gov, NCT01184586) studying the effect of high-energy focused extracorporeal shockwave therapy on patients suffering Dupuytren's disease with patient-related outcome measures such as the DASH score and the Michigan Hand Outcome Questionnaire (MHQ) as primary outcome parameters.

  3. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model.

    PubMed

    Hsu, Robert Wen-Wei; Hsu, Wei-Hsiu; Tai, Ching-Lung; Lee, Kam-Fai

    2004-01-01

    This study investigated the effect of shock-wave therapy (SWT) on collagenase induced tendinopathy in the rabbit patellar tendon. Eighteen rabbits were treated by ultrasonography-guided injection of 0.025 ml collagenase into the patellar tendon in both knees. After tendinopathy was confirmed at 3 weeks post-treatment by the histological examination, SWT was initiated to the right patellar tendon involving 1500 cycles at 0.29 mJ/mm2 in two separated weekly courses from 4 weeks post-treatment. The rabbits were randomly divided into two groups, which were sacrificed at the 4th and 16th week after SWT, respectively. The histological examination, the mechanical and biochemical tests then were performed. The ultimate tensile load in the SWT tendon increased 7.03% at 4 week and 10.34% at 16 week after treatment as compared to the sham group. Hydroxyproline concentrations increased in the SWT tendons over both the 4 and 16 weeks after treatment. Moreover, the pyridinoline concentration increased at the 4th week but decreased at 16th week as compared to the sham group. The histological examination demonstrated increased blast-like tenocyte at the 4th week, while more mature tenocyte with neovasculization at the 16th week. The result obtained here validates the effectiveness of the SWT in the established tendinopathy. SWT may increase collagen synthesis and collagen crosslink formation during early healing process.

  4. Extracorporeal shockwave lithotripsy (ESWL). A treatment synopsis.

    PubMed

    Kasprick, D R

    1989-01-01

    ESWL is a new technology allowing calculi in the genitourinary tract to be fragmented and passed spontaneously. With this procedure possible on an out-patient basis, the positive impact on patient morbidity and lost time from work can be extremely beneficial. However, the impact on health care costs has yet to be determined. With further experience and newer technology, many operative procedures may well become obsolete.

  5. [Imaging procedures prior to the extracorporeal shockwave lithotripsy of gallstones].

    PubMed

    Schneider, H T; Ell, C; Benninger, J; Theobaldy, S; Friedel, N; Rödl, W; Heyder, N; Hahn, E G

    1991-01-25

    In order to determine whether cholecystography and computed tomography (CT) are capable of better gallstone characterization than conventional radiography alone, 91 patients (76 females, 15 males; mean age 47 +/- 12 years) with symptomatic single gallstones were studied prospectively prior to extracorporeal shock-wave lithotripsy with concomitant oral stone dissolution therapy. In addition, the value of oral cholecystography in demonstrating patency of the cystic duct was compared with ultrasound assessment of gallbladder function. Despite "negative" plain gallbladder radiographs in all patients, oral cholecystography showed significant stone calcification in 8 of the 91 patients and CT showed stone calcifications in 52 of the 91 patients. In 12 patients the maximum stone density was between 50 and 90 Hounsfield units, and in 40 patients it was more than 90 Hounsfield units. CT revealed ring-like calcification in the majority (79%) of these stones. Oral cholecystography showed satisfactory concentration of contrast medium in all patients, while ultrasonography of the gallbladder following a chemically defined test meal demonstrated contractility of more than 50% of initial volume in 69 patients and of less than 30% in 9 patients. Although oral cholecystography is a simple, readily available complication-free method, ultrasound assessment of gallbladder contraction is better for selecting patients for extracorporeal shock-wave lithotripsy. CT allows significantly better characterization of gallstones than oral cholecystography and conventional plain gallbladder radiography.

  6. Shockwave-induced compound action potentials in the peripheral nerve.

    PubMed

    Wehner, H D; Sellier, K

    1981-01-01

    To verify a presumed interaction between shockwaves arisen by impacts of high velocity projectiles and nervous tissue an electrophysiological experiment is performed with the following results: In peripheral nerves regular compound action potentials (CAPs) are provoked by shockwaves the amplitudes of which are increased corresponding to the pressure intensity of the shockwaves. The nerve shows no electrical activity below a certain pressure threshold (0.75 bar). Saturation of the CAP amplitude occurs beyond a pressure limit of 8 bar.

  7. Extracorporeal shockwave therapy for shoulder lameness in dogs.

    PubMed

    Becker, Willem; Kowaleski, Michael P; McCarthy, Robert J; Blake, Cara A

    2015-01-01

    The purpose of this article was to describe the outcome of dogs with instability, calcifying, and inflammatory conditions of the shoulder treated with extracorporeal shockwave therapy (ESWT). Medical records for 15 dogs with lameness attributable to the shoulder that failed previous conservative management were retrospectively reviewed. ESWT was delivered to those dogs q 3-4 wk for a total of three treatments. Short-term, in-hospital subjective lameness evaluation revealed resolution of lameness in three of nine dogs and improved lameness in six of nine dogs available for evaluation 3-4 wk following the final treatment. Long-term lameness score via telephone interview was either improved or normal in 7 of 11 dogs (64%). ESWT may result in improved function based on subjective patient evaluation and did not have any negative side effects in dogs with lameness attributable to instability, calcifying, and inflammatory conditions of the shoulder.

  8. Effects of extracorporeal shockwave lithotripsy on renal growth and function: an animal model.

    PubMed

    Claro, J de A; Denardi, F; Ferreira, U; Rodrigues Netto, N; Saldanha, L B; Figueiredo, J F

    1994-06-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children are unclear. At 40 days of age, with an average weight of 166 g, 34 Wistar white rats were divided into three groups: 9 rats (control group) received no shockwaves, 10 rats (Group 1) received 1000 shockwaves at 16.0 kV, and 15 animals (Group 2) received 1000 shockwaves at 17.2 kV. Six months later, at maturity, body weight; lithium and creatinine; fractional sodium, potassium, and lithium excretion; and the clearances of lithium and creatinine were measured, and the kidneys were studied grossly and histologically. We found no significant changes in overall animal or renal growth between the post-SWL groups and the control group. However, there were significant changes in renal function, mainly in Group 2; the animals of this group presented a significant increase in blood lithium and potassium, besides a significant decrease in the fractional potassium excretion compared with the control group. Furthermore, the animals in Group 2 showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, an inappropriate low plasma renin activity and aldosterone deficiency. We conclude that SWL does not affect either overall animal or renal growth but may cause permanent histologic damage and significant changes in renal function.

  9. Comparing Treatment Approaches for Obsessive Compulsive Disorder.

    ERIC Educational Resources Information Center

    Gariglietti, Kelli P.; Schemmel, Todd A.

    The current status of research literature relevant to obsessive compulsive disorder (OCD) is reviewed. Models proposing the etiology and maintenance of OCD, empirically established treatments for OCD, and research supporting cognitive approaches to treatment are also included in the review. Until recently, most of the controlled research…

  10. Comparing Methods of Evaluating Treatment Effects.

    ERIC Educational Resources Information Center

    Powell, Richard

    This paper examines four common measures of treatment outcomes--ethical standards, statistical analysis, standards of care, and social validation--and explores the inherent problems associated with each. Ethical standards may assure the public that only reasoned professional approaches are used, but the ethical treatment of patients does not mean…

  11. [Percutaneous removal of kidney calculi and extracorporeal shockwave lithotripsy in patients with hemorrhagic diatheses].

    PubMed

    Kirschner, P; Ziemer, S; Brien, G; Gromnica-Ihle, E; Schöpke, W; Sydow, K

    1988-07-01

    Hemorrhage is the main complication of percutaneous kidney stone removal. Shock-wave lithotripsy also may causes bleeding complications. It seems that both procedures are contraindicated on patients with coagulation disorders. On the base of two cases the specification of treatment by patients with hemorrhagic diatheses is demonstrated. Modern treatment modalities of urinary stone disease are also applicable to those patients, when attention is paid to some conditions and attentive measures are taken.

  12. Extracorporeal shockwave lithotripsy for a giant calcified gallbladder stone. Case report.

    PubMed

    Herbetko, J; Burhenne, H J

    1992-03-01

    Extracorporeal shockwave lithotripsy to gallstones is an alternative treatment to surgery in the high-risk patient with acute cholecystitis. We describe the successful fragmentation of a giant gallbladder stone and the subsequent removal of fragments through a cholecystostomy tract. Even though the treatment required 22 days in hospital and multiple procedures, these were all considered low risk in this patient with severe chronic obstructive airway disease.

  13. [Extracorporeal shockwave lithotripsy of gallbladder calculi].

    PubMed

    Greiner, L; Jakobeit, C; Schumacher, R; Johanns, W

    1993-08-01

    Shockwave disintegration of gallbladder stones with lythic therapy of residual fragments is successful when all criteria of patient- and stone-selection, shockwave application and lysis are fulfilled. The "Four-S-stones" proved to be the best candidates: solitary, symptomatic, sonolucent in a sufficiently contractile gallbladder. The rate of complications is low. Stone recurrence rate (10 to 15% after three years) is much lower as in previous studies using lythic therapy only. The new therapeutic approach to gallbladder stone disease with fragmentation, spontaneous fragment-clearance and lysis of residual fragments is--as the only truly non-invasive procedure--for 10 to 20% of the patients an alternative equal to operation.

  14. Shock-wave therapy is effective for chronic calcifying tendinitis of the shoulder.

    PubMed

    Loew, M; Daecke, W; Kusnierczak, D; Rahmanzadeh, M; Ewerbeck, V

    1999-09-01

    We report a prospective study of the effects of extracorporeal shock-wave therapy in 195 patients with chronic calcifying tendinitis. In part A 80 patients with chronic symptoms were randomly assigned to a control and three subgroups which had different treatment by low-energy and high-energy shock waves. In part B 115 patients had either one or two high-energy sessions. We recorded subjective, functional and radiological findings at six months after treatment. The results showed energy-dependent success, with relief of pain ranging from 5% in our control group up to 58% after two high-energy sessions. The Constant scores and the radiological disintegration of calcification were also dose-dependent. Shockwave therapy should be considered for chronic pain due to calcific tendinitis which is resistant to conservative treatment.

  15. Causality violation, gravitational shockwaves and UV completion

    NASA Astrophysics Data System (ADS)

    Hollowood, Timothy J.; Shore, Graham M.

    2016-03-01

    The effective actions describing the low-energy dynamics of QFTs involving gravity generically exhibit causality violations. These may take the form of superluminal propagation or Shapiro time advances and allow the construction of "time machines", i.e. spacetimes admitting closed non-spacelike curves. Here, we discuss critically whether such causality violations may be used as a criterion to identify unphysical effective actions or whether, and how, causality problems may be resolved by embedding the action in a fundamental, UV complete QFT. We study in detail the case of photon scattering in an Aichelburg-Sexl gravitational shockwave background and calculate the phase shifts in QED for all energies, demonstrating their smooth interpolation from the causality-violating effective action values at low-energy to their manifestly causal high-energy limits. At low energies, these phase shifts may be interpreted as backwards-in-time coordinate jumps as the photon encounters the shock wavefront, and we illustrate how the resulting causality problems emerge and are resolved in a two-shockwave time machine scenario. The implications of our results for ultra-high (Planck) energy scattering, in which graviton exchange is modelled by the shockwave background, are highlighted.

  16. History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis.

    PubMed

    Sfoungaristos, Stavros; Gofrit, Ofer N; Pode, Dov; Landau, Ezekiel H; Yutkin, Vladimir; Latke, Arie; Duvdevani, Mordechai

    2015-01-01

    To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy.

  17. History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis.

    PubMed

    Sfoungaristos, Stavros; Gofrit, Ofer N; Pode, Dov; Landau, Ezekiel H; Yutkin, Vladimir; Latke, Arie; Duvdevani, Mordechai

    2015-01-01

    To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy. PMID:26445394

  18. [Extracorporeal shockwave lithotripsy in children].

    PubMed

    Charbit, L; Terdjman, S; Gendreau, M C; Guérin, D; Quental, P; Cukier, J

    1989-01-01

    Upper urinary tract lithiasis is a rare condition in children in comparison to its incidence in the adult population. The distribution of lithiasis in children has been reported to be 56% for idiopathic lithiasis, 20% for metabolic lithiasis, and 25% for lithiasis associated with uropathy. Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for upper urinary tract calculi in the adult patient as well as in children after minor changes and complementary material had permitted the utilization of the Dornier HM-3 lithotripter in these small patients. The reported 3-month success rates range from 47% to 83%, according to the number of patients or kidneys free from calculi. The series reported in the literature have a mean of about 60% completely stone-free kidneys evidenced on the X-ray of the abdomen without preparation at 3 months. Its indications and results are comparable with those of ESWL in the adult. However, the long-term results have as yet not been evaluated and, to date, its hypothetical effects on renal growth or arterial pressure have not yet been elucidated.

  19. [The value of shockwave lithotripsy].

    PubMed

    Beglinger, C

    1994-03-26

    The standard treatment for symptomatic cholecystolithiasis remains surgery, the present method of choice being laparoscopic cholecystectomy. Noninvasive treatment options are available, but should be restricted to selected cases. Extracorporal shock wave lithotripsy (ESWL) is an alternative to noninvasive treatment, provided the patients are carefully selected. The main disadvantages include prolonged administration of gall salts and the problem of stone recurrence.

  20. Acute and chronic bioeffects of single and multiple doses of piezoelectric shockwaves (EDAP LT.01).

    PubMed

    Ryan, P C; Jones, B J; Kay, E W; Nowlan, P; Kiely, E A; Gaffney, E F; Butler, M R

    1991-02-01

    Piezoelectric second generation lithotriptors are an established means of administering extracorporeal shockwave lithotripsy (ESWL) enabling treatment to be performed without anaesthesia or analgesia, but higher shockwave doses and multiple or staged treatment are frequently required. The bioeffects of this modality of ESWL, therefore, require further assessment. Seven experimental groups of adult male rabbits were treated using the EDAP LT.01 in order to determine the acute and chronic bioeffects of clinical dose, excess dose, divided excess dose, high frequency and multiple treatment (X10) piezoelectric shockwaves (PSW). Renal function was measured before and after treatment using mercaptoacetyltriglycine (MAG 3) scans. Gross and histological morphological changes were assessed at one and 30 days following application of PSW. Application of single clinical dose PSW was not associated with any significant functional or morphological renal injury. Excess dose PSW caused transient gross renal contusion, which resolved in the majority of animals with no persistent microscopic abnormality. Divided excess dose PSW resulted in no gross or microscopic damage. High frequency PSW was associated with mild histological abnormality. Multiple PSW treatments caused small discrete fibrotic lesions in all cases, without any change in renal function.

  1. Shockwaves increase T-cell proliferation and IL-2 expression through ATP release, P2X7 receptors, and FAK activation.

    PubMed

    Yu, Tiecheng; Junger, Wolfgang G; Yuan, Changji; Jin, An; Zhao, Yi; Zheng, Xueqing; Zeng, Yanjun; Liu, Jianguo

    2010-03-01

    Shockwaves elicited by transient pressure disturbances are used to treat musculoskeletal disorders. Previous research has shown that shockwave treatment affects T-cell function, enhancing T-cell proliferation and IL-2 expression by activating p38 mitogen-activated protein kinase (MAPK) signaling. Here we investigated the signaling pathway by which shockwaves mediate p38 MAPK phosphorylation. We found that shockwaves at an intensity of 0.18 mJ/mm(2) induce the release of extracellular ATP from human Jurkat T-cells at least in part by affecting cell viability. ATP released into the extracellular space stimulates P2X7-type purinergic receptors that induce the activation of p38 MAPK and of focal adhesion kinase (FAK) by phosphorylation on residues Tyr397 and Tyr576/577. Elimination of released ATP with apyrase or inhibition of P2X7 receptors with the antagonists KN-62 or suramin significantly weakens FAK phosphorylation, p38 MAPK activation, IL-2 expression, and T-cell proliferation. Conversely, addition of exogenous ATP causes phosphorylation of FAK and p38 MAPK. Silencing of FAK expression also reduces these cell responses to shockwave treatment. We conclude that shockwaves enhance p38 MAPK activation, IL-2 expression, and T-cell proliferation via the release of cellular ATP and feedback mechanisms that involve P2X7 receptor activation and FAK phosphorylation.

  2. Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons.

    PubMed

    Murata, Ryo; Ohtori, Seiji; Ochiai, Nobuyasu; Takahashi, Norimasa; Saisu, Takashi; Moriya, Hideshige; Takahashi, Kazuhisa; Wada, Yuichi

    2006-07-30

    Although extracorporeal shockwave has been applied in the treatment of various diseases, the biological basis for its analgesic effect remains unclear. Therefore, we investigated the dorsal root ganglion neurons of rats following shockwave exposure to the footpad to elucidate its effect on the peripheral nervous system. We used activating transcription factor 3 (ATF3) and growth-associated phosphoprotein (GAP-43) as markers for nerve injury and axonal regeneration, respectively. The average number of neurons immunoreactive for ATF3 increased significantly in the treated rats at all experimental time points, with 78.3% of those neurons also exhibiting immunoreactivity for GAP-43. Shockwave exposure induced injury of the sensory nerve fibers within the exposed area. This phenomenon may be linked to the desensitization of the exposure area, not the cause of pain, considering clinical research with a particular absence of painful adverse effect. Subsequent active axonal regeneration may account for the reinnervation of exposed area and the amelioration of the desensitization.

  3. [Extracorporeal shockwave therapy in endoscopic therapy-refractory gallstones].

    PubMed

    Tudyka, J; Wechsler, J G; Kratzer, W; Janowitz, P; Stange, E F; Adler, G

    1992-12-22

    Extracorporeal shock-wave lithotripsy (ESWL) was undertaken in 36 patients (12 men, 24 women; mean age 70.9 +/- 2.4 years) with extra- or intrahepatic bile duct stones which could not be removed endoscopically. Stone fragmentation was successful in 32 patients with stones in the choledochal duct and in one with stones in the left hepatic duct. Fragmentation failed in two patients with stones in the left hepatic duct and one with stones in the cystic duct. 26 of the 36 patients were free of stone after spontaneous passage (n = 3) or after endoscopic removal of the residual concrements (n = 23). Complications occurred in only five patients during or after ESWL (cardiac arrhythmias, respiratory failure, pancreatitis, cholangitis).--These data point to ESWL being clearly preferable to surgical intervention in bile duct stones refractory to endoscopic treatment, especially in the elderly with an increased perioperative risk.

  4. Acute cyst rupture, hemorrhage and septic shock after a shockwave lithotripsy in a patient with autosomal dominant polycystic kidney disease.

    PubMed

    Kim, Hyeong Gon; Bae, Sang Rak; Lho, Yong Soo; Park, Hyoung Keun; Paick, Sung Hyun

    2013-06-01

    The incidence of urinary calculi in autosomal dominant polycystic kidney disease (ADPKD) ranges from 10 to 36 %. Shockwave lithotripsy (SWL) for urinary calculi in ADPKD was reported to be a safe and effective treatment option. However, there is a potential risk of cyst rupture and traumatic hemorrhage because of shockwaves. A 39-year-old female with polycystic kidneys and upper ureter stone was treated with SWL and developed life-threatening complications of cyst rupture, traumatic hemorrhage and septic shock. She was initially treated with supportive care in the intensive care unit, but in the end nephrectomy was performed.

  5. [Extracorporeal shockwave lithotripsy in childhood].

    PubMed

    Schultz-Lampel, D; Lampel, A; Lazica, M; Thüroff, J W

    1997-05-01

    In general, the criteria for treatment of urolithiasis in children are the same as those for adults. Today, extracorporeal shock wave lithotripsy (ESWL) is the method of choice for treatment of most pediatric urinary stones. Stone-free rates between 57% and 97% at short-term follow-up and 57%-92% at long-term follow-up have proven the efficacy of ESWL treatment in children. So far, there is no evidence of negative side effects of ESWL treatment in children in the long-term, confirming the safety of ESWL treatment seen in the short-term results. In particular, neither induction of hypertension nor deterioration of renal function have been detected in children when limitation of shock wave energy and shock wave numbers have been carefully observed.

  6. Minimizing masses in explosively driven two-shockwave physics applications

    NASA Astrophysics Data System (ADS)

    Buttler, William; Cherne, Frank; Furlanetto, Michael; Payton, Jeremy; Stone, Joseph; Tabaka, Leonard; Vincent, Samuel

    2015-06-01

    We have experimentally investigated different two-shockwave high-explosives (HE) physics package designs to maximize the variability of the second shockwave peak stress, while minimizing the total HE load of the physics tool. A critical requirement is to also have a large radial diameter of the second shockwave to maintain its value as an HE driven two-shockwave drive. We have previously shown that we could vary the peak-stress of the second-shockwave with a 76 mm diameter HE lens driving different composite boosters of PBX 9501 and TNT. Here we report on our results with a 56- and 50-mm diameter HE lens driving Baritol. The results indicate that the 56-mm diameter HE lens works well, as does the Baritol, giving total HE loads of about 250 mg TNT equivalent explosives.

  7. Extracorporeal piezoelectric shockwave lithotripsy of multiple pancreatic duct stones under ultrasonographic control.

    PubMed

    Kerzel, W; Ell, C; Schneider, T; Matek, W; Heyder, N; Hahn, E G

    1989-09-01

    The first ultrasonographically controlled fragmentation of multiple pancreatic duct stones of up to 14 mm size by means of extracorporeal, piezoelectric shockwave lithotripsy is reported. On account of the ultrasound localization and continuous control during therapy a nasopancreatic tube for instillation of contrast medium and frequent x-ray checks were not necessary. The 48-year-old patient did not experience any pain during the four treatment sessions and during the follow-up period. No complications were noted.

  8. [Complications of extracorporeal shockwave lithotripsy].

    PubMed

    Fuchs, G J; David, R D; Fuchs, A M

    1989-01-01

    The authors reviewed treatments performed worldwide using extracorporeal shock wave lithotripsy since its introduction in West Germany in 1980 to determine the efficacy of this treatment modality and its potential risks. The prevention of complications related to patients or shock wave energy are discussed, as well as the cardiovascular complications related to immersion, prevention of lesions to nearby organs, treatment of ESWL-induced bleeding, treatment of post-ESWL ureteral obstruction, prevention and treatment of infection, and long-term biological effects. Currently, less than 5% of patients are excluded from treatment with ESWL due to technical reasons or increased risk of periprocedural complications. Patients with cardiac pacemakers have been treated safely. Calcifications of the ipsilateral renal artery or aorta are considered only relative contraindications. However, certain technical limitations exist; i.e., the Dornier HM-3 cannot support patients weighing more than 135 kg., and patient height is also a limiting factor. There is an impressively low incidence of complications related to the energy of the shock wave. The severity and extent of damage are dose- and pressure-dependent. The potential for induction of cardiac arrhythmias secondary to the shock wave exists; however, effective prevention is achieved by coupling the shock wave discharge to the electrocardiogram. Complications of immersion are also extremely rare and can be avoided by careful preoperative evaluation. Damage to nearby organs such as pulmonary, gastric, duodenal or colonic contusions, constitute a very infrequent complication. Elevations of liver enzymes have also been noted post-lithotripsy. However, all these changes were transient and had no significant clinical consequences. Management of post-ESWL ureteral obstruction is by endourological procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  10. Risk factors predisposing to repeated extracorporeal shockwave lithotripsy.

    PubMed

    Bolton, D M; Lenaghan, D

    1994-01-01

    The Victorian Lithotripsy Service is geographically unique, representing the only Australian lithotripter for a 900-km radius and serving a patient population of over 3 million, and 26 accredited operator urologists. Because of distance and health service constraints few patients treated for renal calculi on this machine have the opportunity to seek additional treatment by extracorporeal shockwave lithotripsy (ESWL) elsewhere. The treatment histories of all patients who underwent ESWL at this center over a 4-year period were examined, with those patients who required ESWL on more than one occasion being identified and their treatment details reviewed. The retreatment rate was approximately 6%. In patients who required three or more ESWL treatments multiple calculi were present significantly more often than in the overall cohort (p < 0.05), and ESWL alone was ultimately successful in obtaining satisfactory stone fragmentation in only 62% of this group. In view of the high cost of repeated treatments by ESWL the applicability of this treatment method in cases of multiple calculi should be questioned. Initial undertreatment of calculi may also represent a significant factor in the retreatment of some radiopaque calculi.

  11. [Ultrasound controlled extracorporeal shockwave lithotripsy of pancreatic calculi in patients with chronic recurrent pancreatitis].

    PubMed

    Schreiber, F; Gurakuqi, G C; Trauner, M; Krejs, G J

    1994-09-01

    A consecutive series of 10 patients with pancreatic stones due to chronic pancreatitis was treated by extracorporeal shockwave lithotripsy during an investigation period of 2 years. The first step of the therapeutic regime included an endoscopic sphincterotomy prior to shockwave treatment. The targeting procedure was performed strictly under sonographic control. All patients were treated with a second-generation electrohydraulic lithotriptor, fragmentation could be achieved in all 10 cases. In 7 patients stonefreeness could be reached by endoscopic stone extraction, all these patients were symptom-free over a follow-up period of 12 months. In 3 patients complete duct clearance could not be achieved, these patients presented with minor symptoms over the follow-up period.

  12. New developments in shockwave technology intended for meat tenderization: Opportunities and challenges. A review.

    PubMed

    Bolumar, Tomas; Enneking, Mathias; Toepfl, Stefan; Heinz, Volker

    2013-12-01

    Meat tenderness is an important quality parameter determining consumer acceptance and price. Meat tenderness is difficult to ensure in the global meat chain because the production systems are not always aiming at this purpose (ex.: cattle derived from milk production) and by the existence within the carcass of "tough" primals. Different methods can be used by the meat industry to improve meat tenderness each with its advantages and drawbacks. The application of hydrodynamic pressure or shockwaves has showed outstanding improvements by reducing the Warner Bratzler Shear Force by 25% or more. However, the technology has not penetrated into the market as first systems were based on the use of explosives and further developments seemed to lack the robustness to fulfill industrial requirements. The present paper describes the main challenges to construct a prototype for the continuous treatment of meat by shockwaves based on electrical discharges under water. Finally, improvements on the tenderness of meat by using the novel prototype are presented.

  13. A review of the cellular and molecular effects of extracorporeal shockwave therapy.

    PubMed

    Chamberlain, Georgina A; Colborne, G Robert

    2016-01-01

    Extracorporeal shockwave therapy (ESWT) is a novel therapeutic modality and its use in promoting connective tissue repair and analgesic effect has been advocated in the literature. It is convenient, cost-effective, and has negligible complications; it therefore bypasses many of the problems associated with surgical interventions. This paper reviews the proposed mechanisms of action in promoting tissue repair and regeneration as well as analysing its efficacy providing an analgesic effect in clinical applications. Further research will be required to not only identify the underlying mechanisms more precisely, but will also be critical for ensuring consistency across the literature so that the most beneficial treatment protocol can be developed. Extracorporeal shockwave therapy stands as a promising alternative modality in promoting tissue repair.

  14. [Gallbladder morphology after extracorporeal shockwave lithotripsy of gallstones with the MPL-9000].

    PubMed

    Frick, T; Cerncic, P; Hoffmann, R; Stamm, B; Largiadèr, F

    1991-07-01

    The effects of extracorporeal spark-gap shockwave lithotripsy (ESWL) on human gallbladder-morphology are barely known. We studied the gallbladders of nine patients cholecystectomized 5 to 166 days after ESWL. Patients were treated one to three times receiving a mean of 1928 +/- 693 shockwaves per treatment, with a total of 3375 +/- 1307 per patient. Control gallbladders were of randomly selected patients after plain cholecystectomy (age and sex-matched). There was no difference in pathomorphology of the two groups. No signs of trauma related damage (hemorrhage, necrosis, ulceration, scar, or hemosiderin deposits) other than from surgical manipulation were found. Predominant pathomorphological changes were signs of chronic cholecystitis due to gallstone disease. In conclusion, spark-gap ESWL did not induce deleterious morphological damage to the gallbladder, although large numbers of shock waves were applied.

  15. [Endoscopic lithotripsy with pneumatic shockwave (Swiss Lithoclast) using a mini-ureteroscope].

    PubMed

    Knispel, H H; Klän, R; Dieckmann, K P

    1993-09-01

    We performed endoscopic lithotripsy for 23 urinary stones (21 ureteral and 2 bladder stones) with a pneumatic shockwave unit (Swiss Lithoclast; EMS, Angiomed), for the first time applying the probe through the tangential working channel of a semirigid 6.9-Fr ureteroscope (Circon, ACMI). Disintegration was successful in all stones (5-24 mm). Immediately after treatment, the 2 patients with bladder calculi and 10 of the patients with ureteral stones (47.6%) were stone free, while another 5 had residual fragments < 3 mm. Migration of fragments in 4 patients (19%) led to subsequent extracorporeal shock wave lithotripsy. There were no ureteral perforations in this series. Routine application of double-J stents avoided any serious postoperative complications. Endoscopic lithotripsy with the pneumatic shockwave unit was shown to be highly effective regardless of stone composition. The ltihotripsy probe is easily applied through mini-ureteroscopes.

  16. [Extracorporeal shockwave therapy in childhood].

    PubMed

    Villányi, K; Pusztai, C; Székely, J; Götz, F

    1996-05-12

    In 27 children aged 4-17 years extracorporeal shock wave lithotripsy (ESWL) was performed for renal and ureteral calculi between January 1 1993 and December 31 1994 at the University Medical School of Pécs. A total of 32 calculi was treated requiring 34 ESWL sessions. All treatments were done with the standard Dornier Compact Mobile Lithotripter device. The mean size of the stones was 10.65 mm and the number of shock waves averaged 2607. No serious intraoperative or postoperative complications were encountered. No auxiliary procedures were performed. The stonefree rate was 27/32 stones (84.4%) 3 months after treatment. 5 patient has residual stone fragments. Lithotripsy using Dornier Compact Mobile device in our series of pediatric patients was found safe and effective.

  17. Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces

    SciTech Connect

    James A. Smith; Jeffrey M. Lacy; Barry H. Rabin

    2014-07-01

    12. Other advances in QNDE and related topics: Preferred Session Laser-ultrasonics Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces 41st Annual Review of Progress in Quantitative Nondestructive Evaluation Conference QNDE Conference July 20-25, 2014 Boise Centre 850 West Front Street Boise, Idaho 83702 James A. Smith, Jeffrey M. Lacy, Barry H. Rabin, Idaho National Laboratory, Idaho Falls, ID ABSTRACT: The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) which is assigned with reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU. The new LEU fuel is based on a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to complete the fuel qualification process, the laser shock technique is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. The Laser Shockwave Technique (LST) is being investigated to characterize interface strength in fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However the deposition of laser energy into the containment layer on specimen’s surface is intractably complex. The shock wave energy is inferred from the velocity on the backside and the depth of the impression left on the surface from the high pressure plasma pulse created by the shock laser. To help quantify the stresses and strengths at the interface, a finite element model is being developed and validated by comparing numerical and experimental results for back face velocities and front face depressions with experimental results. This paper will report on initial efforts to develop a finite element model for laser

  18. Effects of extracorporeal shockwave lithotripsy at different stages of pregnancy in the rabbit.

    PubMed

    Gümüş, B; Lekili, M; Kandiloğlu, A R; Işisağ, A; Temeltaş, G; Nazli, O; Büyüksu, C

    1997-10-01

    Although SWL is now the most common treatment modality for urinary tract stone disease, it is not regarded as a safe method for pregnant patients because of its potential harmful effects on fetus. Using a rabbit model, we investigated whether SWL might cause fetal injury when administered at various developmental stages. Two groups of pregnant rabbits were given 1000 shockwaves either early or late in the gestational period. Time-matched controls did not receive shockwaves. After spontaneous labor, all newborn rabbits were counted, weighted, and measured, and specimens were taken from organs and examined histopathologically. The numbers, weights, and diameters of the newborns in each group were similar. There was no notable histopathologic finding in the heart and brain specimens of any of the newborns, whereas noticeable congestion and multiple focal intraparanchymal microhemorrhages were found in lungs, livers, and kidneys of the animals that had been exposed to shockwaves early in gestation. In conclusion, this study shows that SWL is not a safe treatment in early pregnancy.

  19. [Extracorporeal shockwave lithotripsy in childhood].

    PubMed

    Frick, J; Köhle, R; Kunit, G

    1988-01-01

    ESWL is a non invasive method for treatment of renal and ureteral stones. This method offers the advantage that all radiopositive renal stones irrespectively of their actual location in the collecting system and the free parts of the ureter can be localized and treated. Between March 1985 and December 1986 in 14 children, aged 2 to 14 years, with renal and ureteral calculi this method was performed. Further should be referred to the fact that two children with complete staghorn calculi were successfully treated by ESWL monotherapy. There was no morbidity and no undue side effects. 12/14 children (= 85%) were free of stones within the first three months following ESWL.

  20. [Controversies on extracorporeal shockwave lithotripsy].

    PubMed

    Ruiz Marcellán, F J; Ibraz Servio, L; Ramón Dalmau, M

    1989-01-01

    We analyzed our experience in 3,000 patients submitted to ESWL. Patient age ranged from 6-92 years. Stone size was 1 cm. in 33.2%, 1-3 cm. in 43.8%, and 23% had incomplete or complete staghorns. Following treatment 83.2% were stone-free, 13.1% had stone fragments that could be passed spontaneously, 3.4% had fragments larger than 4 mm., and 0.3% were submitted to surgery because attempts at stone fragmentation had failed. Our results show that indication of ESWL may be questionable in renal anomalies (horseshoe kidney, caliceal diverticulum, pyeloureteric stricture, urinary diversion), in some cases of lithiasis (cystine stone, infundibular lithiasis, staghorn or ureteral calculi) and in some patients (para and tetraplegics and those with solitary kidneys).

  1. Extracorporeal shockwave lithotripsy of gallstones: clinical experience with 170 patients.

    PubMed

    Dion, Y M; Morin, J; Fraser, W

    1992-04-01

    Between Jan. 19, 1989 and Nov. 23, 1990, 170 patients with symptomatic cholelithiasis were evaluated for possible treatment by extracorporeal shockwave lithotripsy (ESWL). Thirty-one patients were not eligible for treatment, 28 (16%) because of nonvisualization of gallstones by ultrasonography and 3 (2%) because polyps were erroneously diagnosed on ultrasonography. Thirteen (8%) patients failed to comply with the protocol, leaving 126 patients for assessment. At the time of writing, the treatment success rate is 57% at 6 months and 69% at 9 months. Treatment failed in 21 (17%) patients because of unsatisfactory fragmentation in 16 (13%) patients, frequent biliary colic in 3 (2%) patients, acute pancreatitis in 1 (0.8%) patient and severe bile-salt-induced diarrhea in 1 (0.8%) patient. Complications included biliary colic (40 patients), mild diarrhea on bile salts (24 patients), severe diarrhea (1 patient), macroscopic hematuria (4 patients), acute pancreatitis (2 patients) and vagal shock (1 patient). This study demonstrates the effectiveness (87%) of the lithotripter in reducing gallstones to fragments 5 mm in diameter or smaller. However, complete disappearance of these fragments with adjuvant bile-salt therapy may take many months.

  2. Primary extracorporeal shockwave lithotripsy in management of large bladder calculi.

    PubMed

    Husain, I; el-Faqih, S R; Shamsuddin, A B; Atassi, R

    1994-06-01

    Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

  3. [A 10-month experience with extracorporeal shockwave therapy of urolithiasis].

    PubMed

    García Sisamón, F; Ferrer Roda, J; Tudela Bañuls, O; Ferrer Bosch, L

    1990-01-01

    From November 1987 treatment of urinary lithiasis regardless location was initiated in our Service of extracorporal renal lithofragmentation using shockwaves. Up until August 1988 (10 months), 411 patients have been treated representing a total of 590 lithiasis and 699 sessions on which the present communication is based; treatment included calculus of various chemical composition, as well as different sizes and locations. Also the relationship between sex, age, number of waves, use of analgesia, hospital stay, etc, has been considered. Results obtained after a 2.5 months follow-up are: 60.34% fragments-free and 39.41% in expulsion stage. Monotherapy was chosen in 98% cases and multiple drug therapy in the remaining 2%. There has been no case of complementary open surgical therapy. Thus, we consider extracorporal renal lithofragmentation as the ideal treatment for urinary lithiasis, as long as the indication is correct. And we believe it to be the ideal treatment since it is a simple procedure, highly effective and with few complications. PMID:2239390

  4. [A 10-month experience with extracorporeal shockwave therapy of urolithiasis].

    PubMed

    García Sisamón, F; Ferrer Roda, J; Tudela Bañuls, O; Ferrer Bosch, L

    1990-01-01

    From November 1987 treatment of urinary lithiasis regardless location was initiated in our Service of extracorporal renal lithofragmentation using shockwaves. Up until August 1988 (10 months), 411 patients have been treated representing a total of 590 lithiasis and 699 sessions on which the present communication is based; treatment included calculus of various chemical composition, as well as different sizes and locations. Also the relationship between sex, age, number of waves, use of analgesia, hospital stay, etc, has been considered. Results obtained after a 2.5 months follow-up are: 60.34% fragments-free and 39.41% in expulsion stage. Monotherapy was chosen in 98% cases and multiple drug therapy in the remaining 2%. There has been no case of complementary open surgical therapy. Thus, we consider extracorporal renal lithofragmentation as the ideal treatment for urinary lithiasis, as long as the indication is correct. And we believe it to be the ideal treatment since it is a simple procedure, highly effective and with few complications.

  5. Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shockwave lithotripsy?

    PubMed

    Rodrigues Netto, N; Claro, J de A; Ferreira, U

    1994-06-01

    Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combination of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treated with PCNL monotherapy have a good clearance rate. Herein, we have reviewed 102 staghorn stones that underwent PCNL before (1984-1986) (Group 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: there were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, blood urea nitrogen and serum creatinine measurements demonstrated improvement of renal function postoperatively. The stone-free rates were 78% and 89% and the retreatment rates 31% and 18% in Groups 1 and 2, respectively. Complications (29% and 38%) were a function of the technical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remove the entire stone percutaneously safely and economically.

  6. Extracorporeal shockwave lithotripsy for kidney stone on surgical clip.

    PubMed

    Clark, J Y; Kearse, W S

    1997-04-01

    We report the successful use of extracorporeal shockwave lithotripsy for the destruction of a renal stone that had formed around a surgical clip. The SWL led to passage of both the stone and the clip.

  7. [The history of extracorporeal shockwave lithotripsy in Spain].

    PubMed

    Ruíz Marcellán, Francisco Javier; Ibarz Servio, Luis

    2007-10-01

    We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

  8. Shockwave determination of the shear velocity at very high pressures.

    NASA Technical Reports Server (NTRS)

    Anderson, O. L.

    1972-01-01

    Description of a proposed shockwave experiment that may provide some understanding on the behavior of planet core materials in the presence of high temperatures and pressures. Shockwave experimentation is shown to offer promise of revealing some information on shear velocity behavior at high pressures, and its relevance to properties of planet interiors consists in that abrupt changes in shear velocities at boundary layers could be experimentally confirmed where abrupt changes in density are suspected from seismic interpretation.

  9. Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

    PubMed

    Ferreira, U; Claro, J de A; Rodrigues Netto, N; Denardi, F; Figueiredo, J F; Riccetto, C L

    1995-02-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Shockwave-boundary layer interference heating analysis.

    NASA Technical Reports Server (NTRS)

    Hung, F. T.; Barnett, D. O.

    1973-01-01

    Interference heating correlations have been developed based on existing wind tunnel test data taken with simple configurations such as wedge/flat plate and compression corner models. For turbulent flow, peak interference heating was first correlated with shock strength (pressure ratio across shock wave) and then as a function of Reynolds number. The peak interference Stanton number was found to exhibit the same Reynolds number and Prandtl number characteristics as the Stanton number variation for undisturbed flow over a flat plate. Similar correlations were developed for laminar flow. Results indicated that for laminar flow at higher Reynolds number, the impinging shockwave may act as a boundary layer trip and cause boundary layer transition resulting in high interference heating. The correlations derived in this study can be used to scale wind tunnel model test data to a full-scale space vehicle at supersonic or hypersonic flight conditions.

  11. Shockwave loading of mechanochemically active polymer coatings.

    PubMed

    Grady, Martha E; Beiermann, Brett A; Moore, Jeffrey S; Sottos, Nancy R

    2014-04-23

    Thin films of mechanochemically active polymer were subjected to laser-generated, high amplitude acoustic pulses. Stress wave propagation through the film produced large amplitude stresses (>100 MPa) in short time frames (10-20 ns), leading to very high strain rates (ca. 1 × 10(7) to 1 × 10(8) s(-1)). The polymer system, spiropyran (SP)-linked polystyrene (PS), undergoes a force-induced chemical reaction causing fluorescence and color change. Activation of SP was evident via a fluorescence signal in thin films subject to high strain-rates. In contrast, quasi-static loading of bulk SP-linked PS samples failed to result in SP activation. Mechanoresponsive coatings have potential to indicate deformation under shockwave loading conditions.

  12. Does extracorporeal shockwave lithotripsy cause hypertension?

    PubMed

    Montgomery, B S; Cole, R S; Palfrey, E L; Shuttleworth, K E

    1989-12-01

    Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

  13. Influence of shockwave profile on ejecta

    SciTech Connect

    Zellner, Michael B; Dimonte, Guy; Germann, Tim C; Hammerberg, James E; Rigg, Paulo A; Buttler, William T; Stevens, Gerald D; Turley, William D

    2009-01-01

    This effort investigates the relation between shock-pulse shape and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of shocked Sn targets. Two shock-pulse shapes are considered: a supported shock created by impacting a Sn target with a sabot that was accelerated using a powder gun; and an unsupported or Taylor shockwave, created by detonation of high explosive that was press-fit to the front-side of the Sn target. Ejecta production at the back-side or free-side of the Sn coupons were characterized through use of piezoelectric pins. Assay foils, optical shadowgraphy, and x-ray attenuation.

  14. The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs.

    PubMed

    Dahlberg, J; Fitch, G; Evans, R B; McClure, S R; Conzemius, M

    2005-01-01

    Extracorporeal shockwave therapy (ESWT) has expanded from the original uses of human urinary calculi treatment to veterinary orthopaedic applications. This paper investigates the feasibility and efficacy of treating dogs with osteoarthritis of the stifle joint with ESWT. In this study, dogs with persistent stifle lameness despite previous surgical or medical treatment were either treated with ESWT or served as untreated controls. The more lame rear limb of each dog was determined by force platform analysis. The range of motion (ROM) of the stifle joints was assessed by goniometry. Force platform gait analysis and goniometry were performed on both groups for four visits at three-week intervals and a final examination four weeks later. Shock wave therapy was performed three times on the treated dogs, once at each of the first three examinations. A placebo treatment consisting of clipping and wetting the hair was performed on the control dogs. The vertical forces were evaluated for objective analysis of treatment response. For peak vertical force (PVF), four of seven treated dogs improved, while only one of five of control dogs improved. The PVF for the within group analysis did not show any significant change for the treated group, however, the control group has a significant decrease (p = 0.05) in PVF consistent with an increase in lameness. The range of motion (ROM) of the stifle joint improved in five of seven treated dogs and three of five controls. Dogs in the treated group had a trend toward increased ROM (p = 0.07) and a 'positive slope' when compared to dogs in the control group which did not have a significant change (p = 0.78) and had a negative slope indicating the dogs were developing a decrease in ROM. The subjective data provided by client questionnaire did not show significant difference between groups.

  15. Comparative treatment planning using secondary cancer mortality calculations.

    PubMed

    Schneider, U; Lomax, A; Lombriser, N

    2001-01-01

    Calculations of mortality due to secondary cancer have been investigated for its use in comparative treatment planning. A patient with Hodgkin's disease has been chosen as an example and has been planned with different radiation treatment modalities using photons and protons. The ICRP calculation scheme has been used to calculate mortality from dose distributions. To this purpose target volumes as well as critical structures have been outlined in the CT set of a patient with Hodgkin's disease. Dose distributions have been calculated using conventional as well as intensity modulated treatment techniques using photon and proton radiation. From the mean doses of each organ the mortality has been derived. Our work suggests that calculations of mortality can be useful in comparative treatment planning. Such mortality calculations can be helpful to find decisions between radiotherapy treatment techniques (intensity modulated or conventional treatment) or between different types of radiation (photons, electrons, protons, neutrons). PMID:11770547

  16. Percutaneous nephrolithotomy for renal stones following failed extracorporeal shockwave lithotripsy: different performances and morbidities.

    PubMed

    Zhong, Wen; Gong, Ting; Wang, Liang; Zeng, Guohua; Wu, Wenqi; Zhao, Zhigang; Zhong, Weide; Wan, Shaw P

    2013-04-01

    The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

  17. Comparing virtual and real worlds for acrophobia treatment.

    PubMed

    Huang, M P; Himle, J; Beier, K P; Alessi, N E

    1998-01-01

    Traditional treatment of phobias involves a process of gradual exposure to the feared object. Virtual Reality (VR) environments have been used to effectively treat phobias by simulating feared situations, yet these initial studies have been performed by comparing the effect to no-treatment conditions. We are in the process of comparing VR exposure treatment to "gold-standard" in-vivo exposure treatment by replicating an actual in-vivo exposure area in a VR model. The process of controlling for differences between the two environments highlights a general procedure of selecting elements in virtual environment design, targeted towards producing particular emotional effects. It also raises questions about the necessity for highly realistic simulation in VR phobia treatment.

  18. Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

    ERIC Educational Resources Information Center

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

    This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were…

  19. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  20. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae. PMID:26968731

  1. Comparing Burned and Mowed Treatments in Mountain Big Sagebrush Steppe

    NASA Astrophysics Data System (ADS)

    Davies, K. W.; Bates, J. D.; Nafus, A. M.

    2012-09-01

    Fires in mountain big sagebrush [ Artemisia tridentata spp. vaseyana (Rydb.) Beetle] plant communities historically shifted dominance from woody to herbaceous vegetation. However, fire return intervals have lengthened with European settlement, and sagebrush dominance has increased at the expense of herbaceous vegetation in some plant communities. Management actions may be needed to decrease sagebrush in dense sagebrush stands to increase herbaceous vegetation. Prescribed fire is often used to remove sagebrush; however, mechanical treatments, such as mowing, are increasingly used because they are more controllable and do not pose an inherent risk of escape compared with fire. However, information on the effects of burned and mowed treatments on herbaceous vegetation and whether fire and mowed applications elicit similar vegetation responses are limited. We evaluated the effects of prescribed burning and mowing for 3 years after treatment in mountain big sagebrush plant communities. The burned and mowed treatments generally increased herbaceous cover, density, and production compared with untreated controls ( P < 0.05). However, neither treatment induced a response in native perennial forb cover, density, or biomass ( P > 0.05). In contrast, annual forb (predominately natives) cover, density, and biomass increased with mowing and burning ( P < 0.05). Vegetation generally responded similarly in burned and mowed treatments; however, the burned treatment had less sagebrush, greater herbaceous vegetation production, and more bare ground than the mowed treatment ( P < 0.05). These differences should be considered when selecting treatments to decrease sagebrush.

  2. [Anesthesiologic aspects of extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Schockenhoff, B; Rübben, H; Daub, D; Fischer, N

    1986-11-01

    Anesthesiological considerations are discussed on the basis of the limited literature available and our own experience with more than 2000 ESWL treatments. Guidelines concerning anesthesia technique and ESWL treatment of renal and ureteral stones are outlined and compared to our own results and those in the literature. The following techniques are discussed: intubation anesthesia with halogenated carbohydrogens (Fluothane, Ethrane), intubation anesthesia with Fluothane/Ethrane plus opiates, neuroleptic anesthesia, catheter peridural anesthesia (lumbar/thoracic), opiate analgesia and high frequency jet ventilation.

  3. Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis.

    PubMed

    Venzin, C; Ohlerth, S; Koch, D; Spreng, D

    2004-03-01

    A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.

  4. Al 1s-2p Absorption Spectroscopy of Shock-Wave Heating and Compression in Laser-Driven Planar Foil

    SciTech Connect

    Sawada, H.; Regan, S.P.; Radha, P.B.; Epstein, R.; Li, D.; Goncharov, V.N.; Hu, S.X.; Meyerhofer, D.D.; Delettrez, J.A.; Jaanimagi, P.A.; Smalyuk, V.A.; Boehly, T.R.; Sangster, T.C.; Yaakobi, B.; Mancini, R.C.

    2009-05-19

    Time-resolved Al 1s-2p absorption spectroscopy is used to diagnose direct-drive, shock-wave heating and compression of planar targets having nearly Fermi-degenerate plasma conditions (Te ~ 10–40 eV, rho ~ 3–11 g/cm^3) on the OMEGA Laser System [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)]. A planar plastic foil with a buried Al tracer layer was irradiated with peak intensities of 10^14–10^15 W/cm^2 and probed with the pseudocontinuum M-band emission from a point-source Sm backlighter in the range of 1.4–1.7 keV. The laser ablation process launches 10–70 Mbar shock waves into the CH/Al/CH target. The Al 1s-2p absorption spectra were analyzed using the atomic physic code PRISMSPECT to infer Te and rho in the Al layer, assuming uniform plasma conditions during shock-wave heating, and to determine when the heat front penetrated the Al layer. The drive foils were simulated with the one-dimensional hydrodynamics code LILAC using a flux-limited (f =0.06 and f =0.1) and nonlocal thermal-transport model [V. N. Goncharov et al., Phys. Plasmas 13, 012702 (2006)]. The predictions of simulated shock-wave heating and the timing of heat-front penetration are compared to the observations. The experimental results for a wide variety of laser-drive conditions and buried depths have shown that the LILAC predictions using f = 0.06 and the nonlocal model accurately model the shock-wave heating and timing of the heat-front penetration while the shock is transiting the target. The observed discrepancy between the measured and simulated shock-wave heating at late times of the drive can be explained by the reduced radiative heating due to lateral heat flow in the corona.

  5. Time Resolved Shadowgraph Images of Silicon during Laser Ablation:Shockwaves and Particle Generation

    SciTech Connect

    Liu, C.Y.; Mao, X.L.; Greif, R.; Russo, R.E.

    2006-05-06

    Time resolved shadowgraph images were recorded of shockwaves and particle ejection from silicon during laser ablation. Particle ejection and expansion were correlated to an internal shockwave resonating between the shockwave front and the target surface. The number of particles ablated increased with laser energy and was related to the crater volume.

  6. Pelvi-calyceal height, a predictor of success when treating lower pole stones with extracorporeal shockwave lithotripsy.

    PubMed

    Symes, A; Shaw, G; Corry, D; Choong, S

    2005-08-01

    Extra corporeal shockwave lithotripsy (ESWL) is the treatment of choice for the majority of renal stones, however, it has the lowest success rate in complete clearance of stones located in the lower pole. We assess whether pelvi-calyceal height is a useful measurement in predicting successful stone clearance from the lower pole. A total of 105 patients with a solitary lower pole calculus of less than 20 mm treated with ESWL were reviewed. Stone size, location and pelvi-calyceal height were measured by intravenous urogram. Success was defined as complete stone clearance. Fifty-four patients (51.4%) had successful treatments, with the remaining 51 (48.6%) having incomplete stone clearance (including two patients in whom treatment had no effect). There was a statistically significant difference (P<0.0001) in pelvi-calyceal height between the two groups. Mean pelvi-calyceal height in patients with complete stone clearance was 15.1 mm (SD=3.9) compared with 22.9 mm (SD=5.2) for those with incomplete clearance. Pelvi-calyceal height is a useful predictor of success when treating lower pole renal stones with ESWL.

  7. Mechanisms of differing stone fragility in extracorporeal shockwave lithotripsy.

    PubMed

    Zhong, P; Preminger, G M

    1994-08-01

    Clinical experience with extracorporeal shockwave lithotripsy (SWL) has demonstrated significant variations in stone fragility. To understand the physical mechanisms of the differences, we quantitatively determined shockwave-stone interaction under clinically relevant SWL conditions for six stone compositions: calcium oxalate monohydrate (COM), struvite (MAPH), calcium apatite (CA), uric acid (UA), brushite, and cystine. We also characterized the acoustic and mechanical properties of the stones using ultrasound and microindentation techniques. Our results show that renal calculi have distinctly different acoustic and mechanical properties. Higher wave speed, Young's modulus, and fracture toughness were measured from COM and cystine stones, whereas lower values of the corresponding properties were found in CA and MAPH, and the values for brushite and UA stones were in between. Computer modeling of shockwave propagation revealed that under the same shockwave intensity, larger deformation was induced in CA and MAPH stones than in COM and cystine stones. In addition, multiple reflected tensile waves were predicted for stones with concentric layer structure, indicating their susceptibility to shockwave fragmentation. These findings elucidate the mechanisms of the differences in stone fragility observed clinically. Their implications to SWL are discussed.

  8. Post-extracorporeal shockwave lithotripsy residual stone fragments: clinical significance and management.

    PubMed

    Porfyris, O; Delakas, D

    2012-06-01

    Although extracorporeal shockwave lithotripsy (ESWL) is one of the primary treatments for urolithiasis, very often residual fragments of the calculi are still present for a long time after the ESWL session. These fragments are usually asymptomatic and can be managed expectantly, but sometimes they can cause symptoms and require intervention. Secondary procedures are not routinely applied to all patients with residual fragments, but only to those with significant symptoms. Medical therapy may play an important role in the management of residual fragments, by correcting an underlying metabolic disorder and by preventing the growth of residual calculi and the formation of new ones.

  9. [Experience of extracorporeal shock-wave lithotripsy for the urolithiasis in horseshoe kidney].

    PubMed

    Ohyama, A; Asai, Y; Ameno, Y; Sakakura, T; Sugita, O; Kamizuru, M; Sakamoto, W; Nakatani, T; Kishimoto, T; Maekawa, M

    1991-12-01

    At Osaka City University, 1,987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

  10. Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones.

    PubMed

    Tiselius, Hans-Göran; Chaussy, Christian G

    2015-10-01

    At a time when there is an almost unlimited enthusiasm and preference among urologists for endoscopic stone removal, we have found it essential to meet some of the frequently presented arguments on why extracorporeal shockwave lithotripsy (SWL) should not be used. We have based our considerations in this brief article on our 30-35 years' experience with the non-invasive or least invasive technique that SWL represents. Stone disintegration, requirement of repeated treatment sessions, the concern of residual fragments, complications and economic aspects are some points that are discussed.

  11. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    SciTech Connect

    Lacy, Jeffrey M. Smith, James A. Rabin, Barry H.

    2015-03-31

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.

  12. Shockwave Absorption using Network-forming Ionic glass

    NASA Astrophysics Data System (ADS)

    Lee, Jaejun; Yang, Ke; Moore, Jeffrey; Sottos, Nancy; MURI SWED Collaboration

    2015-06-01

    Network-forming ionic glasses composed of di-ammonium cations and citrate anions exhibit significant potential for dissipation of shock wave energy. The long alkyl side chains in the di-ammonium cation form a soft matrix, while the negatively charged heads of anions segregate into hard nanophase domains. Similar to polyurea, which has microphase separation of soft and hard domains, we hypothesize that shock wave dissipation of the ionic glass occurs by bond breaking in the hard domains and/or pressure-induced phase transition. By employing size-tunable alkyl side chains in the cations, we examine the effect of the relative soft domain size on energy dissipation. A series of thin film (ca. 50 μm) ionic glass specimens are subjected to laser-induced compressive stress waves and the transmitted response measured interferometrically. Structural changes of the ionic glass due to shock wave impact are characterized by x-ray diffraction. When compared directly to polyurea films of identical thickness and geometry, the ionic glass showed superior shock-wave mitigating performance. ONR MURI program.

  13. Different modes of fragmenting gallstones in extracorporeal shockwave lithotripsy.

    PubMed

    Nitsche, R; Schweinsberg, V; Klengel, H; Niedmann, P D; Fölsch, U R

    1993-03-01

    Forty radiolucent gallbladder stones from eight patients were fragmented in vitro by extracorporeal shockwave lithotripsy, using the electromagnetic lithotripter Lithostar Plus (Siemens) at five different energy levels. The stones were characterized by size, computed tomography (CT) density, and cholesterol content. The largest residual fragment was measured after every 20 to 100 shock waves. As expected, fewer shock waves were required to achieve fragmentation at higher energy levels. When stones of the same size were compared, there were remarkable differences in the number of shock waves required for fragmentation. These differences must originate in other properties of the stones than size and number. Two different modes of fragmentation were observed: in one group of stones small, flat fragments were chipped off at the beginning of fragmentation ('chipping mode'). These stones initially lost about 25% of their weight as small fragments (< 1 mm) before breaking centrally into some large fragments. In the other group stones initially lost only about 10% of their weight as small fragments (< 1 mm) at the beginning of fragmentation and early broke centrally into some large fragments ('breaking mode'). Stones showing the chipping mode were almost pure cholesterol stones (> 97%) and required significantly less shock waves than stones of the same size showing the breaking mode (cholesterol content, 64-94%). This mode of fragmentation could not be predicted by CT density.

  14. Shock-wave dynamics during oil-filled transformer explosions

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Utkin, A. V.

    2016-08-01

    This paper presents a numerical and experimental study of the shock-wave processes evolving inside a closed vessel filled with mineral oil. Obtained experimental Hugoniot data for oil are compared with the corresponding data for water. It is found that compression of mineral oil and water can be described by approximately the same Hugoniot over a wide pressure range. Such similarity allows the use of water instead of mineral oil in the transformer explosion experiments and to describe the compression processes in both liquids using similar equations of state. The Kuznetsov equation of state for water is adopted for a numerical study of mineral oil compression. The features of the evolution of shock waves within mineral oil are analyzed using two-dimensional numerical simulations. Numerical results show that different energy sources may cause different scenarios of loading on the shell. The principal point is the phase transition taking place at relatively high temperatures for the case of high-power energy sources. In this case, a vapor-gaseous bubble emerges that qualitatively changes the dynamics of compression waves and the pattern of loads induced on the shell. Taking into account the features of the process together with the concept of water-oil similarity, the present work presents a new approach for experimental modeling of transformer shell destruction using an explosion with given characteristics in a water-filled shell.

  15. Numerical simulation of shock and bubble dynamics in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim; Tanguay, Michel

    2002-11-01

    Theoretical evaluation of the efficacy of stone comminution (and potential for tissue damage) during shockwave lithotripsy requires knowledge of the complex stress fields associated with both the incident focussing shock and the dynamics of cavitation bubbles that it induces. While simple models from geometrical acoustics and subsequent modeling of spherical bubbles in isolation (Gilmore equation) can provide estimates, high-speed photography in vitro reveals a far more complex flow with bubble number densities that are sufficiently high such that collective effects associated with a cloud of bubbles are important. This talk will describe a modeling effort aimed at estimating stresses from these complex lithotripter generated flow fields. We compute the time-dependent, compressible, ensemble-averaged two-phase flow equations with a finite-difference scheme. Detailed modeling of the dynamics of bubbles (on the microscale) and high-order weighted essentially nonoscillatory shock-capturing schemes are employed. The model is compared to hydrophone and passive cavitation detection measurements, as well as qualitative comparison with high-speed photography. Finally, we explore collective bubble mechanisms ranging from defocusing and shielding of the stone (for high bubble densities in the focal region) to enhanced stresses due to concerted cloud collapse in a dual-pulse lithotripsy configuration. [Work supported by NIH P01 DK-43881 and NSF under grant CTS-9979258.

  16. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    NASA Astrophysics Data System (ADS)

    Lacy, Jeffrey M.; Smith, James A.; Rabin, Barry H.

    2015-03-01

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.

  17. [Extracorporeal shockwave lithotripsy in gallstone perforation].

    PubMed

    Jakobeit, C

    1992-04-01

    A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting. Repeat gastroscopy 7 days later showed a gallstone, about 4 cm in diameter, which had perforated into the duodenal bulb and could not be removed endoscopically. Because of the serious nature of the other diseases an operation was not undertaken, but an ultrasound-guided extracorporeal shockwave lithotripsy was performed. In three sessions this succeeded without complication to break up the stone, the larger fragments of which were then removed endoscopically while the small ones passed through the gut spontaneously. Subsequent ultrasonography demonstrated a shrunk, stone-free gallbladder with a cholecystoduodenal fistula. Afterwards the patient was again able to take food by mouth without any problems.

  18. Renal rupture following extracorporeal shockwave lithotripsy.

    PubMed

    Torbati, Sam S; Niku, Michelle; Vos, Elaine; Hogan, Shomari

    2014-09-01

    A 41-year-old woman presented to the emergency department with a chief complaint of hematuria three days status post extracorporeal shockwave lithotripsy. The patient described a three-day history of worsening left-sided abdominal pain immediately following the procedure. She denied any fever, chills, changes in bowel habits, hematochezia, increased urinary frequency, urinary urgency, or dysuria. Physical exam revealed tenderness to palpation in the left upper quadrant, left flank and periumbilical region with mild guarding. Laboratory studies revealed an anemic patient with downward trending hematocrit (red blood cell count of 3.41 10(6)/μL, hemoglobin of 10.6 g/dL, and a hematocrit of 31.3% down from 43% a week and a half prior). Urinalysis revealed red and cloudy urine with 3+ leukocytes. A chest radiograph was unremarkable. A computed tomography of the chest, abdomen, and pelvis showed a laceration to the lateral aspect of the mid left kidney with a hematoma measuring 3.2 cm in thickness (Figure). The patient was subsequently admitted to the hospital for monitoring and discharged on day nine.

  19. Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report.

    PubMed

    Markic, D; Valencic, M; Grskovic, A; Spanjol, J; Sotosek, S; Fuckar, Z; Maricic, A; Pavlovic, I; Budiselic, B

    2011-06-01

    We report a case of ureterolithiasis in a patient with an en bloc kidney transplantation, using extracorporeal shockwave lithotripsy (ESWL). The patient presented with asymptomatic macrohematuria. Computed tomography revealed a ureteral calculus just below the pyeloureteral junction with hydronephrosis of the medially positioned kidney. Took two sessions of ESWL were required for complete disintegration of the stone. At 3 years after successful treatment, the patient has an excellent functioning and stone-free graft.

  20. Waste battery treatment options: comparing their environmental performance.

    PubMed

    Briffaerts, K; Spirinckx, C; Van der Linden, A; Vrancken, K

    2009-08-01

    Waste consumer batteries are recycled using different routes based on hydrometallurgical and pyrometallurgical processes. Two hydrometallurgical and two pyrometallurgical treatment scenarios are compared starting from an average composition of Belgian waste batteries. The environmental performance is compared using life cycle analysis (LCA). The recycling rate is studied through mass balance calculation. Each treatment scenario results in a specific recycling rate. The environmental impact and benefits also vary between the treatment options. There is no such thing as a typical hydrometallurgical or pyrometallurgical treatment. When applying a hydrometallurgical treatment scenario, the focus lies on zinc and iron recycling. When allowing manganese recycling, the energy demand of the hydrometallurgical process increases considerably. Both pyrometallurgical options recycle zinc, iron and manganese. According to the LCA, none of the treatment scenarios performs generally better or worse than the others. Each option has specific advantages and disadvantages. The Batteries Directive 2006/66/EC sets out a recycling rate of 50% for consumer waste batteries. Based on metal recycling alone, the mass balances show that the target is difficult to obtain.

  1. Molecular changes after shockwave therapy in osteoarthritic knee in rats

    NASA Astrophysics Data System (ADS)

    Wang, C.-J.; Sun, Y.-C.; Wu, C.-T.; Weng, L.-H.; Wang, F.-S.

    2016-01-01

    This study investigated the molecular changes of DKK-1, MMP13, Wnt-5a and \\upbeta -catenin after extracorporeal shockwave therapy (ESWT) in anterior cruciate ligament transected (ACLT) osteoarthritic (OA) knee in rats. 27 male Spraque-Dawley rats were divided into three groups. Group I was the control one and received sham knee arthrotomy but no ACLT or ESWT. Group II underwent ACLT, but no ESWT. Group III underwent ACLT and received ESWT. The animals were killed at 12 weeks, and the harvested knee specimens were subjected to histopathological examination and immunohistochemical analysis. Radiographs of the knees were obtained at 0 and 12 weeks. At 12 weeks, radiographs of group II showed more arthritic changes with formation of osteochondral fragments, whereas very subtle arthritis was noted in groups I and III. In histopathological examination, group II showed a significant increase of Mankin score and a decrease of subchondral bone as compared to groups I and III. Group III showed a significant decrease of Mankin score and an increase of subchondral bone, with the data comparable to group I. In immunohistochemical analysis, group II showed significant increases of DKK-1 and MMP13 and decreases of Wnt-5a and \\upbeta -catenin in articular cartilage and subchondral bone as compared to groups I and III. Group III showed significant decreases of DKK-1 and MMP13 and increases of Wnt-5a and \\upbeta -catenin, with the data comparable to group I. In conclusion, the application of ESWT causes molecular changes that are consistent with the improvement in subchondral bone remodeling and chondroprotective effect in ACLT OA knees in rats.

  2. [Extracorporeal shock-wave lithotripsy of a salivary stone].

    PubMed

    Iro, H; Schneider, T; Nitsche, N; Waitz, G; Marienhagen, J; Ell, C

    1990-01-01

    Ultrasonography revealed a 12 mm concrement in the left parotid duct of a 67-year-old man with an acute exacerbation of a left-sided purulent parotitis. After the acute phase had subsided under antibiotic therapy it was not possible to remove the stone either by bougie or cutting into the duct close to the papilla. Piezoelectric shockwave lithotripsy with a total of 1000 shock-waves fragmented the stone, and sonography 48 hours and four weeks later demonstrated that the parotid gland was free of stone.

  3. Numerical Simulation of Low-Density Shock-Wave Interactions

    NASA Technical Reports Server (NTRS)

    Glass, Christopher E.

    1999-01-01

    Computational Fluid Dynamics (CFD) numerical simulations of low-density shock-wave interactions for an incident shock impinging on a cylinder have been performed. Flow-field density gradient and surface pressure and heating define the type of interference pattern and corresponding perturbations. The maximum pressure and heat transfer level and location for various interaction types (i.e., shock-wave incidence with respect to the cylinder) are presented. A time-accurate solution of the Type IV interference is employed to demonstrate the establishment and the steadiness of the low-density flow interaction.

  4. Computation of sharp-fin-induced shockwave/turbulent boundary layer interactions

    NASA Technical Reports Server (NTRS)

    Horstman, C. C.

    1986-01-01

    Solutions of the Reynolds-averaged Navier-Stokes equations are presented and are compared with a family of experimental results for the three-dimensional interaction of a sharp-fin-induced shock wave with a turbulent boundary layer. The solutions predict most of the essential features of the flow fields for various shock-wave strengths. However, some features of the measured flow fields, such as secondary separation and size of the largest separated zones were not accurately computed. The computed flow fields, aided by particle tracing techniques, display a prominent vortical structure which can be correlated with the observed surface phenomena.

  5. [Use of extracorporeal shockwave lithotripsy for kidney calculi].

    PubMed

    Trapeznikova, M F; Dutov, V V

    2004-01-01

    278 patients with coral nephrolithiasis were examined in 1990-2003. Extracorporeal shock-wave lithotripsy was made in 46 (16.5%) patients with 48 coral stones (mean age 48.2 +/- 18.3 years) as a basic treatment. The length of the concrement was 4.9 +/- 1.8 cm, width 3.8 +/- 1.4 cm, a relative area 19.72 +/- 13.01 cm2. All the patients have initially undergone internal drain of the kidney by a catheter (n = 13) or stent (n = 33). Each lithotripsy session included, on the average, 2882 +/- 318 impulses (17-19 kV). The number of high-energy impulses per a session comprised 342 +/- 23. A total number of the sessions reached 3.4 +/- 1.55. Initial destruction of the concrement requires 1.6 +/- 0.6 sessions in 10144 +/- 1081.2 impulses per one patient including 1436 +/- 96.6 high-energy impulses. One procedure comprises 2-3 sessions of lithotripsy with a 5-7 day interval. The results were assessed at discharge after the first session and 6 months later, the degree of stones elimination from the kidney, complications, manipulations to manage the complications. At discharge after 3 lithotripsy sessions recovery was achieved only in 3 out of 46 (6.52%) patients. Six months later the fragments eliminated in 26.1% (12 of 46 patients). Monolithotripsy caused complications in 13 patients. Additional manipulations made up 65.2%. Inefficacy of explorative treatment necessitated conversion to open intervention in 6 (13.1% 0 patients. The use of extracorporeal lithotripsy as a monotherapy in coral nephrolithiasis is now limited.

  6. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study.

    PubMed

    Sørlie, Tore; Nergård, Jens-Ivar

    2005-06-01

    Treatment, treatment satisfaction and recovery in Saami and Norwegian patients treated in a psychiatric hospital were compared. Although half of the Saami patients preferred to speak Saami with their therapists, only one patient did. The extensive use of traditional helpers was only partly recognized. Despite no differences in type and amount of treatment or symptom-change during the hospital stay, the Saami patients showed less satisfaction with all investigated treatment parameters including contact with staff, treatment alliance, information and global treatment satisfaction. There was less agreement between the ratings of the therapists and the Saami patients. Suggestions for improvements are made.

  7. [Extracorporeal shockwave lithotripsy in children. Complications and long-term results].

    PubMed

    Gschwend, J E; Paiss, T; Gottfried, H W; Hautmann, R E

    1995-07-01

    ESWL of urinary stones is a well-established treatment in adult patients. The treatment of urinary stones in children has gained increasing importance in recent years. From 1987 to 1993, a series of 27 children with urolithiasis in all parts of the urinary tract were treated by ESWL. Treatment was performed with general anaesthesia or analgosedation. During the treatment no complications occurred. On average, 34 sessions of ESWL, with 2165 shockwaves and 22.3 kV energy, were performed. Minor early complications, such as fever, pain and hydronephrosis, were observed in 7 patients. The overall stone clearance rate was 92%. Stone recurrence occurred in only 1 patient. There were no late complications, such as malfunction of the kidney, skeletal deformation or hypertension after 38 months of follow up. In conclusion, ESWL is the treatment of first choice in paediatric urolithiasis.

  8. Cavitation in ultrasound and shockwave therapy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim

    2014-11-01

    Acoustic waves, especially high-intensity ultrasound and shock waves, are used for medical imaging and intra- and extra-corporeal manipulation of cells, tissue, and urinary calculi. Waves are currently used to treat kidney stone disease, plantar fasciitis, and bone nonunion, and they are being investigated as a technique to ablate cancer tumors and mediate drug delivery. In many applications, acoustic waves induce the expansion and collapse of preexisting or newly cavitating bubbles whose presence can either mediate the generation of localized stresses or lead to collateral damage, depending on how effectively they can be controlled. We describe efforts aimed at simulating the collapse of bubbles, both individually and in clusters, with the aim to characterize the induced mechanical stresses and strains. To simulate collapse of one or a few bubbles, compressible Euler and Navier-Stokes simulations of multi-component materials are performed with WENO-based shock and interface capturing schemes. Repetitive insonification generates numerous bubbles that are difficult to resolve numerically. Such clouds are also important in traditional engineering applications such as caveating hydrofoils. Models that incorporate the dynamics of an unresolved dispersed phase consisting of the bubble cloud are also developed. The results of several model problems including bubble collapse near rigid surfaces, bubble collapse near compliant surfaces and in small capillaries are analyzed. The results are processed to determine the potential for micron-sized preexisting gas bubbles to damage capillaries. The translation of the fundamental fluid dynamics into improvements in the design and clinical application of shockwave lithotripters will be discussed. NIH Grant PO1-DK043881.

  9. Can aspirin prevent gallstone recurrence after successful extracorporeal shockwave lithotripsy?

    PubMed

    Adamek, H E; Buttmann, A; Weber, J; Riemann, J F

    1994-04-01

    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. There is considerable evidence that aspirin prevents cholesterol gallstone formation in animal models and may prevent gallstone recurrence in man. We attempted to clarify the risk of gallstone recurrence after successful piezoelectric lithotripsy in patients taking either low-dose aspirin or no medication. The first 45 patients shown to be completely free from stones after ESWL were randomized into two groups. One group received 100 mg aspirin daily; the other group did not receive any further medical therapy. Patients were further examined on an average of 19.6 months and 21.9 months, respectively. In the aspirin group the recurrence rate was 18.2%, whereas 21.7% of the patients in the control group developed recurrent stones. Seventy-eight per cent of these patients also had a recurrence of biliary pain. By life-table analysis we had, after a follow-up period of 24 months, a stone recurrence rate of 25% (+/- 11) in the aspirin group and 34% (+/- 14) in the control group. Our results indicate that recurrence prophylaxis remains one of the central questions in ESWL. In this preliminary study, 100 mg of aspirin daily was not able to reduce the recurrence rate after successful ESWL. Further studies will have to show whether higher doses of aspirin or other ways of preventing gallstone after ESWL are possible.

  10. [Extracorporeal shock-wave lithotripsy in polycystic kidneys].

    PubMed

    Martínez Sarmiento, M; Broseta Rico, E; Sanz Chinesta, S; García Reboll, L; Martín Abad, L; Jiménez Cruz, J F

    1994-01-01

    Presentation of 6 cases (8 renal units) of lithiasis in polycystic kidneys treated with extracorporeal shockwave lithotrity (ESWL). One patient required puncture of a compressing cyst, prior to ESWL, to facilitate the stones removal. No complications were seen in any of the cases. Therefore, stones in polycystic kidneys can be safely and effectively treated by ESWL.

  11. The complications of extracorporeal shockwave lithotripsy: management and prevention.

    PubMed

    Coptcoat, M J; Webb, D R; Kellett, M J; Fletcher, M S; McNicholas, T A; Dickinson, I K; Whitfield, H N; Wickham, J E

    1986-12-01

    Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.

  12. Root cause analysis following nephrectomy after extracorporeal shockwave lithotripsy (ESWL).

    PubMed

    Cahill, Katie; Cruz, Eneida; Guilbert, Mary Beth; Oser, Meg O'Toole

    2008-12-01

    An adverse event after a routine extracorporeal shockwave lithotripsy procedure set into motion a root cause analysis methodology to decipher why and how the event occurred and offer a solution to prevent it from happening again. The process of performing a root cause analysis is discussed in detail.

  13. Influence of shockwave profile on ejection of micron-scale material from shocked Sn surfaces: an experimental study

    SciTech Connect

    Zellner, Michael B; Byers, Mark E; Hammerberg, James E; Germann, Tim C; Dimonte, Guy; Rigg, Paulo A; Buttler, William T

    2009-01-01

    This effort experimentally investigates the relationship between shock-breakout pressure and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of Sn targets shocked with a supported shockwave. The results are compared with an analogous set derived from HE shocked Sn targets, Taylor shockwave loading. The supported shock-pulse was created by impacting a Sn target with a Ti64 (Ti-6Al-4V) impactor that was accelerated using a powder gun. Ejecta production at the free-surface or back-side of the Sn targets were characterized through use of piezoelectric pins and Asay foils, and heterodyne velocimetry verified the time of shock release and the breakout pressure.

  14. Comparative Review of the Treatment Methodologies of Carotid Stenosis

    PubMed Central

    Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

    2015-01-01

    The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

  15. Effects of high-energy shockwaves on normal human fibroblasts in suspension.

    PubMed

    Kaulesar Johannes, E J; Sukul, D M; Bijma, A M; Mulder, P G

    1994-12-01

    To gain insight in the effects of shockwaves on human cells the relationship between the energy density and the number of shockwaves as well as their effect on suspensions of normal cells was studied. At energy densities of 0.37, 0.6, 0.78, and 1.20 mJ/mm2 fibroblasts were subjected to 50, 100, 250, 500, and 1,000 shockwaves. Each test was performed three times and one sample was used as control. A decrease in viability related to the logarithm of both the number (P = 0.0000) and the energy density (P = 0.001) of the shockwaves was statistically demonstrable 1 hr after the shockwave application. The energy density of the shockwaves has less influence on the viability than the number of applied shockwaves. Seeding of viable cells 1 hr after the shockwave application showed that the decrease in the 48-hr growth potential was statistically dependent of the number of applied shockwaves only (P = 0.0007). After 24 hr no difference in the 48-hr growth potential could be demonstrated between viable shockwave-treated cells and control cells. The literature as well as our own investigations in vitro and in vivo indicate that shockwaves have a logarithmic dose-dependent destructive effect on cells in suspension, but they also seem to have a dose-dependent stimulating influence on the healing process in damaged tissues. Due to the logarithmic relationship between the viability and both the number and energy density of the applied shockwaves it might be expected that even excessive numbers of high-energy-density shockwaves don't soon lead to total destruction of all cells in the suspension.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Piezoelectric shockwave lithotripters: differences in fragmentation efficiency in vitro.

    PubMed

    Schneider, H T; Weisshaar, E; Anderegg, A; Delmont, J P; Benattar, J M; Coendoz, S; Ell, C

    1993-05-01

    In a comparative assessment of the stone fragmentation efficacy of different piezoelectric lithotripters 72 human gallstones consisting of 24 sets of 3 stones each were disintegrated in vitro using the Piezolith 2300, the EDAP LT.01, and the Therasonic. On the basis of the maximum diameter the calculi were divided into group A (6-15 mm; n = 3 x 16) and group B (16-25 mm; n = 3 x 8) and were treated by using the maximum energy setting of each lithotripter (Piezolith 2300: setting 4, high power; EDAP LT.01: 95%; Therasonic: setting 7). Shockwave application was terminated when the residual fragments measured < or = 4 mm or after a total number of 6000 pulses. With the Piezolith 2300 all calculi could be disintegrated into fragments < or = 4 mm. In contrast, fragmentation was not successful, even after 6000 applied pulses, in the case of 2 and 6 stones when using EDAP LT.01 and the Therasonic lithotripters, respectively. With the remaining concrements of group A (n = 3 x 11) the fragmentation end point was achieved after a lower number of pulses when the Piezolith 2300 (median, 250 pulses; range, 50-500 pulses) was used than with the EDAP LT.01 (1000; 150-2500; p < 0.01) and the Therasonic lithotripters (2750; 750-5500; p < 0.01). Similar results were obtained for group B (n = 3 x 6): the Piezolith 2300 required fewer pulses (200; 100-1250) than the EDAP LT.01 (1000; 500-1000; p < 0.05) and the Therasonic (2000, 500-4000; p < 0.05) units.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Comparing Biofouling Control Treatments for Use on Aquaculture Nets

    PubMed Central

    Swain, Geoffrey; Shinjo, Nagahiko

    2014-01-01

    Test panels comprised of uncoated, copper coated and silicone coated 7/8'' (22 mm) mesh knitted nylon net were evaluated to compare their properties and the effectiveness to prevent biofouling. This paper describes test procedures that were developed to quantify the performance in terms of antifouling, cleanability, drag and cost. The copper treatment was the most effective at controlling fouling, however, the silicone treated nets were the easiest to clean. The drag forces on the net were a function of twine diameter, twine roughness and fouling. After immersion, the uncoated nets had the most drag followed by the silicone and copper treatments. The cost of applying silicone to nets is high; however, improved formulations may provide a non-toxic alternative to control fouling. PMID:25474085

  18. Comparing biofouling control treatments for use on aquaculture nets.

    PubMed

    Swain, Geoffrey; Shinjo, Nagahiko

    2014-12-02

    Test panels comprised of uncoated, copper coated and silicone coated 7/8'' (22 mm) mesh knitted nylon net were evaluated to compare their properties and the effectiveness to prevent biofouling. This paper describes test procedures that were developed to quantify the performance in terms of antifouling, cleanability, drag and cost. The copper treatment was the most effective at controlling fouling, however, the silicone treated nets were the easiest to clean. The drag forces on the net were a function of twine diameter, twine roughness and fouling. After immersion, the uncoated nets had the most drag followed by the silicone and copper treatments. The cost of applying silicone to nets is high; however, improved formulations may provide a non-toxic alternative to control fouling.

  19. Large-Eddy Simulation of Shock-Wave Boundary Layer Interaction and its Control Using Sparkjet

    NASA Astrophysics Data System (ADS)

    Yang, Guang; Yao, Yufeng; Fang, Jian; Gan, Tian; Lu, Lipeng

    2016-06-01

    Large-eddy simulation (LES) of an oblique shock-wave generated by an 8° sharp wedge impinging onto a spatially-developing Mach 2.3 turbulent boundary layer and their interactions has been carried out in this study. The Reynolds number based on the incoming flow property and the boundary layer displacement thickness at the impinging point without shock-wave is 20,000. The detailed numerical approaches are described and the inflow turbulence is generated using the digital filter method to avoid artificial temporal or streamwise periodicity. Numerical results are compared with the available wind tunnel PIV measurements of the same flow conditions. Further LES study on the control of flow separation due to the strong shock-viscous interaction is also conducted by using an active control actuator “SparkJet” concept. The single-pulsed characteristics of the control device are obtained and compared with the experiments. Instantaneous flowfield shows that the “SparkJet” promotes the flow mixing in the boundary layer and enhances its ability to resist the flow separation. The time and spanwise averaged skin friction coefficient distribution demonstrates that the separation bubble length is reduced by maximum 35% with the control exerted.

  20. Extracorporeal shockwave therapy for plantar fasciitis and other musculoskeletal conditions utilizing the Ossatron--an update.

    PubMed

    Wilner, Joel M; Strash, Walter W

    2004-07-01

    Extracorporeal shockwave therapy for treatment of plantar fasciitis and other areas of the body has been well documented since the early 1990s. A high level of efficacy and patient satisfaction after undergoing electrohydraulic shock wave treatments has been reported not only for plantar fasciopathy but other musculoskeletal indications. Electrohydraulic devices have a bimodal response: early suppression of nocioceptor reactivity followed by subsequent target tissue remodeling and healing through neovascularization and recruitment of new tissue target specific cells. Both responses are not present with low energy electromagnetic devices. The focus of this article is treatment of chronic proximal plantar fasciitis; however, other pathologies of the lower extremity demonstrate great promise for this emerging technology.

  1. Piezolith extracorporeal shockwave lithotripsy: the Hotel-Dieu de France experience.

    PubMed

    Merhej, S; Nemr, E; Armache, K; Chalouhy, E; Chaiban, R; Moukarzel, M; Khoury, R

    1994-10-01

    A total of 1500 patients underwent treatment with the Wolf Piezolith 2300 extracorporeal shockwave lithotripter for renal, ureteral, and bladder stones. Follow-up data were available at 3 months for 1435 patients. At that time, the overall stone-free rate was 82.7%: 82.4% for patients with renal stones, 81.0% for those with ureteral stones, and 100% for those with bladder stones. The overall success rate was 92.3%: 93.8% for patients with renal stones, 87.1% for those with ureteral stones, and 100% for those with bladder stones. The auxiliary treatment rate was 14.9%, and the retreatment rate was 53%. The effectiveness quotient was 49.2%. The Wolf Piezolith 2300 is an effective treatment for most stones smaller than 30 mm.

  2. Working mechanism of extracorporeal shockwave therapy in non-urological disciplines

    NASA Astrophysics Data System (ADS)

    Schaden, Wolfgang

    2005-04-01

    For 32 years of extracorporeal shockwave lithotripsy (ESWL) only the mechanical strength of shockwaves were of clinical interest. For use in orthopaedics, the absence of dangerous long term effects (malignant degeneration, etc.) is the only important message. The mechanical model tries to explain the effect of shock waves by the provocation of microleasions in the tissue stimulating repairing processes. First doubts on this mechanical model came up when Schaden (2001) could show, that less energy is more efficient in the treatment of non-unions. Due to the basic research of the last years knowledge increased about the microbiological effects. Under the influence of shock waves the change of permeability of cell membranes and the liberation of free radicals was reported. Also the production of nitric oxide (NO) and different growth factors like vascular endothelial growth factor (VEGF), bone morphogenetic proteins (BMP), transforming growth factor-beta 1 (TGF-b1), insulin-like growth factor-I (IGF-I) etc. was observed. The biological model tries to explain the effect of shock waves by stimulating the ingrowth of blood vessels and liberation of growth factors. Under the influence of shock waves, biological tissues seem to be able to produce important substances to initiate healing processes.

  3. Safety of ipsapirone treatment compared with lorazepam: discontinuation effects.

    PubMed Central

    Busto, U E; Naranjo, C A; Bremner, K E; Peachey, J E; Bologa, M

    1998-01-01

    OBJECTIVE: To determine discontinuation effects of ipsapirone, a novel azapirone and partial 5-HTIA agonist that has anxiolytic effects clinically and has not caused dependence or withdrawal symptoms in animals, and to compare these effects with those of the benzodiazepine lorazepam, owing to concern about dependence or withdrawal symptoms following use of these drugs. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Outpatient and inpatient treatment. PARTICIPANTS: Sixty-five healthy male volunteers who had experience with sedative-hypnotics or anxiolytics and did not meet DSM-III-R criteria for abuse or dependence. INTERVENTIONS: Participants were randomized to receive ipsapirone 15 mg per day (n = 17), ipsapirone 22.5 mg per day (n = 16), lorazepam 3 mg per day (n = 16), or placebo (n = 16) as outpatients for 36 days (treatment) followed by single-blind placebo as inpatients for 3 days and as outpatients for 6 days (withdrawal). OUTCOME MEASURES: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Spielberger State Anxiety Scale, Sleep Quality Questionnaire, General Symptom Checklist, self-rated intoxication, Clinical Institute Withdrawal Assessment--Benzodiazepines (CIWA-Benzo), psychomotor testing and urine drug screen. RESULTS: Only 45 subjects completed the study; discontinuation rates did not significantly differ among treatment groups. At day 39, fewer and less severe symptoms (e.g., insomnia and fatigue) were found on the CIWA-Benzo scale after treatment with ipsapirone or placebo than after treatment with lorazepam (p < 0.05). Subjects reported longer sleep latency and poorer sleep quality after receiving lorazepam than after receiving ipsapirone or placebo. Scores on the HAM-D, Spielberger State Anxiety and HAM-A scales did not change from baseline. CONCLUSIONS: Withdrawal symptoms were detected after discontinuation of therapeutic doses of lorazepam. Significantly fewer symptoms were observed after

  4. Independent evaluator knowledge of treatment in a multicenter comparative treatment study of panic disorder.

    PubMed

    Roll, David; Ray, Susan E; Marcus, Sue M; Passarelli, Vincent; Money, Roy; Barlow, David H; Woods, Scott W; Shear, M Katherine; Gorman, Jack M

    2004-03-01

    The purpose of this study was to examine independent evaluators' (IEs) blindness to treatment condition during a Multicenter Comparative Treatment Study of Panic Disorder. IEs were 15 doctoral- and masters-level clinicians in psychology, social work, and medicine. They conducted three post-treatment assessments with each patient. Immediately after each assessment interview, IEs completed a form indicating which of the five possible treatments they believed the patient had received and any specific information that provided IEs with information about a patient's treatment condition. These forms were completed for 170 patients. Analyses were conducted to determine the accuracy of guesses about treatment condition by IEs during post-treatment assessments, the relationship between accuracy of IE guessing and actual treatment assignment, the relationship between accurate guessing and outcome ratings, and contributors to the breaking of the blind. A significant relationship was found between IE guesses and actual treatment at all three assessment points, across individual IEs, treatment sites, and IE professional affiliations. IEs were no more accurate in their guessing about patients taking medication than those receiving behavior therapy. Patients and project staff inadvertently provided information to IEs that enhanced the rates of accurate guessing. Implications of these findings on interpretation of the treatment study are discussed, and recommendations are made for improving blindness procedures.

  5. Extracorporeal shockwave therapy for Peyronie's disease does not correct penile deformity.

    PubMed

    Strebel, R T; Suter, S; Sautter, T; Hauri, D

    2004-10-01

    To evaluate whether extracorporeal shockwave therapy (ESWT) offers an effective treatment for the main complications of Peyronie's disease (PD), that is, penile deformity and angulation, painful erection and most importantly unsatisfied sexual intercourse. From September 1999 to January 2001, 52 patients with PD were treated with ESWT. Pain during erection was assessed with a visual analogue scale. Penile deviation was determined by photographs with a goniometer. Five treatment sessions were performed at weekly intervals. Each consisted of 3000 shockwaves with an emission frequency of 120 shockwaves/min and a mean intensity of 0.17 mJ/mm(2). A Storz Minilith SL 1 with integrated inline ultrasound probe was used. In all, 52 patients were evaluated 6 weeks after ESWT for early follow-up. Before ESWT intercourse was difficult or impossible for 40 men; 29 patients suffered mainly from penile deformity, 14 from painful erection and eight mainly from loss of distal rigidity. A total of 30 patients mentioned painful erection before treatment. In 28 patients (93%) pain reduction was achieved. A total relief of pain was observed in 19 patients (63%). Mean pain score dropped from 4.2 to 1.3 in patients who suffered predominantly from painful erections. Intercourse satisfaction improved in 11 patients after therapy. Mean angulation before (40 degrees ) and after (37 degrees ) ESWT did not change significantly. Late follow-up after 11.1 months (4-17 months) could be completed in 36 patients. In total, 19 men reported that ESWT improved their PD. Of these, 16 noted no change. Only one of the patients noticed a worsening of his disease during or after treatment. Complication rate was low with only minor side effects such as minimal skin bruising; one urethral bleeding occurred. ESWT did reduce pain during erection in patients suffering mainly from painful erection due to PD. However, penile angulation did not improve significantly in our setup and thus intercourse difficulties

  6. Indirect Estimation of the Comparative Treatment Effect in Pharmacogenomic Subgroups

    PubMed Central

    Sorich, Michael J.; Coory, Michael; Pekarsky, Brita A. K.

    2013-01-01

    Evidence of clinical utility is a key issue in translating pharmacogenomics into clinical practice. Appropriately designed randomized controlled trials generally provide the most robust evidence of the clinical utility, but often only data from a pharmacogenomic association study are available. This paper details a method for reframing the results of pharmacogenomic association studies in terms of the comparative treatment effect for a pharmacogenomic subgroup to provide greater insight into the likely clinical utility of a pharmacogenomic marker, its’ likely cost effectiveness, and the value of undertaking the further (often expensive) research required for translation into clinical practice. The method is based on the law of total probability, which relates marginal and conditional probability. It takes as inputs: the prevalence of the pharmacogenomic marker in the patient group of interest, prognostic effect of the pharmacogenomic marker based on observational association studies, and the unstratified comparative treatment effect based on one or more conventional randomized controlled trials. The critical assumption is that of exchangeability across the included studies. The method is demonstrated using a case study of cytochrome P450 (CYP) 2C19 genotype and the anti-platelet agent clopidogrel. Indirect subgroup analysis provided insight into relationship between the clinical utility of genotyping CYP2C19 and the risk ratio of cardiovascular outcomes between CYP2C19 genotypes for individuals using clopidogrel. In this case study the indirect and direct estimates of the treatment effect for the cytochrome P450 2C19 subgroups were similar. In general, however, indirect estimates are likely to have substantially greater risk of bias than an equivalent direct estimate. PMID:24015225

  7. [Extracorporeal shockwave crushing of gallstones. Preliminary report].

    PubMed

    Brøns, J H; Damgaard, B; Rasmussen, S G; Juul, N; Højgaard, L; Kehlet, H; Krag, E; Matzen, P; Stage, J G; Stage, P

    1991-01-28

    Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of symptomatic x-ray negative stones in 23 patients. The number of ESWL sessions per patient was 1.8 (range 1-4). In 18 patients (78%), adequate fragmentation was seen comparable to results obtained elsewhere. Oral bile acid therapy was used after ESWL in the 18 patients mentioned and the mean follow-up period was five months (range 3-8 months). Four patients had by now passed all stones while 12 patients still had remaining stone fragments and one patient a gallstone. After ESWL, one patient was and one patient a gallstone. After ESWL, one patient was referred for cholecystectomy at his own request. Of the remaining five patients, cholecystectomy was performed in two and was scheduled for in three. Complications after ESWL were seen in two patients who developed acute pancreatitis. Thus, our preliminary experience shows that ESWL resulted in fragmentation and passing of gallbladder stones, but not without complications. Like the gallstone groups in Lyon, Montreal and Munich we are convinced that ESWL should be performed in accordance with prospectively designed protocols in order to establish optimal planning of indications and strategies for future treatment.

  8. [Gd-DTPA-supported magnetic resonance tomographic perfusion follow-up of shockwave-treated tumors].

    PubMed

    Naegele, M; Goetz, A E; Gamarra, F; Lumper, W; Conzen, P F; Hahn, D; Brendel, W; Lissner, J

    1989-05-01

    The signal characteristics of 14 shockwave-treated and 14 solid control tumors were studied before and after injection of Gd-DTPA in an animal model. T1-weighted images of shockwave-treated tumors documented no significant signal intensity increase after contrast media injection in comparison with the untreated control tumors. The reduction of perfusion in shockwave-treated tumors can be documented in vivo by the signal intensity changes of the tumors after contrast media injection.

  9. [Extracorporeal shockwave lithotripsy of stones in lower calices of kidney].

    PubMed

    Martov, A G; Peniukova, I V; Moskalenko, S A; Peniukov, V G; Peniukov, D V; Balykov, I S

    2013-01-01

    The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74.4%) patients. Residual stone fragments (> or = 5 mm) were identified in 73 (25.6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P = 0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p = 0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a

  10. Experience with 500 extracorporeal shockwave lithotripsy patients using a low-cost unit: the "Econolith".

    PubMed

    Simon, D

    1995-06-01

    The Econolith (Medispec Ltd.) is a modular extracorporeal shockwave (SWL) system that uses the spark gap as its source for lithotripsy. In this study, the immediate and late results and complications in 500 patients (640 treatments) treated with this machine during the last 2 years were summarized. An average fragmentation rate of 86% was achieved after the first treatment. A stone-free situation at 3 months was achieved in 75% of the cases; 18% had small (< 5mm) fragments, and 7% had larger fragments. Auxiliary procedures were required in 8% of the patients. Minor complications such as hematuria, colic, and urinary tract infection were seen in 6% of the patients. The Econolith system is safe and effective. Its mobility and low cost enable any urologist to use this technology even with a low monthly turnover of patients.

  11. Electrohydraulic extracorporeal non-water bath shock-wave lithotripsy of gallstones: two years' experience.

    PubMed

    Frick, T W; Hoffmann, R; Schlumpf, R; Largiadèr, F

    1991-01-01

    A prospective study was performed to evaluate the effectiveness of extracorporeal shockwave lithotripsy (ESWL) using a non-water bath lithotripter in combination with oral chemolitholysis on gallstone clearance. Patients were treated without general anesthesia or parenteral analgesia. We treated 74 patients selected according to the widely accepted criteria. Only 2 patients could not be sufficiently treated because of pain. After a 2 year period, 24 (32%) patients showed complete stone clearance, 35 (47%) patients had residual fragments, 5 (7%) patients underwent cholecystectomy, 2 (3%) patients were lost to follow up, and 8 (11%) patients discontinued the treatment before fragment clearance. According to the life-table estimate, 77% of our patients with successful ESWL and uncomplicated oral chemolitholysis are stonefree after 1 year. We consider the major advantage of this nonsurgical treatment of gallstone disease is that general anesthesia or parenteral analgesia has become unnecessary.

  12. [Experience with extracorporeal shockwave lithotripsy based on 5 years' clinical use].

    PubMed

    Chaussy, C; Fuchs, G

    1985-11-01

    After 6 years of experimental research at the Departments of Urology and Surgical Research of the Ludwig-Maximilian University in Munich, extracorporeal shock-wave lithotripsy (ESWL) was introduced into clinical use in 1980. Uniquely successful and increasingly requested by stone patients, the method soon became widespread. Currently more than 70 lithotriptors are in operation worldwide and over 30,000 treatments have been carried out successfully. Clinical experience in all centers has proved the safety, reliability and reproducibility of the method. Currently, approximately 70% of nonselected stone patients are eligible to receive ESWL treatment and, when combined with endourological procedures, more than 95% of patients can benefit from this method and thus avoid open surgery.

  13. Extracorporeal shockwave lithotripsy for urinary calculi in autosomal dominant polycystic kidney disease.

    PubMed

    Delakas, D; Daskalopoulos, G; Cranidis, A

    1997-06-01

    Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder. Renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Thirteen patients with ADPKD and symptomatic or obstructive renal stones presented to our hospital for evaluation and treatment with extracorporeal shockwave lithotripsy (SWL). A total of 16 renal units were treated. The auxiliary procedures included placement of a double-J stent in nine kidneys when the stone was larger than 8 mm in diameter. Eleven patients (85%) were stone free 3 months after lithotripsy; a second treatment was necessary in two patients. We conclude that SWL can be used as a primary management tool for renal stones in patients with ADPKD.

  14. Original lithotomy positioning for transperineal extracorporeal shockwave lithotripsy for distal ureteric calculi with Tripter X1.

    PubMed

    Andrianne, R; Vandeberg, C; Bonnet, P; Nicolas, H; Coppens, L; Bouffioux, C; de Leval, J

    1992-01-01

    Extracorporeal shockwave lithotripsy (ESWL) has been initially designed for stones located in the kidney and the upper ureter. Our lithotripter is no exception. Its components (the table and the orientation of the semi-ellipsoid reflector) are adapted for the treatment of kidney or lumbar ureter stones. However, the elements forming the unit of treatment (the table, the C-arm and the Tripter) can be modified in such a way that focalization of stones of the lower ureter becomes possible through a perineal exposure. The aim is to avoid the pelvic bone shield while a good focalization of the stone is realized. From June 1989 to March 1991, 35 patients were treated for distal ureteric stones by ESWL in this original positioning.

  15. In situ extracorporeal shockwave lithotripsy of distal ureteral stones: parameters for therapeutic success.

    PubMed

    Mattelaer, P; Schröder, T; Fischer, N; Jakse, G

    1994-01-01

    Between January and December 1989, 123 patients with distal ureteral stones were treated with in situ extracorporeal shockwave lithotripsy (ESWL) using a modified HM3 Dornier lithotriptor. One hundred and three patients (83.7%) were stone-free, 20 patients (16.3%) had small residual stones (< 1 mm2) that passed spontaneously. In situ ESWL treatment alone was successful in 88 of the 103 stone-free patients (85.4%). Fifty-six (54.4%) needed 1 ESWL session, 26 (25.2%) needed 2 ESWL sessions. Nineteen of the 123 patients (15.4%) needed auxiliary endourological measures. The results of ESWL treatment were correlated to pretherapeutically identified parameters such as stone size, radiopacity, outer contour, shape, inner structure, biochemical analysis of the stones and grade of dilatation of the upper urinary tract. The results prove that size (> or = 75 mm2), radiopacity and grade of dilatation have a direct correlation to the difficulty to disintegrate ureteral stones.

  16. [Extracorporeal shockwave lithotripsy for upper urinary tract stone].

    PubMed

    Lechevallier, E; Traxer, O; Saussine, C

    2008-12-01

    Extracorporeal shockwave lithotripsy (ESWL) is the fragmentation of stone by means of acoustic shockwaves created by an extracorporeal source. ESWL brakes the stone by spallation and squeezing. The optimal frequency for fragmentation is 1Hz. The initial power must be low, then progressively increased during the session. The contra-indications for ESWL are pregnancy, major deformities, severe obesity, aortic aneurism, uncontrolled coagulation disorders, untreated urinary infection, cardiac pacemaker. A stone density of 1000UH is a risk factor for fragmentation failure. The success rate for the kidney and the ureter is 60-80% and 80%, respectively. Stone clearance may be facilitated by alpha blockers. Asymptomatic and non-infected residual fragments less than 4mm must be followed-up annually.

  17. Mesoscale simulations of shockwave energy dissipation via chemical reactions

    NASA Astrophysics Data System (ADS)

    Antillon, Edwin; Strachan, Alejandro

    2015-02-01

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials that undergo volume-reducing chemical reactions under shockwave-loading conditions. We find that such chemical reactions can attenuate the shockwave and characterize how the parameters of the chemical model affect this behavior. The simulations show that the magnitude of the volume collapse and velocity at which the chemistry propagates are critical to weaken the shock, whereas the energetics in the reactions play only a minor role. Shock loading results in transient states where the material is away from local equilibrium and, interestingly, chemical reactions can nucleate under such non-equilibrium states. Thus, the timescales for equilibration between the various degrees of freedom in the material affect the shock-induced chemistry and its ability to attenuate the propagating shock.

  18. Mesoscale simulations of shockwave energy dissipation via chemical reactions.

    PubMed

    Antillon, Edwin; Strachan, Alejandro

    2015-02-28

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials that undergo volume-reducing chemical reactions under shockwave-loading conditions. We find that such chemical reactions can attenuate the shockwave and characterize how the parameters of the chemical model affect this behavior. The simulations show that the magnitude of the volume collapse and velocity at which the chemistry propagates are critical to weaken the shock, whereas the energetics in the reactions play only a minor role. Shock loading results in transient states where the material is away from local equilibrium and, interestingly, chemical reactions can nucleate under such non-equilibrium states. Thus, the timescales for equilibration between the various degrees of freedom in the material affect the shock-induced chemistry and its ability to attenuate the propagating shock. PMID:25725713

  19. Mesoscale simulations of shockwave energy dissipation via chemical reactions.

    PubMed

    Antillon, Edwin; Strachan, Alejandro

    2015-02-28

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials that undergo volume-reducing chemical reactions under shockwave-loading conditions. We find that such chemical reactions can attenuate the shockwave and characterize how the parameters of the chemical model affect this behavior. The simulations show that the magnitude of the volume collapse and velocity at which the chemistry propagates are critical to weaken the shock, whereas the energetics in the reactions play only a minor role. Shock loading results in transient states where the material is away from local equilibrium and, interestingly, chemical reactions can nucleate under such non-equilibrium states. Thus, the timescales for equilibration between the various degrees of freedom in the material affect the shock-induced chemistry and its ability to attenuate the propagating shock.

  20. Extracorporeal shockwave lithotripsy for lower pole calculi smaller than one centimeter.

    PubMed

    Chaussy, Christian; Bergsdorf, Thorsten

    2008-10-01

    Extracorporeal shockwave lithotripsy (ESWL) has revolutionized the treatment of urinary calculi and became the accepted standard therapy for the majority of stone patients. Only for stones located in the lower calix, ESWL displayed a limited efficacy. Since the stone-free rate seemed to be preferential, endoscopic maneuvers like percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) have been proposed as the primary approach for this stone localization.Stone size seems to be the most important parameter in regard to the stone-free rate, whereas anatomical characteristics of the lower pole collecting system are discussed controversial. Various studies show a good stone clearance between 70-84% for stones up to 1 cm in diameter. Additional physical and medical measures are suitable to improve treatment results. Stone remnants after ESWL, defined as clinical insignificant residual fragments (CIRF) will not cause problems in every case and will pass until up to 24 months after treatment; in total 80-90% of all patients will become stone-free or at least symptom-free.When complete stone-free status is the primary goal, follow-up examinations with new radiological technologies like spiral CT show that the stone-free rate of ESWL and endoscopically treated patients (RIRS) does not differ significantly. However, in comparison to endoscopic stone removal, shockwave therapy is noninvasive, anesthesia-free and can be performed in an outpatient setup. Therefore, ESWL remains the first choice option for the treatment of lower caliceal stones up to 1 cm. The patient will definitely favour this procedure.

  1. Raman study of the shockwave effect on collagens.

    PubMed

    Cárcamo, José J; Aliaga, Alvaro E; Clavijo, R Ernesto; Brañes, Manuel R; Campos-Vallette, Marcelo M

    2012-02-01

    The Raman spectra (1800-200 cm(-1)) of isolated dried collagen types I and III were recorded at different times after shockwave (SW) application in aqueous media. SWs were applied in a single session. One week after the SW application the vibrational data analysis indicates changes in the conformation of the collagens; orientational changes are also inferred. During the next three weeks collagens tended to recover the conformation and orientation existing before SW application.

  2. Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy.

    PubMed

    Mark, S D; Gray, J M; Wright, W L

    1990-09-01

    Ancillary procedures associated with extracorporeal shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out-patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.

  3. Towards collisions of inhomogeneous shockwaves in AdS

    NASA Astrophysics Data System (ADS)

    Fernández, Daniel

    2015-07-01

    We perform a numerical simulation of the evolution of inhomogeneities with transverse profile in a collision of gravitational shockwaves in asymptotically anti-de Sitter spacetime. This constitutes a step closer towards an accurate holographic description of the thermalization of a strongly coupled plasma, which can model the dynamics of heavy ion collisions. The results indicate that the considered inhomogeneities typically become hydrodynamical earlier or at the same moment when hydrodynamics applies to the background, even though they decay slowly.

  4. International Shock-Wave Database: Systematization of Experimental Data

    NASA Astrophysics Data System (ADS)

    Levashov, Pavel R.; Khishchenko, Konstantin V.; Lomonosov, Igor V.; Minakov, Dmitry V.; Zakharenkov, Alexey S.

    2011-06-01

    In this work, we announce the creation of the International Shock-Wave Database (ISWDB). Shock-wave and related dynamic material response data serve for calibrating, validating, and improving material models over very broad regions of the pressure-temperature-density phase space. Our objectives are (i) to develop a database on thermodynamic and mechanical properties of materials under conditions of shock wave and other dynamic loadings, selected related quantities of interest, and the meta-data that describes the provenance of the measurements and material models, and (ii) to make this database available internationally thru the Internet, in an interactive form. The development and operation of the ISWDB will be guided by input from a steering committee. The database will be installed on two mirrored web-servers, one in Russia and the other in USA. The database will provide access to original experimental data on shock compression, non-shock dynamic loadings, isentropic expansion, measurements of sound speed in the Hugoniot state, and time-dependent free-surface or window-interface velocity profiles. We believe that the ISWDB will be a useful tool for the shock-wave community.

  5. Comparing epidemiologically estimated treatment need with treatment provided in two dental schemes in Ireland

    PubMed Central

    2012-01-01

    Background Valid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers’ perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn. Methods This paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a ‘free’ service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student’s t-test to compare means between the survey and claims databases. Results Among employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds. Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01). Conclusions Significant differences were found between epidemiologically estimated need and treatment provided

  6. Al 1s-2p absorption spectroscopy of shock-wave heating and compression in laser-driven planar foil

    SciTech Connect

    Sawada, H.; Regan, S. P.; Radha, P. B.; Epstein, R.; Li, D.; Goncharov, V. N.; Hu, S. X.; Meyerhofer, D. D.; Delettrez, J. A.; Jaanimagi, P. A.; Smalyuk, V. A.; Boehly, T. R.; Sangster, T. C.; Yaakobi, B.; Mancini, R. C.

    2009-05-15

    Time-resolved Al 1s-2p absorption spectroscopy is used to diagnose direct-drive, shock-wave heating and compression of planar targets having nearly Fermi-degenerate plasma conditions (T{sub e}{approx}10-40 eV, {rho}{approx}3-11 g/cm{sup 3}) on the OMEGA Laser System [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)]. A planar plastic foil with a buried Al tracer layer was irradiated with peak intensities of 10{sup 14}-10{sup 15} W/cm{sup 2} and probed with the pseudocontinuum M-band emission from a point-source Sm backlighter in the range of 1.4-1.7 keV. The laser ablation process launches 10-70 Mbar shock waves into the CH/Al/CH target. The Al 1s-2p absorption spectra were analyzed using the atomic physic code PRISMSPECT to infer T{sub e} and {rho} in the Al layer, assuming uniform plasma conditions during shock-wave heating, and to determine when the heat front penetrated the Al layer. The drive foils were simulated with the one-dimensional hydrodynamics code LILAC using a flux-limited (f=0.06 and f=0.1) and nonlocal thermal-transport model [V. N. Goncharov et al., Phys. Plasmas 13, 012702 (2006)]. The predictions of simulated shock-wave heating and the timing of heat-front penetration are compared to the observations. The experimental results for a wide variety of laser-drive conditions and buried depths have shown that the LILAC predictions using f=0.06 and the nonlocal model accurately model the shock-wave heating and timing of the heat-front penetration while the shock is transiting the target. The observed discrepancy between the measured and simulated shock-wave heating at late times of the drive can be explained by the reduced radiative heating due to lateral heat flow in the corona.

  7. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  8. Women in addictions treatment: comparing VA and community samples.

    PubMed

    Davis, Tania M; Carpenter, Kelly M; Malte, Carol A; Carney, Molly; Chambers, Sharon; Saxon, Andrew J

    2002-07-01

    Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.

  9. Treatment Acceptability of Alternative Marital Therapies: A Comparative Analysis.

    ERIC Educational Resources Information Center

    Bornstein, Philip H.; And Others

    1983-01-01

    Examined the acceptability of four therapeutic models (i.e., behavioral, psychoanalytic, systems, and eclectic) used in treatment of marital discord. Subjects (N=88) evaluated four treatment sequences as they applied to a marital case history. Results showed that, among varying treatments, behavioral and systems approaches were rated more…

  10. Fertility measures in women after extracorporeal shockwave lithotripsy of distal ureteral stones.

    PubMed

    Erturk, E; Ptak, A M; Monaghan, J

    1997-10-01

    Long-term effects of extracorporeal shockwave lithotripsy (SWL) on female fertility remain a concern. Thirty-nine women of childbearing age who were treated for distal ureteral stones were surveyed. The mean age of these women was 33 years, and the average stone size was 6.9 mm. The mean calculated radiation exposure to the ovaries and the uterus was 7.53 and 10.9 mSv, respectively. Ten women (26%) attempted to become pregnant. No fertility problems were noted in these women, and 11 healthy babies were delivered. These preliminary findings provide further information regarding the safety of SWL in the treatment of distal ureteral stones in women of reproductive age.

  11. Outcome assessment of double-J stents during extracorporeal shockwave lithotripsy of small solitary renal calculi.

    PubMed

    Low, R K; Stoller, M L; Irby, P; Keeler, L; Elhilali, M

    1996-08-01

    The utility of indwelling double-J ureteral stents during extracorporeal shockwave lithotripsy (SWL) of renal calculi is ill defined. We evaluated 179 patients treated with SWL for small (< 20 mm in diameter) solitary renal calculi with (N = 27) or without (N = 152) indwelling ureteral stents. There was no significant difference in the stone-free rates at 1 month (both 52%) and 3 months (61% nonstented group v 67% stented group; P = 0.45) or in the retreatment rates (13.3% nonstented group v 14.8% stented group; P = 0.60). The incidence and severity of pain/renal colic were similar for the two treatment groups. There was minimal morbidity associated with SWL in either group. Placement of double-J stents for the purpose of improving stone-free rates, alleviating pain, or preventing ureteral obstruction in conjunction with SWL of solitary renal calculi < 20 mm in diameter is unnecessary.

  12. Prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy. An assessment of prophylactic epidural blood patching.

    PubMed

    Sengupta, P; Bagley, G; Lim, M

    1989-01-01

    The prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy was investigated by a controlled clinical trial which compared epidural injection of 10 ml of autologous blood with 10 ml of normal saline immediately after intrathecal injection of local anaesthetic. The incidence of postdural puncture headache was 8.3% in the group that received blood compared with 45% in the group that received saline, a significant reduction (p less than 0.01). The incidences of backache and lower limb paraesthesiae were similar in both groups. No serious complications were reported.

  13. Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy.

    PubMed

    Haffner, Nicolas; Antonic, Vlado; Smolen, Daniel; Slezak, Paul; Schaden, Wolfgang; Mittermayr, Rainer; Stojadinovic, Alexander

    2016-07-01

    Tibial non-unions are common cause of demanding revision surgeries and are associated with a significant impact on patients' quality of life and health care costs. Extracorporeal shockwave therapy (ESWT) has been shown to improve osseous healing in vitro and in vivo. The main objective of present study was to evaluate the efficacy of ESWT in healing of tibial non-unions unresponsive to previous surgical and non-surgical measures. A retrospective multivariant analysis of a prospective open, single-centre, clinical trial of tibia non-union was conducted. 56 patients with 58 eligible fractures who met the FDA criteria were included. All patients received 3000-4000 impulses of electrohydraulic shockwaves at an energy flux density of 0.4mJ/mm(2) (-6dB). On average patients underwent 1.9 times (±1.3SD) surgical interventions prior to ESWT displaying the rather negatively selected cohort and its limited therapy responsiveness. In 88.5% of patients receiving ESWT complete bone healing was observed after six months irrespective of underlying pathology. The multivariant analysis showed that time of application is important for therapy success. Patients achieving healing received ESWT earlier: mean number of days between last surgical intervention and ESWT (healed - 355.1 days±167.4SD vs. not healed - 836.7 days±383.0SD; p<0.0001). ESWT proved to be a safe, effective and non-invasive treatment modality in tibial non-unions recalcitrant to standard therapies. The procedure is well tolerated, time-saving, lacking side effects, with potential to significantly decrease health care costs. Thus, in our view, ESWT should be considered the treatment of first choice in established tibial non-unions.

  14. Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy.

    PubMed

    Haffner, Nicolas; Antonic, Vlado; Smolen, Daniel; Slezak, Paul; Schaden, Wolfgang; Mittermayr, Rainer; Stojadinovic, Alexander

    2016-07-01

    Tibial non-unions are common cause of demanding revision surgeries and are associated with a significant impact on patients' quality of life and health care costs. Extracorporeal shockwave therapy (ESWT) has been shown to improve osseous healing in vitro and in vivo. The main objective of present study was to evaluate the efficacy of ESWT in healing of tibial non-unions unresponsive to previous surgical and non-surgical measures. A retrospective multivariant analysis of a prospective open, single-centre, clinical trial of tibia non-union was conducted. 56 patients with 58 eligible fractures who met the FDA criteria were included. All patients received 3000-4000 impulses of electrohydraulic shockwaves at an energy flux density of 0.4mJ/mm(2) (-6dB). On average patients underwent 1.9 times (±1.3SD) surgical interventions prior to ESWT displaying the rather negatively selected cohort and its limited therapy responsiveness. In 88.5% of patients receiving ESWT complete bone healing was observed after six months irrespective of underlying pathology. The multivariant analysis showed that time of application is important for therapy success. Patients achieving healing received ESWT earlier: mean number of days between last surgical intervention and ESWT (healed - 355.1 days±167.4SD vs. not healed - 836.7 days±383.0SD; p<0.0001). ESWT proved to be a safe, effective and non-invasive treatment modality in tibial non-unions recalcitrant to standard therapies. The procedure is well tolerated, time-saving, lacking side effects, with potential to significantly decrease health care costs. Thus, in our view, ESWT should be considered the treatment of first choice in established tibial non-unions. PMID:27158008

  15. Semen quality after extracorporeal shockwave lithotripsy for the management of lower ureteric stones: a review of the literature.

    PubMed

    Gulur, Dev Mohan; Philip, Joe

    2011-10-01

    Extracorporeal Shockwave Lithotripsy has long been an important tool in the urologists' armamentarium for the treatment of distal ureteric stones. Several studies have been conducted on the morbidity and adverse effects of ESWL on human tissues but the effect of lithotripsy on semen and testes remains inconclusive. Impact on semen analysis and testes is important because the seminal vesicles and testes are exposed to the shock waves due to their anatomical proximity to the distal ureter. This article has reviewed all the published literature in English language on semen analysis after lithotripsy.

  16. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    PubMed

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  17. [Extracorporeal shockwave lithotripsy of gallstones: how many patients are suitable for it?].

    PubMed

    Rambow, A; Staritz, M; Klose, P; Thelen, M; Meyer zum Büschenfelde, K H

    1989-06-01

    The proportion of patients with gallbladder stones suitable for extracorporeal shockwave lithotripsy (ESWL) was analysed prospectively in 200 patients aged 17-76 years (62 males, 138 females) with symptomatic cholecystolithiasis. Criteria for inclusion were clinical symptoms, solitary stones (diameter 10-30 mm) or up to three stones with comparable total volume, contractile gallbladder, no calcification of stones, normal biliary tract anatomy. To check these criteria a step-by-step diagnostic procedure was instituted which consisted of history, ultrasonography with contractility test, abdominal X-ray film, computed tomography measurement of stone density, and endoscopic retrograde cholangiography. Only 19 patients fulfilled the criteria. The others had to be excluded because of history (35), stone size or number (73), impaired gallbladder contractility (27), calcified stone (30), pigment content (12), and/or biliary tract anatomy. Thus only a surprisingly small percentage (about 10%) of patients with symptomatic gallbladder stones is suitable for ESWL.

  18. How do patients' treatment preferences compare with those of clinicians?

    PubMed Central

    Montgomery, A; Fahey, T

    2001-01-01

    The shared model of medical decision making has been proposed as the preferred method of determining patients' treatment. However, agreement may be more difficult to achieve if patients' and clinicians' preferences are polarised. The aim of this paper is to explore how closely patients and clinicians agree in their preferences for different treatment options. Only studies that made quantifiable estimates of preferences were included. There is some evidence that patients and health professionals often do not agree on treatment preference in the areas of cardiovascular disease, cancer, obstetrics and gynaecology, and acute respiratory illness. However, the magnitude and direction of these differences vary and may depend on the condition of interest. Most of the research to date is cross sectional; longitudinal research is required to investigate whether preferences change over time and are related to treatment choice, adherence to medication if taken, and health outcomes. Key Words: patient preference; treatment choice; decision making; patient-caregiver communication PMID:11533437

  19. [Extracorporeal shockwave treatment of delayed bone healing. A critical assessment].

    PubMed

    Rompe, J D; Eysel, P; Hopf, C; Vogel, J; Küllmer, K

    1997-10-01

    Since the late 1980s, experiments have been performed to influence physiologic and disturbed healing of bone. However, the mainly negative results of animal studies, cannot be applied to the human nonunion situation as long as there is no adequate animal pseudarthrosis model. Prospective clinical studies in various centres have resulted in success rates of more than 50%, although the majority of patients had been treated repeatedly and ineffectively with the gold standard of re-osteosynthesis and grafting. Since the mechanisms are not yet understood, only such desperate conditions are an indication for the application of high-energy extracorporal shock waves.

  20. [Extracorporeal shockwave lithotripsy: treatment of choice in ureteral calculi].

    PubMed

    Rigatti, P; Montorsi, F; Guazzoni, G; Maffezzini, M

    1989-05-15

    Extracorporeal shock wave lithotripsy represents the therapy of choice for reno-ureteral stone disease being resolutive in more than 85% of cases. This procedure can be successfully applied to ureteral stones providing appropriate preoperative cystoscopic manipulations and a correct positioning of the patient on the stretcher of the lithotripter. We hereby report our experience in 119 patients with ureteral lithiasis submitted to extracorporeal shock wave lithotripsy with a 98% success rate.

  1. [Extracorporeal shockwave therapy of radiohumeral epicondylopathy-- an alternative treatment concept].

    PubMed

    Rompe, J D; Hopf, C; Küllmer, K; witzsch, U; Nafe, B

    1996-01-01

    During the last 2 years 75 patients referred to our hospital for operation of a persistent tennis elbow were followed prospectively after receiving low-energetic extracorporal shock wave therapy. 3 times in weekly intervals all patients received 1000 impulses of the energy density 0.06 mJ/mm2. Follow-ups were performed at 3, 6, 12, 24 weeks. Statistical analysis showed significant improvement both of subjective and objective criteria. 41 patients became painfree. Only 7 patients decided to have an operation after the 24-weeks-follow-up. Ambulatory shock wave therapy is a considerable alternative before surgical intervention in chronic tennis elbow.

  2. [Extracorporeal shockwave lithotripsy in the treatment of urolithiasis in children].

    PubMed

    Dzeranov, H K; Pavlov, A Iu; Cherepanova, E V

    2009-01-01

    Extracorporeal shock wave lithotripsy (ESWL) was performed in 1451 children with urolithiasis aged from 7 months to 16 years. A total of 2464 sessions were made. Low-energy impulses in ESWL were effective in 98.8% children with concrements up to 2.0 cm in size and in 98.8% of those with stones larger than 2.0 cm. We believe that main factors of high efficiency of ESWL in children are: more friable structure of stones, small depth of stone location, faster evacuation of the stone fragments. ESWL with low energy impulses is highly effective and is not accompanied with traumatic complications. Renal parenchyma is not affected.

  3. [Clinical experiences with extracorporeal shockwave lithotripsy].

    PubMed

    Ackermann, D; Merz, V; Marth, D; Zehntner, C

    1989-07-01

    Clinical experience with 2738 patients treated by extracorporeal shock wave lithotripsy between March 1985 and December 1988 is reported. All treatments were performed with the Dornier HM-3 lithotriptor. 34% of the patients needed auxiliary measures, consisting primarily of urological manipulation to improve urinary drainage or for better localization and/or focussing of the stones. Severe complications were rare; urosepticemia occurred in 0.3%, 2 patients had to undergo nephrectomy because of abscessing pyelonephritis, and there was one death due to recurrent pulmonary embolism in a patient with polycythemia vera. ESWL was used for stones in the entire upper urinary tract. The stone free rate for pelvic calculi smaller than 2 cm was 79% three months after treatment; a further 16% showed desintegrated material smaller than 5 mm, augmenting the success rate to 95%. The success rate dropped to 74% for very large renal stones of more than 4 cm. A stone free rate of 84-96% was ascertained for ureteral calculi 3 months after ESWL. Absolute contraindications for ESWL are acute pyelonephritis, coagulation disorders and pregnancy. The patients must tolerate anesthesia, as most treatments with this lithotriptor must be carried out under peridural or general anesthesia and only in a few exceptional cases is treatment in sedoanalgesia possible. ESWL is now generally accepted in view of its negligible invasiveness, low morbidity and the high success rate. Modern treatment of urinary calculi is inconceivable without considering ESWL.

  4. Comparative assessment of water treatment using polymeric and inorganic coagulants

    NASA Astrophysics Data System (ADS)

    Manda, Innocent K. M.; Chidya, Russel C. G.; Saka, John D. K.; Biswick, Timothy T.

    2016-06-01

    Portable water plays a vital role in improving human life, particularly in controlling the spread of diseases. However, problems associated with lack of potable water are still common especially in developing countries including Malawi. Until now little information exists on the effectiveness of available commercial coagulants used by national water boards in Malawi. Therefore, this study was undertaken in Southern Region Water Board (SRWB) to investigate the efficiency of polymeric coagulants (sufdfloc 3850 and algaefloc 19s) in turbidity reduction comparative with inorganic coagulant (aluminium sulphate) at Zomba, Liwonde, Mangochi, Chikwawa and Mulanje Treatment plants. The jar test method was used to determine the effectiveness of the water coagulants. The results revealed that sudfloc 3850 was most effective in reducing turbidity at Mangochi (99.4 ± 0.06%) and Liwonde (97.2 ± 0.04%) using 0.4 mg L-1 flocculant dose. The Zomba, Mulanje and Chikwawa plants gave 19.56 ± 0.03%, 29.23 ± 0.02% and 9.43 ± 0.02% total reductions respectively. Algaefloc 19s afforded the highest turbidity reduction at Liwonde and Mangochi plants (98.66 ± 0.06 and 97.48 ± 0.05% at a dose of 0.4 and 0.6 mg L-1 respectively), while Chikwawa provided the lowest (9.52 ± 0.01%). At the Zomba and Mulanje plants 20.5 ± 0.03% and 28.4 ± 0.04% reductions were obtained respectively. The inorganic flocculant, alum provided a 99.0 ± 0.05% and 98.6 ± 0.04% reduction at a dose of 4.0 mg L-1 and 6.0 mg L-1 at Zomba and Liwonde plants respectively. The lowest reductions in turbidity were achieved at Chikwawa (7.50 ± 0.01%), Mangochi (12.97 ± 0.02%) and Mulanje (25.00 ± 0.02). The best and optimum pH ranges for polymeric and inorganic coagulants were 7.20-7.80 and 7.35 to 7.57 respectively. The results further revealed that sudfloc 3850 and algaefloc 19s achieved faster formation of heavy flocs than alum. At 0.4 mg L-1 flocculant dosage sudfloc 3850 and algaefloc 19s required ten times

  5. A comparative analysis of odour treatment technologies in wastewater treatment plants.

    PubMed

    Estrada, José M; Kraakman, N J R Bart; Muñoz, Raúl; Lebrero, Raquel

    2011-02-01

    Biofiltration, activated sludge diffusion, biotrickling filtration, chemical scrubbing, activated carbon adsorption, regenerative incineration, and a hybrid technology (biotrickling filtration coupled with carbon adsorption) are comparatively evaluated in terms of environmental performance, process economics, and social impact by using the IChemE Sustainability Metrics in the context of odor treatment from wastewater treatment plants (WWTP). This comparative analysis showed that physical/chemical technologies presented higher environmental impacts than their biological counterparts in terms of energy, material and reagents consumption, and hazardous-waste production. Among biological techniques, the main impact was caused by the high water consumption to maintain biological activity (although the use of secondary effluent water can reduce both this environmental impact and operating costs), biofiltration additionally exhibiting high land and material requirements. From a process economics viewpoint, technologies with the highest investments presented the lowest operating costs (biofiltration and biotrickling filtration), which suggested that the Net Present Value should be used as selection criterion. In addition, a significant effect of the economy of scale on the investment costs and odorant concentration on operating cost was observed. The social benefits derived from odor abatement were linked to nuisance reductions in the nearby population and improvements in occupational health within the WWTP, with the hybrid technology exhibiting the highest benefits. On the basis of their low environmental impact, high deodorization performance, and low Net Present Value, biotrickling filtration and AS diffusion emerged as the most promising technologies for odor treatment in WWTP.

  6. Mechanisms of shockwave action in the human kidney.

    PubMed

    Roessler, W; Steinbach, P; Seitz, R; Hofstaedter, F; Wieland, W F

    1995-12-01

    The effects on the human kidney parenchyma of high-energy shockwaves (HESW) with different energy densities were examined. Kidneys of patients treated by radical nephrectomy for renal cell carcinoma were perfused with cold HTK solution immediately after nephrectomy and kept in hypothermia (8 degrees C) for a maximum of 4 hours. The tumor-free parenchyma was treated with 2000 shocks at energy outputs of 15 kV (16 MPa, 0.15 mJ/mm2), 17 kV (32 MPa, 0.25 mJ/mm2), 19 kV (50 MPa, 0.4 mJ/mm2), and 21 kV (65 MPa, 0.6 mJ/mm2) in an experimental electromagnetic shockwave system (Siemens Co., Erlanger, Germany). Resulting tissue effects were analyzed by histologic and immunohistochemical examinations and confocal laser scanning microscopy. Different sensitivities of cell components, blood vessels, and tubules were found. Laser scanning microscopy revealed nuclear alterations in the vicinity of the focus up to a distance of approximately 10 mm. Severe histologic changes were found in a smaller zone, while immunohistochemistry studies revealed negative collagen IV staining in an area of approximately 4 x 4 mm (all distances measured within the plane perpendicular to the acoustic axis). From these results, it can be concluded that HESW directly damage the tubules and the vascular system, which might explain the clinical changes after extracorporeal shockwave lithotripsy in human patients. The extent of these effects seems to be dependent on the applied energy.

  7. [Extracorporeal shockwave lithotripsy (ESWL). Our experience].

    PubMed

    Frattini, A; Ferretti, S; Arena, F; Larosa, M; Cortellini, P

    1995-01-01

    The authors report their experience with a third generation lithotripter Storz-Modulith SL 20 with fluoroscopic and echography stone localization. A total of 284 patients, between september '92 and august '94, with 149 renal and 135 ureteral stones, underwent 483 treatments. The mean treatment rate was 1,7 and the over-all stone free rate was 93%. Auxiliary procedures before ESWL were performed in 5.1% of the sessions (stenting, nephrostomy tube) and in 1% post-ESWL manipulations for lithiasic steinstrasse. Complications as: renal damage, steinstrasse etc. occurred in 2.5% of the session; in 20 patients ESWL procedure failed.

  8. Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi.

    PubMed

    Thornhill, J A; Moran, K; Mooney, E E; Sheehan, S; Smith, J M; Fitzpatrick, J M

    1990-06-01

    The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.

  9. Stone fragmentation pattern of piezoelectric shockwave lithotripsy in vitro.

    PubMed

    Grenabo, L; Hedelin, H; Mohsenvand, C; Rodin, L; Wang, Y H; Pettersson, S

    1998-06-01

    Whole stones (N = 64; largest diameter 5-15 mm) were treated in vitro with piezoelectric shockwaves using the Edap LT-01 lithotripter with 2.5 Hz at either 100% or 54% power. The number of fragments larger than 2 mm was counted after every 30 seconds. The stones were defined as totally broken when all fragments were < 2 mm. Total fragmentation time was correlated with the energy level and the size of the stone. The number of large fragments did not correlate with the energy level but rather with the original size of the stone.

  10. Renal milk of calcium: contraindication to extracorporeal shockwave lithotripsy.

    PubMed

    Heidenreich, A; Vorreuther, R; Krug, B; Moul, J W; Engelmann, U H

    1996-01-01

    Renal milk-of-calcium (MOC) cysts are rare findings, with only approximately 60 cases reported in the literature. The diagnosis depends on the demonstration of the typical "half-moon" configuration on horizontal beam radiography; classical ultrasound finding is a gravity-dependent, echogenic shadowy material in a renal cyst. The importance of the MOC syndrome lies in its recognition and differentiation from a renal stone in order to avoid unwarranted surgery or extracorporeal shock-wave lithotripsy (ESWL). We have encountered five patients with renal MOC and present the typical clinical and radiological features in order to facilitate differential diagnosis.

  11. Impact of shockwave lithotripsy on upper urinary tract calculi.

    PubMed

    Riehle, R A; Näslund, E B; Fair, W; Vaughan, E D

    1986-10-01

    Extracorporeal shock wave lithotripsy (ESWL) currently is performed in selected urologic centers to treat over 80 per cent of patients with symptomatic upper urinary tract calculi. This noninvasive technique utilizing shockwaves to disintegrate stones into sand-sized particles allows the patient to pass the particles with spontaneous urination and replaces most surgery or percutaneous endoscopy for stone removal. However, stone-free success rates must be individualized depending on stone position, stone size, and composition. Lithotripsy of renal stones prior to migration and proximal ureteral stones early in their symptomatic course may alter significantly the incidence of distal ureteral calculi requiring hospitalization, cystoscopy, or ureteroscopy.

  12. Acoustic cavitation generated by an extracorporeal shockwave lithotripter.

    PubMed

    Coleman, A J; Saunders, J E; Crum, L A; Dyson, M

    1987-02-01

    Evidence is presented of acoustic cavitation generated by a Dornier extracorporeal shockwave lithotripter. Using x-ray film, thin aluminum sheets, and relatively thick metal plates as targets, evidence of liquid jet impacts associated with cavitation bubble collapse was observed. The jet impact was violent enough to puncture thin foils and deform metal plates. Furthermore, numerous jet impacts were generated over a volume of greater than 200 cm3. It is likely that such violent cavitation will also occur in tissue, and observed biological effects (e.g. renal calculus disintegration and tissue trauma) may be related to cavitation damage.

  13. [Extracorporeal shockwave therapy for erectile dysfunction and Peyronie's disease].

    PubMed

    Zhu, Ji-Yin; Jiang, Rui

    2014-09-01

    Penile vascular endothelial damage, vasomotor dysfunction, and blood flow deficiency are the major causes of erectile dysfunction (ED). Current management of ED mostly depends on selective phosphodiesterase type 5- (PDE5) inhibitors, which fail for some ED patients. For Peyronie's disease-induced ED, surgical and physical therapies are used in addition to PDE5I medication, but frequently it is difficult to achieve satisfactory results. Recent studies show that the low-intensity extracorporeal shockwave therapy can promote angiogenesis and improve blood flow to the penis, which promises to be a novel effective therapy for ED and Peyronie's disease.

  14. Fiber-coupled optical pyrometer for shock-wave studies

    SciTech Connect

    Holmes, N.C. )

    1995-03-01

    We have developed a new optical pyrometer with unique advantages for shock-wave studies and for measurements of systems that are moving with respect to the detection system. Our pyrometer is fully fiber optic coupled. This completely eliminates any time-dependent imaging or aperture effects common to imaging pyrometers, and is simple to align and calibrate. The sensitivity is also higher than typical imaging systems used for shock experiments. The design is excellent for observations of time-varying phenomena. Detection is done with fast photomultiplier tubes with roughly 1 ns response. In addition, one may also include a streaked spectroscopic system, making this system ideal for fast spectroscopic studies.

  15. [Sonography and biliary extracorporeal shockwave lithotripsy].

    PubMed

    Jakobeit, C; Greiner, L

    1992-12-01

    Ultrasound is an indispensable tool for preliminary diagnosis ('filter function'), during treatment ('monitoring function') and in the followup examinations ('follow-up function') after shock wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which experience to date has shown to be rare.

  16. [Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery].

    PubMed

    Kriegmair, M; Schüller, J; Schmeller, N; Knipper, A; Muschter, R; Hofstetter, A G

    1990-07-01

    The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

  17. Summary of comparative results integrated nonthermal treatment and integrated thermal treatment systems studies

    SciTech Connect

    1996-12-01

    In July 1994, the Idaho National Engineering Laboratory (INEL), under a contract from U.S. Department of Energy`s (DOE) Environment Management Office of Science and Technology (OST, EM-50) published a report entitled {open_quotes}Integrated Thermal Treatment System Study - Phase 1 Results{close_quotes} (EGG-MS-11211). This report was the culmination of over a year of analysis involving scientists and engineers within the DOE complex and from private industry. The purpose of that study was {open_quotes}to conduct a systematic engineering evaluation of a variety of mixed low level waste (MLLW) treatment system alternatives.{close_quotes} The study also {open_quotes}identified the research and development, demonstrations, and testing and evaluation needed to assure unit operability in the most promising alternative system.{close_quotes} This study evaluated ten primary thermal treatment technologies, organized into complete {open_quotes}cradle-to-grave{close_quotes} systems (including complete engineering flow sheets), to treat DOE MLLW and calculated mass balances and 20-year total life cycle costs (TLCC) for all systems. The waste input used was a representative heterogenous mixture of typical DOE MLLW. An additional study was conducted, and then, based on response to these studies, additional work was started to investigate and evaluate non-thermal treatment options on a footing comparable to the effort devoted to thermal options. This report attempts to present a summary overview of the thermal and non-thermal treatment technologies which were examined in detail in the process of the above mentioned reviews.

  18. Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

    ERIC Educational Resources Information Center

    Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory

    2010-01-01

    Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…

  19. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    ERIC Educational Resources Information Center

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  20. Public and Private Management of Wastewater Treatment: A Comparative Study.

    ERIC Educational Resources Information Center

    O'Toole, Laurence J., Jr.

    1991-01-01

    The costs and performance of contract management of municipal wastewater treatment facilities are considered, using information from a nationwide empirical examination of evidence from individual plants, municipalities, and regulatory agencies. The broad issues arising in the evaluation are outlined as the specifics are discussed. (SLD)

  1. Inactivation of Ascaris eggs in soil by microwave treatment compared to UV and ozone treatment.

    PubMed

    Mun, Sungmin; Cho, Shin-Hyeong; Kim, Tong-Soo; Oh, Byung-Taek; Yoon, Jeyong

    2009-09-01

    This study reports on the effect of microwave radiation for inactivation of Ascaris lumbricoides eggs in 25 g of soil compared to ultraviolet irradiation and ozone expose. Microwave radiation at 700 W with 14% water content (w/w) achieved approximately 2.5 log inactivation of eggs in soil within 60s. On the other hand, UV irradiation at 3 mW cm(-2) with and without shaking soil for 3600 s achieved approximately 0.32 and 0.01 log inactivation of eggs, respectively. In ozone treatment, 0.13 log inactivation of eggs was achieved with 5.8+/-0.7 mg L(-1) of dissolved ozone dose for 30 min in a continuous diffusion reactor. In addition, the inactivation of eggs by three disinfection techniques was conducted in water in order to compare the inactivation efficiency of eggs in soil. The inactivation efficiency of microwave radiation was found to be no significant difference between in soil and water. However, the inactivation efficiency of UV irradiation was significantly increased in water while in ozone expose there was no significant difference between in soil and water. Microwave treatment thus proved to be the most efficient method in controlling A. lumbricoides eggs in soil.

  2. Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis.

    PubMed

    Mueller, M; Bockstahler, B; Skalicky, M; Mlacnik, E; Lorinson, D

    2007-06-01

    The objective of this study was to evaluate the effects of extracorporeal radial shock wave therapy on the hindlimb function of dogs suffering from hip osteoarthritis. Twenty-four client-owned dogs with hip osteoarthritis were investigated; 18 of them received radial shockwave therapy and six were left untreated as controls. Force plate analysis on a treadmill was used to assess the dogs' hindlimb function before treatment and four weeks after the last treatment, and the treated dogs were re-evaluated three and six months after the treatment. The parameters chosen for evaluation were peak vertical force and vertical impulse, and the calculated symmetry indices. In the treated dogs, differences between the ground reaction forces exerted by the right and left hindlegs disappeared four weeks after the treatment, whereas in the control dogs only the peak vertical force distribution changed significantly. The significant improvement in the treated dogs was confirmed by changes in the symmetry indices. Significant improvements in vertical impulse and peak vertical force were observed three months after the treatment.

  3. [Extracorporeal shock-wave lithotripsy for children].

    PubMed

    Wakabayashi, A; Matsuda, H; Uemura, T; Kohri, K; Kurita, T; Kanbara, N; Tamura, M

    1988-06-01

    We performed extracorporeal shock wave lithotripsy (ESWL) on a 5-year-old and 8-year-old. Ureteral calculi in both patients were disintegrated, and all fragments were passable spontaneously. The 5-year-old girl was the youngest of the cases of ESWL reported in Japan. As this patient was 107 cm in height, we put a styrofoam layer on the back of this patient. This protected her lung from the shock wave, and the height limit was released from the ESWL treatment. These cases and the peculiarities and devices for ESWL in the pediatric field are discussed. PMID:3223460

  4. Treatment/Comparative therapeutics: cancer of the larynx and hypopharynx.

    PubMed

    McMullen, Caitlin P; Smith, Richard V

    2015-07-01

    This article reviews the management of laryngeal and hypopharyngeal squamous cell carcinoma. Available therapies for early and late stage cancers are discussed, and the literature is reviewed. The indications and outcomes of surgical and nonsurgical modalities are discussed and compared.

  5. Effects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability.

    PubMed

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-01-01

    [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams' exercises and McKenzie's exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients' dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA.

  6. Mesoscale simulations of shockwave energy dissipation via chemical reactions

    NASA Astrophysics Data System (ADS)

    Antillon, Edwin; Strachan, Alejandro

    2015-06-01

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials under shockwave-loading conditions. An additional implicit variable (the particle size) is used to describe volume-reducing chemical reactions using an intra-molecular potential inspired by Transition State Theory, while the dynamics of the center-of-mass motion evolves according to inter-particle forces. The equations of motion are derived from a Hamiltonian and the model captures both: total energy conservation and Galilean invariance. We demonstrate that this model captures complex thermo-mechanical-chemical processes, and we use these features to explore materials with the capabilities to dissipate shocks-wave energy due to ballistic impacts. Our results characterize how the parameters of the chemical model affect shock-wave attenuation, and we elucidate on how the coupling between the different energy-transferring mechanisms influences nucleation of chemistry for conditions away from equilibrium.

  7. [Intracorporeal shockwave lithotripsy using the neodymium YAG laser].

    PubMed

    Schmeller, N T; Hofstetter, A; Kriegmair, M; Frank, F; Wondrazek, F

    1989-09-10

    The problem of suitable energy transfer and conversion for intraureteral lithotripsy has not yet been solved satisfactorily. Laser-induced shockwave lithotripsy (LISL) appears to be a very promising solution to this problem. We report on initial clinical experience using a Q-switched Nd:YAG laser generating a shockwave on the metallic surface of an optomechanic coupler. This leads to the fine fragmentation of a urinary calculus situated close to or in contact with the coupler. Only minimal side effects occur in biological tissue. Further development of the coupler resulted in considerable increase of its fragmentation capability with no increase in side-effects. As a result, application under fluoroscopic control alone became possible, which appears adequate in approximately half of the cases. In the other half visual inspection via ureteroscopy is required. Laser-induced lithotripsy is the only technique that uses a flexible transmission system, results in the fine fragmentation of calculi, and is free of serious side effects on tissue, i.e. does not lead to perforation of the wall of the ureter.

  8. Shockwave Processing of Composite Boron and Titanium Nitride Powders

    NASA Astrophysics Data System (ADS)

    Beason, Matthew T.; Gunduz, I. Emre; Mukasyan, Alexander S.; Son, Steven F.

    2015-06-01

    Shockwave processing of powders has been shown to initiate reactions between condensed phase reactants. It has been observed that these reactions can occur at very short timescales, resulting in chemical reactions occurring at a high pressure state. These reactions have the potential to produce metastable phases. Kinetic limitations prevent gaseous reactants from being used in this type of synthesis reaction. To overcome this limitation, a solid source of gaseous reactants must be used. An example of this type of reaction is the nitrogen exchange reaction (e.g. B + TiN, B + Si3N4 etc.). In these reactions nitrogen is ``carried'' by a material that can be then reduced by the second reactant. This work explores the possibility of using nitrogen exchange reactions to synthesize the cubic phase of boron nitride (c-BN) through shockwave processing of ball milled mixtures of boron and titanium nitride. The heating from the passage of the shock wave (pore collapse, plastic work, etc.) combined with thermochemical energy from the reaction may provide a means to synthesize c-BN. This material is based upon work supported by the Department of Energy, National Nuclear Security Administration, under Award Number(s) DE-NA0002377. National Defense Science & Engineering Graduate Fellowship (NDSEG), 32 CFR 168a.

  9. Laboratory Simulations of Supernova Shockwave Progagation and ISM Interaction

    SciTech Connect

    Hansen, J F; Edwards, M J; Robey, H F; Miles, A R; Froula, D; Gregori, G; Edens, A; Ditmire, T

    2003-08-29

    High Mach number shockwaves were launched in laboratory plasmas to simulate supernova shockwave propagation. The experiments were carried out at inertial fusion facilities using large lasers. Spherical shocks were created by focusing laser pulses onto the tip of a solid pin surrounded by ambient gas. Ablated material from the pin would rapidly expand and launch a shock through the surrounding gas. Planar shocks were created by ablating material from one end of a cylindrical shocktube. Laser pulses were typically 1 ns in duration with ablative energies ranging from <1 J to >4 kJ. Shocks were propagated through various plasmas, and observed at spatial scales of up to 5 cm using optical and x-ray cameras. Interferometry techniques were used to deduce densities, and emission spectroscopy data were obtained to infer electron temperatures. Experimental results confirm that spherical shocks are Taylor-Sedov, and that radiative shocks stall sooner than non-radiative shocks. Unexpected results include the birth of a second shock ahead of the original, stalling shock, at the edge of the radiatively preheated region. We have begun experiments to simulate the interaction between shocks and interstellar material (ISM), and the subsequent turbulent mixing. Comparisons between experimental data and numerical simulations of shock evolution, stall, second shock birth, and interstellar material (ISM) interaction will be presented.

  10. Comparative treatment effectiveness of conventional trench and seepage pit systems.

    PubMed

    Field, J P; Farrell-Poe, K L; Walworth, J L

    2007-03-01

    On-site wastewater treatment systems can be a potential source of groundwater contamination in regions throughout the United States and other parts of the world. Here, we evaluate four conventional trench systems and four seepage pit systems to determine the relative effectiveness of these systems for the treatment of septic tank effluent in medium- to coarse-textured arid and semiarid soils. Soil borings were advanced up to twice the depth of the trenches (4 m) and seepage pits (15 m) at two horizontal distances (30 cm and 1.5 m) from the sidewalls of the systems. Soil samples were analyzed for various biological and chemical parameters, including Escherichia coli, total coliform, pH, total organic carbon, total dissolved solids, total nitrogen, ammonium-nitrogen, and nitrate-nitrogen. Most soil parameters investigated approached background levels more rapidly near the trenches than the seepage pits, as sampling distance increased both vertically and horizontally from the sidewalls of the systems.

  11. Comparative environmental analysis of waste brominated plastic thermal treatments

    SciTech Connect

    Bientinesi, M. Petarca, L.

    2009-03-15

    The aim of this research activity is to investigate the environmental impact of different thermal treatments of waste electric and electronic equipment (WEEE), applying a life cycle assessment methodology. Two scenarios were assessed, which both allow the recovery of bromine: (A) the co-combustion of WEEE and green waste in a municipal solid waste combustion plant, and (B) the staged-gasification of WEEE and combustion of produced syngas in gas turbines. Mass and energy balances on the two scenarios were set and the analysis of the life cycle inventory and the life cycle impact assessment were conducted. Two impact assessment methods (Ecoindicator 99 and Impact 2002+) were slightly modified and then used with both scenarios. The results showed that scenario B (staged-gasification) had a potentially smaller environmental impact than scenario A (co-combustion). In particular, the thermal treatment of staged-gasification was more energy efficient than co-combustion, and therefore scenario B performed better than scenario A, mainly in the impact categories of 'fossil fuels' and 'climate change'. Moreover, the results showed that scenario B allows a higher recovery of bromine than scenario A; however, Br recovery leads to environmental benefits for both the scenarios. Finally the study demonstrates that WEEE thermal treatment for energy and matter recovery is an eco-efficient way to dispose of this kind of waste.

  12. [Extracorporeal shockwave lithotripsy of bile duct stones].

    PubMed

    Wenzel, H; Greiner, L; Jakobeit, C; Lazica, M; Thüroff, J

    1989-05-12

    Extracorporeal lithotripsy (EL) was undertaken in 50 patients (mean age 73.7 years; range 29-90 years) with extrahepatic and, in five, with intrahepatic gallstones, the usual endoscopic methods having been unsuccessful in removing the stones. Occasionally stone fragments were passed spontaneously, but in most they had to be removed endoscopically, in 48 (96%) with extrahepatic and in three (60%) with intrahepatic stones. Biliary tract or gallbladder infections occurred after the lithotripsy and associated local litholysis in seven of the 48 with extrahepatic (14%) and three of the five (60%) with intrahepatic stones. There was one hospital death. The results indicate that EL has definite advantages over surgical treatment in these patients, who are usually elderly and in whom surgical intervention is more risky.

  13. New concepts in the treatment of ureteral calculi.

    PubMed

    Painter, D J; Keeley, F X

    2001-07-01

    The management of patients with ureteral stones remains under debate in several areas. The ability to predict spontaneous passage has improved but remains imprecise, whilst the range of therapeutic options continues to widen. Excellent results can be obtained by both shockwave lithotripsy and ureteroscopic methods, with relatively minimal complications. Routine ureteral stenting is not warranted whichever treatment is chosen. In future, directly comparative studies should be designed to incorporate quality-of-life parameters rather than just stone-free status, to improve our understanding of the effect of treatment decisions on patients.

  14. Extracorporeal shock-wave therapy for chronic lateral tennis elbow--prediction of outcome by imaging.

    PubMed

    Maier, M; Steinborn, M; Schmitz, C; Stäbler, A; Köhler, S; Veihelmann, A; Pfahler, M; Refior, H J

    2001-07-01

    Today the clinical use of extracorporeal shockwave application (ESWA) for the treatment of lateral tennis elbow is hampered by the lack of results from randomized controlled trials and of predictive parameters of clinical outcome. The present prospective study aimed to provide the latter by means of magnetic resonance imaging (MRI). Twenty-three female and 19 male patients with unilateral chronic tennis elbow of the dominant site were clinically examined before and after repetitive low-energy ESWA. MRI was performed before ESWA to evaluate signal intensity changes or contrast enhancement of the common extensor tendon and the lateral epicondyle. After ESWA (mean follow-up period 18.6 months for all patients), clinical evaluation showed a significantly better mean clinical performance after ESWA than before treatment. Interestingly, male patients showed a significantly better mean clinical performance after ESWA than female patients, and male and female patients differed significantly in the signal intensity of the common extension tendon cross-section and tendon thickening on MRI. For female patients, MRI scans could be applied for predicting a positive clinical outcome of ESWA. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWA using imaging prior to treatment. This may serve as an important step towards overcoming the therapeutic nihilism with respect to the non-operative management of this condition recently in the literature.

  15. Comparative efficacy of treatments for pediculosis capitis infestations.

    PubMed

    Meinking, T L; Taplin, D; Kalter, D C; Eberle, M W

    1986-03-01

    Ovicidal activity and killing times were evaluated for six pediculicides, using viable eggs and recently fed head lice from infested children. Lice were continuously exposed to the products until death, and elapsed time was recorded. Eggs were immersed for ten minutes, rinsed, and dried. Four synergized pyrethrin products (RID, R&C Shampoo, A-200 Pyrinate Shampoo, A-200 Pyrinate Liquid) killed all lice in ten to 23 minutes, and 23% to 32% of treated eggs hatched; 0.5% malathion lotion (Prioderm Lotion) killed lice within five minutes and was highly ovicidal, with only 5% of eggs hatching. One percent lindane shampoo (Kwell Shampoo) was the slowest-acting pediculicide, requiring approximately three hours to kill all lice; 30% of the eggs hatched after treatment. The in vitro results for RID, Prioderm Lotion, and K well Shampoo were validated by clinical trials.

  16. Secnidazole vs. paromomycin: comparative antiprotozoan treatment in captive primates.

    PubMed

    Gracenea, M; Gómez, M S; Fernández, J; Feliu, C

    1998-02-01

    The antiprotozoan activity of secnidazole was studied in Cercocebus t. torquatus, Cercopithecus campbelli, Erythrocebus patas (Cercopithecidae), and Gorilla gorilla (Pongidae) compared with that of paromomycin in Cercocebus t. lunulatus (Cercopithecidae), E. patas, and G. gorilla (Pongidae) by coprological analysis. The antiprotozoan activity of both drugs depended on the parasite species and the host species. The drugs acted in a similar way on Entamoeba coli parasitising C. t. torquatus, and E. patas. This activity was different from that observed on I. buestchlii from the same host species. Nevertheless, E. coli parasitising cercopithecids and pongids responded to drugs differently. PMID:9606042

  17. A Treatment Study of Suicidal Adolescent with Personality Disorder or Traits: Mode Deactivation Therapy as Compared to Treatment as Usual

    ERIC Educational Resources Information Center

    Apsche, Jack A.; Bass, Christopher K.; Siv, Alexander M.

    2006-01-01

    This treatment research compares Mode Deactivation Therapy(MDT) to Treatment as Usual (TAU) with suicidal adolescents. This treatment research study examines the effects of MDT vs. TAU on adolescents who had co-morbid mental health issues as well as, personality disorders and traits. MDT was shown to be more effective in reducing suicidal thoughts…

  18. Evaluation of basal membrane antibody (immunoglobulin G) formation after high-energy shockwave application in rats.

    PubMed

    Sarica, K; Türkölmez, K; Koşar, A; Alçiğir, G; Ozdiler, E; Göğüş, O

    1998-12-01

    To evaluate the immune pathologic effects of high-energy shockwave (HESW) application on glomerular and tubular basal membrane antibody (IgG) formation, an experimental study on rats has been performed. Following application of different numbers of shockwaves (100-200-500), the presence of antibody was examined with the direct immunofluorescent technique 2 weeks and 3 months postprocedure. Whereas specimens examined after 2 weeks showed antibody formation in only one animal (500 HESWs), being located in the tubular tissues, all treated kidneys demonstrated various degrees of antibody formation in both tubular and glomerular tissues after 3 months. Antibody formation had a close relation to the number of HESWs applied and the time of examination after shockwave application. Apart from the well-defined functional and morphologic side effects of shockwave therapy, the possibility of immunologic alterations after this form of therapy has to be evaluated thoroughly in both clinical and experimental studies.

  19. Extracorporeal Shockwave Lithotripsy Monotherapy is not Adequate for Management of Staghorn Renal Calculi.

    PubMed

    Koko, Abdelmoniem K; Onuora, Vincent C; Al Turki, Mohammed A; Mesbed, Ahmed H; Al Jawini, Nasser A

    2003-01-01

    Between 1990 and 1999 a total of 186 patients with staghorn renal stones were treated in our unit. Of them, 76 patients were managed by extra-corporeal shockwave lithotripsy (ESWL) alone using a third generation Siemen's Lithostar Plus lithotriptor. Sixty-one of these patients who completed a follow-up of 41 months formed the subjects of this study. ESWL was done after routine stenting of the affected side in all cases except one. The mean number of ESWL sessions was 5.2, delivering an average 15,940 shocks per patient. The average hospital stay was 21.68 days and the duration of the treatment was 1-41 months (mean 6.75 months). Significant complications occurred in 35 patients (57.4%) eight of whom sustained multiple significant complications. A total of 162 auxiliary procedures were used in conjunction with ESWL and in the management of complications. The stone free rate at three months was 18%, but rose by the end of the treatment period (41 months) to 63.9%. Our study indicates that ESWL monotherapy is associated with high morbidity rates, high rates of unplanned invasive procedures as well as prolonged treatment periods and hospitalization. Thus, ESWL monotherapy is not adequate for the management of staghorn calculi.

  20. [Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

    PubMed

    Rambow, A; Staritz, M; Grosse, A; Treese, N; Mayer, K; Meyer zum Büschenfelde, K H

    1991-02-15

    Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.

  1. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Coleman, A. J.; Leighton, T. G.; White, P. R.; Hurrell, A. M.

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  2. [Shockwave lithotripsy in gallbladder and bile duct calculi: indications and results].

    PubMed

    Paumgartner, G

    1990-01-01

    Extracorporeal shock-wave lithotripsy combined with adjuvant litholytic therapy (ursodeoxycholic acid and chenodeoxycholic acid) is a relatively safe and effective noninvasive therapy for selected patients with symptomatic radiolucent gallbladder stones. The best results (80% stone-free patients within 1 year) are obtained with radiolucent solitary stones with a diameter of less than 20 mm. Shock-wave lithotripsy achieves rapid clearance of stones in about 80% of patients with bile duct calculi in whom endoscopic procedures fail.

  3. Thermal loading of laser induced plasma shockwaves on thin films in nanoparticle removal

    SciTech Connect

    Varghese, Ivin; Zhou Dong; Peri, M. D. Murthy; Cetinkaya, Cetin

    2007-06-01

    Damage concerns, such as substrate/film material alterations, damage, and delamination of thin films, have become a central problem in sub-100 nm particle removal applications. In the laser induced plasma (LIP) removal technique both LIP shockwave and radiation heating are potential sources of thermomechanical damage. The specific objective of current study is to conduct a computational investigation of the LIP shockwave effect on the thermoelastic response of a thin chromium (Cr) film deposited on a quartz substrate and to identify the conditions leading to the onset of plastic film deformations. The experimentally characterized shockwave pressure and temperature (approximated from gas dynamic relations) were prescribed as boundary conditions in the computational analysis. From the shockwave arrival times for different travel distances, the shockwave radius as well as the velocity were obtained as a function of the shockwave propagation time. Radial (and circumferential) stresses, caused by thermal expansion of the Cr film, were most dominant and, hence, of damage concern. It is determined that the resultant temperature rise utilizing a 1064 nm Nd:yttrium-aluminum-garnet (YAG) laser (450 mJ) due to the film-shockwave interactions was not sufficiently high to initiate film and/or substrate damage. No material alteration/damage of the Cr film is predicted due to the temperature and pressure of LIP shockwaves at the firing distance of 2 mm, with a high strain rate gain factor of two (minimum), though damage was observed experimentally for 1064 nm Nd:YAG laser at the pulse energy of 370 mJ. Reported results indicate that the leading cause of observed thin film damage during nanoparticle removal is almost certainly radiation heating from the LIP core.

  4. Extracorporeal shockwave lithotripsy and litholytic therapy in cholelithiasis.

    PubMed

    Erdamar, I; Avci, G; Füzün, M; Harmancioğlu, O

    1992-03-01

    Extracorporeal shockwave lithotripsy (ESWL) and litholytic therapy were used in 100 patients over a period of 16 months. ESWL was carried out with a Lithostar Plus and chenodeoxycholic acid was used as the lytic agent, given until 3 months after complete disappearance of stones. Within a period of 8-12 months, stones disappeared completely in 82 per cent of the patients who had a single stone less than or equal to 20 mm in diameter and in 50 per cent of those with a single stone greater than 20 mm in size or with multiple stones. Complications requiring surgery developed in five patients: three had acute cholecystitis and two developed acute pancreatitis. Of the patients in whom complete stone clearance was achieved, two of 11 followed up developed recurrence of stones 4 months after cessation of lytic therapy.

  5. Laser shockwave technique for characterization of nuclear fuel plate interfaces

    SciTech Connect

    Perton, M.; Levesque, D.; Monchalin, J.-P.; Lord, M.; Smith, J. A.; Rabin, B. H.

    2013-01-25

    The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process. Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.

  6. Laser Shockwave Technique For Characterization Of Nuclear Fuel Plate Interfaces

    SciTech Connect

    James A. Smith; Barry H. Rabin; Mathieu Perton; Daniel Lévesque; Jean-Pierre Monchalin; Martin Lord

    2012-07-01

    The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process. Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.

  7. Extracorporeal shockwave therapy for urolithiasis with renal insufficiency.

    PubMed

    Bhatia, V; Biyani, C S; al-Awadi, K

    1995-01-01

    Management of urolithiasis with renal insufficiency poses a multidimensional nephrourological situation. Sixty-two patients of potentially reversible calculus obstructive nephropathy and azotemia were treated with extracorporeal shockwave lithotripsy (ESWL) on the Sieman's Lithostar. These patients were treated under sedoanalgesia after the initial therapeutic ureteral stenting. Satisfactory fragmentation was achieved in all the patients. The incidence of major complications was 3.2% with an 85% stone-free rate at 6 months. Pre- and post-ESWL hemodialysis was required in 14 and 3 patients, respectively. All patients had variable levels of improvement in the renal function. Proper selection of cases is mandatory for satisfactory outcome. The combination of ureteral stenting followed by phased ESWL represents an attractive alternative to traditional surgical management of stones with renal insufficiency.

  8. [Extracorporeal shockwave lithotripsy on the Sonolith-3000 apparatus].

    PubMed

    Tkachuk, V N; Veroman, V Iu; Komiakov, B K; Bannikov, V V; Sapelkin, A V; Ivanov, A O; Iudkevich, B A; Kalashian, R K

    1991-01-01

    The authors observed 812 patients with nephrolithiasis who underwent 876 sessions of shock-wave lithotripsy on Sonolith-3000 lithotriptor supplied with an ultrasonic system of the stone localization. The size of nephroliths ranged from 0.7 to 4.2 cm. Large-size nephroliths required repeated sessions and pretreatment establishment of the stent. The procedure proceeded without anesthesia. Subsequent renal colic was reported in 126 (15.5%), an exacerbation of pyelonephritis in 45 (5.5%), subcapsular hematoma in 4 (0.5%) of the patients. 790 patients showed clinical response (97.3%), with a complete destruction of the stone in 446 (54.9%) and partial one in 344 (42.4%) cases. 27 subjects were treated in outpatient setting. According to the authors, lithotripsy is contraindicated in urinary tract obstruction below the stone, renal failure, chronic pyelonephritis in the active phase of inflammation, marked impairment of cardiac rhythm.

  9. Laser shockwave technique for characterization of nuclear fuel plate interfaces

    NASA Astrophysics Data System (ADS)

    Perton, M.; Lévesque, D.; Monchalin, J.-P.; Lord, M.; Smith, J. A.; Rabin, B. H.

    2013-01-01

    The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process. Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.

  10. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

    PubMed

    Panah, A; Patel, S; Bourdoumis, A; Kachrilas, S; Buchholz, N; Masood, J

    2013-10-01

    Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

  11. Stone recurrence after shockwave lithotripsy: possible enhanced crystal deposition in traumatized tissue in rabbit model.

    PubMed

    Sarica, K; Soygür, T; Yaman, O; Ozer, G; Sayin, N; Akbay, C; Küpeli, S; Yaman, L S

    1996-12-01

    To evaluate the possible traumatizing effect of high-energy shockwaves (HESW) on new stone formation as indicated by crystal deposition in the renal parenchyma, we performed an experimental study in 50 rabbits. During severe oxaluria induced by continuous ethylene glycol (0.75%) administration, animals in the first group (N = 15) received 500 to 1500 shockwaves. Animals in the second group (N = 15) underwent no specific therapy apart from ethylene glycol administration. In a third group of animals (N = 15), only shockwave administration was applied. Sham group animals constituted the last group in our study (N = 5). Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. Crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals subjected to HESW application, especially in those receiving relatively high (1000 or 1500) numbers of shockwaves. On the other hand, no crystal formation and deposition was detectable in animals undergoing only ethylene glycol therapy or shockwave administration alone. Sham group animals demonstrated no significant renal histopathology. The traumatic effects of HESW should be evaluated as a factor in new stone formation after SWL.

  12. The Influence of Shockwave Therapy on Orthodontic Tooth Movement Induced in the Rat.

    PubMed

    Hazan-Molina, Hagai; Aizenbud, Itay; Kaufman, Hana; Teich, Sorin; Aizenbud, Dror

    2016-01-01

    Shockwave therapy is used in medicine due to its ability to stimulate healing processes. The application of orthodontic force evokes an inflammatory reaction resulting in tooth movement. Shockwave therapy might have an effect on both inflammatory and periodonal ligament cytokine profiles. Our aim was to evaluate the fluctuations of different inflammatory cytokines after orthodontic force induction with and without shockwave therapy. An orthodontic appliance was applied between the rats' molars and incisors. In conjunction with the commencement of orthodontic force, the rats were treated with a single episode of 1000 shock waves and the gingival crevicular fluid was collected for 3 days. The expression and concentration of different cytokines was evaluated by a commercial 4-multiplex fluorescent bead-based immunoassay. The level of all cytokines displayed a similar trend in both shockwave-treated and untreated groups; the concentration peaked on the first day and declined thereafter. In all cases, however, the cytokine levels were smaller in the shockwave-treated than in untreated animals; a significant difference was found for sRANKL and borderline difference for IL-6 on Day 1. We conclude that shockwave therapy during the induction of orthodontic tooth movement influences the expression of inflammatory cytokines.

  13. Anesthesia for extracorporeal shockwave lithotripsy: Teikyo University Hospital experience using the third generation lithotripter.

    PubMed

    Kurihara, Koji; Kamiyama, Yutaka; Saito, Keisuke; Yasuda, Mitsuko; Ide, Hisamitsu; Muto, Satoru; Okada, Hiroshi; Horie, Shigeo

    2007-08-01

    A single-board certified urologist with training and experience in anesthesiology was assigned to treat 502 patients (185 with renal stones, 317 with ureteral stones) using the Dornier Compact Delta lithotripter under general or epidural anesthesia. Data were obtained regarding stone location, stone size, shockwave use, stone-free rate, and complications. In all, 502 stones were treated with the Dornier Compact Delta lithotripter. Among renal stones, 73% were in the renal pelvis. Among ureteral stones, 60% were in the upper, 10% in the middle, and 30% in the lower ureter. Diameters of 61.8% of stones were less than 1 cm. The mean number of shocks was 3,471 at a mean power setting of 5. The stone-free rate for renal stones was 71.5%, while for ureteral stones this reached 99%. The efficiency quotient was calculated as 0.65. One patient with a renal stone developed perinephric hematoma requiring 3 units of transfusion. With a success rate higher than that reported for other lithotripters, the Dornier Compact Delta lithotripter represents a feasible treatment for urolithiasis. We stress that even in the third generation machines the lithotripsy under anesthesia can improve the treatment efficacy.

  14. Piezoelectric extracorporeal shockwave lithotripsy for bile duct stone formation after choledochal cyst excision.

    PubMed

    Okada, Yasuhiro; Miyamoto, Masatoshi; Yamazaki, Toru; Motoi, Isamu; Kuribayashi, Masato; Kodama, Koichi

    2007-04-01

    We report a case of bile duct stones in which piezoelectric extracorporeal shockwave lithotripsy (ESWL) was highly effective for the clearance of stones. A 16-year-old girl, who had undergone excision of a choledochal cyst when she was 3 years old, presented a spiking fever and colic abdominal pain. Radiological investigations showed two large stones incarcerating to the proximal end of hepatico-jejunostomy anastomosis. Massive debris was also present in intrahepatic bile duct proximal to the anastomosis. She underwent piezoelectric ESWL with an EDAP LT02 lithotripter. An average of 40 min ESWL session was repeated at intervals of 2 or 3 days. Neither anesthetic nor sedative treatment was required. By the end of the sixth session, the stones incarcerated were fragmented and the debris in the intrahepatic bile duct was completely eliminated. We conclude that piezoelectric ESWL is a less invasive, effective and repeatable method, therefore, it could be a treatment of choice for bile duct stone formation after choledochal cyst excision.

  15. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    SciTech Connect

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  16. The effects of shockwave on systemic concentrations of nitric oxide level, angiogenesis and osteogenesis factors in hip necrosis.

    PubMed

    Wang, Ching-Jen; Yang, Ya-Ju; Huang, Chung-Cheng

    2011-07-01

    This study investigated the effects of shockwave on systemic concentrations of nitric oxide (NO) level, angiogenic and osteogenic and anti-inflammatory factors in hips with osteonecrosis of the femoral head (ONFH). Thirty-five patients (47 hips) with ONFH were enrolled in this study. Each hip was treated with 6,000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood was obtained for the measurements of serum NO level, angiogenic factors (VEGF, vWF, FGF basic and TGF-β1); osteogenic factors (BMP-2, osteocalcin, alkaline phosphatase, DKK-1 and IGF); and anti-inflammation markers (sICAM and sVCAM) before treatment and at 1, 3, 6 and 12 months after treatment. The hips were evaluated with clinical assessment, serial radiograph and MRI. At 12 months, the overall results showed 83% improved and 17% un-improved. Total hip was performed in 4 cases (8.5%). Serum NO3 level showed significant elevation at 1 month after treatment, but the changes at 3, 6 and 12 months were not significant. For angiogenesis, significant elevations of VEGF, vWF and FGF basic and a decrease in TGF-β1 were observed at 1 month, but the changes at 3, 6 and 12 months were non-significant. For osteogenesis, BMP-2, osteocalcin, alkaline phosphatase and IGF were significantly elevated, while DKK-1 was decreased at 1 month, but the changes at 3, 6 and 12 months were not significant. For anti-inflammation markers, significant decreases in sICAM and sVCAM were noted at 1 month after treatment, but the changes at 3, 6 and 12 months were non-significant. Local ESWT application results in significant elevations of serum NO level, angiogenic and osteogenic and anti-inflammatory factors in ONFH.

  17. Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation.

    PubMed

    Park, H; Park, M; Park, T

    1998-12-01

    Extracorporeal shockwave lithotripsy (SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stones. During a period of 2 years, from January 1994 to December 1995, 651 patients with ureteral stones were treated, and 589 patients were retrospectively reviewed, excluding 62 patients with incomplete follow-up. Four hundred forty-two patients were treated with SWL using the MPL 9000 with ultrasonic guidance and 115 patients with ureteroscopic manipulations using 7.9F to 11.5F rigid and semirigid ureteroscopes. In SWL treatments, the overall stone-free rate was 74.7% with one session. The stone-free rate was significantly affected by the size of stones, being 83.6% when the stone was <1.0 cm and 42.1% when the stone was >1.0 cm. The stone-free rate after a second SWL session was 84.4% and was 90.3% after a third session. The stone-free rates according to the site of the stone were 72.4 (proximal), 70.0 (mid), and 80.2% (distal) after a single session. In ureteroscopic manipulation, an overall stone-free rate of 87.8% was obtained regardless of the size of the stones. The success rates according to the location of stones were 75.0 (proximal), 94.6 (mid), and 86.4% (distal). Open ureterolithotomy was performed in 32 patients, with a 100% success rate. In our study, the size of the stones was the most important factor influencing the success rate of SWL treatment. We consider ureteroscopic manipulation as the first-line treatment modality when the stone is >1.0 cm, especially if it is in the distal ureter. Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.

  18. Extracorporeal shock-wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ-induced diabetes.

    PubMed

    Kuo, Yur-Ren; Wang, Chun-Ting; Wang, Feng-Sheng; Chiang, Yuan-Cheng; Wang, Ching-Jen

    2009-01-01

    Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing. A dorsal skin defect (area, 6 x 5 cm) in a streptozotocin-induced diabetes rodent model was used. Fifty male Wistar rats were divided into five groups. Group I consisted of nondiabetic control; group II included diabetic control receiving no ESWT; group III included rats that underwent one session of ESWT (ESW-1) on day 3 (800 impulses at 0.09 mJ/mm(2)) postwounding; group IV included rats that underwent two sessions of ESWT (ESW-2) on days 3 and 7; and group V included rats that underwent three sessions of ESWT (ESW-3) on days 3, 7, and 10. The wound healing was assessed clinically. Blood perfusion scan was performed with laser Doppler. The VEGF, eNOS, and PCNA were analyzed with immunohistochemical stain. The results revealed that the wound size was significantly reduced in the ESWT-treated rats, especially in the ESW-2 and ESW-3 groups, as compared with the control (p<0.01). Blood perfusion was significantly increased after ESWT compared with the controls. Histological findings revealed a significant reduction in the topical pro-inflammatory reaction in the ESWT group as compared with the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and PCNA expressions were observed in the ESWT group, especially in the ESW-2 and ESW-3 groups, as compared with the control. In conclusion, treatment with an optimal session of ESWT significantly enhanced diabetic wound healing associated with increased neo-angiogenesis and tissue regeneration, and topical anti-inflammatory response.

  19. Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis

    PubMed Central

    Li, Bao-Zhu; Threapleton, Diane Erin; Wang, Ji-Yao; Xu, Jian-Ming; Yuan, Jin-Qiu; Zhang, Chao; Li, Peng; Guo, Biao; Mao, Chen

    2015-01-01

    Objective To determine the most efficacious treatment for eradication of Helicobacter pylori with the lowest likelihood of some common adverse events among pre-recommended and newer treatment regimens. Design Systematic review and network meta-analysis. Data sources Cochrane Library, PubMed, and Embase without language or date restrictions. Study selection Full text reports of randomised controlled trials that compared different eradication treatments for H pylori among adults. Results Of the 15 565 studies identified, 143 were eligible and included. Data on 14 kinds of treatments were available. Of 91 possible comparisons for the efficacy outcome, 34 were compared directly and the following treatments performed better: seven days of concomitant treatment (proton pump inhibitor and three kinds of antibiotics administered together), 10 or 14 days of concomitant treatment, 10 or 14 days of probiotic supplemented triple treatment (standard triple treatment which is probiotic supplemented), 10 or 14 days of levofloxacin based triple treatment (proton pump inhibitor, levofloxacin, and antibiotic administered together), 14 days of hybrid treatment (proton pump inhibitor and amoxicillin used for seven days, followed by a proton pump inhibitor, amoxicillin, clarithromycin, and 5-nitroimidazole for another seven days), and 10 or 14 days of sequential treatment (five or seven days of a proton pump inhibitor plus amoxicillin, followed by five or seven additional days of a proton pump inhibitor plus clarithromycin and 5-nitroimidazole or amoxicillin). In terms of tolerance, all treatments were considered tolerable, but seven days of probiotic supplemented triple treatment and seven days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported. Conclusion Comparison of different eradication treatments for H pylori showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, 10 or 14 days of

  20. Effect of Shockwave Curvature on Run Distance Observed with a Modified Wedge Test

    NASA Astrophysics Data System (ADS)

    Lee, Richard; Dorgan, Robert; Sutherland, Gerrit; Benedetta, Ashley; Milby, Christopher

    2011-06-01

    The effect of wave curvature on shock initiation in PBXN-110 was investigated using a modified wedge test configuration. Various thicknesses of PBXN-110 donor slabs were used to define the shockwave curvature introduced to wedge samples of the same explosive. The donor slabs were initiated with line-wave generators so that the introduced shock would be the same shape, magnitude and duration across the entire input surface of the wedge. The shock parameters were varied for a given donor thickness via different widths of PMMA spacers placed between the donor and the wedge. A framing camera was used to observe where initiation occurred along the face of the wedge. Initiation always occurred at the center of the shock front instead of the sides like that reported by others using a much smaller test format. Results were compared to CTH calculations to indicate if there were effects associated with highly curved shock fronts that could not be adequately predicted. The run distance predicted in CTH for a 50.8 mm thick donor slab (low curvature) compared favorably with experimental results. However, results from thinner donor slabs (higher curvature) indicate a more sensitive behavior than the simulations predicted.

  1. Effect of shockwave curvature on run distance observed with a modified wedge test

    NASA Astrophysics Data System (ADS)

    Lee, Richard; Dorgan, Robert J.; Sutherland, Gerrit; Benedetta, Ashley; Milby, Christopher

    2012-03-01

    The effect of wave curvature on shock initiation in PBXN-110 was investigated using a modified wedge test configuration. Various widths of PBXN-110 donor slabs were used to define the shockwave curvature introduced to wedge samples of the same explosive. The donor slabs were initiated with line-wave generators so that the shock from the donor would be the same shape, magnitude and duration across the entire input surface of the wedge. The shock parameters were varied for a given donor with PMMA spacers placed between the donor and the wedge sample. A high-speed electronic framing camera was used to observe where initiation occurred along the face of the wedge. Initiation always occurred at the center of the shock front instead of along the sides like that reported by others using a much smaller test format. Results were compared to CTH calculations to indicate if there were effects associated with highly curved shock fronts that could not be adequately predicted. The run distance predicted in CTH for a 50.8 mm wide donor slab (low curvature) compared favorably with experimental results. However, results from thinner donor slabs (higher curvature) indicate a more sensitive behavior than the simulations predicted.

  2. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model.

    PubMed

    Qiu, Xuefeng; Lin, Guiting; Xin, Zhongcheng; Ferretti, Ludovic; Zhang, Haiyang; Lue, Tom F; Lin, Ching-Shwun

    2013-03-01

    Introduction.  Low-energy shockwave therapy (LESWT) has been shown to improve erectile function in patients suffering from diabetes mellitus (DM)-associated erectile dysfunction (ED). However, the underlying mechanism remains unknown. Aim.  The aim of this study is to investigate whether LESWT can ameliorate DM-associated ED in a rat model and examine the associated changes in the erectile tissues. Methods.  Newborn male rats were intraperitoneally injected with 5-ethynyl-2-deoxyuridine (EdU; 50 mg/kg) for the purpose of tracking endogenous mesenchymal stem cells (MSCs). Eight weeks later, eight of these rats were randomly chosen to serve as normal control (N group). The remaining rats were injected intraperitoneally with 60 mg/kg of streptozotocin (STZ) to induce DM. Eight of these rats were randomly chosen to serve as DM control (DM group), whereas another eight rats were subject to shockwave (SW) treatment (DM+SW group). Each rat in the DM+SW group received 300 shocks at energy level of 0.1 mJ/mm(2) and frequency of 120/minute. This procedure was repeated three times a week for 2 weeks. Another 2 weeks later, all 24 rats were evaluated for erectile function by intracavernous pressure (ICP) measurement. Afterward, their penile tissues were examined by histology. Main Outcome Measures.  Erectile function was measured by ICP. Neuronal nitric oxide synthase (nNOS)-positive nerves and the endothelium were examined by immunofluorescence staining. Smooth muscle and MSCs were examined by phalloidin and EdU staining, respectively. Results.  STZ treatment caused a significant decrease in erectile function and in the number of nNOS-positive nerves and in endothelial and smooth muscle contents. These DM-associated deficits were all partially but significantly reversed by LESWT. MSCs (EdU-positive cells) were significantly more numerous in DM+SW than in DM rats. Conclusion.  LESWT can partially ameliorate DM-associated ED by promoting regeneration of n

  3. Management of common bile duct stones using a second-generation extracorporeal shockwave lithotriptor.

    PubMed

    Nicholson, D A; Martin, D F; Tweedle, D E; Rao, P N

    1992-08-01

    Fifty-four patients with common bile duct stones (8-36 mm in diameter) that could not be removed after endoscopic sphincterotomy, even with the use of mechanical lithotripsy, underwent extracorporeal shockwave lithotripsy (ESWL) using a Siemens Lithostar. Their median age was 75.5 (range 34-89) years. Patients received 4000-6000 shocks per session over approximately 60 min. Seventeen underwent two sessions and two patients three or more. Thirty-seven patients had one stone, ten had two, and seven had three or more. Spontaneous clearance of fragments occurred in only three patients before further endoscopic retrograde cholangiopancreatography was performed to remove fragments. Stones were removed and ducts cleared endoscopically in 35 patients, giving a total of 38 of 54 patients (70 per cent) with complete duct clearance. Fragmentation in response to lithotripsy was dependent on stone size; the number of stones had little effect. ESWL was well tolerated without any haematological or biochemical abnormality. Computed tomography in the first 20 patients showed no hepatic or pancreatic change after treatment. ESWL combined with endoscopic extraction of fragments is an alternative to surgery when preliminary endoscopic extraction and mechanical lithotripsy have failed.

  4. Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys.

    PubMed

    Kirkali, Z; Esen, A A; Mungan, M U

    1996-02-01

    Although extracorporeal shockwave lithotripsy (SWL) has dramatically changed the management of urinary tract stone disease, the anatomic abnormalities of horseshoe kidneys cause some difficulties in the use of SWL in this disorder. In this study, 18 patients with stone-bearing horseshoe kidneys were investigated retrospectively in order to determine the effectiveness of SWL. Patients received an average of 11,437 + or - 3062 shocks at an average of 18.8 kV with the Siemens Lithostar. Ten patients were treated in the supine position; stones could be localized in the prone position in eight. Catheterization with a double-J stent was the only adjunctive procedure; it was used in four patients prior to SWL. Adequate stone fragmentation (smaller than 5 mm) was achieved in 14 of the 18 patients (78%). Although 5 of them (28%) became stone free within 6 months after the treatment, residual fragments persisted in 9 patients (50%) during the mean follow-up of 55 months. Stones of 4 patients (22%) were not fragmented adequately. We concluded that although adequate fragmentation can be achieved in stone-bearing horseshoe kidneys, the anatomic abnormalities prevent fragment passage in a substantial number of patients.

  5. Prostaglandin E2 and Connexin 43 crosstalk in the osteogenesis induced by extracorporeal shockwave.

    PubMed

    Chen, Youbin; Xu, Jiankun; Liao, Haojie; Ma, Zebin; Zhang, Yuantao; Chen, Hongjiang; Huang, Zhonglian; Hu, Jun

    2016-09-01

    As a type of mechanical stimulation, extracorporeal shockwave (ESW) has been widely used in the clinic to treat bone fracture delayed union and non-unions. A large number of studies have shown beneficial effects of ESW in promoting fracture healing by inducing bone regeneration; however, the underlying mechanisms remain unclear. ESW has been shown to induce the production of prostaglandin E2 (PGE2), which is essential for gap junction intercellular communication in response to mechanical stress. Among the 19 known gap junction subunits, connexin43 (Cx43) is the most prevalent for mediating the response of mechanical stress. However, to our knowledge, the effect of ESW on Cx43 expression has not been reported before. Herein, we propose that a crosstalk between PGE2 and Cx43 is involved in the enhancement of osteogenesis induced by ESW. We review the currently available data to propose an unrevealed, but important mechanism via which ESW treatment affects osteogenic differentiation of bone marrow stromal cells.

  6. Extracorporeal shockwave enhanced regeneration of fibrocartilage in a delayed tendon-bone insertion repair model.

    PubMed

    Chow, Dick Ho Kiu; Suen, Pui Kit; Huang, Le; Cheung, Wing-Hoi; Leung, Kwok-Sui; Ng, Chun; Shi, San Qiang; Wong, Margaret Wan Nar; Qin, Ling

    2014-04-01

    Fibrous tissue is often formed in delayed healing of tendon bone insertion (TBI) instead of fibrocartilage. Extracorporeal shockwave (ESW) provides mechanical cues and upregulates expression of fibrocartilage-related makers and cytokines. We hypothesized that ESW would accelerate fibrocartilage regeneration at the healing interface in a delayed TBI healing model. Partial patellectomy with shielding at the TBI interface was performed on 32 female New Zealand White Rabbits for establishing this delayed TBI healing model. The rabbits were separated into the control and ESW group for evaluations at postoperative week 8 and 12. Shielding was removed at week 4 and a single ESW treatment was applied at week 6. Fibrocartilage regeneration was evaluated histomorphologically and immunohistochemically. Vickers hardness of the TBI matrix was measured by micro-indentation. ESW group showed higher fibrocartilage area, thickness, and proteoglycan deposition than the control in week 8 and 12. ESW increased expression of SOX9 and collagen II significantly in week 8 and 12, respectively. ESW group showed a gradual transition of hardness from bone to fibrocartilage to tendon, and had a higher Vickers hardness than the control group at week 12. In conclusion, ESW enhanced fibrocartilage regeneration at the healing interface in a delayed TBI healing model.

  7. Induced gall-bladder contraction accelerates fragment clearance after extracorporeal shockwave lithotripsy.

    PubMed

    Ziegenhagen, D J; Zehnter, E; Kruis, W; Pohl, C

    1993-01-01

    At the end of extracorporeal shockwave lithotripsy (ESWL) gallstone fragments are dispersed throughout the gall-bladder. In this state they should be expelled more easily than when later sedimented to the gall-bladder fundus. Thus, a randomized study was performed to evaluate the clinical benefit of induced gall-bladder contraction after ESWL. One hundred and five patients with radiolucent gallstones (1-3 stones, diameter < or = 30 mm) were randomized to received either saline or an infusion of 0.2 micrograms/kg ceruletide. Stone clearance rates and incidence of biliary symptoms were recorded. Clearance rates at 6 weeks and 3 months after ESWL were significantly (P < 0.025) improved by the ceruletide infusion. This effect, resulting in shortened bile acid therapy, was limited to patients with small solitary stones and dependent on a good initial fragmentation. Major side effects attributable to ceruletide were not observed. These results suggest that induced gall-bladder contraction can be successfully applied as an adjuvant treatment in a subgroup of patients with small solitary gallstones.

  8. Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation?

    PubMed

    Buchholz, N P; Meier-Padel, S; Rutishauser, G

    1997-08-01

    The aim of this study was to follow the fate of residual stone fragments (RF) < 5 mm after extracorporeal shockwave lithotripsy (SWL) over a sufficiently long period to determine how many are spontaneously cleared and after what time interval. A further aim was to clarify their role in clinical outcome and stone recurrence and regrowth. The clinical and radiologic data of 266 patients were analyzed. The patients were followed up for a mean of 387 days. After SWL, 55 patients (21%) had residual fragments < 5 mm in diameter. There were no significant differences between the stone-free patients and those with RF with regard to age, sex, relevant medical history, or SWL treatment. After a mean follow-up of 2.5 years, 12.7% of the residual fragments had not passed spontaneously, but all of them were clinically silent and located exclusively in the lower calices and the proximal ureter. Only 2% of the patients with RF showed stone regrowth, and no stone recurrences were observed within the follow-up period. In conclusion, although a minor pathophysiological role of RF < or = 5 mm cannot be discounted in recurrence and regrowth of kidney stones after SWL, more invasive attempts to clear all minor fragments do not seem warranted.

  9. Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system.

    PubMed

    Hausdorf, J; Lemmens, M A M; Heck, K D W; Grolms, N; Korr, H; Kertschanska, S; Steinbusch, H W M; Schmitz, C; Maier, M

    2008-07-31

    Application of extracorporeal shockwaves (ESW) to the musculoskeletal system may induce long-term analgesia in the treatment of chronic tendinopathies of the shoulder, heel and elbow. However, the molecular and cellular mechanisms behind this phenomenon are largely unknown. Here we tested the hypothesis that long-term analgesia caused by ESW is due to selective loss of nerve fibers in peripheral nerves. To test this hypothesis in vivo, high-energy ESW were applied to the ventral side of the right distal femur of rabbits. After 6 weeks, the femoral and sciatic nerves were investigated at the light and electron microscopic level. Application of ESW resulted in a selective, substantial loss of unmyelinated nerve fibers within the femoral nerve of the treated hind limb, whereas the sciatic nerve of the treated hind limb remained unaffected. These data might indicate that alleviation of chronic pain by selective partial denervation may play an important role in the effects of clinical ESW application to the musculoskeletal system.

  10. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    PubMed

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis. PMID:23970650

  11. Prostaglandin E2 and Connexin 43 crosstalk in the osteogenesis induced by extracorporeal shockwave.

    PubMed

    Chen, Youbin; Xu, Jiankun; Liao, Haojie; Ma, Zebin; Zhang, Yuantao; Chen, Hongjiang; Huang, Zhonglian; Hu, Jun

    2016-09-01

    As a type of mechanical stimulation, extracorporeal shockwave (ESW) has been widely used in the clinic to treat bone fracture delayed union and non-unions. A large number of studies have shown beneficial effects of ESW in promoting fracture healing by inducing bone regeneration; however, the underlying mechanisms remain unclear. ESW has been shown to induce the production of prostaglandin E2 (PGE2), which is essential for gap junction intercellular communication in response to mechanical stress. Among the 19 known gap junction subunits, connexin43 (Cx43) is the most prevalent for mediating the response of mechanical stress. However, to our knowledge, the effect of ESW on Cx43 expression has not been reported before. Herein, we propose that a crosstalk between PGE2 and Cx43 is involved in the enhancement of osteogenesis induced by ESW. We review the currently available data to propose an unrevealed, but important mechanism via which ESW treatment affects osteogenic differentiation of bone marrow stromal cells. PMID:27515217

  12. Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

    NASA Astrophysics Data System (ADS)

    Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

    1997-05-01

    Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

  13. Dynamics of plasma expansion and shockwave formation in femtosecond laser-ablated aluminum plumes in argon gas at atmospheric pressures

    SciTech Connect

    Miloshevsky, Alexander; Harilal, Sivanandan S.; Miloshevsky, Gennady Hassanein, Ahmed

    2014-04-15

    Plasma expansion with shockwave formation during laser ablation of materials in a background gasses is a complex process. The spatial and temporal evolution of pressure, temperature, density, and velocity fields is needed for its complete understanding. We have studied the expansion of femtosecond (fs) laser-ablated aluminum (Al) plumes in Argon (Ar) gas at 0.5 and 1 atmosphere (atm). The expansion of the plume is investigated experimentally using shadowgraphy and fast-gated imaging. The computational fluid dynamics (CFD) modeling is also carried out. The position of the shock front measured by shadowgraphy and fast-gated imaging is then compared to that obtained from the CFD modeling. The results from the three methods are found to be in good agreement, especially during the initial stage of plasma expansion. The computed time- and space-resolved fields of gas-dynamic parameters have provided valuable insights into the dynamics of plasma expansion and shockwave formation in fs-pulse ablated Al plumes in Ar gas at 0.5 and 1 atm. These results are compared to our previous data on nanosecond (ns) laser ablation of Al [S. S. Harilal et al., Phys. Plasmas 19, 083504 (2012)]. It is observed that both fs and ns plumes acquire a nearly spherical shape at the end of expansion in Ar gas at 1 atm. However, due to significantly lower pulse energy of the fs laser (5 mJ) compared to pulse energy of the ns laser (100 mJ) used in our studies, the values of pressure, temperature, mass density, and velocity are found to be smaller in the fs laser plume, and their time evolution occurs much faster on the same time scale. The oscillatory shock waves clearly visible in the ns plume are not observed in the internal region of the fs plume. These experimental and computational results provide a quantitative understanding of plasma expansion and shockwave formation in fs-pulse and ns-pulse laser ablated Al plumes in an ambient gas at atmospheric pressures.

  14. Comparative study of mechanical, hydrothermal, chemical and enzymatic treatments of digested biofibers to improve biogas production.

    PubMed

    Bruni, Emiliano; Jensen, Anders Peter; Angelidaki, Irini

    2010-11-01

    Organic waste such as manure is an important resource for biogas production. The biodegradability of manures is however limited because of the recalcitrant nature of the biofibers it contains. To increase the biogas potential of the biofibers in digested manure, we investigated physical treatment (milling), chemical treatment (CaO), biological treatment (enzymatic and partial aerobic microbial conversion), steam treatment with catalyst (H(3)PO(4) or NaOH) and combination of biological and steam treatments (biofibers steam-treated with catalyst were treated with laccase enzyme). We obtained the highest methane yield increase through the chemical treatment that resulted in 66% higher methane production compared to untreated biofibers. The combination of steam treatment with NaOH and subsequent enzymatic treatment increased the methane yield by 34%. To choose the optimal treatment, the energy requirements relative to the energy gain as extra biogas production have to be taken into account, as well as the costs of chemicals or enzymes.

  15. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

    PubMed Central

    Vahdatpour, Babak; Kianimehr, Lida; Ahrar, Mohmmad Hossein

    2016-01-01

    Background: Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF. Materials and Methods: Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment. Results: Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115). Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term. PMID:27274499

  16. Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

    NASA Astrophysics Data System (ADS)

    Shan, Tzu-Ray; Wixom, Ryan R.; Thompson, Aidan P.

    2016-08-01

    In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed by coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. The formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

  17. Extracorporeal shockwave therapy: A systematic review of its use in fracture management.

    PubMed

    Petrisor, Ba; Lisson, Selene; Sprague, Sheila

    2009-04-01

    Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies' overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures). However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.

  18. Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

    DOE PAGESBeta

    Shan, Tzu -Ray; Wixom, Ryan R.; Thompson, Aidan P.

    2016-08-11

    In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed bymore » coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.« less

  19. [High energy extracorporeal shockwave therapy (ESWT) in pseudarthrosis].

    PubMed

    Schoellner, C; Rompe, J D; Decking, J; Heine, J

    2002-07-01

    The gold standard for treatment of pseudarthrosis is operation with osteosynthesis and grafting. More than 10 years ago, extracorporeal shock wave therapy (ESWT) was additionally introduced as a noninvasive and low-risk treatment for pseudarthrosis. The aim of our prospective study was to analyze the treatment effect in a homogeneous group of patients and to develop prognostic factors. Forty-three consecutive patients were included in this study. All patients had been operated on for trauma or undergone selective osteotomy and had developed pseudarthrosis that persisted for 9 months. All patients received high-energy ESWT (0.6 mJ/mm2) with 3000 impulses (Siemens Osteostar) in one session under regional anesthesia. To differentiate active from inactive pseudarthrosis, a bone scintigraphy was compulsory. Clinical and radiological follow-ups were done at 4-week intervals starting 8 weeks after ESWT for 9 months. Cortical bridging was found in 31 of 43 (72.1%) pseudarthroses at 4.0 +/- 0.6 months after ESWT. Of 31 (80.6%) successfully treated patients, 25 had a positive scintigraphy compared to 4 of 12 (33.3%) treatment failures. Of 35 (82.9%) patients with a positive bone scintigraphy, 29 had bony healing compared to 2 of 8 (25%) patients with a negative bone scintigraphy. Six of these eight patients smoked more than 20 cigarettes a day. ESWT is still a clinically experimental treatment method. The absence of complications justifies its use for pseudarthrosis treatment. Further controlled studies are mandatory.

  20. Shock-induced bubble collapse in a vessel: Implications for vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran; Colonius, Tim

    2014-11-01

    In shockwave lithotripsy, shocks are repeatedly focused on kidney stones so to break them. The process leads to cavitation in tissue, which leads to hemorrhage. We hypothesize that shock-induced collapse (SIC) of preexisting bubbles is a potential mechanism for vascular injury. We study it numerically with an idealized problem consisting of the three-dimensional SIC of an air bubble immersed in a cylindrical water column embedded in gelatin. The gelatin is a tissue simulant and can be treated as a fluid due to fast time scales and small spatial scales of collapse. We thus model the problem as a compressible multicomponent flow and simulate it with a shock- and interface-capturing numerical method. The method is high-order, conservative and non-oscillatory. Fifth-order WENO is used for spatial reconstruction and an HLLC Riemann solver upwinds the fluxes. A third-order TVD-RK scheme evolves the solution. We evaluate the potential for injury in SIC for a range of pressures, bubble and vessel sizes, and tissue properties. We assess the potential for injury by comparing the finite strains in tissue, obtained by particle tracking, to ultimate strains from experiments. We conclude that SIC may contribute to vascular rupture and discuss the smallest bubble sizes needed for injury. This research was supported by NIH Grant No. 2PO1DK043881 and utilized XSEDE, which is supported by NSF Grant No. OCI-1053575.

  1. Comparison of hydrodynamic simulations with two-shockwave drive target experiments

    NASA Astrophysics Data System (ADS)

    Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

    2015-11-01

    We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number (A --> - 1) of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments.

  2. Biliary extracorporeal shockwave lithotripsy: short-term and long-term observations in an animal model.

    PubMed

    Vergunst, H; Terpstra, O T; Brakel, K; Nijs, H G; Laméris, J S; ten Kate, F J; Schröder, F H

    1993-08-01

    The short- and long-term effects of biliary extracorporeal shockwave lithotripsy (ESWL) using an electromagnetic lithotriptor were investigated in 26 pigs. After implantation of single human gallstones into their gallbladders, all but 4 control pigs were subjected to 4,000 or 8,000 shock waves and killed one day (n = 9), one week (n = 7), or one year (n = 6) thereafter. Post-ESWL, no abnormalities of chest radiographs or laboratory tests were detected. Apart from focal injury of the gallbladder and liver, in 4 out of 9 pigs subpleural pulmonary hemorrhages were found one day post-ESWL. However, tissue damage was largely reversed within one week and after one year only small hepatic scars persisted as permanent damage. Stone fragmentation occurred in 19 (86%) out of 22 pigs, and was adequate (fragments < or = 5 mm) in 9 (41%) pigs. Tissue damage and stone fragmentation after 4,000 as compared with 8,000 shock waves were not significantly different. These data warrant further evaluation of this lithotriptor in human studies.

  3. Shockwave-induced plasticity via large-scale nonequilibrium molecular dynamics

    SciTech Connect

    Holian, B.L.

    1998-07-01

    Nonequilibrium molecular-dynamics (MD) simulations of shock waves in single crystals have shown that, above a threshold strength, strongly shocked crystals deform in a very simple way. Rather than experiencing massive deformation, a simple slippage occurs at the shock front, relieving the peak shear stress, and leaving behind a stacking fault. Later calculations quantified the apparent threshold strength, namely the yield strength of the perfect crystal. Subsequently, pulsed x-ray experiments on shocked single crystals showed relative shifts in diffraction peaks, confirming our MD observations of stacking faults produced by shockwave passage. With the advent of massively parallel computers, we have been able to simulate shock waves in 10-million atom crystals with cross-sectional dimensions of 100{times}100 fcc unit cells (compared to earlier 6{times}6 systems). We have seen that the increased cross-section allows the system to slip along all of the available {l_brace}111{r_brace} slip planes, in different places along the now non-planar shock front. These simulations conclusively eliminate the worry that the kind of slippage we have observed is somehow an artifact of transverse periodic boundary conditions. Thus, future simulations are much more likely to show that weak-shock plasticity is nucleated by pre-existing extended defects embedded in the sample. {copyright} {ital 1998 American Institute of Physics.}

  4. Chronic kidney disease in urolithiasis patients following successful extracorporeal shockwave lithotripsy.

    PubMed

    Maeda, Satoshi; Naganuma, Toshihide; Takemoto, Yoshiaki; Shoji, Tetsuo; Okamura, Mikio; Nakatani, Tatsuya

    2012-01-01

    Recently, it has been reported that kidney stones are a significant and independent risk factor for chronic kidney disease (CKD) in the general population. However, the prevalence of CKD in patients following successful extracorporeal shockwave lithotripsy (ESWL) has yet to be elucidated. In the present study, the prevalence of CKD and the clinical factors associated with the presence of CKD in patients following successful ESWL were investigated. A cross‑sectional study was performed in 114 patients who had undergone ESWL for upper urinary tract stones and 96 age- and gender-matched healthy control subjects. We initially determined the stage of CKD and compared the prevalence of CKD between healthy subjects and patients who underwent successful ESWL. We then investigated the clinical factors associated with the presence of CKD by logistic regression analysis. The prevalence of CKD was significantly higher in patients following successful ESWL than in the healthy subjects [40 patients (35.1%) vs. 9 healthy controls (9.4%), P<0.0001]. Logistic regression analysis showed that the significant factors associated with the presence of CKD were increased body mass index (BMI) and the presence of a ureteric stone (pre‑ESWL stone position). The findings indicated that there was a high prevalence of CKD among patients following successful ESWL, and that an increased BMI and a ureteric stone were factors associated with the presence of CKD.

  5. How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics?

    PubMed

    Jeong, Byong Chang; Park, Hyoung Keun; Kwak, Cheol; Oh, Seong-June; Kim, Hyeon Hoe

    2005-08-01

    Our aim was to investigate the subjective pain felt by patients during shockwave lithotripsy (SWL) and endoscopic procedures such as cystoscopy, retrograde ureteral stenting, retrograde pyelography (RGP), and ureteroscopic lithotripsy performed in an outpatient clinic, and to identify how severe pain during such procedures is. We estimated subjective pain in 984 patients after SWL (186), cystoscopy (489), retrograde ureteral stenting (127), RGP (97), and ureteroscopic lithotripsy (85) performed by a single expert in an outpatient clinic using a prospective questionnaire with a ten point visual analog scale between January 2001 and December 2003. There was no premedication in any procedure except ureteroscopic lithotripsy for which an intramuscular injection of analgesics (pethidine HCl 50 mg) was used. The pain scale score in SWL was 6.62+/-2.27, the highest among the procedures (P<0.05). Pain scores for endoscopies were 4.48+/-2.07 in retrograde ureteral stenting, 3.81+/-2.06 in ureteroscopic lithotripsy, 3.72+/-1.75 in RGP, and 3.08+/-1.95 in cystoscopy. In this study, we observed that patients feel most pain in SWL without anesthesia, and that pain during ureteroscopic lithotripsy under local anesthesia is not high, compared with other endoscopic procedures.

  6. Spectroscopic diagnostics of plume rebound and shockwave dynamics of confined aluminum laser plasma plumes

    SciTech Connect

    Yeates, P.; Kennedy, E. T.

    2011-06-15

    Generation and expansion dynamics of aluminum laser plasma plumes generated between parallel plates of varying separation ({Delta}Z = 2.0, 3.2, 4.0, and 5.6 mm), which confined plume expansion normal to the ablation surface, were diagnosed. Space and time resolved visible emission spectroscopy in the spectral range {lambda} = 355-470 nm and time gated visible imaging were employed to record emission spectra and plume dynamics. Space and time resolved profiles of N{sub e} (the electron density), T{sub e} (the electron temperature), and T{sub ionz} (the ionization temperature) were compared for different positions in the plasma plume. Significant modifications of the profiles of the above parameters were observed for plasma-surface collisions at the inner surface of the front plate, which formed a barrier to the free expansion of the plasma plume generated by the laser light on the surface of the back plate. Shockwave generation at the collision interface resulted in delayed compression of the low-density plasma plume near the inner ablation surface, at late stages in the plasma history. Upon exiting the cavity formed by the two plates, through an aperture in the front plate, the plasma plume underwent a second phase of free expansion.

  7. Comparison of hydrodynamic simulations with two-shockwave drive target experiments

    NASA Astrophysics Data System (ADS)

    Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

    2015-11-01

    We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number A --> - 1 of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments. This work was supported in part by the (U.S.) Department of Energy (DOE) under Contract No. DE-AC52-06NA2-5396.

  8. Use of the Hugoniot elastic limit in laser shockwave experiments to relate velocity measurements

    NASA Astrophysics Data System (ADS)

    Smith, James A.; Lacy, Jeffrey M.; Lévesque, Daniel; Monchalin, Jean-Pierre; Lord, Martin

    2016-02-01

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. This fuel-cladding interface qualification will ensure the survivability of the fuel plates in the harsh reactor environment even under abnormal operating conditions. One of the concerns of the project is the difficulty of calibrating and standardizing the laser shock technique. An analytical study under development and experimental testing supports the hypothesis that the Hugoniot Elastic Limit (HEL) in materials can be a robust and simple benchmark to compare stresses generated by different laser shock systems.

  9. Shock-wave cosmology inside a black hole

    PubMed Central

    Smoller, Joel; Temple, Blake

    2003-01-01

    We construct a class of global exact solutions of the Einstein equations that extend the Oppeheimer–Snyder model to the case of nonzero pressure, inside the black hole, by incorporating a shock wave at the leading edge of the expansion of the galaxies, arbitrarily far beyond the Hubble length in the Friedmann–Robertson–Walker (FRW) spacetime. Here the expanding FRW universe emerges be-hind a subluminous blast wave that explodes outward from the FRW center at the instant of the big bang. The total mass behind the shock decreases as the shock wave expands, and the entropy condition implies that the shock wave must weaken to the point where it settles down to an Oppenheimer–Snyder interface, (bounding a finite total mass), that eventually emerges from the white hole event horizon of an ambient Schwarzschild spacetime. The entropy condition breaks the time symmetry of the Einstein equations, selecting the explosion over the implosion. These shock-wave solutions indicate a cosmological model in which the big bang arises from a localized explosion occurring inside the black hole of an asymptotically flat Schwarzschild spacetime. PMID:12972640

  10. [Electromagnetic shockwave lithotripsy of gallstones. Preliminary clinical experiences].

    PubMed

    Neuhaus, H; Brandstetter, K; Hagenmüller, F; Gerhardt, P; Classen, M

    1990-01-26

    75 applications of extracorporeal electromagnetically produced shock-waves were performed on 40 patients with symptomatic gallbladder stones (27 women and 13 men; mean age 43.5 [25-69] years). The patients had up to three stones each, with a maximal diameter of 35 mm. Computed tomography revealed partial calcification of the stones in nine patients. Stone fragmentation succeeded in all patients. Two weeks after lithotripsy two patients were free of stone. Maximal fragment diameter, as measured by ultrasound, was less than 6 mm in 19 patients, 6-10 mm in 14, and 11-15 mm in five. At reexamination of 24 patients three months later, three additional patients were free of stone by ultrasound. No significant side effects were noted during the first 30 days after the procedure. But during further observation mild pancreatitis developed in two, while in one choledochal concrements caused obstructive jaundice which necessitated endoscopic papillotomy. These results demonstrate the effectiveness of this method of fragmenting gall-bladder stones.

  11. Control of cavitation activity by different shockwave pulsing regimes.

    PubMed

    Huber, P; Debus, J; Jöchle, K; Simiantonakis, I; Jenne, J; Rastert, R; Spoo, J; Lorenz, W J; Wannenmacher, M

    1999-06-01

    The aim of the study was to control the number of inertial cavitation bubbles in the focal area of an electromagnetic lithotripter in water independently of peak intensity, averaged intensity or pressure waveform. To achieve this, the shockwave pulses were applied in double pulse sequences, which were administered at a fixed pulse repetition frequency (PRF) of 0.33 Hz. The two pulses of a double pulse were separated by a variable short pulse separation time (PST) ranging from 200 micros to 1500 ms. The number and size of the cavitation bubbles were monitored by scattered laser light and stroboscopic photographs. We found that the number of inertial cavitation bubbles as a measure of cavitation dose was substantially influenced by variation of the PST, while the pressure pulse waveform, averaged acoustic intensity and bubble size were kept constant. The second pulse of each double pulse generated more cavitation bubbles than the first. At 14 kV capacitor voltage, the total number of cavitation bubbles generated by the double pulses increased with shorter PST down to approximately 400 micros, the cavitation lifespan. The results can be explained by cavitation nuclei generated by the violently imploding inertial cavitation bubbles. This method of pulse administration and cavitation monitoring could be useful to establish a cavitation dose-effect relationship independently of other acoustic parameters.

  12. In vitro biomechanical evaluation of single impulse and repetitive mechanical shockwave devices utilized for spinal manipulative therapy.

    PubMed

    Liebschner, Michael A K; Chun, Kwonsoo; Kim, Namhoon; Ehni, Bruce

    2014-12-01

    Mechanical shockwave therapy devices have been in clinical use for almost 40 years. While most often used to treat back pain, our understanding of their biomechanical performance is very limited. From biomechanical studies we know that biological tissue is viscoelastic and preferably excited around its resonance frequency. Targeting these frequencies has been the focus in extracorporeal shock wave lithotripsy, but these concepts are relatively new in orthopedic and rehabilitation therapies. The exact mechanism by which shockwave therapy acts is not known. Knowledge of the performance characteristics of these devices, correlated with clinical outcome studies, may lead to better patient selection, improvement of device functionality, and knowledge of the underlying working principals of therapy. The objectives of this study were to determine the ability of several commercial shockwave devices to achieve a desired thrust profile in a benchtop setting, determine the thrust profile in a clinical analog, and determine the influence of operator experience level on device performance. We conducted two different types of testing: (1) bench testing to evaluate the devices themselves, and (2) clinical equivalent testing to determine the influence of the operator. The results indicated a significant dependence of thrust output on the compliance of the test media. The Activator V-E device matched the ideal half-sine thrust profile to 94%, followed by the Impulse device (84%), the Activator IV/FS (74%), and the Activator II (48%). While most devices deviated from the ideal profile on the return path, the Impulse device exhibited a secondary peak. Moreover, the Activator V-E device provided evidence that the device performs consistently despite operator experience level. This has been a major concern in manual spinal manipulation. Based on our results, a hyper-flexible spine would receive a lower peak thrust force than a hypo-flexible spine at the same power setting. Furthermore

  13. Are prophylactic antibiotics necessary during extracorporeal shockwave lithotripsy?

    PubMed

    Pettersson, B; Tiselius, H G

    1989-05-01

    A randomised clinical study was carried out on patients admitted for ESWL treatment in order to establish the requirement for prophylactic treatment with antibiotics during this procedure. Patients with clinical signs of urinary tract infection, evidence of infectious stones or a positive urine culture were excluded. All other patients were consecutively randomised into 3 groups which were given either trimethoprim + sulphamethoxazole or mecillinam (Group A), methenamine hippurate (Group B), or no treatment at all (Group C). Evaluation with respect to clinical signs of infection was done immediately after the treatment and 4 weeks later. In addition, a urine culture was performed 2 weeks after ESWL, i.e. 1 week after completing treatment with antibiotics and methenamine hippurate. With respect to infectious complications there were no differences between Groups A and C, between Groups B and C or between Group A and B+C, whereas an unexplained slightly higher infectious rate was recorded for Group B compared with Group A. In all patients the occurrence of bacteriuria was low (6.7%) despite the fact that almost 30% of patients had a ureteric catheter during the ESWL procedure. Patients with ureteric catheters did not present with more infectious complications than those without. All patients had a bladder catheter during ESWL. It was concluded that prophylactic treatment with antibiotics during ESWL treatment is unnecessary in all situations where an infectious aetiology is unlikely.

  14. Comparative health-effects assessment of drinking-water-treatment technologies. Final report

    SciTech Connect

    Not Available

    1988-03-09

    On October 8-9, 1987 the Drinking Water Subcommittee of the Science Advisory Board's Environmental Health Committee met to independently review of Office of Drinking Water report to Congress entitled Comparative Health Effects Assessment of Drinking Water Treatment Technologies. The objective of the report is to compare the health effects resulting from the use of different drinking-water-treatment technologies with those prevented by biological treatment. The Subcommittee concludes that the constraints of time and available budget, the report adequately surveys the available information on health effects pf chemicals involved in water treatment, including cost estimates. The rationale for the specific approach used in examining water-treatment processes should be articulated. The introduction should also clearly state that there is a disparity in knowledge for the various treatment techniques.

  15. Comparative trial of treatment with Prioderm lotion and Kwellada shampoo in children with head lice.

    PubMed

    Mathias, R G; Huggins, D R; Leroux, S J; Proctor, E M

    1984-02-15

    The safety and efficacy of treatment with a new pediculicide lotion, Prioderm (0.5% malathion in isopropanol), were compared with those of treatment with Kwellada (1% lindane) shampoo in a randomized trial of children with head lice. The children's scalps were examined for live lice immediately, 7 days and 4 to 6 weeks following treatment. To determine the in-vitro ovicidal effect of treatment, samples of hair with nits were removed before and immediately following treatment; the subsequent rates of hatching were compared. No live lice were present immediately following either treatment. At 7 days after treatment 2 of the 29 children treated with Prioderm lotion and 4 of the 33 children treated with Kwellada shampoo were infested with live lice, whereas at 4 to 6 weeks after treatment 5 and 3 children respectively were infested. The initial effectiveness of treatment was 93% in the children treated with Prioderm lotion and 88% in those treated with Kwellada shampoo; however, a large difference in efficacy could have been missed owing to the small number of children in the study. Both preparations demonstrated in-vitro ovicidal activity, but neither totally abolished post-treatment hatching. No side effects were reported from either preparation. Because ovicidal activity was incomplete two treatments with the same pediculicides should be given about 7 days apart.

  16. Sonographically-guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis.

    PubMed

    Schreiber, F; Gurakuqi, G C; Pristautz, H; Trauner, M; Schnedl, W

    1996-03-01

    Over a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone-free patients showed no further symptoms over the follow-up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow-up period.

  17. Donor-gifted allograft lithiasis: extracorporeal shockwave lithotripsy with over table module using the Lithostar Plus.

    PubMed

    Bhadauria, R P; Ahlawat, R; Kumar, R V; Srinadh, E S; Banerjee, G K; Bhandari, M

    1995-01-01

    Allograft lithiasis is usually secondary. Donor-graft lithiasis is a rare cause and only 5 cases have been reported. We report 2 such cases which are the first in the live-related transplantation programme. The pressing need to increase the donor pool in developing countries, safety of therapy in graft lithiasis coupled with minimal estimated risk of lithiasis recurrence in the donor are the main justifications for accepting calculi bearing kidney for transplantation. The 2 cases underwent extracorporeal shockwave lithotripsy using the overhead table module of the Lithostar Plus. The technical ease of lithotripsy using an on-line ultrasound module in these 'ectopically' placed kidneys is discussed. The effect of shockwaves on allograft function was studied by a pre- and post-renal scan (99Tc-DTPA) and serum creatinine. No adverse effect of shockwave on allograft function was noted both on short- and long-term follow-up.

  18. [The importance of computed tomography and magnetic resonance tomography in shockwave cholelithotripsy].

    PubMed

    Golder, W A; Tempel, U; Gmeinwieser, J

    1989-01-01

    With shockwave-lithotripsy a new method of therapy has been introduced, whose efficiency is essentially determined by that of the accompanying imaging diagnostics. This poses several new problems for the diagnostic radiologist. While sonography and conventional cholegraphy have an important place in connection with shockwave-lithotripsy, the role of computed tomography (CT) and magnetic resonance tomography (MRT) has not yet been established. According to our experiences and experimental data pre-interventional CT improves the accuracy for measurements of the calcium content of concrements and gives the best survey on the topography of the upper abdomen of patients with biliary concrements. MRT before lithotripsy does not yield important additional information. Applied after intervention it at least equals CT. Besides localization and description of the diseased gall-bladder the detection of complications with CT and MRT is one of the tasks of the radiologist in connection with shockwave-lithotripsy.

  19. Patient Perception of Treatment Burden is High in Celiac Disease Compared to Other Common Conditions

    PubMed Central

    Shah, Sveta; Akbari, Mona; Vanga, Rohini; Kelly, Ciaran P.; Hansen, Joshua; Theethira, Thimmaiah; Tariq, Sohaib; Dennis, Melinda; Leffler, Daniel A.

    2014-01-01

    Introduction The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of celiac disease, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares to other medical treatments, and there are limited data on the socio-economic factors influencing treatment adherence. In this study we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence. Methods A survey was mailed to participants with: CD, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), and end stage renal disease on dialysis (ESRD). Surveys included demographic information and visual analog scales measuring treatment burden, importance of treatment, disease-specific and overall health status. Results We collected surveys from 341 celiac and 368 non-celiac participants. Celiac participants reported high treatment burden, greater than participants with GERD or HTN and comparable to ESRD. Conversely, patients with CD reported the highest health state of all groups. Factors associated with high treatment burden in CD included poor adherence, concern regarding food cost, eating outside the home, higher income, lack of college education and time limitations in preparing food. Poor adherence in CD was associated with increased symptoms, income, and low perceived importance of treatment. Discussion Participants with CD have high treatment burden but also excellent overall health status in comparison with other chronic medical conditions. The significant burden of dietary therapy for celiac disease argues for the need for safe adjuvant treatment as well as interventions designed to lower the perceived burden of the GFD. PMID:24980880

  20. Estimation of the thermodynamic parameters of a shock-wave action on high-porosity heterogeneous materials

    NASA Astrophysics Data System (ADS)

    Kinelovskii, S. A.; Maevskii, K. K.

    2016-08-01

    The properties of high-porosity powder mixtures during shock-wave loading are determined using a thermodynamically equilibrium model. The calculations performed with this model agree well with the data obtained from experiments over a wide pressure range. An equation of state of the Mie-Grüneisen type is used for condensed phases on the assumption of a temperature-dependent Grüneisen coefficient. The thermodynamic properties of mixtures are described for two or more condensed components over wide pressure and porosity ranges up to aerogels. Only the parameters of components are used to calculate the behavior their mixtures. The calculation results are compared with both the experimental data and the simulation results obtained by other authors.

  1. Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

    ERIC Educational Resources Information Center

    Lindsay, William R.; Michie, Amanda M.; Steptoe, Lesley; Moore, Fhionna; Haut, Fabian

    2011-01-01

    Background: Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method:…

  2. Comparing drinking water treatment costs to source water protection costs using time series analysis.

    EPA Science Inventory

    We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reductio...

  3. A Comparative Evaluation of Minimal Therapist Contact and 15-Session Treatment for Female Orgasmic Dysfunction.

    ERIC Educational Resources Information Center

    Morokoff, Patricia J.; LoPiccolo, Joseph

    1986-01-01

    Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…

  4. Experimental studies of hypersonic shock-wave boundary-layer interactions

    NASA Technical Reports Server (NTRS)

    Lu, Frank K.

    1992-01-01

    Two classes of shock-wave boundary-layer interactions were studied experimentally in a shock tunnel in which a low Reynolds number, turbulent flow at Mach 8 was developed on a cold, flat test surface. The two classes of interactions were: (1) a swept interaction generated by a wedge ('fin') mounted perpendicularly on the flat plate; and (2) a two-dimensional, unseparated interaction induced by a shock impinging near an expansion corner. The swept interaction, with wedge angles of 5-20 degrees, was separated and there was also indication that the strongest interactions prossessed secondary separation zones. The interaction spread out extensively from the inviscid shock location although no indication of quasi-conical symmetry was evident. The surface pressure from the upstream influence to the inviscid shock was relatively low compared to the inviscid downstream value but it rose rapidly past the inviscid shock location. However, the surface pressure did not reach the downstream inviscid value and reasons were proposed for this anomalous behavior compared to strongly separated, supersonic interactions. The second class of interactions involved weak shocks impinging near small expansion corners. As a prelude to studying this interaction, a hypersonic similarity parameter was identified for the pure, expansion corner flow. The expansion corner severely damped out surface pressure fluctuations. When a shock impinged upstream of the corner, no significant changes to the surface pressure were found as compared to the case when the shock impinged on a flat plate. But, when the shock impinged downstream of the corner, a close coupling existed between the two wave systems, unlike the supersonic case. This close coupling modified the upstream influence. Regardless of whether the shock impinged ahead or behind the corner, the downstream region was affected by the close coupling between the shock and the expansion. Not only was the mean pressure distribution modified but the

  5. [THE BONE DEFECT HEALING UNDER THE INFLUENCE OF RADIAL EXTRACORPOREAL SHOCK-WAVE THERAPY IN EXPERIMENT].

    PubMed

    Gertsen, G I; Se-Fey; Ostapchuk, R M; Lesovoy, A V; Zherebchuk, V V

    2016-03-01

    In experiment on 24 rabbits the processes of reparative osteogenesis in perforated defect of proximal tibial metaphysis under the influence of extracorporeal shock-wave therapy were studied. In accordance to data of clinical, roentgenological and morphological investiagations, conducted in terms 5, 15, 30 and 45 days of observation, there was established, that under the influence of extracorporeal shock-wave therapy in the bone marrow in the traumatic region a vasodilatation, as well as the blood cells exit from capillaries and sinusoid vessels with creation of massive regions of osseous endostal regenerate, guaranteeing the tibial integrity restoration, occurs. PMID:27514097

  6. Selection Bias When Using Instrumental Variable Methods to Compare Two Treatments But More Than Two Treatments Are Available.

    PubMed

    Ertefaie, Ashkan; Small, Dylan; Flory, James; Hennessy, Sean

    2016-05-01

    Instrumental variable (IV) methods are widely used to adjust for the bias in estimating treatment effects caused by unmeasured confounders in observational studies. It is common that a comparison between two treatments is focused on and that only subjects receiving one of these two treatments are considered in the analysis even though more than two treatments are available. In this paper, we provide empirical and theoretical evidence that the IV methods may result in biased treatment effects if applied on a data set in which subjects are preselected based on their received treatments. We frame this as a selection bias problem and propose a procedure that identifies the treatment effect of interest as a function of a vector of sensitivity parameters. We also list assumptions under which analyzing the preselected data does not lead to a biased treatment effect estimate. The performance of the proposed method is examined using simulation studies. We applied our method on The Health Improvement Network (THIN) database to estimate the comparative effect of metformin and sulfonylureas on weight gain among diabetic patients. PMID:27227722

  7. [Shockwave destruction of stones in the kidneys and ureters].

    PubMed

    Lopatkin, N A; Simonov, V Ia; Dzeranov, N K; Martov, A G; Zakhmatov, Iu M

    1989-01-01

    Experience gained in the use of the first Soviet unit and western lithotriptors is based on the treatment of over 2500 patients of different age groups. Comparative characteristics of lithotriptors are provided to mark substantial advantages of the Soviet unit. Distant lithotripsy (DL) is much more effective and atraumatic as compared with conventional surgical interventions. The use of DL provides positive effect in 97-99% of cases. The rate of complications is extremely low, amounting to 5-10%. Indications and contraindications as to the use of DL are given. Contraindications include cases requiring reconstructive surgical interventions and the presence of coral-like calculi and acute inflammation. The Soviet unit appeared especially effective in the treatment of children with urolithiasis. The cure was attained in 97.2% of the patients, no serious complications occurred. Functional studies of the kidneys did not reveal any changes both in the short- and long-term periods after DL.

  8. A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis.

    PubMed

    Escobedo, A A; Cañete, R; Gonzalez, M E; Pareja, A; Cimerman, S; Almirall, P

    2003-07-01

    To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur.

  9. A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis.

    PubMed

    Escobedo, A A; Cañete, R; Gonzalez, M E; Pareja, A; Cimerman, S; Almirall, P

    2003-07-01

    To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur. PMID:12930613

  10. Histomorphologic and ultrastructural findings of shockwave-induced lesions in the isolated perfused kidney of the pig.

    PubMed

    Back, W; Köhrmann, K U; Bensemann, J; Rassweiler, J; Alken, P

    1994-08-01

    The aim of this investigation was the development of an easily reproducible model with which to evaluate shockwave-induced renal tissue damage using light and electron microscopy. Kidneys (n = 45) from freshly slaughtered pigs were perfused under physiologic conditions and treated with shockwaves at different doses (2-250 shockwaves; 12-20 kV) on the Modulith SL 20 lithotripter. The dose-dependent alterations in tissue structure were characterized by disintegration of tubular cells leading to circumscribed gap-like defects resulting from reticular fiber disruptions. Even after low shockwave doses, cellular and subcellular alterations could be observed. Our findings in this ex vivo model verify the development of considerable strictly localized, dose-dependent shockwave-induced damage of the renal parenchyma. On morphologic grounds, we cannot confirm a primary lesion or rupture of blood vessel walls as the cause of the shockwave lesions. The destruction of tubular cells in combination with disruption of peritubular and pericapillary reticular fiber coats results in capillarotubular leaks, which can explain even severe transitory macrohematuria after clinical shockwave lithotripsy without renal hematoma formation.

  11. Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

    PubMed

    Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

    2013-06-01

    Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange.

  12. Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

    PubMed

    Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

    2013-06-01

    Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange. PMID:23557723

  13. Additional treatment of wastewater reduces endocrine disruption in wild fish--a comparative study of tertiary and advanced treatments.

    PubMed

    Baynes, Alice; Green, Christopher; Nicol, Elizabeth; Beresford, Nicola; Kanda, Rakesh; Henshaw, Alan; Churchley, John; Jobling, Susan

    2012-05-15

    Steroid estrogens are thought to be the major cause of feminization (intersex) in wild fish. Widely used wastewater treatment technologies are not effective at removing these contaminants to concentrations thought to be required to protect aquatic wildlife. A number of advanced treatment processes have been proposed to reduce the concentrations of estrogens entering the environment. Before investment is made in such processes, it is imperative that we compare their efficacy in terms of removal of steroid estrogens and their feminizing effects with other treatment options. This study assessed both steroid removal and intersex induction in adult and early life stage fish (roach, Rutilus rutilus). Roach were exposed directly to either secondary (activated sludge process (ASP)), tertiary (sand filtrated (SF)), or advanced (chlorine dioxide (ClO(2)), granular activated charcoal (GAC)) treated effluents for six months. Surprisingly, both the advanced GAC and tertiary SF treatments (but not the ClO(2) treatment) significantly removed the intersex induction associated with the ASP effluent; this was not predicted by the steroid estrogen measurements, which were higher in the tertiary SF than either the GAC or the ClO(2). Therefore our study highlights the importance of using both biological and chemical analysis when assessing new treatment technologies.

  14. Ketazolam compared to diazepam and placebo in the treatment of anxiety.

    PubMed

    Kleber, R J

    1980-01-01

    Compared to placebo, ketazolam given once daily was more effective in alleviating the symptoms of anxiety than was diazepam given three times a day in this 28-day double-blind study in fifty-six out-patients. Ketazolam patients reported fewer, milder side-effects than diazepam patients. In particular, drowsiness was reported less than 8% as often during ketazolam treatment as during diazepam treatment.

  15. Weighted log-rank statistic to compare shared-path adaptive treatment strategies.

    PubMed

    Kidwell, Kelley M; Wahed, Abdus S

    2013-04-01

    Adaptive treatment strategies (ATSs) more closely mimic the reality of a physician's prescription process where the physician prescribes a medication to his/her patient, and based on that patient's response to the medication, modifies the treatment. Two-stage randomization designs, more generally, sequential multiple assignment randomization trial designs, are useful to assess ATSs where the interest is in comparing the entire sequence of treatments, including the patient's intermediate response. In this paper, we introduce the notion of shared-path and separate-path ATSs and propose a weighted log-rank statistic to compare overall survival distributions of multiple two-stage ATSs, some of which may be shared-path. Large sample properties of the statistic are derived and the type I error rate and power of the test are compared with the standard log-rank test through simulation. PMID:23178734

  16. Shockwave application in calcifying tendinitis of the shoulder--prediction of outcome by imaging.

    PubMed

    Maier, M; Stäbler, A; Lienemann, A; Köhler, S; Feitenhansl, A; Dürr, H R; Pfahler, M; Refior, H J

    2000-01-01

    This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p < 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits before ESWA were not associated with the clinical outcome, negative contrast reactions around the deposits (p) = 0.0001), synovia (p = 0.0049) and bursae (p < 0.01) were associated with improved clinical outcomes. After the total study group was divided into two groups, one with Constant scores > or = 75% (n = 43) and the other with scores < 75% (n = 22), the positive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.95; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.49) and bursae (ppv: 0.86; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA.

  17. Extracorporeal shockwave therapy promotes chondrogenesis in cartilage tissue engineering: A hypothesis based on previous evidence.

    PubMed

    Ji, Qiaodan; He, Chengqi

    2016-06-01

    The dearth of intrinsic regenerative capacity of articular cartilage makes it a challenge to deal with the cartilage defects. Among all the recommended clinical options, cartilage tissue engineering (CTE) which is highlighted of dominant features and less drawbacks for functional cartilage restoration, has been emphasized recently. Shock waves, a mode of therapeutic mechanical forces, utilized in extracorporeal shockwave therapy (ESWT), is hypothesized to enhance proliferation, chondrogenic differentiation, and cartilage extracellular matrix production of target cells seeded on bioactive scaffolds. The hypothesis is firstly based on cellular mechanotransduction by which cells convent the shockwave mechanical signals into biochemical responses via integrins, iron channels, cytoskeletal filaments, growth factor receptors and nuclei. Secondly, by modulating gene expression and up-regulating the release of various growth factors which are of vital importance in three-dimensional cartilage culture environment, ESWT holds a promising potential to favor the cell sources (e.g. chondrocytes and stem cells) to mimic the optimal functional cartilage. In all, on the basis of cellular mechanotransduction and previous evidence, the hypothesis is developed to support the beneficial effects of ESWT on chondrogenesis in CTE. If this hypothesis is confirmed, shockwaves may allow a better success in combination with other stimulating factors for cartilage repair. There is a paucity of studies investigating the assistant role of shockwave stimulation in CTE. Further research is required to elucidate the mechanisms, and explore effectiveness and appropriate protocols of this novel stimulative factor in cartilage tissue engineering.

  18. Endoscopic gallbladder catheterisation and extracorporeal shockwave lithotripsy in the management of Mirizzi's syndrome.

    PubMed

    Martin, D F; Tweedle, D E; Rao, P N

    1988-11-01

    A novel approach to the management of Mirizzi's syndrome due to a mucocele of the gallbladder is reported. Endoscopic retrograde catheterisation of the gallbladder permitted decompression, and was followed by extracorporeal shockwave lithotripsy of gallbladder calculi in an 80-year-old man considered unfit for operation.

  19. Extracorporeal shockwave therapy promotes chondrogenesis in cartilage tissue engineering: A hypothesis based on previous evidence.

    PubMed

    Ji, Qiaodan; He, Chengqi

    2016-06-01

    The dearth of intrinsic regenerative capacity of articular cartilage makes it a challenge to deal with the cartilage defects. Among all the recommended clinical options, cartilage tissue engineering (CTE) which is highlighted of dominant features and less drawbacks for functional cartilage restoration, has been emphasized recently. Shock waves, a mode of therapeutic mechanical forces, utilized in extracorporeal shockwave therapy (ESWT), is hypothesized to enhance proliferation, chondrogenic differentiation, and cartilage extracellular matrix production of target cells seeded on bioactive scaffolds. The hypothesis is firstly based on cellular mechanotransduction by which cells convent the shockwave mechanical signals into biochemical responses via integrins, iron channels, cytoskeletal filaments, growth factor receptors and nuclei. Secondly, by modulating gene expression and up-regulating the release of various growth factors which are of vital importance in three-dimensional cartilage culture environment, ESWT holds a promising potential to favor the cell sources (e.g. chondrocytes and stem cells) to mimic the optimal functional cartilage. In all, on the basis of cellular mechanotransduction and previous evidence, the hypothesis is developed to support the beneficial effects of ESWT on chondrogenesis in CTE. If this hypothesis is confirmed, shockwaves may allow a better success in combination with other stimulating factors for cartilage repair. There is a paucity of studies investigating the assistant role of shockwave stimulation in CTE. Further research is required to elucidate the mechanisms, and explore effectiveness and appropriate protocols of this novel stimulative factor in cartilage tissue engineering. PMID:27142133

  20. Ultrafast Time Response Pressure-Sensitive Paint for Unsteady Shock-Wave Research

    NASA Astrophysics Data System (ADS)

    Numata, Daiju; Asai, Keisuke

    Pressure-Sensitive Paint (PSP) is an optical pressure measurement technique widely used in aerodynamic experiments, and has been applied to unsteady shock-wave phenomena [1, 2]. However, one of the largest problems to apply PSP to high-speed and unsteady phenomena is the response time of PSP.

  1. A solid-phase mechanism of shock-wave formation of dust particles of heavy metals

    NASA Astrophysics Data System (ADS)

    Lin, E. E.; Mikhailov, A. L.; Khvorostin, V. N.

    2016-08-01

    The possibility of formation of dust particles in solid as a result of shock-wave destruction of the initial crystalline material structure and subsequent coalescence of atomic clusters (nanoparticles), which leads to the aggregation of mesocrystalline particles (grains) in the shocked layer, is discussed.

  2. Comparing Guidelines for Statin Treatment in Canada and the United States

    PubMed Central

    Hennessy, Deirdre A; Bushnik, Tracey; Manuel, Douglas G; Anderson, Todd J

    2015-01-01

    Background New guidelines for cardiovascular disease risk assessment and statin eligibility have recently been published in the United States by the American College of Cardiology and the American Heart Association (ACC-AHA). It is unknown how these guidelines compare with the Canadian Cardiovascular Society (CCS) recommendations. Methods and Results Using data from the Canadian Health Measures Survey 2007–2011, we estimated the cardiovascular disease risk and proportion of the Canadian population, aged 40 to 75 years without cardiovascular disease, who would theoretically be eligible for statin treatment under both the CCS and ACC-AHA guidelines. The survey sample used (n=1975) represented 13.1 million community dwelling Canadians between the ages of 40 and 75 years. In comparing the CVD risk assessment methods, we found that calculated CVD risk was higher based on the CCS guidelines compared with the ACC-AHA guidelines. Despite this, a similar proportion and number of Canadians would be eligible for statin treatment under the 2 sets of recommendations. Some discordance in recommendations was found within subgroups of the population, with the CCS guidelines recommending more treatment for individuals who are younger, with a family history of CVD, or with chronic kidney disease. The ACC-AHA recommend more treatment for people who are older (age 60+ years). These results likely overestimate the treatment rate under both guidelines because, in primary prevention, a clinician–patient discussion must occur before treatment and determines uptake. Conclusions Implementing the ACC-AHA lipid treatment guidelines in Canada would not result in an increase in individuals eligible for statin treatment. In fact, the proportion of the population recommended for statin treatment would decrease slightly and be targeted at different subgroups of the population. PMID:26175357

  3. Percutaneous endoscopic treatment of cholelithiasis.

    PubMed

    Griffith, D P; Rubio, P A; Gleeson, M J

    1990-01-01

    Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

  4. Comparing systems for costing hospital treatments. The case of stable angina pectoris.

    PubMed

    Larsen, Jytte; Skjoldborg, Ulla Slothuus

    2004-03-01

    This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

  5. [Extracorporeal shockwave therapy in symptomatic heel spurs. An overview].

    PubMed

    Buch, M; Knorr, U; Fleming, L; Theodore, G; Amendola, A; Bachmann, C; Zingas, C; Siebert, W E

    2002-07-01

    Extracorporeal shock wave application (ESWA) has been successfully used for years in routine clinical management of plantar fasciitis. So far no clinical trails have shown the efficiency in placebo-controlled protocols. This paper presents an overview of conservative and operative treatment modalities with respect to their efficacy. Results of a prospective randomized placebo-controlled double-blind multicenter trial to show efficiency and safety of ESWT are presented. In patients treated conservatively without success, a single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002 of the shock wave device used.

  6. Comparing drinking water treatment costs to source water protection costs using time series analysis

    NASA Astrophysics Data System (ADS)

    Heberling, Matthew T.; Nietch, Christopher T.; Thurston, Hale W.; Elovitz, Michael; Birkenhauer, Kelly H.; Panguluri, Srinivas; Ramakrishnan, Balaji; Heiser, Eric; Neyer, Tim

    2015-11-01

    We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reduction in the watershed rather than pay for treatment on site. To illustrate, we use daily observations from 2007 to 2011 for the Bob McEwen Water Treatment Plant, Clermont County, Ohio, to understand the relationship between treatment costs and water quality and operational variables (e.g., turbidity, total organic carbon [TOC], pool elevation, and production volume). Part of our contribution to understanding drinking water treatment costs is examining both long-run and short-run relationships using error correction models (ECMs). Treatment costs per 1000 gallons (per 3.79 m3) were based on chemical, pumping, and granular activated carbon costs. Results from the ECM suggest that a 1% decrease in turbidity decreases treatment costs by 0.02% immediately and an additional 0.1% over future days. Using mean values for the plant, a 1% decrease in turbidity leads to $1123/year decrease in treatment costs. To compare these costs with source water protection costs, we use a polynomial distributed lag model to link total phosphorus loads, a source water quality parameter affected by land use changes, to turbidity at the plant. We find the costs for source water protection to reduce loads much greater than the reduction in treatment costs during these years. Although we find no incentive to protect source water in our case study, this framework can help DWTPs quantify the trade-offs.

  7. Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.

    PubMed

    Webb, D R; McNicholas, T A; Whitfield, H N; Wickham, J E

    1985-11-01

    The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.

  8. Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

    PubMed

    Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

    2016-04-01

    Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.

  9. [Physical-technical principles of extracorporeal shockwave therapy (ESWT)].

    PubMed

    Gerdesmeyer, L; Maier, M; Haake, M; Schmitz, C

    2002-07-01

    Extracorporeal shock waves in orthopaedics are currently applied in the treatment of chronic enthesiopathies such as lateral epicondylitis, plantar heel spur, as well as in calcifying tendinitis of the shoulder or in bony nonunions. Detailed knowledge of physical parameters and properties of shock waves appear to be necessary to determine clinically relevant dose-effect relations and to make shock wave devices, clinical results, and basic science in shock wave therapy more comparable. This study gives an overview of physical parameters and properties in shock wave therapy. Measurement technologies, types of shock wave devices, and mechanisms of shock waves are also described.

  10. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.

    PubMed

    Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

    2011-02-01

    The purpose of this study was to determine and compare the efficacy of kinesio tape and physical therapy modalities in patients with shoulder impingement syndrome. Patients (n = 55) were treated with kinesio tape (n = 30) three times by intervals of 3 days or a daily program of local modalities (n = 25) for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping (20, 40, and 50, respectively) group were statistically significantly lower (p values were 0.001, 0.01, and 0.001, respectively) at the first week examination as compared with the physical therapy group (50, 70, and 70, respectively). However, there was no significant difference in the same parameters between two groups at the second week (0.109, 0.07, and 0.218 for rest, night, and movement median pain scores, respectively). Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

  11. Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment

    PubMed Central

    Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Noroozi, Alireza; Habibi, Mojtaba; Bowen, Sarah

    2015-01-01

    Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. Methods: The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results: The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion: The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders. PMID:26877751

  12. Brazilian Green Propolis Compared to Miconazole Gel in the Treatment of Candida-Associated Denture Stomatitis

    PubMed Central

    Capistrano, Hermínia Marques; de Assis, Eliene Magda; Leal, Rosana Maria; Alvarez-Leite, Maria Eugênia; Brener, Sylvie; Bastos, Esther Margarida Alves Ferreira

    2013-01-01

    Aim. To evaluate the efficacy of Brazilian green propolis in comparison to miconazole gel in the treatment of Candida-associated denture stomatitis. Methods. Forty-five denture stomatitis patients, with palatal mucosa erythema levels classified according to Newtons's criteria and with positive culture to Candida spp., were randomly divided into three treatment groups: 15 received miconazole gel 2%, 15 received propolis gel 2,5%, and 15 received propolis 24% for mouthwash. After four daily use lasting two weeks, they were reexamined for the denture stomatitis degree and for a second culture of Candida. The Wilcoxon's test was applied to compare the results of clinical classification of the denture stomatitis and the Candida spp. colonies numbers, before and after each treatment. The Kruskall-Wallis's test was used to compare efficacy among the three treatment groups. Results. There were a significant reduction or complete remission of denture stomatitis (P < 0.05) and a significant decrease of Candida colonies for the three groups (P < 0.05). There was no difference in the efficacy among the treatment groups (P > 0.05). Conclusion. Brazilian green propolis has a similar effect as miconazole in the treatment of Candida-associated denture stomatitis being an alternative in the therapeutics of this condition. PMID:23737855

  13. Brazilian green propolis compared to miconazole gel in the treatment of Candida-associated denture stomatitis.

    PubMed

    Capistrano, Hermínia Marques; de Assis, Eliene Magda; Leal, Rosana Maria; Alvarez-Leite, Maria Eugênia; Brener, Sylvie; Bastos, Esther Margarida Alves Ferreira

    2013-01-01

    Aim. To evaluate the efficacy of Brazilian green propolis in comparison to miconazole gel in the treatment of Candida-associated denture stomatitis. Methods. Forty-five denture stomatitis patients, with palatal mucosa erythema levels classified according to Newtons's criteria and with positive culture to Candida spp., were randomly divided into three treatment groups: 15 received miconazole gel 2%, 15 received propolis gel 2,5%, and 15 received propolis 24% for mouthwash. After four daily use lasting two weeks, they were reexamined for the denture stomatitis degree and for a second culture of Candida. The Wilcoxon's test was applied to compare the results of clinical classification of the denture stomatitis and the Candida spp. colonies numbers, before and after each treatment. The Kruskall-Wallis's test was used to compare efficacy among the three treatment groups. Results. There were a significant reduction or complete remission of denture stomatitis (P < 0.05) and a significant decrease of Candida colonies for the three groups (P < 0.05). There was no difference in the efficacy among the treatment groups (P > 0.05). Conclusion. Brazilian green propolis has a similar effect as miconazole in the treatment of Candida-associated denture stomatitis being an alternative in the therapeutics of this condition.

  14. [The atraumatic restorative treatment approach in pediatric dental care: a comparative clinical study].

    PubMed

    Dmitrova, A G; Kulakov, A A

    2015-01-01

    The aim of this study was to assess and compare the discomfort levels during Atraumatic Restorative Treatment and Minimal Cavity Preparation using rotary instruments and Air abrasion method. The results of the study suggest that ART induces less discomfort, therefore this method can be recommended for children who have a fear of dental procedures as well as for children with intellectual disabilities. PMID:26145474

  15. Comparing Cognitive Behavior Therapy, Problem Solving Therapy, and Treatment as Usual in a High Risk Population

    ERIC Educational Resources Information Center

    Stewart, Carment D.; Quinn, Andrea; Plever, Sally; Emmerson, Brett

    2009-01-01

    Cognitive behavior therapy (CBT), problem-solving therapy (PST), or treatment as usual (TAU) were compared in the management of suicide attempters. Participants completed the Beck Hopelessness Scale, Beck Scale for Suicidal Ideation, Social Problem-Solving Inventory, and Client Satisfaction Questionnaire at pre- and posttreatment. Both CBT and PST…

  16. Comparing the Effects of Four Instructional Treatments on EFL Students' Achievement in Writing Classified Ads

    ERIC Educational Resources Information Center

    Khodabandeh, Farzaneh

    2016-01-01

    The current study set out to compare the effect of traditional and non-traditional instructional treatments; i.e. explicit, implicit, task-based and no-instruction approaches on students' abilities to learn how to write classified ads. 72 junior students who have all taken a course in Reading Journalistic Texts at the Payame-Noor University…

  17. Treatment Gain for Sexual Offenders against Children Predicts Reduced Recidivism: A Comparative Validity Study

    ERIC Educational Resources Information Center

    Beggs, Sarah M.; Grace, Randolph C.

    2011-01-01

    Objective: To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. Method: We compared 3…

  18. COMPARING RBF WITH BENCH-SCALE CONVENTIONAL TREATMENT FOR PRECURSOR REDUCTION

    EPA Science Inventory

    The reduction of disinfection by-product (DBP) precursors upon riverbank filtration (RBF) at three drinking water utilities in the mid-Western United States was compared with that obtained using a bench-scale conventional treatment train on the corresponding river waters. The riv...

  19. Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

    ERIC Educational Resources Information Center

    Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

    2016-01-01

    Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

  20. DUI/DWAI Offenders Compared to Clients Seen in an Outpatient Alcohol-Treatment Facility.

    ERIC Educational Resources Information Center

    Packard, Michele A.

    1987-01-01

    Examined client records to compare 50 subjects admitted to a drinking-driver program and 50 subjects admitted to an outpatient alcohol treatment clinic. Highly significant differences were found between groups on 10 of 12 drinking indices, suggesting that clients referred for alcohol-related traffic offenses represent a population different from…