Biomedical subjects
C Chaussy
Publications and source records attributed to C Chaussy.
[Extracorporeal shockwave lithotripsy today--an assessment of current status].
Extracorporeal shock wave lithotripsy (ESWL) is standard therapy for urolithiasis. With comparable technical principles, various lithotripters have been developed and are in routine use. Renal pelvic stones, calyceal stones, ureteral stones, and other special forms can be treated with varying results. Currently, the so-called clinically insignificant residual fragments and the recurrence of calculi are under discussion. Whereas the side effects of ESWL are well known, studies comparing ESWL with other endourological procedures are still lacking.
[Ureteral calculi. In situ ESWL treatment with booster technique].
After treatment of more than 3000 kidney and ureteral stones with the Siemens Lithostar Multiline the results of the first 1400 ureteral stone treatments using the "Booster technique" and 3-month follow-up findings are reported. There was a disintegration rate of 98% directly after treatment; 1 week after "Booster technique" treatment 96% of the patients were free of stones and without any symptoms. The 3-month follow-up showed a stone-free rate of 97%. Only in 13% of the cases auxiliary procedures were necessary, 7% of them before extracorporeal shock wave lithotripsy (ESWL) and 6% after ESWL. 43% of the treatments were performed without any premedication, anaesthesia or sedoanalgesia. Our data even prove that in situ ESWL is a safe and effective method for the treatment of ureteral stones. In comparison to endoscopic procedures, it is superior in regard to invasivity, side effects, complications and necessity of analgesia, while being just as efficient. Therefore it is recommended as first choice method in the treatment of ureteral stones.
[Complications with portable ESWL--a multicenter study].
An increasing number of urological departments are taking advantage of portable lithotripsy units if a system is not available in their clinic or purchase does not seem feasible; however, infrequent application of ESWL in such a setting should not increase the rate of complications. From 1993 to 1995, up to 54 urological departments using mobile lithotripsy units collected data concerning all major complications. A total of 12,901 treatments were performed which led to 85 major complications (0.66%). Of them 64 were intrarenal or perirenal hematomas. There was no fatal complication. In three patients nephrectomy had to be performed subsequently. The probability of complications can be calculated according to these data. Overall, less frequent application of ESWL does not yield higher complication rates than those at ESWL centers where larger numbers of treatments are performed.
[Problem cases in routine diagnosis by the pathologist--indications and accuracy of rapid section diagnosis. Uropathology].
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[Fibroepithelial polyp of the kidney pelvis].
Benign fibroepithelial polyps of the renal pelvis are rare. Because of suspected malignancy in imaging procedures an ureteronephrectomy was carried out in the reported case. Histology, however, yielded no evidence of malignancy. The diagnosis of benign fibroepithelial polyp was entertained. It remains an open question whether the pathologic changes represent a hamartoma or a reactive postinflammatory process, revealing primitive myxoid stroma within the polypous portion and increasing fibrosis with diffuse submucosal involvement of the ureteral basis.
Side effects of high-energy shockwaves in the human kidney: first experience with model comparing two shockwave sources.
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.
[Current status of extracorporeal shockwave lithotripsy].
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.
International consultation on BPH sponsored by WHO. Report of the sub-group on other non medical treatment.
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[Ureteral stents].
Due to the increasing clinical importance of ureteral stents, the advantages and disadvantages of the different materials used are described and discussed. The spectrum of indications includes palliative, curative and auxiliary uses of ureteral stents. In spite of the low complication rate, the advisability of clinical application of stents should always be critically considered before the final decision is made. The possibility of treating the basic disease should be considered in each patient, to lessen the likelihood of "permanent stent patients".
Short-term changes of laboratory values after extracorporeal shock wave lithotripsy: a comparative study.
Since the inception of extracorporeal shock wave lithotripsy 9 years ago treatment strategies have changed. Patients currently are receiving larger numbers of higher voltage shock waves. However, upper limits of safety for these treatments have not been established. In an attempt to address this question a comparative study of effects of extracorporeal shock wave lithotripsy on laboratory values between 2 stone centers, Munich and Tucson, using different treatment strategies 3 to 4 years apart was done to identify possible differing effects. Patient stone burdens were similar. However, Tucson patients received almost twice the number of shock waves. Both groups showed a significant decrease in hematocrit (by 8.7 per cent in Munich and 6.4 per cent in Tucson). Both groups had a significant increase in white blood count (14.5 per cent in Munich and 22.7 per cent in Tucson). In addition, both groups had increased serum levels of glutamic oxaloacetic transaminase of 43.3 and 59.7 per cent, respectively. However, only the Tucson group showed increases in serum glutamic pyruvic transaminase, lactic dehydrogenase and total bilirubin in 51.5, 40.8 and 46 per cent of the patients, respectively. Further analysis indicated that extracorporeal shock wave lithotripsy was associated with 2 significant short-term changes of blood or serum laboratory values: 1) those presumed to be dilutional from related infusions, rather than extracorporeal shock wave lithotripsy treatments themselves and 2) those presumed to be related to cellular injury after high energy treatments. Elevated serum glutamic pyruvic transaminase, lactic dehydrogenase and total bilirubin values of Tucson patients clearly were related to higher kilovolts and number of shocks or to treatments on the right side.(ABSTRACT TRUNCATED AT 250 WORDS)
[Extracorporeal shock wave lithotripsy: the evolution of a revolution].
Extracorporeal shockwave lithotripsy has now been in clinical use for 8 years, and it has replaced other treatment techniques for the majority of surgical calculi in the upper urinary tract. For the first time it provides a completely noninvasive method for the treatment of renal and ureteral calculi. The current range of indications means that approximately 70% of nonselected urinary stone patients can be treated by this method, while 25% of the patients with more complex stones in the upper urinary tract can receive treatment with the lithotripter combined with endourological procedures. The clinical role of this method is determined by a high success rate and minimal complications. This has led to a rapid worldwide acceptance in the urological community, and up to now more than 1.5 million patients with urinary stone disease have been treated.
[Prevalence and incidence of arterial hypertension in patients with kidney calculi treated by extracorporeal shock wave lithotripsy].
Follow-up studies were conducted on 806 patients to investigate the question of whether or not arterial hypertension can develop subsequent to ESWL. First of all, it was determined that 509 of 518 patients who were subjected to ESWL treatment from December 1985 to December 1986 still had normotension (n = 410) or hypertension (RR greater than or equal to, 160/95, n = 99) prior to and on an average of 9.3 months after ESWL. Six hypertensive patients became normotensive subsequent to ESWL. Only 1 patient developed hypertension following ESWL. Secondly, the 288 patients who were subjected to ESWL treatment from May 1982 to May 1984 revealed a 3.1% incidence of arterial hypertension within a period of 3.6 years following ESWL. This incidence, however, only illustrates that there was a pronounced age-related increase in the prevalence of hypertension (0.8% per year) in these study groups.
[Long-term experiences following extracorporeal shockwave lithotripsy in patients with urinary calculi].
A report is given on the experience we have had over a period of up to 7 years following ESWL treatment in urinary stone patients. 131I-hippuran clearance studies were conducted on 19 patients prior to and 6.6 years subsequent to ESWL. There was no evidence of any degree of deterioration in total renal function or of any form of dysfunction in the kidney treated. Follow-up examinations on 247 patients showed a 7% recurrent stone rate within a period of 3.6 years following ESWL. In 16% of the cases, residual concretions were found 6 months after ESWL, only 4% of which were larger than 5 mm in diameter. In 22%, concretions were discovered 3.6 years after ESWL 36% of which were larger than 5 mm. This size increase in the fragments accounts for the stone growth.
Transurethral ultrasonic ureterolithotripsy using a solid-wire probe.
A multicenter study evaluates a new technique for transurethral ultrasonic ureterolithotripsy utilizing a solid-wire probe. The transverse vibrations of the probe cause greater stone disintegration. A small ureteroscope is used and a basket is not required. There was a 96.6 per cent success rate in 118 cases. This technique has significantly improved ultrasonic lithotripsy. It has proved to be useful for upper ureteral stones not amenable to extracorporeal shock-wave lithotripsy and lower ureteral stones including "steinstrasse."
Use of extracorporeal shock-wave lithotripsy in quadriplegic patients.
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Extracorporeal shock wave lithotripsy.
Urolithiasis represents the symptomatic manifestation of various metabolic disturbances which persist after elimination of the immediate problem, i.e., urinary stones, and may lead to the development of recurrent stones. Invasive surgical removal of recurrent stones is sometimes associated with considerable problems. Against this backdrop it is not surprising that after development (1974-1980) and clinical testing (1980-1982) at the Department of Urology of the Ludwig Maximilian University in Munich, a meanwhile clinically proven method of totally noninvasive extracorporeal lithotripsy (ESWL) has disseminated within a relatively short time (from October 1983), first in West Germany (April 1986: 20 ESWL centers) and later all over the world (April 1986: 133 ESWL centers). With the advent of ESWL and semiinvasive techniques of stone extraction (percutaneous lithotripsy, ureterorenoscopy) a transformation of the therapeutic strategy for urolithiasis has been ushered in.
[Extracorporeal lithotripsy in the treatment of renal lithiasis. 5 years' experience].
The historical background to extracorporeal lithotripsy using shock waves is described and indications for use of this treatment discussed in relation to other types of therapy for reno-ureteral lithiasis: percutaneous or trans-ureteral endoscopy. The reduction in invasive surgical procedures is emphasized. The first human use of extracorporeal lithotripsy by shock waves dates back to 1980. Since then, more than 30,000 calculi have been treated in this way, either exclusively or in combination with other therapy. For simple small calculi (less than 1 cm in diameter and situated in the pelvis or a calyx) the incidence of complications is minimal: renal colic (15%), fever (13%), need for complementary therapy (7%). With extension of use of extracorporeal lithotripsy to complex calculi (multiple calculi, staghorn calculi) these figures increased to 30, 5 and 12% respectively. Patients with obstructive and infected lithiasis were treated by percutaneous drainage nephrostomy with intensive antibiotic therapy prior to extracorporeal treatment. Extending indications also provided data on contraindications: coagulation disorders, major vascular problems, abnormal size or weight of patient, pregnancy and finally difficulty in localizing calculi. Of interest is the almost total lack of efficacy of shock waves for treating staghorn calculi. Treatment in these cases should be by an initial percutaneous approach to reduce size of calculus followed by extracorporeal lithotripsy under nephrostomy cover. Surgery for lithiasis should therefore be reserved for complex lithiasis cases with large caliceal calculi proximal to a long narrow infundibulum and to calculi proximal to a stenosis of pyelo-ureteral junction. Whenever possible, lumbar ureter calculi should be raised towards the pelvis by endoscopic manipulation before extracorporeal lithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)