PubMed Health⌕ Search

Biomedical subjects

H G Tiselius

Publications and source records attributed to H G Tiselius.

At least 37 records · Page 2Linked to original sources
PubMed1989

Evaluation of extracorporeal shock wave lithotripsy without anesthesia using a Dornier HM3 lithotriptor without technical modifications.

In 210 patients with urolithiasis extracorporeal shock wave lithotripsy was performed without regional, general or infiltration anesthesia by means of a technically unmodified Dornier HM3 lithotriptor. The stone burden varied from small ureteral stones to complete staghorn stones. All patients were given premedication with pethidine and diazepam, and a lidocaine-prilocaine-containing cream was applied on the skin at the entry site of the shock wave. Energy usually varied between 14 and 16 kv. More than 90% of the patients reported the pain to be at most of moderate intensity and acceptable. Less than 3% found the treatment unpleasant. The results were compared to those obtained in 250 patients treated with anesthesia according to the original procedure, with a generator voltage of 18 to 23 kv. The number of extracorporeal shock wave lithotripsy sessions for ureteral and large stones was somewhat higher with the low energy method than with the original procedure. However, the therapeutic result in terms of renal units without stones after 4 weeks was similar to that recorded for patients treated with the anesthesia method. According to these promising results we believe that extracorporeal shock wave lithotripsy without anesthesia in an unmodified Dornier HM3 lithotriptor can be performed successfully in a majority of patients and is an attractive alternative to other technical modifications of the equipment.

Anesthesia↗
PubMed1989

Extracorporeal shock wave lithotripsy of stones in the mid ureter.

We treated successfully 16 patients with stones in the mid ureter, that is overlying the pelvic bone, in the prone position with a Dornier HM3 lithotriptor. The lithotriptor was equipped with the original reflector and generator system, and all treatments were performed with only surface anesthesia of the skin and premedication with pethidine chloride and diazepam. Between 1 and 3 sessions were necessary with up to 2,000 shock waves at each session. The generator voltage was varied between 14 and 18 kv. After completion of extracorporeal shock wave lithotripsy all patients became free of stones without ureteroscopy or transureteral manipulation except for a ureteral catheter and fluid irrigation during treatment.

Diazepam↗
PubMed1989

Are prophylactic antibiotics necessary during extracorporeal shockwave lithotripsy?

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.

Adult↗
PubMed1989

Standardized estimate of the ion activity product of calcium oxalate in urine from renal stone formers.

An estimate of the ion activity product of calcium oxalate [AP(CaOx) index(s)] was calculated for a standardized 24-hour urine volume of 1,500 ml. AP(CaOx) index(s) was higher in stone formers than in normal subjects and higher in men than women. There was a good correlation between AP(CaOx) index(s) and our previously described CaOx risk index. AP(CaOx) index(s) might be particularly useful for comparison of different groups of patients as well as for comparison of men and women. It can be assumed that such an index will be very useful for evaluation of patients with short-term urine collections.

Calcium Oxalate↗
PubMed1989

Stone formation and urine composition in calcium stone formers without medical treatment.

A retrospective estimate of the annual rate of stone formation (fSF) was obtained in only 154 (35%) of 438 patients without medical treatment at our out-patient stone clinic. Eighty-three of these patients had never been on any prophylactic treatment and were only given advice concerning drinking and dietary habits. There was a high calcium excretion in 46%, high oxalate in 17%, low citrate in 11%, low magnesium in 17%, and increased urate in 16% of the patients. As much as 25% had a 24-hour urine volume below 1,000 ml. There was a good correspondence between stone formation during the follow-up period (tT) and a period of the same length following diagnosis (tA). The mean (+/- SD) tT was 3.2 +/- 1.9 years, with an fSF of 0.19 +/- 0.43. During the tA period fSF was 0.13 +/- 0.31. The number of patients who formed new stones during these periods were 21 and 22, respectively. It is suggested that stone formation during tT and tA advantageously might be used for preliminary evaluation of the therapeutic response. The risk of forming a urine highly supersaturated with calcium oxalate was expressed in terms of a standardized AP(CaOx) index calculated for a 24-hour urine volume of 1,500 ml. There was no relationship between this AP(CaOx) index and fSF. When only those patients were considered who formed new stones during the first 10 years after diagnosis, slightly higher values of the standardized AP(CaOx) index were recorded than in the recurrence-free group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Classification of patients subjected to extracorporeal shock wave lithotripsy.

A simple system is described for classification of patients with urolithiasis treated with extracorporeal shock wave lithotripsy (ESWL). According to the size and number of concrements in each kidney the patients were subgrouped in six different ESWL-types (A-F). The main purpose was thereby to be able to discriminate between different stone situations regarding the need for resources and to evaluate the therapeutic results in an appropriate way. Of 709 patients treated with ESWL during the first year, 2% were of ESWL-type A, 46% of type B, 24% of type C, 16% of type D, 5% of type E, and 7% of type F. There was a good relationship between ESWL-type, number of shock waves and duration of the treatment session, number of ESWL-sessions, and duration of hospital stay. With knowledge of the ESWL-type distribution in a group of patients with urolithiasis this classification provides a basis for estimates of treatment capacity and required number of beds. With a weekly capacity of 24 treatments the required number of beds usually varied between 20 and 25. The hospital stay varied between 2 and 35 days, with the longest hospital stay recorded for patients belonging to ESWL-type E undergoing a combined procedure with percutaneous surgery, ESWL, and often irrigation with hemiacidrin. The presented system for classification might be a useful tool for planning, organization and assessment of renal stone treatment based on ESWL.

Humans↗
PubMed1988

Phosphate treatment of patients with renal calcium stone disease.

Orthophosphate was administered in a daily dose of 1.0-1.5 g to 32 patients during a median treatment period of 3.1 years. The patients were followed with repeated serum and urine analyses and KUB radiographs. Urine composition with respect to calcium oxalate supersaturation was favorably affected. There were reductions of urinary calcium (p less than 0.01) and calcium/citrate quotients (p less than 0.001). During the follow-up period 31 new stones were formed by 12 patients. When the rate of stone formation during treatment was compared with that during a period of similar length following diagnosis, there was no difference. On the other hand, 73 stones had formed during a period of similar length before the start of treatment. This demonstrates the problem concerning evaluation of medical prophylaxis. Four of 11 patients treated for a period longer than that expected for new stone formation continued to form stones. Stone formation was also recorded in 8 out of 15 patients with a shorter follow-up. Despite favorable biochemical effects the clinical result with orthophosphate treatment was disappointing, at least with the doses used in this study.

Adult↗
PubMed1988

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones.

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.

Adolescent↗
PubMed1988

Hemiacidrin: a useful component in the treatment of infectious renal stones.

Experimental irrigation of 15 infectious renal stones with hemiacidrin resulted in complete dissolution of 11 stones within 5 days. Three of the undissolved stones had a calcium oxalate (CaOx) content of more than 10%. Stones containing calcium phosphate (CaP) and magnesium ammonium phosphate (MAP) and weighing less than 500 mg were most easily dissolved. Twenty-five stones placed in 10 ml of hemiacidrin resulted in complete dissolution of 13 and partial dissolution of 11. Even this experiment showed that the CaOx content was of importance for the outcome of hemiacidrin treatment. After treatment the MAP and CaP fractions had decreased and CaOx increased. In 36 clinical irrigations of residual concrements of known chemical composition, 5 resulted in total stone dissolution and 21 in a reduced stone volume, whereas the result was inconclusive in 3. Seven stones were not affected by the treatment, these stones were usually composed of CaP and CaOx. There was a good correlation between the dissolution test and the clinical response to hemiacidrin treatment. Based on these findings it is suggested that hemiacidrin might be a useful complement to the modern techniques of stone fragmentation such as extracorporeal shock wave lithotripsy and percutaneous surgery, at least for infectious stones with a CaOx content of less than 10%.

Calcium Oxalate↗