Use of Extracorporeal Shock Waves in the Treatment of Pseudarthrosis, Tendinopathy and Other Orthopedic Diseases

Traumatic brain injury caused by explosive or blast events is traditionally divided into four phases: primary, secondary, tertiary, and quaternary blast injury. These phases of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury phase represents the response of brain tissue to the initial blast wave. Among the four phases of bTBI, there is a remarkable paucity of information about the cause of primary bTBI. On the other hand, 30 years of research on the medical application of shockwaves (SW) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by supersonic flow. The resultant tissue injury includes several features observed in bTBI, such as hemorrhage, edema, pseudoaneurysm formation, vasoconstriction, and induction of apoptosis...

Mechanisms of Primary Blast-Induced Traumatic Brain Injury: Insights from Shock-Wave Research

Extracorporeal shock wave lithotripsy of pancreatic duct stones (largest stone 12 (SD) 6 mm) was performed in 24 patients with abdominal pain and a dilated duct system (main pancreatic duct 10 (3) mm). The procedure was well tolerated in all but two patients, who had a mild pancreatitic attack immediately after lithotripsy. Disintegration of the stones was achieved in 21 patients. This allowed complete clearance of the duct system by an endoscopic approach in 10 (42%) patients and partial clearance in 7 (29%) patients. Within a mean follow up period of 24 (14) months half of the patients showed complete or considerable relief of pain and alleviation of symptoms was achieved in seven patients. Relief of pain occurred more often after complete ductal clearance. There were no fatalities within the follow up period. These findings underline the value of a combined non-surgical approach, using endoscopy and adjuvant shock wave lithotripsy to patients with large pancreatic calculi and pain attacks.

https://gut.bmj.com/content/gutjnl/33/7/969.full.pdf

Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study.

Extracorporeal shock wave lithotripsy of pancreatic stones was performed in eight patients with chronic pancreatitis and a dilated duct system harbouring stones 5 to 20 mm (means 10 (SD) 5 mm) in diameter. After endoscopic sphincterotomy of the pancreatic orifice the stones were disintegrated by shock waves under fluoroscopic control using a kidney lithotripter (Dornier HM3). The procedure was well tolerated by all but one patient, who had a mild pancreatitic attack immediately after lithotripsy. Clearance of the pancreatic duct systems from the larger stones was achieved in seven of eight patients. Half of the patients showed no improvement in the intensity and frequency of pain. The other patients had a marked amelioration of symptoms, however, both immediately and during a mean follow up interval of 11 (eight) months. A selective combined approach by endoscopy and extracorporeal shock wave lithotripsy for the treatment of pancreatic stones seems promising.

https://gut.bmj.com/content/gutjnl/30/10/1406.full.pdf

Extracorporeal shock wave lithotripsy of pancreatic stones.

Almost all the therapeutic efforts in the treatment of chronic pancreatitis are directed towards pain control. Endoscopic techniques available for this purpose are endoscopic retrograde cholangiopancreatography (combined or not with extracorporeal shock wave lithotripsy) and endoscopic ultrasound. Pancreatic stones and strictures, pancreatic pseudocysts, and common bile duct strictures complicating chronic pancreatitis can be treated by endoscopy. The development of endoscopic ultrasound extended the possibilities in the treatment of pancreatic pseudocysts and main pancreatic duct drainage. Endoscopy is considered the first-line treatment in chronic pancreatitis and can be useful also as a 'bridge to surgery'. In fact the endoscopic approach to chronic pancreatitis can predict the response to surgical therapy as a definitive treatment. Medical, endoscopic and surgical methods for the management of chronic pancreatitis should all be considered in decision-making, and the best treatment should be chosen case by case and according to the local expertise.

The role of endoscopy in the therapy of chronic pancreatitis.

We report the case of a 33-year-old woman with chronic calcifying pancreatitis in whom an intraductal pancreatic stone with a diameter of 8 mm was successfully disintegrated with extracorporeal shock waves, permitting subsequent endoscopic extraction of the fragments The patient had a mild attack of pancreatitis after the treatment We conclude that shockwave lithotripsy of a pancreatic duct stone in patients with chronic pancreatitis is possible It should, however, be viewed with reservation until further experience has been gained

Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.

The extracorporeal shock-wave lithotripsy (ESWL) was introduced for clinical use at the Department of Urology at the LM-University of Munich in 1980. Since then, the procedure has proved to be safe throughout the world. New apparatus has been developed by various manufacturers during the last three years. Dornier Medizintechnik, Germering, were the first to construct the experimental and clinically-applicable lithotripters (HM 1–3) and have also contributed to further developments of new instruments. We are presently reporting our clinical experience with the two new Dornier lithotripter developments, HM-4 and MPL 9000, which are in clinical use at the Klinikum Grosshadern of LM-University in Munich.

New Techniques and Developments in Extracorporeal Shock-Wave Lithotripsy: The Dornier HM-4 and MPL 9000

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Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.

New Techniques and Developments in Extracorporeal Shock-Wave Lithotripsy: The Dornier HM-4 and MPL 9000