Jüngst, Dieter

English

Open Access LMU

The Journal of Lithotripsy & Stone Disease A State-of-the-Art Journal Dealing with the Management of Urinary & Biliary Tract Stone Disease Editor-in-Chief L A U R E N C E B. K A N D E L Associate Editors M A R T I N I. R E S N I C K S T E P H E N E. S T E I N B E R G R O B E R T W. SUMMERS E D I T O R I A L B O A R D U R O L O G Y S E C T I O N Christian Chaussy Stephen Dretler Gerhard Fuchs Lloyd Harrison Masa-aki Kuwahara James Lingeman Stefan Loening Michael Marberger Xavier Martin David McCullough Charles Pak S C I E N C E A N D T E C H N O L O G Y S E C T I O N Edwin Carstensen Oliver Cass Lawrence Crum Michael Delius Peter Lewin Joseph Macaluso B I L I A R Y S E C T I O N Desmond Birkett H . Joachim Burhenne Peter Cotton Joseph Ferrucci James Maher Ronald Malt David Nahrwold Gustav Paumgartner Thierry Ponchon Leslie Schoenfield Johnson Thistle S u b s c r i p t i o n s o n a c a l e n d a r y e a r ( J a n . - D e c . ) basis o n l y a n d m u s t b e p r e p a i d . A l l c u r r e n t y e a r issues p u b l i s h e d p r i o r t o o r d e r i n g a re s u p p l i e d . For i n f o r m a t i o n o n ava i l ab i l i t y a n d p r i c e s o f s ing le issues a n d b a c k issues, c o n t a c t t h e p u b l i s h e r d i r e c t l y . The Journal of Lithotripsy & Stone Disease ISSN 1 0 4 0 - 2 1 5 2 , is p u b l i s h e d q u a r t e r l y b y F u t u r a P u b l i s h i n g C o m p a n y , I nc . , 2 B e d f o r d R idge R o a d , P .O . B o x 3 3 0 , M o u n t K i sco , N.Y. 1 0 5 4 9 , U.S.A. Y e a r l y s u b s c r i p t i o n ra te in U.S.A., a n d C a n a d a , $ 6 5 . 0 0 , F o r e i g n , $ 6 5 . 0 0 p lus $ 1 0 . 0 0 f o r s h i p p i n g ( i n c l u d e s a i r se rv ice ) . P r e p a y m e n t m u s t b e in U.S. f u n d s t h r o u g h a n A m e r i c a n b a n k . Y e a r l y s u b s c r i p t i o n in Japan (air c a r g o se rv i ce o n l y ) , c o n t a c t I g a k u - S h o i n , L t d . , 1 -28-36 H o n g o B u n k y o - k u , T o k y o , Japan . Postmaster: S e n d a d d r e s s c h a n g e s t o T h e Journa l o f L i t h o t r i p s y & S t o n e D i s e a s e , 2 B e d f o r d R i d g e R o a d , P .O. Box 3 3 0 , M o u n t K i sco , N.Y. 1 0 5 4 9 , S e c o n d Class p o s t a g e p a i d a t M o u n t K isco a n d at a d d i t i o n a l m a i l i n g o f f i ces . C o p y r i g h t © 1 9 9 0 b y F u t u r a P u b l i s h i n g C o m p a n y , Inc . P r i n t e d in t h e U.S.A A U T H O R INDEX Adwers, James R., 199-204 Agarwal, Ravinder, 117-123 Albrecht, Walter, 3 0 9 - 3 1 7 Anaisc, D . , 224-228 Appel , Betty, 302-308 Baert, L . , 46 -49 Baron, J., 298-300 Bechtold, Robert E., 8 4 - 1 0 2 Beck, M . , 24-30 Belas, M . , 39 -41 Berding, Ch. , 24 -30 Bjorno, L . , 4 -16 Boyce, Wi l l i am H . , 3 2 2 - 3 3 1 Braf, Z . , 298-300 Brendel, Walter, 103-110 , 161-163 Burhenne, H . Joachim, 111-116 Caos, A n t o n i o , 220-223 Carmignani, L . , 133-138 Debre, B., 39 -41 Decho, Janice, 143-145 De Cobelli , O. , 133-138 Delius, Michael, 103-110 , 161-163 Denny, Donald F., Jr., 143-145 Diokno, Ananias C , 3 1 - 3 4 Dyer, Raymond B., 302 -308 Fache, J. Stephen, 111-116 Festi, Davide, 279-285 Flam, T. , 39 -41 Foo, K.T. , 19-23 Frischer, Ζ., 224-228 Geise, Richard Α., 2 8 9 - 2 9 7 Gcrshon, Charles R., 42 -45 Gleeson, Malachy J., 184-198 Goetz, A l w i n , 103-110 Graff, J., 24-30 Greenstein, Α., 298-300 Grif f i th , Donald P., 184-198 Harrison, L loyd H . , 302 -308 Harvey, Jean Α., 124-132 Heinrich, R., 50-54 H i l l , Käthy D . , 124-132 Hobbie, Rüssel K., 2 8 9 - 2 9 7 Holbrook , Ryan F., 17-18 Hollander, Jay B., 3 1 - 3 4 Kandel, Laurence B., 35 -38 Karstaedt, Nolan, 302-308 Kaver, I . , 298-300 Lachin, John M . , 340-362 Landas, Steve, 211-219 Larcher, P., 133-138 Lee, Thomas S., 289 -297 Liebich, Hans-Georg, 103-110 Lingeman, James E., 3 1 8 - 3 1 9 Livne, Pinhas M . , 205-210 Loening, Stefan Α., 2 1 1 - 2 1 9 Lubaroff, David M . , 211 -219 Macaluso, Joseph N . , 1-3 Mal t , Ronald Α., 17-18 Mandressi, Α., 133-138 Marberger, Michael, 3 0 9 - 3 1 7 Markowitz , David M . , 143-145 Marks, Jay W. , 332-336 Matzkin , H . , 298-300 McCul lough, David, 302 -308 Morr ison, Kevin, 143-145 Mueller, Wol f ram, 103-110 Neighbors, T . H . , 4 - 1 6 O t t , David J., 84-102 Pak, Charles Y.C., 124-132 — " - -u^S-C»«.r. 5 l ! Ν - Y, ^ m l u m » « r - ..nc μ - * ^ * - * * * - » * -- - - . - · -'-* ' · , ~ 7 . - ^ - ' " ' ' - " - - - -" : " ·"•"- - : ».« _ ~ . . , ™ . - . . . . . . . 1 — _ ~ : o o e •zrxzrzzxz~ ο j 0 !'> , «--<-» ι ' '."^Xitrci , , „5 ; 1 U J ....... Γ" j Rapaport, F.T., 224-228 Rawat, Brijendra, 111-116 Ren, Zong-Ying, 211-219 Rocco, F., 133-138 Roda, Enrico, 279-285 Rodriquez, A.P. , 42-45 Schoborg, Thomas W . , 42-45 Schoenfield, Leslie J., 332-362 Schreckenberg, Α., 50 -54 Servadio, Ciro , 205-210 Shabtai, M . , 224-228 Silverman, David G. , 143-145 Simon, Dan, 205-210 Singh, V.R. , 117-123 Smith, M.J .V. , 325-331 Sparrow, H o l y n K., 211-219 Sperling, Malcolm J., 320-321 Steg, Α., 3 9 - 4 1 Steincrt, Bruce, 31 -34 Stewart, Charles, 139-142 Tan, E.C., 19-23 Taroni , Francesco, 279-285 Thompson, Wi l l iam M . , 289-297 Tucker, Robert, 211-219 T u n g , K . H . , 19-23 Türk, Christian, 309-317 Waltzer, W . C . , 224-228 Wasnick, Robert J., 139-142 Watson, Nat Ε., 84-102 White , Robert I . , Jr., 143-145 Wil lemen, P., 46 -49 W o l f m a n , Neil T . , 84-102 , 302-308 Yendt, Edmund R., 164-183 Zagoria, Ronald J., 302-308 Zerbib, M . , 39 -41 Zicgelbaum, Michael, 35-38 Zierden, E., 50-54 380 Journal o f Lithotripsy and Stone Disease V o l . 2, No. 4, 1990 SUBJECT INDEX Abdominal compression, 143-145 Acute obstructive urolithiasis, 46 -49 Anatrophic nephrotomy, 322-331 Anterior body wal l , 29 Bile acids, 17 Bile duct stones, 220-222 Biliar)' endoprostheses, 220-222 Biliarv l i thotripsy, 111-116 Biliary tree, 84 -100 Biochemical abnormality, 126-127 Blast path, 3 1 - 3 4 Bone, shock waves through, 24-30 Calcification, 174-175 Calyrhaphy, 322-331 Chenodiol , 332-362 Cholecystolithotomy, 17 Choledocholithiasis, 50-54 , 93 -98 Cholelithiasis, 86 -88 Computers, 58 -61 Direx machine, 205-210 Dogs, 103-109 D r u g chcmolysis, 188, 189-190 D u n n i n g prostate tumors, 211-218 Electrohydraulic l i thotr ipsy, 3 5 - 3 8 , 42-45 Endoscopy, 220-222 Endourology, 309-317 Epidemiology, and gallstone disease, 279-285 Extracorporeal shock wave l i thotripsy (ESWL), 18 Direx machine, 205-210 and endourology on same table, 309-317 erosion o f th in films by, 289-297 immediate in situ as monotherapy, 4 6 - 4 9 mapping o f extended focus, 31 -34 M i l l evaluation o f kidneys treated w i t h , 302-308 piezoelectric by EDAP L T - 0 1 , 19-22 short-term effect on renal f u n c t i o n , 298-300 see also Lithotripters Fiber coupl ing system, P U L S O L I T H , 61 Gallbladder, 84 -100 Gallstones Chenodiol for dissolution of, 332-362 early American results and new reality, 199-204 H a r r i n g t o n rod contraindicat ion to l i thotripsy, 320 - 321 lesson f rom epidemiology, 279-285 models for recurrence rates, 17-18 treatment alternatives, 184-194 H a r r i n g t o n rod, 320 - 321 Hyperparathyroidism, 175-176 Hyperthermia, 211 -218 Hypotens ion , 143-145 Iliac ureteral stones, 24 -30 Intrahepatic ductal calculi, 98 -100 Kidneys hemorrhage, 103-109 stones, 117-122 treated w i t h extracorporeal shock wave l i thotripsy, 302-308 Lasers pulsed dye, 3 9 - 4 1 P U L S O L I T H l i thotr ipter , 55 -61 Li thotr ipters P U L S O L I T H , 5 5 - 6 1 short-term effect o f portable on renal f u n c t i o n , 298 -300 ultrasound based multipurpose, 5 0 - 5 4 Magnetic resonance imaging ( M R I ) , " 3 0 2 - 3 0 8 Methyl- tert -butyl ether lavage, 188-189 M g / C a ratio, 176 Monochromatic focused sound fields, in biological media, 4 -15 Monotherapy, 4 6 - 4 9 M R I see Magnetic resonance imaging Nat iona l Cooperative Gallstone Study, 3 3 2 - 3 6 2 Nephrotomy, 322 - 331 Obstructive urolithiasis, 46 -49 Percutaneous cholecystol i thotomy ( P C C L ) , 190-192 Phosphate therapy, 177-178 Plastic calyrhaphy, 322 -331 Posterior body w a l l , 29 Prostate tumors, 211-218 Pulsed dye laser, 3 9 - 4 1 P U L S O L I T H laser l i thotr ipter , 55 -61 Radiographs, 63, 264, 366-368 Regional hyperthermia, 211-218 Renal calculi associated w i t h megadose vitamin C, 139-142 dietary measures, 177 fluid intake, 176 -177 influence o f thiazides, 178-181 overview, 164-182 phosphate therapy, 177-178 surgical classification, 133-138 uricosuric agents, 181-182 Renal f u n c t i o n , and portable extracorporeal l i thotr ipter , 298 -300 Renal transplantation, 224-227 Shock waves biological effects of, 103-109 high energy, 211 -218 through bone, 2 4 - 3 0 see also Extracorporeal shock wave l i thotripsy Siemens Lithostar, 111-116 Sound fields, 4 - 1 5 Stones bile duct , 2 2 0 - 2 2 2 clearance rates, 22 fragmentation, 2 1 - 2 2 kidney, 117-122 large renal, 21 -22 sonographic local izat ion in gallbladder and bil iar) ' tree, 84-100 urinary risk factors, 124-131 see also Gallstones Supine posi t ion, 24 -30 , 143-145 Thiazides, 178-181 Ultrasound and kidney stones, 117-122 and mult ipurpose l i thotr ipter , 50-54 stone local izat ion in gallbladder and biliar) ' tree, 8 4 - 1 0 0 Ureter, 4 2 - 4 5 Ureteral calculi electrohydraulic l i thotripsy of, 35-38 laser l i thotr ipsy of, 3 9 - 4 1 surgical classification, 133-138 Uric acid calculi , 3 1 - 3 4 Uricosuric agents, 181-182 Urinary risk factors, 124-131 Urolithiasis, 2 2 4 - 2 2 7 V i t a m i n C, 139-142 X-ray di f f ract ion, 118 V o l . 2, N o . 4, 1990 Journal o f L i t h o t r i p s y a m i Stone Disease 381 L I T E R A T U R E R E V I E W B I L E C O N C E N T R A T I O N I S A K E Y F A C ­T O R F O R N U C L E A T I O N O F C H O L E S ­T E R O L C R Y S T A L S A N D C H O L E S T E R O L S A T U R A T I O N I N D E X I N G A L L B L A D ­D E R B I L E O F G A L L S T O N E P A T I E N T S . Van Erpecunty K., van Berge Henegowen, G., Stoel-winder, B., et αι.: Hepatology 11: 1-6, 1990. T h e study of V a n Erpecum et al. suggests that nucleation of cholesterol monohydrate crystals occurred more rapidly in concentrated than in di­lute gallbladder biles of patients with cholesterol gallstones. Furthermore, patients with solitary cholesterol stones revealed longer nucleation times in gall­bladder bile than patients with multiple stones. These findings point to an important role of bile concentration in the formation of cholesterol crystals and to a different pathogenesis of solitary and multiple cholesterol gallstone. I n agreement with several prior observations cholesterol crystals were observed in the majority (79%) of gallbladder biles from patients with cholesterol gallstones, but not in gallbladder biles from patients with pigment stones. However, in contrast to the results of the cholesterol nuclea­tion time, the presence of crystals was not in­fluenced by total lipid concentration or number of stones. Moreover, the presence of cholesterol crystals in bile did not have predictive value for a short nucleation time in filtered bile of the same patient. Methodological problems may be one explana­tion for this difference. For ultrafiltration, 0.22 μηι Millex filters were used, which may retain not only crystals but, additionally, cholesterol-phos-pholipid vesicles, particulary if these are fused and aggregated to larger complexes. Since vesicles play a key role in the formation of cholesterol crystals, removal of part of those vesicles by ultra­filtration could prolong cholesterol nucleation in a subsequent assay. It is therefore conceivable that the results obtained in the cholesterol nucleation studies of V a n Erpecum may be affected by the use of ultrafiltration. T h e finding of a negative correlation between total biliary lipids and the cholesterol saturation index is interesting. However, since no relation between total lipid concentration or cholesterol saturation index and the presence or absence of cholesterol crystals was seen, the value of both V o l . 2, N o . 4, 1990 parameters in the prediction of bile lithogenicity is clearly limited. Taken together, V a n Erpecum's study shows that the presence of cholesterol crystals in gall­bladder bile is of key importance in the pathogene­sis of cholesterol gallstones, while the role of bile concentration ana the cholesterol saturation in­dex in this process is less evident. Dieter Jüngst M u n i c h , Germany Journal o f Lithotripsy and Stone Disease 377 

Bile Concentration is a key factor for nucleation of cholesterol crystals and cholesterol saturation index in gallbladder bile of gallstone patients

Universität München: Elektronischen Publikationen

The Journal of 
Lithotripsy & 
Stone Disease 
A State-of-the-Art Journal Dealing with the 
Management of Urinary & Biliary Tract Stone Disease 
Editor-in-Chief 
L A U R E N C E B. K A N D E L 
Associate Editors 
M A R T I N I. R E S N I C K S T E P H E N E. S T E I N B E R G R O B E R T W. SUMMERS 
E D I T O R I A L B O A R D 
U R O L O G Y S E C T I O N 
Christian Chaussy 
Stephen Dretler 
Gerhard Fuchs 
Lloyd Harrison 
Masa-aki Kuwahara 
James Lingeman 
Stefan Loening 
Michael Marberger 
Xavier Martin 
David McCullough 
Charles Pak 
S C I E N C E A N D 
T E C H N O L O G Y S E C T I O N 
Edwin Carstensen 
Oliver Cass 
Lawrence Crum 
Michael Delius 
Peter Lewin 
Joseph Macaluso 
B I L I A R Y S E C T I O N 
Desmond Birkett 
H . Joachim Burhenne 
Peter Cotton 
Joseph Ferrucci 
James Maher 
Ronald Malt 
David Nahrwold 
Gustav Paumgartner 
Thierry Ponchon 
Leslie Schoenfield 
Johnson Thistle 
S u b s c r i p t i o n s o n a c a l e n d a r y e a r ( J a n . - D e c . ) basis o n l y a n d m u s t b e p r e p a i d . A l l c u r r e n t y e a r issues 
p u b l i s h e d p r i o r t o o r d e r i n g a re s u p p l i e d . For i n f o r m a t i o n o n ava i l ab i l i t y a n d p r i c e s o f s ing le issues a n d 
b a c k issues, c o n t a c t t h e p u b l i s h e r d i r e c t l y . 
The Journal of Lithotripsy & Stone Disease ISSN 1 0 4 0 - 2 1 5 2 , is p u b l i s h e d q u a r t e r l y b y F u t u r a P u b l i s h i n g 
C o m p a n y , I nc . , 2 B e d f o r d R idge R o a d , P .O . B o x 3 3 0 , M o u n t K i sco , N.Y. 1 0 5 4 9 , U.S.A. Y e a r l y 
s u b s c r i p t i o n ra te in U.S.A., a n d C a n a d a , $ 6 5 . 0 0 , F o r e i g n , $ 6 5 . 0 0 p lus $ 1 0 . 0 0 f o r s h i p p i n g ( i n c l u d e s a i r 
se rv ice ) . P r e p a y m e n t m u s t b e in U.S. f u n d s t h r o u g h a n A m e r i c a n b a n k . Y e a r l y s u b s c r i p t i o n in Japan 
(air c a r g o se rv i ce o n l y ) , c o n t a c t I g a k u - S h o i n , L t d . , 1 -28-36 H o n g o B u n k y o - k u , T o k y o , Japan . 
Postmaster: S e n d a d d r e s s c h a n g e s t o T h e Journa l o f L i t h o t r i p s y & S t o n e D i s e a s e , 2 B e d f o r d R i d g e 
R o a d , P .O. Box 3 3 0 , M o u n t K i sco , N.Y. 1 0 5 4 9 , S e c o n d Class p o s t a g e p a i d a t M o u n t K isco 
a n d at a d d i t i o n a l m a i l i n g o f f i ces . 
C o p y r i g h t © 1 9 9 0 b y F u t u r a P u b l i s h i n g C o m p a n y , Inc . P r i n t e d in t h e U.S.A 
A U T H O R INDEX 
Adwers, James R., 199-204 
Agarwal, Ravinder, 117-123 
Albrecht, Walter, 3 0 9 - 3 1 7 
Anaisc, D . , 224-228 
Appel , Betty, 302-308 
Baert, L . , 46 -49 
Baron, J., 298-300 
Bechtold, Robert E., 8 4 - 1 0 2 
Beck, M . , 24-30 
Belas, M . , 39 -41 
Berding, Ch. , 24 -30 
Bjorno, L . , 4 -16 
Boyce, Wi l l i am H . , 3 2 2 - 3 3 1 
Braf, Z . , 298-300 
Brendel, Walter, 103-110 , 161-163 
Burhenne, H . Joachim, 111-116 
Caos, A n t o n i o , 220-223 
Carmignani, L . , 133-138 
Debre, B., 39 -41 
Decho, Janice, 143-145 
De Cobelli , O. , 133-138 
Delius, Michael, 103-110 , 161-163 
Denny, Donald F., Jr., 143-145 
Diokno, Ananias C , 3 1 - 3 4 
Dyer, Raymond B., 302 -308 
Fache, J. Stephen, 111-116 
Festi, Davide, 279-285 
Flam, T. , 39 -41 
Foo, K.T. , 19-23 
Frischer, Ζ., 224-228 
Geise, Richard Α., 2 8 9 - 2 9 7 
Gcrshon, Charles R., 42 -45 
Gleeson, Malachy J., 184-198 
Goetz, A l w i n , 103-110 
Graff, J., 24-30 
Greenstein, Α., 298-300 
Grif f i th , Donald P., 184-198 
Harrison, L loyd H . , 302 -308 
Harvey, Jean Α., 124-132 
Heinrich, R., 50-54 
H i l l , Käthy D . , 124-132 
Hobbie, Rüssel K., 2 8 9 - 2 9 7 
Holbrook , Ryan F., 17-18 
Hollander, Jay B., 3 1 - 3 4 
Kandel, Laurence B., 35 -38 
Karstaedt, Nolan, 302-308 
Kaver, I . , 298-300 
Lachin, John M . , 340-362 
Landas, Steve, 211-219 
Larcher, P., 133-138 
Lee, Thomas S., 289 -297 
Liebich, Hans-Georg, 103-110 
Lingeman, James E., 3 1 8 - 3 1 9 
Livne, Pinhas M . , 205-210 
Loening, Stefan Α., 2 1 1 - 2 1 9 
Lubaroff, David M . , 211 -219 
Macaluso, Joseph N . , 1-3 
Mal t , Ronald Α., 17-18 
Mandressi, Α., 133-138 
Marberger, Michael, 3 0 9 - 3 1 7 
Markowitz , David M . , 143-145 
Marks, Jay W. , 332-336 
Matzkin , H . , 298-300 
McCul lough, David, 302 -308 
Morr ison, Kevin, 143-145 
Mueller, Wol f ram, 103-110 
Neighbors, T . H . , 4 - 1 6 
O t t , David J., 84-102 
Pak, Charles Y.C., 124-132 
— " - -u^S-
C»«.r. 5 l ! Ν - Y, 
^ m l u m » « r - ..nc μ - * ^ * - * * * - » * -
- - - . - · -
'-* ' · , ~ 7 . - ^ - ' " ' ' - " - - - -
" : " ·"•"- - : 
».« _ ~ . . , ™ . - . . . . . . 
. 1 — _ ~ : o o e 
•zrxzrzzxz~ ο j 
0 
!'> 
, «--<-» ι 
' '."^Xitrci , , „5 ; 1 U J 
....... Γ" j 
Rapaport, F.T., 224-228 
Rawat, Brijendra, 111-116 
Ren, Zong-Ying, 211-219 
Rocco, F., 133-138 
Roda, Enrico, 279-285 
Rodriquez, A.P. , 42-45 
Schoborg, Thomas W . , 42-45 
Schoenfield, Leslie J., 332-362 
Schreckenberg, Α., 50 -54 
Servadio, Ciro , 205-210 
Shabtai, M . , 224-228 
Silverman, David G. , 143-145 
Simon, Dan, 205-210 
Singh, V.R. , 117-123 
Smith, M.J .V. , 325-331 
Sparrow, H o l y n K., 211-219 
Sperling, Malcolm J., 320-321 
Steg, Α., 3 9 - 4 1 
Steincrt, Bruce, 31 -34 
Stewart, Charles, 139-142 
Tan, E.C., 19-23 
Taroni , Francesco, 279-285 
Thompson, Wi l l iam M . , 289-297 
Tucker, Robert, 211-219 
T u n g , K . H . , 19-23 
Türk, Christian, 309-317 
Waltzer, W . C . , 224-228 
Wasnick, Robert J., 139-142 
Watson, Nat Ε., 84-102 
White , Robert I . , Jr., 143-145 
Wil lemen, P., 46 -49 
W o l f m a n , Neil T . , 84-102 , 302-308 
Yendt, Edmund R., 164-183 
Zagoria, Ronald J., 302-308 
Zerbib, M . , 39 -41 
Zicgelbaum, Michael, 35-38 
Zierden, E., 50-54 
380 Journal o f Lithotripsy and Stone Disease V o l . 2, No. 4, 1990 
SUBJECT INDEX 
Abdominal compression, 143-145 
Acute obstructive urolithiasis, 46 -49 
Anatrophic nephrotomy, 322-331 
Anterior body wal l , 29 
Bile acids, 17 
Bile duct stones, 220-222 
Biliar)' endoprostheses, 220-222 
Biliarv l i thotripsy, 111-116 
Biliary tree, 84 -100 
Biochemical abnormality, 126-127 
Blast path, 3 1 - 3 4 
Bone, shock waves through, 24-30 
Calcification, 174-175 
Calyrhaphy, 322-331 
Chenodiol , 332-362 
Cholecystolithotomy, 17 
Choledocholithiasis, 50-54 , 93 -98 
Cholelithiasis, 86 -88 
Computers, 58 -61 
Direx machine, 205-210 
Dogs, 103-109 
D r u g chcmolysis, 188, 189-190 
D u n n i n g prostate tumors, 211-218 
Electrohydraulic l i thotr ipsy, 3 5 - 3 8 , 
42-45 
Endoscopy, 220-222 
Endourology, 309-317 
Epidemiology, and gallstone disease, 
279-285 
Extracorporeal shock wave l i thotripsy 
(ESWL), 18 
Direx machine, 205-210 
and endourology on same table, 
309-317 
erosion o f th in films by, 289-297 
immediate in situ as monotherapy, 
4 6 - 4 9 
mapping o f extended focus, 31 -34 
M i l l evaluation o f kidneys treated 
w i t h , 302-308 
piezoelectric by EDAP L T - 0 1 , 19-22 
short-term effect on renal f u n c t i o n , 
298-300 
see also Lithotripters 
Fiber coupl ing system, P U L S O L I T H , 61 
Gallbladder, 84 -100 
Gallstones 
Chenodiol for dissolution of, 332-362 
early American results and new reality, 
199-204 
H a r r i n g t o n rod contraindicat ion to 
l i thotripsy, 320 - 321 
lesson f rom epidemiology, 279-285 
models for recurrence rates, 17-18 
treatment alternatives, 184-194 
H a r r i n g t o n rod, 320 - 321 
Hyperparathyroidism, 175-176 
Hyperthermia, 211 -218 
Hypotens ion , 143-145 
Iliac ureteral stones, 24 -30 
Intrahepatic ductal calculi, 98 -100 
Kidneys 
hemorrhage, 103-109 
stones, 117-122 
treated w i t h extracorporeal shock 
wave l i thotripsy, 302-308 
Lasers 
pulsed dye, 3 9 - 4 1 
P U L S O L I T H l i thotr ipter , 55 -61 
Li thotr ipters 
P U L S O L I T H , 5 5 - 6 1 
short-term effect o f portable on renal 
f u n c t i o n , 298 -300 
ultrasound based multipurpose, 
5 0 - 5 4 
Magnetic resonance imaging ( M R I ) , 
" 3 0 2 - 3 0 8 
Methyl- tert -butyl ether lavage, 188-189 
M g / C a ratio, 176 
Monochromatic focused sound fields, in 
biological media, 4 -15 
Monotherapy, 4 6 - 4 9 
M R I see Magnetic resonance imaging 
Nat iona l Cooperative Gallstone Study, 
3 3 2 - 3 6 2 
Nephrotomy, 322 - 331 
Obstructive urolithiasis, 46 -49 
Percutaneous cholecystol i thotomy 
( P C C L ) , 190-192 
Phosphate therapy, 177-178 
Plastic calyrhaphy, 322 -331 
Posterior body w a l l , 29 
Prostate tumors, 211-218 
Pulsed dye laser, 3 9 - 4 1 
P U L S O L I T H laser l i thotr ipter , 55 -61 
Radiographs, 63, 264, 366-368 
Regional hyperthermia, 211-218 
Renal calculi 
associated w i t h megadose vitamin C, 
139-142 
dietary measures, 177 
fluid intake, 176 -177 
influence o f thiazides, 178-181 
overview, 164-182 
phosphate therapy, 177-178 
surgical classification, 133-138 
uricosuric agents, 181-182 
Renal f u n c t i o n , and portable 
extracorporeal l i thotr ipter , 
298 -300 
Renal transplantation, 224-227 
Shock waves 
biological effects of, 103-109 
high energy, 211 -218 
through bone, 2 4 - 3 0 
see also Extracorporeal shock wave 
l i thotripsy 
Siemens Lithostar, 111-116 
Sound fields, 4 - 1 5 
Stones 
bile duct , 2 2 0 - 2 2 2 
clearance rates, 22 
fragmentation, 2 1 - 2 2 
kidney, 117-122 
large renal, 21 -22 
sonographic local izat ion in 
gallbladder and bil iar) ' tree, 
84-100 
urinary risk factors, 124-131 
see also Gallstones 
Supine posi t ion, 24 -30 , 143-145 
Thiazides, 178-181 
Ultrasound 
and kidney stones, 117-122 
and mult ipurpose l i thotr ipter , 50-54 
stone local izat ion in gallbladder and 
biliar) ' tree, 8 4 - 1 0 0 
Ureter, 4 2 - 4 5 
Ureteral calculi 
electrohydraulic l i thotripsy of, 35-38 
laser l i thotr ipsy of, 3 9 - 4 1 
surgical classification, 133-138 
Uric acid calculi , 3 1 - 3 4 
Uricosuric agents, 181-182 
Urinary risk factors, 124-131 
Urolithiasis, 2 2 4 - 2 2 7 
V i t a m i n C, 139-142 
X-ray di f f ract ion, 118 
V o l . 2, N o . 4, 1990 Journal o f L i t h o t r i p s y a m i Stone Disease 381 
L I T E R A T U R E R E V I E W 
B I L E C O N C E N T R A T I O N I S A K E Y F A C ­
T O R F O R N U C L E A T I O N O F C H O L E S ­
T E R O L C R Y S T A L S A N D C H O L E S T E R O L 
S A T U R A T I O N I N D E X I N G A L L B L A D ­
D E R B I L E O F G A L L S T O N E P A T I E N T S . 
Van Erpecunty K., van Berge Henegowen, G., Stoel-
winder, B., et αι.: Hepatology 11: 1-6, 1990. 
T h e study of V a n Erpecum et al. suggests that 
nucleation of cholesterol monohydrate crystals 
occurred more rapidly in concentrated than in di­
lute gallbladder biles of patients with cholesterol 
gallstones. 
Furthermore, patients with solitary cholesterol 
stones revealed longer nucleation times in gall­
bladder bile than patients with multiple stones. 
These findings point to an important role of 
bile concentration in the formation of cholesterol 
crystals and to a different pathogenesis of solitary 
and multiple cholesterol gallstone. 
I n agreement with several prior observations 
cholesterol crystals were observed in the majority 
(79%) of gallbladder biles from patients with 
cholesterol gallstones, but not in gallbladder biles 
from patients with pigment stones. However, in 
contrast to the results of the cholesterol nuclea­
tion time, the presence of crystals was not in­
fluenced by total lipid concentration or number 
of stones. Moreover, the presence of cholesterol 
crystals in bile did not have predictive value for a 
short nucleation time in filtered bile of the same 
patient. 
Methodological problems may be one explana­
tion for this difference. For ultrafiltration, 0.22 
μηι Millex filters were used, which may retain not 
only crystals but, additionally, cholesterol-phos-
pholipid vesicles, particulary if these are fused and 
aggregated to larger complexes. Since vesicles 
play a key role in the formation of cholesterol 
crystals, removal of part of those vesicles by ultra­
filtration could prolong cholesterol nucleation in 
a subsequent assay. It is therefore conceivable that 
the results obtained in the cholesterol nucleation 
studies of V a n Erpecum may be affected by the 
use of ultrafiltration. 
T h e finding of a negative correlation between 
total biliary lipids and the cholesterol saturation 
index is interesting. However, since no relation 
between total lipid concentration or cholesterol 
saturation index and the presence or absence of 
cholesterol crystals was seen, the value of both 
V o l . 2, N o . 4, 1990 
parameters in the prediction of bile lithogenicity 
is clearly limited. 
Taken together, V a n Erpecum's study shows 
that the presence of cholesterol crystals in gall­
bladder bile is of key importance in the pathogene­
sis of cholesterol gallstones, while the role of bile 
concentration ana the cholesterol saturation in­
dex in this process is less evident. 
Dieter Jüngst 
M u n i c h , Germany 
Journal o f Lithotripsy and Stone Disease 377 


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Bile Concentration is a key factor for nucleation of cholesterol crystals and cholesterol saturation index in gallbladder bile of gallstone patients

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