Percutaneous pulsed-dye laser lithotripsy of gallbladder stones in swine.

Human gallstones were surgically implanted in the gallbladders of 14 pigs. Nine to 16 days later a sheath was successfully placed percutaneously into the gallbladders of 13 animals using ultrasound and fluoroscopy. Two methods were used to guide laser fragmentation: (1) fluoroscopy and a steerable double lumen catheter (two animals), and (2) a flexible endoscope (11 animals). Laser treatment was done in 12 animals with a flashlamp-pumped pulsed-dye laser. A mean of 3600 pulses/animal were delivered using a wavelength of 504 nm and a maximum energy of 60 mJ/pulse. No fragmentation occurred in two animals, partial fragmentation occurred in six, and complete fragmentation occurred in four. Endoscopic guidance was superior to fluoroscopic guidance. Complications (sheath dislodgment, gallbladder perforation, bleeding) occurred in eight of 14 animals. Pulsed-dye laser fragmentation of gallbladder stones is feasible using endoscopic guidance. The use of this technique through an acute percutaneous tract may be associated with complications.

CT evaluation of esophageal perforation following endoscopic sclerotherapy.

We report a case of contained esophageal perforation following endoscopic sclerotherapy for bleeding esophageal varices. CT demonstration of the perforation is presented.

Percutaneous cholecystolithotomy with endoscopic lithotripsy by using a pulsed-dye laser: preliminary experience.

Percutaneous cholecystolithotomy with endoscopically directed lithotripsy with a pulsed-dye laser was performed in eight patients for the treatment of symptomatic gallstones. All patients had stones that were not amenable to therapy by less invasive techniques. During the first stage of a two-stage procedure, a cholecystostomy catheter was placed percutaneously. During the second stage, performed at least 10 days later, the stones were fragmented with a laser and removed. Fragmentation of the stones was successful in all patients. In six patients, the gallbladder was completely cleared of stones, as assessed with endoscopy and cholecystography. In two patients, residual fragments remained in the gallbladder. No laser-related complications occurred. This preliminary experience suggests that the pulsed-dye laser is safe and effective in endoscopically directed lithotripsy of gallbladder stones.

Needle biopsy of renal allografts: comparison of two techniques.

Two techniques for renal allograft biopsy were retrospectively evaluated to compare relative safety and efficacy. After ultrasound (US) localization of the kidney and biopsy with a hand-held 14-gauge cutting needle, an adequate specimen was obtained in 74 of 77 cases (96%). Major complications occurred in six of these 77 cases (8%). One hundred four biopsies were performed by using a smaller 18-gauge cutting needle with a spring-loaded biopsy "gun" and real-time US guidance. With this newer technique, specimens adequate for diagnosis were obtained in 99 biopsies (95%). There was a single major complication with this technique (1%). The 18-gauge needle with real-time US guidance yields comparably adequate specimens with a lower frequency of complications.