[Ultrasonically guided drainage of pleural empyema]. / Ultralydvejledt draenage af pleuraempyem.

Sufficient drainage of the infected pleural space may be difficult without other image guidance than simple frontal and lateral chest radiograms. When the suspected empyema is difficult to locate we recommend insertion of a 10F pigtail catheter guided by ultrasound. This is illustrated by two patient histories. The method is safe, with the advantage of a precise localisation of the drainage catheter in relation to the empyema, the lung and the diaphragm.

[Right-sided rupture of the diaphragm diagnosed by CT]. / Højresidig diaphragmaruptur diagnosticeret ved CT.

The diagnosis of rupture of the hemidiaphragm is difficult but important. Straight x-ray of the thorax is usually pathological but is not always diagnostic. After straight x-ray, the literature recommends ultrasound as a diagnostic method but this may, however, cause problems on account of the intercostal approach. Before the introduction of ultrasound, pneumoperitoneum would have been a conclusive but potentially dangerous method. In the case reported here, a relevant thoracic trauma more than 20 years ago caused recurrent right-sided pneumonia in a man aged 41 years. Straight x-ray of the thorax showed apparent elevation of the right hemi-diaphragm and ultrasound did not contribute towards convincing distinction between rupture and elevation. CT was performed and depicted rupture of the right hemidiaphragm. CT is recommended as a non-invasive and accurate diagnostic method in cases where the ultrasonic findings are inconclusive.

[Endoscopic percutaneous transhepatic cholelithotripsy in the treatment of complicated stones in the deep biliary tracts]. / Endoskopisk perkutan transhepatisk kolelitotripsi til behandling af vanskelige sten i de dybe galdeveje.

The results of endoscopic percutaneous transhepatic cholelithotripsy in seven patients with stones in the deep biliary passages which could not be treated by endoscopic papillotomy (EST) or extracorporeal shock wave lithotripsy (ESWL) are presented. A new dilator technique combined with mechanical or laser-lithotripsy was employed. All of the patients were relieved of the stones after uncomplicated course. It is concluded that endoscopic percutaneous cholelithotripsy which can be carried out under local anaesthesia, should be offered to patients with stones in the deep biliary passages which are not accessible to conventional treatment with EST or ESWL.

[Extracorporeal shockwave crushing of gallstones. Preliminary report]. / Ekstrakorporal galdestensknusning. En praeliminaer rapport. Hvidovre Hospitals Galdestensgruppe.

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of symptomatic x-ray negative stones in 23 patients. The number of ESWL sessions per patient was 1.8 (range 1-4). In 18 patients (78%), adequate fragmentation was seen comparable to results obtained elsewhere. Oral bile acid therapy was used after ESWL in the 18 patients mentioned and the mean follow-up period was five months (range 3-8 months). Four patients had by now passed all stones while 12 patients still had remaining stone fragments and one patient a gallstone. After ESWL, one patient was and one patient a gallstone. After ESWL, one patient was referred for cholecystectomy at his own request. Of the remaining five patients, cholecystectomy was performed in two and was scheduled for in three. Complications after ESWL were seen in two patients who developed acute pancreatitis. Thus, our preliminary experience shows that ESWL resulted in fragmentation and passing of gallbladder stones, but not without complications. Like the gallstone groups in Lyon, Montreal and Munich we are convinced that ESWL should be performed in accordance with prospectively designed protocols in order to establish optimal planning of indications and strategies for future treatment.