Advanced rai stage in patients with chronic lymphocytic leukaemia correlates with simultaneous hypermethylation of plural tumour suppressor genes.

Hypermethylation of CpG islands within gene promoters is one of various mechanisms of gene silencing involved in the pathogenesis of human cancer. By using methylation-specific polymerase chain reaction we explored aberrant promoter methylation of five tumour suppressor genes in 29 patients with chronic lymphocytic leukaemia. Aberrant methylation of DLC1, SHP1, p15 and p16 occurred, respectively, in 89.7 %, 70 %, 62.1 % and 31 % of patients at diagnosis. Lamin A/C was unmethylated in all the samples. Hypermethylation of at least one gene was detected in 96.6 % of patients. Concurrent methylation of two or more genes correlated with Rai stage at diagnosis.

[Analgesia in extracorporeal shock wave lithotripsy. Experience with a lithotripsy apparatus made in Czechoslovakia]. / Analgézie pri litotrypsi extrakorporální rázovou vlnou. Zkusenosti na ceskoslovenském litotryptoru.

The authors describe their experience with the use of analgesia during lithotripsy by an extracorporeal impulse wave (LERV). They made a total of 253 lithotripsies in various indications in a total of 150 patients. Most frequently ataracoanalgesia was administered (a combination of diazepam and phentanyl), however, administration of midazolam (Dormicum) is also adequate. This is due among others to the favourable physical properties of the impulse waves generated by the apparatus used. In the discussion the authors give a brief account of the causes of painfulness of LERV, based on contemporary ideas and experience.

[Shock-wave lithotripsy in choledocholithiasis in a female patient with a cardiac pacemaker]. / Litotrypse rázovou vlnou pro choledocholitiázu u nemocné s kardiostimulátorem.

BACKGROUND: Extracorporeal shock wave lithotripsy is relatively contraindicated in patients with an implanted cardiac pacemaker. Shock waves can damage the pacemaker by mechanical pressure and also by electromagnetic induction. Since the distance between the applicator and the pacemaker is small during biliary lithotripsy, the risk of damaging the pacemaker is greater. In the following case, the patient presented with a stone in the common bile duct, and had an implanted pacemaker. Lithotripsy with non-synchronized shock waves was the method of choice since conventional surgery was high risk in this specific case. CASE REPORT: In an 84-year-old woman with a stone in the proximal part of the common bile duct, endoscopic attempts of extraction failed. Therefore, shock wave lithotripsy was indicated. This patient had serious heart disease with an interference of spontaneous heart action with the pacemaker at a ratio of 1:1. We decided to treat with shock wave lithotripsy. The application of shock waves was without side effects on the patient and the pacemaker. CONCLUSION: This case is interesting as it highlights the possibility of using the Czech made MEDILIT lithotriptor in the treatment of choledocholitiasis in patients with a pacemaker. Even so, it is necessary to monitor the patient's ECG to ensure the possibility of immediate external stimulation.

[Treatment of pancreatic stones with extracorporeal lithotripsy with sonographic localization]. / Lécba pankreatikolitiázy extrakorporální litotrypsí se sonografickým zamerením.

BACKGROUND: Pancreatic stones may be treated by endoscopic extraction or by surgery. Extracorporeal shock wave lithotripsy increased possibility of noninvasive steps to their elimination. The aim of this study was to describe our first experience with this method. METHOD AND RESULTS: 10 patients (6 men and 4 women) in average age 47 years (between 19 to 72 years) were treated. The lithotriptor MEDILIT with sonographic targeting was used for fragmentation of pancreatic stones. Fragmentation was achieved in 8 patients, in 4 cases we observed spontaneous disappearnace, in 3 cases an endoscopic extraction of fragments was necessary. In one case good fragmentation was observed at control ECRP, but the repeated Wirsungography showed a big pseudocyst which had not been diagnosed at the first examination and surgery was necessary. In 2 cases no fragmentation was achieved and in these cases surgery was also indicated. No serious side effects were observed, nor elevation of amylase values compared with the situation before the shock wave treatment. CONCLUSIONS: Extracorporeal shock wave lithotripsy of pancreatic stones revealed good fragmentation and disappearance stone from ductus Wirsungi without serious side effects on clinical course and surrounding soft tissues.

[Shock-wave lithotripsy in the treatment of 12 patients with choledocholithiasis using an apparatus manufactured in Czechoslovakia]. / Litotrypse rázovou vlnou pri lécbe 12 nemocných s choledocholitiázou na Ceskoslovenském zarízení.

Lithotripsy by shock wave was performed in 12 patients with choledocholithiasis using the authors' own apparatus. The shock wave is created by an electric spark and the concentration is made by a rotational semi-elipsoid. The pressures attained in the second focus are 150 MPa. The focusing of the stones and the setting to the site of maximal pressures is made by means of two X-ray projections. Patients were indicated for the procedure when the method of endoscopic extraction had failed. Before the procedure a nasobiliary drain was inserted and after administration of analgesia on average 520 shocks were applicated. During the procedure no complications were observed. Fragmentation was achieved in 11 patients. Spontaneous release of fragments was recorded in five of the patients and in 6 during the check-up ERCP endoscopic extraction was made.

[Treatment of kidney stones using shock-wave lithotripsy with sonographic control]. / Lécba ledvinových kamenu litotrypsí rázovou vlnou se sonografickým zamerením.

Lithotripsy by means of an extracorporeal shock-wave was performed in 128 patients with urolithiasis. In this group for the first time in Czechoslovakia ultrasound control of kidney stones was used in 44 patients; in the remainder X-ray control was used. The authors used equipment designed and manufactured locally. The ultrasonic probe is laterally connected with the shock-wave applicator. Disappearance of the fragments after lithotripsy was achieved in 39 patients where ultrasonic control was used. The paper presents the results, discusses the advantages and limitations of ultrasonic control in extracorporeal lithotripsy of urolithiasis.

[Biological effects of interacting shock waves. A modeling study of the effects of interacting shock waves using erythrocyte hemolysis]. / Biologické úcinky interagujících rázových vln. Modelová studie úcinku IRV s vyuzitím stanovení hemolýzy erytrocytu.

AIM: The effects of high-energy shock wave on tissues were discussed in literature. The shock wave sources which were used for experiments were developed for stone fragmentation. The side effects of the applicators are generally low. Increase of shock wave pressure induce bigger negative pressure amplitude and this may cause significantly bigger side effects. We used tow shock waves, with time interval of 5 microseconds. In our opinion, the first shock wave causes acoustic inhomogenity in shock wave focus and therefore second shock wave acts in a region with different acoustic parameters. The second shock wave may loss energy in the focus area by dissipation or absorption. We termed the coupled shock waves as "interacting shock waves". METHODS AND RESULTS: Hemolysis of erythrocytes was used for examination of biological toxicity. Shock wave pressure was 80 MPa, the ratio of positive to negative pressure of single shock waves is 30. For correlation we applied 50 and 100 single shock waves and 50 or 100 couples of two shock waves. Hemolysis after 50 simple shock waves was 4.28 times lower compared with hemolysis after the same number of coupled shock waves (interacting shock waves). CONCLUSION: After 50 couples of shock waves hemolysis is 2.14 times higher compared with 100 single shock waves. This result suggests that the hypothesis of some interaction existing between two shocks applied in a very short time interval make future study rightful.

Treatment of a gastric bezoar by extracorporeal shock wave lithotripsy.

A bezoar of the stomach was diagnosed by X-ray and endoscopy in an 8-year-old boy who presented with intermittent dull epigastric pain. Attempts at endoscopic extraction failed because of the size and hardness of the bezoar. Extracorporeal shock wave lithotripsy was therefore applied using ultrasound to locate the bezoar. Disintegration of the bezoar and spontaneous evacuation of the fragments was achieved.

Extracorporeal shock-wave lithotripsy of the common bile duct stone with ultrasound localization.

Extracorporeal shock-wave lithotripsy with ultrasonographic localization of the common bile duct stone was successfully performed. The apparatus used is described and the advantages and disadvantages of ultrasonographic versus X-ray common bile duct stone localization are discussed.