PURPOSE: In order to evaluate microstructural changes after shock wave exposure, gross, light microscopic and transmission electron microscopic findings were analyzed with rabbit gallgladders. MATERIALS AND METHODS: A preliminary study(2 rabbits) was performed to determine the dosage intensity of shock waves needed to inflict damage, using a EDAP LT 01 piezoelectric extracorporeal shock wave Iothotriptor. The gallbladders of three different groups of rabbits were given shock waves of various intensity. A storage value of 100, 50, 25 at rate of 20/sec under 80% power were given to group I (4 rabbits), group II( 4 rabbits), and group III(3 tabits), respectively. The rabbits were sacrified 6--12 hours later. RESULTS: The observed pathologic changes in the transmission electron microscopy were vaculization of cytoplasm and swelling of epithelial cells with dilatation and structural alteration of intracellular organelles, especially endoplasmic reticulum. Cell membrane rupture and necrosis were observed at the markedly affected area. The structural changes of intracellular organelles were minimally found at a storage value of 25. However, above pathologeic changes with dilatation and structural alterations of endoplasmic reticulums were more profund at value of 100. CONCLUSION: Early histologic changes induced by shock waves are dose dependent and the findings of cellular damage caused by ESWL might be explained as above.
Cell Membrane ; Cytoplasm ; Dilatation ; Endoplasmic Reticulum ; Epithelial Cells ; Gallbladder* ; Microscopy, Electron, Transmission ; Necrosis ; Organelles ; Rabbits ; Rupture ; Shock*

BACKGROUND: Surgical resection is generally accepted as the first choice of treatment for primary hepatic malignancy. But liver resection of primary hepatic malignancy is associated with a high incidence of recurrence, that has a poor prognosis. The goal of this research was to assess the rationale and result of treatment of recurrence following resection of primary hepatic malignancy. PATIENTS & METHODS: This was a retrospective study of 258 patients who had done hepatic resection with primary hepatic malignancy from 1990. Jan to 1999. Dec. And retrospective analysis of 72 patients with recurrent intrahepatic malignancy after hepatic resection. We exclude extrahepatic recurrence. The treatment methods of intrahepatic recurrence are variable. They include repeated hepatic resection, transcatheter arterial chemoembolization, percutaneous injection therapy of alcohol or hot saline, holmium-166 injection therapy, systemic chemotherapy and combined therapy. RESULTS: The cases of hepatic re-resection are 8, the cases of transcatheter arterial chemoembolization are 19, the cases of percutaneous injection therapy of alcohol or hot saline are 7, the cases of holmium- 166 injection therapy are 6, the cases of systemic chemotherapy are 13 and the cases of combined therapy are 13. In the poor general condition, 6 patients, only conservative therapy was applied. The survival rate of 72 patients with recurrent intrahepatic malignancy after hepatic resection is 61.6%, 46.6%, 33.5%, 26.9%, 15.5%, 2.7% at 3 month, 6 month, 9month, 1year, 2year, 3year. The survival rate of the cases of hepatic re-resection is 100%, 85.7%, 71.4%, 71.4%, 47.6%. The survival rate of transcatheter arterial chemoembolization is 89.5%, 73.0%, 61.8%, 61.8%, 44.1%. 11.0%. The survival rate of percutaneous injection therapy of alcohol or hot saline is 100%, 71.4%, 42.9%, 42.9%, 14.3%, 0%. The survival rate of holmium-166 injection therapy is 66.7%, 66.7%, 66.7%, 33.3%, 33.3%. The survival rate of systemic chemotherapy is 53.9%, 38.5%, 30.8%, 15.4%, 15.4%, 0%. The survival rate of combined therapy is 100%, 84.6%, 69.2%, 69.2%, 41.5%, 0%. And the survival rate of conservative therapy is 54.1%, 39.8%, 19.9%, 14.2%, 7.6%, 3.8%. CONCLUSION: We got results that the hepatic resection, holmium-166 injection therapy, and transcatheter arterial chemoembolization combined therapy were better than systemic chemotherapy and percutaneous injection therapy of alcohol or hot saline in longterm survival rate.
Drug Therapy ; Humans ; Incidence ; Liver ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Rate