Anti-miss-shot control device for selective stone disintegration in extracorporeal shock wave lithotripsy

A new device to prevent erroneously focused shock waves to the renal parenchyma during extracorporeal shock wave lithotripsy (ESWL) has been developed; an anti-miss-shot control device (AMCD) and experiments have been conducted to evaluate its effectiveness. For shock wave generation and stone localization, piezoceramic elements (PSE) and ultrasound localization, respectively were used. After stone localization, probing ultrasounds (PU) were emmitted from the PSE towards the focal region and the reflected sound levels (RSL) were monitored by the PSE which also functioned as a microphone. A direct hit by the PU to the stone or a miss was judged from the RSL, i.e. a high RSL indicates a direct hit and a low RSL indicates a miss. Shock waves were generated only when the RSL exceeded the level which indicated a direct hit. The experimental results showed that the injury to the renal parenchyma was decreased by using the AMCD. Clinical application of the AMCD is expected to increase the safety of ESWL.This article was processed using Springer-Verlag T_EX Shock Waves macro package 1990.     

Medical applications and bioeffects of extracorporeal shock waves

Lithotripter shock waves are pressure pulses of microsecond duration with peak pressures of 35–120 MPa followed by a tensile wave. They are an established treatment modality for kidney and gallstone disease. Further applications are pancreatic and salivary stones, as well as delayed fracture healing. The latter are either on their way to become established treatments or are currently under investigation. Shock waves generate tissue damage as a side effect which has been extensively investigated in the kidney, the liver, and the gallbladder. The primary adverse effects are local destruction of blood vessels, bleedings, and formation of blood clots in vessels. Investigations on the mechanism of shock wave action revealed that lithotripters generate cavitation both in vitro and in vivo. An increase in tissue damage at higher pulse administration rates, and also at shock wave application with concomitant gas bubble injection suggested that cavitation is a major mechanism of tissue damage. Disturbances of the heart rhythm and excitation of nerves are further biological effects of shock waves; both are probably also mediated by cavitation. On the cellular level, shock waves induce damage to cell organelles; its extent is related to their energy density. They also cause a transient increase in membrane permeability which does not lead to cell death. Administered either alone or in combination with drugs, shock waves have been shown to delay the growth of small animal tumors and even induce tumor remissions. While the role of cavitation in biological effects is widely accepted, the mechanism of stone fragmentation by shock waves is still controversial. Cavitation is detected around the stone and hyperbaric pressure suppresses fragmentation; yet major cracks are formed early before cavitation bubble collapse is observed. The latter has been regarded as evidence for a direct shock wave effect.This article was processed using Springer-Verlag T_EX Shock Waves macro package 1.0 and the AMS fonts, developed by the American Mathematical Society.     

First report on the persist time of the free radical produced by shock wave pulses employed in clinical ESWL

The shock wave used in extracorporeal shock wave lithotripsy (ESWL) induces strong cavitation and generates a large amount of free radicals (FR). In order to evaluate the harmfulness of FR in the ESWL, information on the incidence and persist time of FR caused by shock waves is required. FR markers can estimate the amount of FR generated, but not how long the FRs will survive. The OH* FR generated by the ESWL shock wave reacts with luminol and emits blue light, which is called sonochemical luminescence (SCL) phenomenon. In this study, FR generation and persist time were measured by recording SCL phenomenon with a sensitive photomultiplier tube (PMT) that responds in nanoseconds. As a result of measurement with the PMT, when the electromagnetic shock wave used in clinical practice was irradiated to the luminol solution, the amount of light emitted per unit time reached its maximum value within a very short time (< ∼600us) and then exponentially decreased for a long time (∼several hundred ms). The measured FR persist time reaches a maximum of 1000 ms. As the output setting of the shock wave generator increases, the minimum or average FR persist time increases, but the maximum value does not show a high correlation with the output setting. The amount of generated FR shows a very high correlation with the shock wave setting, and when the setting is changed from low to high, it increases very sensitively, rapidly and non-linearly. In order to reduce the risk of FR in patient treatment using lithotripsy, the output setting of the shock wave should be minimized, and the interval between the shock wave pulses should be sufficiently larger than the FR persist time. Therefore, it is recommended to avoid increasing the output setting and setting the shock wave irradiation frequency below 1 Hz to shorten the treatment time in clinical practice. For the purpose of formulating these recommendations, additional studies on the generation and persist time of FR depending on the shock wave generation method and set conditions in living tissue or similar environment are required in the future.     

Cavitation phenomena in extracorporeal microexplosion lithotripsy

An experimental investigation was made of cavitation phenomena induced by underwater shock wave focusing applied to the extracorporeal microexplosion lithotripsy (microexplosion ESWL). Firstly an underwater microexplosion generated by detonation of a 10 mg silver azide pellet was studied and secondly underwater shock focusing and its induced cavitation phenomena were investgated. Underwater shock wave was focused by using a semi-ellipsoidal reflector in which a shock wave generated at the first focal point of the reflector was reflected and focused at the second focal point. It is found that an explosion product gas bubble did not produce any distinct rebound shocks. Meantime cavitation appeared after shock focusing at the second focal point where expansion waves originated at the exit of the reflector were simultaneously collected. A shock/bubble interaction is found to contribute not only to urinary tract stone disintegration but also tissue damage. The cavitation effect associated with the microexplosion ESWL was weaker in comparison with a spark discharge ESWL. The microexplosion ESWL is an effective method which can minimize the number of shock exposures hence decreasing tissue damage by conducting precise positioning of urinary tract stones.This article was processed using Springer-Verlag T_EX Shock Waves macro package 1.0 and the AMS fonts, developed by the American Mathematical Society.     

体外冲击波碎石技术的力学机理的研究

体外冲击波粉碎结石术(extracorporeal shock wave lithotripsy, ESWL)是冲击波和聚焦原理在医疗领域的最成功的应用, 因其无手术介入, 使用方便, 碎石率高, 治疗费用低, 已成为尿路结石的首选治疗方法.但是这种技术也有尚待完善之处, 例如: 对于大结石ESWL的治疗效率较低; 对人体组织有短期或长期的副作用,甚至可能造成 器官功能的不可逆性丧失等.ESWL通过一系列作用力粉碎结石和损伤人体组织的过程颇为复 杂.从ESWL技术诞生之时起, 人们就同步开展了关于ESWL的实验室的和临床的基础研究, 以期达到最好的碎石效果和最小的副作用.至今ESWL的破坏机制逐渐被人们所认识,但仍然 存在争论.冲击波直接的破坏机制已经比较清楚, 而它诱发的空化破坏机制是当前ESWL研究 的一个具有挑战性的热点.评定碎石机冲击波以及碎石效率的标准还在不断的完善之中.     

大跨屋盖结构考虑模态耦合的等效静力风荷载

基于荷载响应相关法提出了一种计算大跨屋盖结构等效静力风荷载的新方法. 该方法不 再分别计算结构的背景响应和共振响应,而是采用完全二次型组合法直接计算结构的整体动 态响应;而且这种方法能够考虑多阶模态的贡献和各阶模态响应间的耦合效应. 最后,将一 大跨屋盖结构(深圳市民中心)作为实际工程应用案例,计算了它的等效静力风荷载,并将 其与其他方法的计算结果进行比较,以验证方法的有效性.     

Acoustic streaming in lithotripsy fields: preliminary observation using a particle image velocimetry method

This study considers the acoustic streaming in water produced by a lithotripsy pulse. Particle image velocimetry (PIV) method was employed to visualize the acoustic streaming produced by an electromagnetic shock wave generator using video images of the light scattering particles suspended in water. Visualized streaming features including several local peaks and vortexes around or at the beam focus were easily seen with naked eyes over all settings of the lithotripter from 10 to 18 kV. Magnitudes of the peak streaming velocity measured vary in the range of 10-40 mm s(-1) with charging voltage settings. Since the streaming velocity was estimated on the basis of a series of the video images of particles averaged over 1/60s, the time resolution limited by the video frame rate which is 1-2 orders of magnitude larger than driving acoustic activities, measured velocities are expected to be underestimated and were shown a similar order of magnitude lower than those calculated from a simple theoretical consideration. Despite such an underestimation, it was shown that, as predicted by theory, the magnitude of the streaming velocity measured by the present PIV method was proportional to acoustic intensity. In particular it has almost a linear correlation with peak negative pressures (r=0.98683, p=0.0018).     

The role of cavitation effects in the mechanisms of destruction and explosive processes

The paper presents a review of the experimental results, mathematical models and numerical investigations of wave processes and the dynamics of liquid media under impulse loading. The presence of micro-inhomogeneities can change substantially the state of the liquid, the structure of the applied wave field and the mechanisms of the physical processes that take place in the liquid. Some crucial research trends received proper attention: the cavitation fracture of liquid under explosive loading, different methods of describing the mechanisms of pressurized-liquid tank explosions, the effects of bubble cavitation and inhomogeneities on the sensitivity of high explosives (HE) to the initiation and propagation of detonation, the problem of focusing the shock waves, and destruction of stones in lithotriptors. Received 10 August 1995 / Accepted 18 June 1996