Lithotripters, Stones and Lithotripsy

Stones in kidneys, urinary tract, urinary bladder and gall bladder could be treated with open surgery, percutaneous laproscopic surgery or lithotripsy. Treatment of stones in organs with drugs is of limited scope. A lithotripter is an instrument which breaks up stones in situ by shockwaves, which are focused on them. There are a variety of lithotripters available worldwide. Kidney stones or renal calculi are effectively treated with extracorporeal shockwave lithotripsy (ESWL), though sometimes percutaneous nephrolithotomy (PCNL) or open surgery is also required to remove renal stones. The lithotripsy treatment is said to be successful if stones are eliminated or reduced to <2 mm size. Comparative total cost of treatment by lithotripsy is almost half than by open surgery. ESWL has its own advantages as there is no blood loss and very little morbidity. Extracorporeal shockwave lithotripsy (ESWL) is the cheapest and quickest way of returning patient to normal life.

Extracorporeal shockwave lithotripsy is the best option as a mono-therapy for a medium-size stone (1-2 cm). However, for larger and stag-horn type stones, the best results could only be achieved by multi model approach. After nephrolithotripsy, the fragments of stones are expected to be passed in the urine within about 3 months time. The success rate varies with the size of stones but is always above 80% with ESWL and >90% for percutaneous nephrolithotomy (PCNL). Depending on the location, volume and composition, ureteral and kidney stones need endoscopic treatment via uretero-renoscopy (URS) and/or percutaneous nephrolithotomy.

Anti-thyroid Drugs: Precautions in Pregnancy, Lactation and Asthma

The thyroid gland of our body controls the body metabolism through its iodine containing hormones. Normal thyroid gland is not palpable but the enlarged thyroid gland could be felt in front of the neck and may be associated with non-toxic or toxic goitre. Goitrous gland may have normal function or under function (hypothyroidism) or over function hyperthyroidism). The exophthalmic goitre is known as Graves's disease and in this
disease the eye balls protrude due to thyrotoxicosis.

The compounds used as anti-thyroid drugs include carbimazole and propylthiouracil. Anti-thyroid drugs inhibit the formation of thyroxine and triiodothyronine (T3) in the thyroid gland. Propylthiouracil also retard the peripheral conversion of thyroxine into triiodothyronine (T3). The same drugs are also used for the treatment of thyrotoxicosis and preparation for thyroidectomy. Anti-thyroid drugs may suppress the bone marrow so blood cell counts are advisable at regular intervals during the course of treatment. Pregnant and/or lactating patients with thyrotoxicosis need to consult the endocrinologist and to reduce the dose to minimum. Patients with tracheal obstruction or asthma also need extra care during the treatment of hyperthyroidism or thyrotoxicosis. Anti-thyroid drugs may cause nausea, gastro-intestinal upset, thyroid enlargement, agranulocytosis, granulocytopenia ( low count of neutrophils and eosinophils), leucopenia (low count of white blood cells) and thrombocytopenia low count of platelets); that is why regular blood counts are advisable. Self-treatment of hyperthyroidism or thyrotoxicosis is not advisable, as it needs investigative follow up. However, carbimazole oral drug is started with a dose of 15-45mg daily in divided doses depending on the severity of the disease and maintenance dose could be 2.5-25mg daily for 12 months. For thyroidectomy preparation, the dose may be 15-45mg daily in divided doses for 2-4 weeks depending on the severity of the disease.

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