137 SHOCK-WAVE LITHOTRIPSY OF GALLBLADDER STONES: HOW MANY PATIENTS ARE SUITABLE?

A.Remb~w, M.Staritz, P.K!ose~ K.-H.Meyer zum BOschenfelde. Depts. of Medicine I and Radiology~ University of Mainz, D-6500 Mainz, FRG.

Extracorporeal shock-wave hthotripsy (ESL) with adjuvant oral litholysis offers a new the- rapeutic approach to the treatment of gallbladder stones (NEJM 1988,318:393). ESL-technology and adjuvant oral litholysis require careful selection of patients. The aim of our study was, therefore, to elucidate how many patients with symptomatic cholecystolithiasis are suitable for ESL. Methods: 125 p a t i e n t s (31 men, 94 women; age 17-76 years) were p rospec t i ve l y inc luded. The se- l e c t i o n c r i t e r i a comprised were a h i s t o r y of b i l i a r y pain, l i m i t a t i o n of the number o f r a d i o - l ucen t ga l l s tones ( s o l i t a r y c a l c u l i ~ 3 cm, or ~ 3 stones W 1 cm), c o n t r a c t i l e g a l l b l a d d e r , and normal anatomy of the biliary tree. Patients were submitted to a diagnostic schedule con- sistlng of history, sonography of the gallbladder before and after a standardised meal (con- tractility), plain abdominal X-ray and ERCP. Computed tomography served to differentiate be- tween cholesterol and pigment stones. Results: Only 12 out of 125 patients fulfilled the selection criteria. The remaining 113 pa- tients were excluded from ESL by history (18), number and/or size of the stones (42), insuf- ficient contractility of the gallbladder (21), calcification of stones (24), bilirubinate as main stone component (4) or abnormal anatomy of the bile ducts (4). Discussion: To date, only 10% of patients with symptomatic gallbladder stones are suitable for extracorporeal shock-wave lithotripsy. Since most of the selection criteria could be eva- luated by noninvasive and inexpensive investigations careful selection of the patients should be performed in order to improve the success rate of therapy.

138 INTRACELLULAR TRANSPORT OF BILE SALTS. INFLUENCE OF MONENSIN ON BILE SECRETION IN ISOLATED PERFUSED RAT LIVER.

M.O. Reynier, I. Ab°u-Hashieh'TB~2 8 RichardM' C. Crotte, J.P. Cano M and A. G~rolami. INSERM U.260 and U. - Faeult~ de M~decine, Marseille, France.

The role of the Golgi apparatus in the biliary function of hepatocytes is not well establis- hed. Polymeric IgA and horseradish peroxidase (HRP) seem to be secreted in bile without inter- action with Golgi saccules. Contradictory results have been obtained in bile salt transport studles. The present work was designed to study the influence on the biliary secretion of taurocholate and HRP of monensin, an ionophore which inhibits some vesicular transport path- ways and particularly transport within the Golgi complex.

The study was made on isolated perfused rat liver. Biliary secretion of bile salts and HRP was measured under perfuslon of taurocholate (lO0 ~M) and HRP (lO mg/lO0 g rat body weight) in control conditions (Krebs-Henseleit pH = 7.4, 30 ml/min) and after addition of monensin (0.8 pM and 5.0 pM) in the perfusate. An ultramicroscopic examinatlon of the liver was done at the end of the perfusion (90 minutes).

The results were l) Morphologically, the cisternae of the GOlgi complex were markedly swollen upon monensin perfusion at 0.8 ~M as well as at 5 ~M. 2) the biliary appearance of HRP was delayed with 0.8 pM monensin (the peak of secretion is 30 min after perfusion instead of 20 min in controls 2 p~O.05) and almost suppressed with monensin 5 pM. 3) Biliary secre- tion of taurocholate (1960 + 35 nmoles/min) which was near the Tm for taurocholate in our conditions, was not modified even with monensin 5 wM.

In conclusion, this work suggests that the intracellular pathway of taurocholate does not involve a transport across the Golgi apparatus and is independent on the transport mechanisms of biliary proteins.

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