Document Detail

Fragmentation of uric acid calculi with the holmium: YAG laser produces cyanide.
MedLine Citation:
PMID:  12355566     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: To independently test previously reported findings of cyanide evolution under holmium:yttrium aluminum garnet (Ho:YAG) (holmium) lithotripsy of uric acid calculi, determine if this occurs with other forms of intracorporeal lithotripsy, and establish if this occurs due to a photothermal, photochemical, or photoacoustic reaction. STUDY DESIGN/MATERIALS AND METHODS: Human uric acid calculi were fragmented in vitro through exposure to holmium, ultrasound, and electrohydraulic (EHL) energy sources. The following parameters were varied: total laser energy, individual laser pulse energy, ultrasonic energies, and EHL energies. Uric acid powder was suspended in solution and exposed to holmium laser energy in vitro. Serum and irrigant samples from a human patient were collected following intrarenal holmium lithotripsy of a uric acid calculus. All samples were analyzed for hydrogen cyanide (HCN) content. RESULTS: Holmium lithotripsy of solid uric acid calculi produces cyanide. The yield is linearly dependent upon total laser energy delivered. Pulse energy does not affect cyanide yield. Photothermal mechanisms coupling laser energy to the solid crystal lattice are responsible for the production of cyanide. Ultrasound and EHL lithotripsy do not produce cyanide. A clinically insignificant level of cyanide was detected in the blood of a single patient following laser lithotripsy of a uric acid calculus. CONCLUSIONS: Our study confirms that cyanide is produced by a photothermal mechanism during holmium laser lithotripsy of uric acid calculi, and that the amount produced is clinically insignificant.
Robin L Zagone; Todd M Waldmann; Michael J Conlin
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Publication Detail:
Type:  In Vitro; Journal Article    
Journal Detail:
Title:  Lasers in surgery and medicine     Volume:  31     ISSN:  0196-8092     ISO Abbreviation:  Lasers Surg Med     Publication Date:  2002  
Date Detail:
Created Date:  2002-09-30     Completed Date:  2003-01-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8007168     Medline TA:  Lasers Surg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  230-2     Citation Subset:  IM    
Copyright Information:
Copyright 2002 Wiley-Liss, Inc.
Division of Urology and Renal Transplantation, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA.
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MeSH Terms
Holmium / chemistry*,  radiation effects
Hot Temperature
Hydrogen Cyanide / analysis,  chemical synthesis*
Lithotripsy, Laser*
Uric Acid / chemistry*,  radiation effects
Urinary Calculi / therapy*
Yttrium / chemistry*,  radiation effects
Reg. No./Substance:
69-93-2/Uric Acid; 74-90-8/Hydrogen Cyanide; 7440-60-0/Holmium; 7440-65-5/Yttrium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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