Document:

AMENDMENT TO FIRST AMENDED AND
                    RESTATED AGREEMENT OF LIMITED PARTNERSHIP

                                       OF

                         OHIO MOBILE LITHOTRIPTER, LTD.

     THIS  AMENDMENT,  effective  January 1, 2000,  is entered into by and among
Ohio Litho,  Inc., a Delaware  corporation,  the General  Partner of Ohio Mobile
Lithotripter,  Ltd., a Texas limited  partnership (the  "Partnership"),  and the
Limited Partners of the Partnership.

                                    RECITALS:
                                    --------

                  A. The General Partner and the Limited  Partners,  hereinafter
collectively  referred to as the  "Partners,"  entered into that  certain  First
Amended and Restated  Agreement of Limited  Partnership dated August 1, 1991, as
heretofore  amended  (the  "Agreement").  Capitalized  terms used herein and not
otherwise defined shall have the meanings given them in the Agreement.

     B. The Partners desire to amend the Agreement to substitute the Partnership
as the  holder  of the  right of first  refusal  under  of  Section  9.03 of the
Agreement.

                  NOW, THEREFORE, the Partners agree as follows:

     1. Section 9.03 of the Agreement is hereby amended by deleting  subsections
(b) and (c) thereof in their entirety and by substituting the language set forth
below:

                  (b) Upon receipt of such notice,  the  Partnership  shall have
         the right and option, exercisable at any time during a period of thirty
         (30) days from the date of the  Selling  Partner's  notice of the Offer
         (the "Option  Period"),  to purchase all or any portion of the Purchase
         Interest.  If the Partnership  elects to exercise its option,  it shall
         give  written  notice to the Selling  Partner and the sale and purchase
         shall be closed  within  thirty  (30) days  after the end of the Option
         Period.  Any purchase  made under this  paragraph  shall be on the same
         terms and conditions as contained in the Offer.

                  (c) If the  Partnership  does not elect to purchase all of the
         Purchase  Interest,  the Selling  Partner shall be free for a period of
         sixty (60) days after the expiration of the foregoing notice periods to
         sell the Purchase Interest to the purchaser named in the Offer upon the
         terms and conditions contained in the Offer, subject to the requirement
         of consent by the General Partner  pursuant to Section 9.02;  provided,
         that the said  purchaser  qualifies  as a Qualified  Purchaser.  In the
         event that the sale is not consummated within such sixty

<PAGE>

         (60)-day period, no sale shall be made without again complying with the
         provisions of this Section 9.03.

                  IN WITNESS WHEREOF, the Partners have hereunto set their hands
and seals effective as of the date first written above.

                                    OHIO LITHO, INC., as General Partner and as
                                      Attorney-In-Fact for the Limited Partners

                                     By:_________________________________ (SEAL)

                                        ---------------------------------
                                              (Type Name and Title)

<PAGE>

                         AMENDMENT TO FIRST AMENDED AND
                    RESTATED AGREEMENT OF LIMITED PARTNERSHIP

                                       OF

                         OHIO MOBILE LITHOTRIPTER, LTD.

THIS  AMENDMENT,  effective  January 1, 2000,  is entered into by and among Ohio
Litho,  Inc.,  a  Delaware  corporation,  the  General  Partner  of Ohio  Mobile
Lithotripter,  Ltd., a Texas limited  partnership (the  "Partnership"),  and the
Limited Partners of the Partnership.

                                                     RECITALS:
                                                     --------

                  A. The General Partner and the Limited  Partners,  hereinafter
collectively  referred to as the  "Partners,"  entered into that  certain  First
Amended and Restated  Agreement of Limited  Partnership dated August 1, 1991, as
heretofore  amended  (the  "Agreement").  Capitalized  terms used herein and not
otherwise defined shall have the meanings given them in the Agreement.

     B. The  Partners  desire to amend the  Agreement  to delete in its entirety
Section 10.02(g) of the Agreement.

                  NOW, THEREFORE, the Partners agree as follows:

     1. Section 10.02(g) of the Agreement is hereby deleted in its entirety with
the effect that such provision shall be void and of no effect.

                  IN WITNESS WHEREOF, the Partners have hereunto set their hands
and seals effective as of the date first written above.

                                     OHIO LITHO, INC., as General Partner and as
                                      Attorney-In-Fact for the Limited Partners

                                     By:_________________________________ (SEAL)

                                        ---------------------------------
                                                 (Type Name and Title)

<PAGE>
                         AMENDMENT TO FIRST AMENDED AND
                    RESTATED AGREEMENT OF LIMITED PARTNERSHIP

                                       OF

                         OHIO MOBILE LITHOTRIPTER, LTD.

     THIS  AMENDMENT,  effective  February 1, 2000, is entered into by and among
Ohio Litho,  Inc., a Delaware  corporation,  the General  Partner of Ohio Mobile
Lithotripter,  Ltd., a Texas limited  partnership (the  "Partnership"),  and the
Limited Partners of the Partnership.
                                                     RECITALS:
                                                     --------

                  A. The General Partner and the Limited  Partners,  hereinafter
collectively  referred to as the  "Partners,"  entered into that  certain  First
Amended and Restated  Agreement of Limited  Partnership dated August 1, 1991, as
heretofore  amended  (the  "Agreement").  Capitalized  terms used herein and not
otherwise defined shall have the meanings given them in the Agreement.

                  B. The  Partners  desire  to amend the  Agreement  to effect a
redesignation of the Partnership's geographic service area as defined in Section
16.16(a)  effective  on the date  appropriate  consents  are  received  from the
General Partner and Two Thirds in Interest of the Limited Partners.

                  NOW, THEREFORE, the Partners agree as follows:

     1.  Section  16.16(a) of the  Agreement  is hereby  amended by deleting the
following language from the last sentence thereof:

                    "(excluding any territory located in Cuyahoga County, Ohio)"

                  IN WITNESS WHEREOF, the Partners have hereunto set their hands
and seals effective as of the date first written above.

                                    OHIO LITHO, INC., as General Partner and as
                                      Attorney-In-Fact for the Limited Partners

                                   By:_________________________________ (SEAL)

                                      ---------------------------------
                                            (Type Name and Title)

<PAGE>SECOND AMENDMENT TO
                       AGREEMENT OF LIMITED PARTNERSHIP OF
                       PACIFIC MEDICAL LIMITED PARTNERSHIP

                  THIS AMENDMENT,  effective as of the 1st day of January, 1999,
is entered into by and among  Lithotripters,  Inc., a North Carolina corporation
and the General Partner of Pacific Medical Limited Partnership, a Hawaii limited
partnership (the "Partnership"), and the Limited Partners of the Partnership.

                                    RECITALS:
                                    --------

                  1. The General Partner and the Limited  Partners,  hereinafter
collectively  referred to as the "Partners," entered into that certain Agreement
of Limited  Partnership of Pacific  Medical Limited  Partnership  dated April 1,
1996,  as  amended by that  certain  First  Amendment  to  Agreement  of Limited
Partnership of the Partnership, effective as of August 1, 1998.

          2.  The  Partners  desire  to  amend  the  Agreement  to  reflect  the
     assignment by  Lithotripters,  Inc. (the  "Assignor") of a two percent (2%)
     limited  partnership  interest in the  Partnership  to Charles D. Kim, Jr.,
     M.D. and a two percent (2%) limited partnership interest in the Partnership
     to Richard I. Tsou, M.D.

                  NOW,  THEREFORE,  in  consideration  of the  mutual  promises,
covenants,  conditions and agreements herein contained, the parties hereto agree
as follows:

                           Schedule  A-1 is  deleted  in its  entirety  and  new
                  Schedule A-2, attached hereto, is substituted in its place.

                  IN WITNESS WHEREOF, the Partners have hereunto set their hands
and seals effective as of the date first-above written.

                                                     GENERAL PARTNER:

                                                     Lithotripters, Inc.

                                         By:/s/ Joseph Jenkins, M.D.
                                         ---------------------------
                                                     Joseph Jenkins, M.D.
                                                     President

                                              ALL THE LIMITED PARTNERS OF THE
                                              PARTNERSHIP WHOSE NAMES APPEAR ON
                                              SCHEDULE A-2

                                         By:/s/ Joseph Jenkins, M.D.      (SEAL)
                                         ---------------------------
                                                 Joseph Jenkins, M.D.,
                                                 Attorney-in-Fact*

*  Pursuant  to a  Power  of  Attorney  given  by the  Limited  Partners  in the
Agreement.

                                                       1-

<PAGE>

                                                                    SCHEDULE A-2

                        Schedule of Partnership Interests

                       PACIFIC MEDICAL LIMITED PARTNERSHIP

           CONTRIBUTIONS OF CAPITAL TO THE PARTNERSHIP AND GUARANTIES

                            Cash                                    Percentage

General Partner          Contribution           Guaranty(1)           Interest

Lithotripters, Inc.      $47,688                   $330,402.80               20%

Limited Partners

Lithotripters, Inc.      $47,250                   $181,721.54               11%

Antonio Tan              $10,000                    $66,080.56                4%

Robert Carlile           $10,000                    $66,080.56                4%

Herbert Chinn            $10,000                    $66,080.56                4%

Rick Davis               $10,000                    $66,080.56                4%

Terry Yee                 $5,000                    $33,040.28                2%

William Flanagan          $2,250                    $16,520.14                1%

Keith Mooney              $2,500                    $16,520.14                1%

Franklin Clark            $2,250                    $16,520.14                1%

Thomas Jordan             $2,250                    $16,520.14                1%

William Jordan            $2,250                    $16,520.14                1%

Philip Gallina            $2,250                    $16,520.14                1%

William Grine             $2,250                    $16,520.14                1%

Jack Cassell              $2,500                    $16,520.14                1%

Marilyn Hata             $10,000                    $66,080.56                4%

Charles D. Kim, Jr.        N/A(2)              $33,040.28(3)                  2%

David Kychenbecker        $10,000                   $66,080.56                4%

<PAGE>

                            Cash                                      Percentage

General Partner          Contribution                Guaranty(1)       Interest

Douglas Gary Lattimer    $10,000                    $66,080.56                4%

William Yarborough       $10,000                    $66,080.56                4%

Dan Myers                 $2,250                    $16,520.14                1%

Jim Brady                 $2,250                    $16,520.14                1%

Tom Mobley                $2,250                    $16,520.14                1%

Timothy Quillen           $2,250                    $16,520.14                1%

James Monroe              $2,250                    $16,520.14                1%

J. Ronald Smith           $2,250                    $16,520.14                1%

David M. Coussens         $2,500                    $16,520.14                1%

Denis E. Healey           $2,500                    $16,520.14                1%

Lewis F. Russell          $2,500                    $16,520.14                1%

Alan Terry                $2,250                    $16,520.14                1%

Anthony Rand              $2,250                    $16,520.14                1%

Joseph Jenkins            $2,250                    $16,520.14                1%

Rene Sepulveda            $2,500                    $16,520.14                1%

Robert McAlpine           $2,250                    $16,520.14                1%

Lance Templeton           $2,500                    $16,520.14                1%

Lelan C. Byrd             $2,500                    $16,520.14                1%

Donald A. Stewart         $2,500                    $16,520.14                1%

Larry Raithaus             N/A(2)              $33,040.28(3)                  2%

Richard I. Tsou            N/A(2)              $33,040.28(3)                  2%

William Yarborough, M.D.,
    Inc.                   N/A(2)              $66,080.56(3)                  4%

         TOTAL:         $238,438                 $1,652,014.00              100%
                        ========                 =============              ====

<PAGE>

(1)      Represents the estimated  principal portion of each Partner's  guaranty
         obligation,  as each Partner's  obligation under the Guaranty  includes
         not only principal,  but also (as provided in the Guaranty) accrued and
         unpaid interest,  late payment  penalties and all costs incurred by the
         Bank in collecting any defaulted obligations.

(2) Larry Raithaus,  M.D.,  Charles D. Kim, Jr., M.D., Richard I. Tsou, M.D. and
William Yarborough,  M.D., Inc. received their limited partnership  interests by
an  assignment   from   Lithotripters,   Inc.  and  therefore  made  no  capital
contributions to the Partnership.

(3)  Pursuant to the terms of the  assignments  by  Lithotripters,  Inc.,  Larry
Raithaus,  M.D.,  Charles D. Kim, Jr., M.D.,  Richard I. Tsou,  M.D. and William
Yarborough,  M.D.,  Inc.  assumed their pro rata portion of the initial  limited
partner guaranty of Lithotripters, Inc.
<PAGE>

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