Is the 10th and 11th intercostal space a safe approach for percutaneous nephrostomy and nephrolithotomy?

The aim of this study was to determine the rate of complications in percutaneous nephrostomy (PCN) and nephrolithotomy (PCNL) performed through the 11th and 10th intercostal spaces using our monitoring technique and to discuss the safety of the procedure. Out of 398 PCNs and PCNLs carried out during a 3-year period, 56 patients had 57 such procedures performed using an intercostal approach. The 11th intercostal route was used in 42 and the 10th in 15 cases. One patient had two separate nephrostomies performed through the 10th and 11th intercostal spaces. The technique utilizes bi-planar fluoroscopy with a combination of a conventional angiographic machine to provide anterior-posterior fluoroscopy and a C-arm mobile fluoroscopy machine to give a lateral view, displayed on two separate monitors. None of the patients had clinically significant thoracic or abdominal complications. Two patients had minor chest complications. Only one developed changes (plate atelectasis, elevation of the hemi-diaphragm) directly related to the nephrostomy (2%). The second patient had bilateral plate atelectasis and unilateral congestive lung changes after PCNL. These changes were not necessarily related to the procedure but rather to general anesthesia during nephrolithotomy. The authors consider PCN or PCNL through the intercostal approach a safe procedure with a negligible complication rate, provided that it is performed under bi-planar fluoroscopy, which allows determination of the skin entry point just below the level of pleural reflection and provides three-dimensional monitoring of advancement of the puncturing needle toward the target entry point.

Intratesticular varicocele: evaluation using conventional and Doppler sonography.

OBJECTIVE: The aim of this study was to describe the conventional and Doppler sonographic appearances of intratesticular varicoceles and to determine their occurrence. SUBJECTS AND METHODS: One thousand forty men with various testicular problems were examined using conventional and Doppler sonography, and the incidence of intratesticular varicocele and other conditions was recorded. Eighteen patients with intratesticular varicoceles were further examined, allowing us to study the various sonographic and Doppler parameters of this rare entity. RESULTS: Intratesticular varicocele was identified in 18 (1.7%) patients. The condition was bilateral in seven patients and unilateral in 11. Of 25 testes involved, 12 (48%) were right-sided and 14 (56%) were isolated without any ipsilateral extratesticular varicocele. The shape of the intratesticular varicocele was tubular in 21 cases and oval in five; one patient had both oval and tubular varicoceles. Diameters ranged from 2 to 8 mm (mean, 3.1 mm). Mean venous flow velocity was 2.8 cm/sec and had an inverse relationship to the diameter of the intratesticular varicocele. CONCLUSION: Intratesticular varicocele is seen in fewer than 2% of the symptomatic population. The condition has a characteristic sonographic appearance of dilated tubular intratesticular veins with a proximity to the mediastinum testis. Variations from previously published reports included presentation with an oval shape, more frequent bilateral occurrence, greater number of isolated right-sided intratesticular varicoceles, and fewer associations with an extratesticular varicocele.

Abdominal tuberculosis in Qatar: a clinico-radiological study.

SETTING: Hamad General Hospital, the tertiary health centre for Doha, Qatar. OBJECTIVE: The purpose of the study was to define and correlate the role of radiology with clinical and pathological findings in abdominal tuberculosis. MATERIAL AND METHODS: A total of 59 patients (47 males and 12 females) diagnosed bacteriologically and/ or histologically for abdominal tuberculosis were radiologically assessed. Evaluation was based on the analysis of plain abdominal radiographs, gastro-intestinal contrast studies (barium meal follow through and barium enema), ultrasonography and computed tomography. RESULTS: Plain abdominal radiographs performed in 38 patients were positive in 19 cases (50%). Gastrointestinal contrast examinations were positive in 27 out of 34 cases (80%). Ultrasound examinations were abnormal in 25 out of 31 cases (81%), while computed tomography, performed in 24 patients, revealed abnormal findings in 19 cases (80%). Combined radiographic and imaging procedures revealed peritoneal involvement (ascites) in 16 patients (27%), bowel involvement in 36 (61%), mass lesion in 11 (19%), lymphadenopathy in 13 (22%) and organ involvement in 13 (22%). CONCLUSION: There was no single radiological method that provided all necessary information suggestive of abdominal tuberculosis. Although unequivocal diagnosis of abdominal tuberculosis can only be made by culture and histological findings, combined computed tomography and ultrasound findings were the most important imaging tools in the diagnostic process for abdominal tuberculosis, while contrast studies helped to assess the extent of bowel disease, hence influencing decisions concerning surgery.

Renal papillary necrosis in Kuwait.

In 2,158 consecutive routine urograms, 85 patients (51 males and 34 females) were found to have typical changes of renal papillary necrosis, an incidence of 3.9% (2.8% in males, 9.4% in females). The changes were bilateral in 60 patients (71.6%) and unilateral in 25 (29.4%). 3 patients were diabetics, 4 had sickle cell anaemia and 7 had obstructive uropathy. 19 patients admitted to analgesic abuse. The remaining 52 patients were idiopathic but a combination of analgesic abuse and dehydration may have been the cause in this group. The possible reasons for the high incidence of RPN especially in females in this hot desert environment are discussed. The literature on the subject is briefly reviewed.

Powdered diatrizoic acid for radiography of the respiratory tract. Part II. Clinical application.

The diagnostic and clinical value of 41 examinations using insufflation and/or inhalation of powdered diatrizoic acid for tracheobronchography, tracheography, laryngography, nasopharyngography, and sinusography was investigated in 35 patients. Diatrizoic acid was found to be useful when applied by insufflation for demonstration of the nasopharynx, trachea and greater bronchi, especially in patients with airway stenosis and low pulmonary reserve. Double contrast images were obtained with good demonstration of anatomic details and adequate diagnostic value. Visualization of the peripheral bronchi by insufflation was satisfactory only when excessive secretions were not present. The inhalation method was adequate only for visualization of the trachea and main bronchi. The method was found to be safe since diatrizoic acid produced no toxic, allergic or febrile reactions and was given in relatively small amounts without impairment of respiratory function.

Powdered diatrizoic acid for radiography of the respiratory tract. Part I. Experimental investigation.

Powdered diatrizoic acid as a contrast medium administered by inhalation and insufflation for visualization of the airways was tested in vitro and in 21 dogs. Good radiopacity of the contrast medium and its antibacterial activity was found in vitro. In the majority of animal experiments visualization of the bronchial tree down to segmental and partially to subsegmental bronchi with only minimal agglomeration of contrast medium and with good or very good demonstration of anatomic details was achieved. In the majority of dogs contrast medium was eliminated from the lungs within 18 hours. Arterial blood gases tested on 5 dogs showed only unimportant changes after contrast medium administration. No adverse reactions were observed. Histologic and ultrastructural examinations after contrast studies showed phagocytic reaction to diatrizoic acid, transient impairment of production of surfactant, reactive changes of bronchial mucosa, and no fibrotic changes in the long-term observation.

Life-threatening post-nephrolithotomy hemorrhage resulting in cessation of kidney function, treated by transcatheter arterial embolization with subsequent restoration of excretory function.

A massive post-nephrolithotomy renal hemorrhage was successfully controlled by selective arterial embolization using Gelfoam particles. Prior to embolization, the kidney showed no excretory function due to complete obstruction of its collecting system by blood clots. Long-term observation revealed restoration of excretory function of the treated kidney and only minimal loss of its parenchyma.

[Catheter embolization: parenchyma-preserving therapy of renal bleeding of nonmalignant etiology]. / Katheterembolisation: Die parenchymschonende Therapie der Nierenblutungen nicht-maligner Atiologie.

9 patients with life-threatening renal bleeding of non-malignant origin, including trauma, AV fistulas, pseudoaneurysms and polycystic kidneys, were embolised after angiographic demonstration of the leakage. In all cases, the bleeding was stopped and in one case only nephrectomy was necessary 3 days after the initial embolisation procedure. Transcatheter renal embolisation should be performed as selectively as possible. With this technique most of the renal parenchyma can be saved. Embolisation is a safe and inexpensive procedure which also can be performed in critically ill patients.