Renal phlebography in diagnosis of poorly vascularized renal malignancies.

Eight cases are presented to demonstrate the value and limitations of renal phlebography in the diagnosis of poorly vascularized renal malignancies. Because of the easier compressibility of the thinner venous channels, malignant tumors may cause more pronounced phlebographic changes than seen in corresponding arteriographic studies. Changes include venous compression and amputation, tumor thrombus, and venous neovascularity. It is believed that the supplementary use of renal phlebography at the same time arteriography is being accomplished may increase the chances of preoperatively diagnosing such hypovascular renal malignancies as papillary-tubular adenocarcinomas, metastatic and necrotic malignancies, and invasive transitional cell carcinomas.

Multiple extra-adrenal and thoracic pheochromocytomas.

On the basis of a case of multiple, extra-adrenal intrathoracic pheochromocytomas (total of 6 tumors), the value of dynamic computerized tomography investigations, venous sampling, scintigrams with 131I-meta iodobenzylguanide, and selective arteriography is discussed.

Computed tomographic and angiographic findings in renal oncocytoma.

Nine cases with histologically proven renal oncocytoma are presented. In all cases, ultrasonography gave the first indication of a tumour and intravenous urography was tumour-specific in only six, whilst angiography was so in only four of the cases with peripheral extension beyond the normal organ limits. Examination by computed tomography showed retrospectively, in the three cases with smaller oncocytomas up to 3 cm in diameter, findings that seemed promisingly characteristic: without contrast medium, the tumour appeared homogeneously hyperdense in comparison with normal renal parenchyma, but homogeneously hypodense after injection of contrast medium. One of the smaller oncocytomas, however, showed regions of heterogeneity both with and without contrast medium. Only one oncocytoma of 4 cm diameter presented the central stellate, low-attenuation "scar" described by Quinn et al. The angiographic criteria cited by Ambos were fulfilled in only three of the larger oncocytomas. In four of the cases, the tumour was enucleated and the organ left in situ on the basis of frozen section diagnosis. Those patients with tumours extending outside the organ or those of questionable diagnosis on frozen section were treated by nephrectomy. In one patient, the pathologist suspected metastasis from the thyroid; hemithyroidectomy confirmed on oncocytic adenoma of the left thyroid lobe.

[The demonstration and staging of bladder carcinoma. A comparative study between magnetic resonance tomography, computed tomography and radioimmunoscintigraphy]. / Nachweis und Stadieneinteilung des Harnblasenkarzinoms. Eine vergleichende Untersuchung zwischen Magnetresonanztomographie, Computertomographie und Radioimmunszintigraphie.

The purpose of the present study was to compare the effectiveness of MRI, CT and radioimmunoscintigraphy in the staging and detection of bladder cancers in 28 patients. We distinguish two groups: Group I included the tumour stages CIS-T3A and the second group the deep infiltrative tumours T3B-T4. MRI was slightly superior to CT in respect of tumour staging (75% correct results as compared to 63%). No understaging occurred with MRI, whereas in 22% of the cases the stage of the tumour was underestimated using CT diagnostics. Overstaging occurred in 25% of the MRI and 15% of the CT-diagnostics, respectively. RIS cannot distinguish the tumour groups, and hence this method is useful only for the detection of the primary tumour and metastases. In 77% of cases the tumour was detected and in 15% the tumour could be safely excluded.

[Computed tomographic studies of the scrotal contents, particularly the testis]. / Computertomographische Untersuchungen des Scrotalinhaltes, insbesondere des Hodens.

CT examination of the testes was carried out in 49 patients for the investigation of testicular tumours. Hypodensity and inhomogeneity were typical of teratomas and hyperdensity and relative homogeneity of seminomas. Granulomatous orchitis and lymphomas showed the same characteristics as seminomas. Three testes in the abdomen could be localised and classified. One non-palpable primary tumour was found as well as an old partially calcified tumour, three old torsions and one lipo-sarcoma. In about 10% it was not possible to distinguish between tumour and inflammatory lesions. Compared with sonography, CT has advantages, particularly in the diagnosis of old torsion.

[Computed tomography of acute bacterial nephritis]. / Computertomographie bei akuten bakteriellen Nierenentzündungen.

Five case reports are used to illustrate that it is possible by computed tomography to differentiate between acute diffuse, acute focal and abscess-forming types of renal infection. In acute diffuse renal inflammatory disease, intravenously injected contrast medium remains in various parts of the renal tissue after an interval of two to six hours following injection. Acute focal inflammatory disease and abscesses produce localised hypodense or isodense lesions. Sequential increase in density following a contrast bolus injection permits the distinction of focal nephritis from an abscess. These findings provides information concerning the type and duration of treatment.

[Observations on the formation of the secondary venous system of the abdominal cavity with special reference to idiopathic left-sided varicocele]. / Betrachtungen zur Ausbildung des sekundären Venensystems des Bauchraumes unter besonderer Berücksichtigung der idiopathischen linksseitigen Varikozele.

Based on 1,778 radiologic investigations of vena cava inferior, left renal vein and left spermatic vein the anomalies due to incorrect transformations from the first to the second abdominal venous system are presented. A persistent vena cardinalis posterior could be demonstrated in two cases. Varicoceles were seen with and without insufficient valves of the spermatic vein and venous outflow obstruction of the renal vein, respectively. Based on the demonstrated phlebographies disorders of ontogenesis seem to be the cause of the idiopathic left-sided varicoceles.

[Considerations regarding the differential diagnosis during the angiography of non-functioning kidneys (author's transl)]. / Differentialdiagnostische Gesichtspunkte bei der Angiographie stummer Nieren.

Utilizing selective renal arteriograms and phlebograms in 7 patients, the differential diagnostic difficulties in separating poorly vascularized tumors from inflammatory lesions are discussed. Retrograde studies either offered no help, or could technically not be accomplished; arteriography proved equivocal in most cases. However, renal phlebography was found to be quite helpful, in that a non-visualized or reduced opacification of the intrarenal venous system, along with irregular extrinsic venous impressions, spoke more for a malignant tumor. When the contrast was able to fill the veins out to the periphery, a tumor could with great certainty be ruled out. Severe inflammatory conditions, while demonstrating a generalized reduction in the opacification of the venous system, did not show the bizarre venous wall irregularities seen with tumors. Retroperitoneal fibrosis and its special diagnostic difficulties are discussed.

[Magnetic resonance tomography in the differential diagnosis of pathologic changes in scrotal contents--a comparison with computed tomography]. / Kernspintomographie (KST) in der Differentialdiagnose pathologischer Veränderungen des Skrotalinhaltes--ein Vergleich mit der Computertomographie (CT).

48 patients with scrotal pathology were examined by magnetic resonance tomography (MRI) and computed tomography (CT). The diagnostic results were compared to surgical and histological findings. The correct diagnosis could be detected in 81% by CT and in 85% by MR. Another 27 patients were examined only by MR with positive results in 88%. Demonstration of tunica albuginea, imaging of testes in various planes and diagnostic accuracy in about 88% with missing ionising irradiation make MRI the most reliable diagnostic imaging in the classification of scrotal pathology. False negative results were found in 1/48 by CT and none by MRI. False positive results could be found in 2/75 of MRI examinations but none in CT.

[Computer tomography in the investigation of renal trauma (author's transl)]. / Computertomographische Untersuchungen bei Nierenverletzungen.

Two patients with blunt renal injuries (Hodges grade I and II), and two further patients with spontaneous renal and/or retroperitoneal hemorrhage, were studied with excretory urography, isotope scanning, ultrasound, angiography, and computerized tomography. The most important additional information provided by the CT scan was the disclosure of small parenchymal lacerations, as well as the presence and extent of perirenal hematomas. These abnormalities could also be monitored with CT studies during the healing phases. Renal excursion studies during breathing and the usual tomography seem to be no longer necessary in renal trauma cases if one plans to utilize CT scanning. Likewise, the necessity for angiographic studies decreases. Ultrasound, however, may still be helpful in certain cases of perirenal hematoma.

[Varicocele in childhood. Treatment indications and value of sclerotherapy]. / Die Varikozele im Kindesalter. Behandlungsindikation und Stellenwert der Sklerotherapie.

Varicocele is the most common surgically correctable cause of male subfertility. The incidence of varicocele is about the same in adolescents as in men (16.3%). Percutaneous transfemoral sclerotherapy has been performed in 42 of the authors' own cases; it is an alternative to surgical ligation of the varicocele and should be recommended whenever a varicocele is found, to prevent gonadotoxic damage.

[Idiopathic left-sided varicocele. An ontogenetic abnormality?]. / Die idiopathische linksseitige Varikozele. Eine ontogenetische Fehlentwicklung?

Phlebograms for sclerotherapy of varicoceles were performed in 659 patients. In 484 cases no valves of the left spermatic vein could be demonstrated. However, 172 patients showed sufficient valves or absent insertions of the spermatic veins at typical point with retrograde flow through collaterals (persistent intercardinal anastomoses). The value of nutcracker phenomena I and II is discussed. Ontogenetic disorders in the development of the secondary abdominal venous system are responsible for the occurrence of the idiopathic left-sided varicocele.

[Value of nuclear medicine and ultrasonography in the management of renal trauma (author's transl)]. / Kombinierte nichtinvasive Diagnostik beim Nierentrauma. Erfahrungen mit dem Einsatz von Nuklearmedizin und Sonographie.

Intravenous urography remains the most decisive investigative method in the management of blunt renal trauma. Even minor urographical changes would merit scintiscan and ultrasound examination in order to visualize or rule out parenchymal lesions, intra- or extrarenal hematomas and urine extravasation as well as assess respirational excursions of the kidney. Follow-up studies may be performed without hesitation. Major lesions (primarily a urinoma) and alarming clinical findings necessitate further diagnostic procedures (angiography, possibly after computer tomography). In case of a surgical intervention, angiography cannot be replaced by any other diagnostic method to date. There are no comparative studies of patients with similar injuries managed alternatively with immediate operation or a conservative approach. However, based on our diagnostic possibilities and therapeutical results, we are in favor of a more expectant management of major renal trauma.

[Super-selective embolization of a kidney angioma]. / Superselektive Embolisation eines Nierenangioms.

Superselective embolization of a centrally situated renal arteriovenous angioma in a 68-year-old woman is reported. The cardinal symptom was a recurrent painless gross hematuria, which disappeared after treatment. The embolization technique and the results of a 7-month follow-up examination are described.

[Renal oncocytoma. Diagnosis and its therapeutic consequences]. / Renale Onkozytome. Diagnostik und deren therapeutische Konsequenzen.

The angiographic findings (hypovascularity, spokewheel phenomenon, lucent rim, linear course of vessels) and CT features (central scar, hyperdense without contrast medium) of 20 patients with renal oncocytomas were analyzed. Simultaneously seven patients with renal cell carcinoma preoperatively misdiagnosed as oncocytoma were compared and critically discussed. Preoperatively, reliable differentiation of renal oncocytoma and renal carcinoma is not possible. Nevertheless, in the presence of features typical for oncocytoma the operative strategy should be "kidney-preserving surgery".

[Spontaneous fistulae and abscesses of the upper urinary tract (author's transl)]. / Spontane Hautfisteln und Abszesse im Bereich der oberen ableitenden Harnewege.

Spontaneous cutaneous fistulae and abscesses of the renal pelvis and ureter have become rare. Six case reports demonstrate their etiology and differential diagnostic problems. If there is no underlying urologic disease, above all no urolithiasis, other causes of fistulae and abscesses should be kept in mind, the most frequent of these being Crohn's disease.

[Nuclear magnetic resonance tomography for improving the differential diagnosis of pathologic changes in the scrotal contents]. / Kernspintomographie (KST) zur Verbesserung der Differentialdiagnose pathologischer Veränderungen des Skrotalinhalts.

A total of 75 patients with scrotal pathology were examined using magnetic resonance imaging (MRI). The diagnostic results were compared with operative and histological findings and with the sonographic results available. Compared with sonography, MRI showed diagnostic advantages in the detection and characterization of malignant tumors and in the exclusion of non-tumorous testicular pathology (old torsions, periorchitis, old hematomas). No false-negative results were found by MRI. False-positive results were found in 2 out of 75 MRI examinations. The possibility of showing tunica albuginea, of imaging testes in various planes and its diagnostic accuracy of about 88% as well as the lack of ionizing irradiation make MRI the most reliable form of diagnostic imaging in the classification of scrotal pathology. Sonography (51/75) showed high sensitivity in detecting testicular disease (90%), but its specificity (55%) was disappointing and could not be quantified with regards to the differentiation of testicular cancer.

[Carcinoma of the kidney with production of renin. A special form of hypertension]. / Les carcinomes du rein avec production de rénine. Une forme spéciale de l'hypertension.

A correlation between the tumour and hypertension was investigated in 129 patients with renal cancer. Forty-one patients (31.8%) suffered from hypertension. Primary increased renin secretion was detected in 6 of these patients (14.6%). The renin activity quotient measured in the renal veins between the renal tumour and the contralateral kidney was between 4 and 7. Secondary hyperaldosteronism was detected in only 2 of the patients with a significantly different renin activity in the renal veins. The renin level detected in the tumour itself of these 6 patients was significantly higher than the level detected in the parenchyma of the same kidney. Renin was demonstrated immunohistochemically in the tumours of these patients. The blood pressure returned to normal after nephrectomy in 5 patients and a marked fall in blood pressure was observed in the 6th patient. Cell cultures of 3 tumours revealed autonomous renin production. Renin-secreting renal carcinomas represent a rare form of renal hypertension, which is why the possibility of renal cancer should also be considered when investigating a case of hypertension.