Transluminal dilatation and stent placement in obstructed ureters in dogs through the use of percutaneous nephropyelostomy.

Through an artificially created ureteral obstruction in the dog, a ureteral stent was placed with the aid of a percutaneous nephrostomy tube. The stent was removed after two weeks. This resulted in permanent relief of the obstruction in the treated animals. In contrast to this, the control animals remained completely obstructed with resultant hydronephrosis and loss of kidney. It is proposed that this method can be used in humans where nephropyelostomy had been placed and where surgical correction of the obstructed ureter is not feasible.

Iothalamate ethyl ester as hepatolienographic agent.

In search of a hepatolienographic agent, the iothalamate ethyl ester particulate suspension was prepared with the average particle size of 1.5 mu in diameter. When mixed with plasma of different animal species, the physical properties of the particular suspension changed significantly. The nature of this difference is not understood but is probably related to protein-particle interaction in the different species. Doses of 550 mg iodine per kg body weight as a single intravenous infusion of the particulate suspension resulted in satisfactory opacification of liver and spleen in rats, followed by complete loss of radiopacity within three days. Larger doses resulted in the death of the rats within 12-14 hours. In general, the mice tolerated larger doses than rats, but there was very poor opacification of the liver, despite good opacification of spleen. Further work is being carried out to improve the suspension and to better understand the difference in behavior of the particulate suspension in different animal species.

Angiographic demonstration and transcatheter embolic control of post-traumatic intercostal arterial hemorrhage.

A new method for arresting uncontrollable intercostal hemorrhage is presented. It consists of selective transcatheter embolization of the bleeding artery, either by pieces of gel foam or autologous blood clots. In the patient presented in this paper, the hemorrhage was identified and successfully controlled by embolizing the bleeding artery. Thoracotomy was unnecessary, and there were no complications related to the procedure.

Effect of abdominal perineal resection on genitourinary tract.

One hundred ten patients at the UCLA Medical Center underwent abdominal resection from 1974 to 1980. The following effects on the urinary tract are discussed: surgical complications, anatomic changes, and functional complications. Urologic investigation and management of incontinence will be presented.

Control of renal arterial bleeding after percutaneous biopsy.

Transcatheter arterial embolization is becoming an accepted method of controlling massive acute hemorrhage, including that secondary to blunt and penetrating renal trauma. Two patients with retroperitoneal bleeding postrenal biopsy and angiographically proved pseudoaneurysms at the biopsy sites had successful embolization without sequelae. Experimental and clinical experience with transcatheter embolization is reviewed. It appears that this modality is a safe, effective way of controlling renal hemorrhage.

Fluoroscopy-guided percutaneous transperitoneal fine needle biopsy of renal masses.

Percutaneous transperitoneal fine needle biopsy is a harmless, easy to perform, and most direct procedure used to diagnose uncertain causes of ureteral obstruction and displacement of various parts of the urinary tract system. Frequently it is the least invasive method that can decide further treatment.

Anterior transperitoneal approach for removal of renal stones.

An anterior transperitoneal approach was used for removal of stones from 15 kidneys in 13 patients. Exposure of the anterior portion of the pelvis was readily accomplished making excellent exposure of the interior of the kidney possible. Minimal urinary drainage was noted postoperatively. The operative procedures done with the patients in the supine position were well tolerated.

Diagnostic effects of edge sharpening filtration and magnification on digitally subtracted renal images.

The improved appearance of digital radiographs filtered to improve local contrast and sharpen edges has not increased acceptance of these images by radiologists. Furthermore, many radiologists assert that correct diagnosis is not improved with these filtered images. This study was designed to test this assertion for digital subtraction angiograms (DSA) of renal images. Four experiments are described. First, phantom studies identified filters and their parameters thought likely to be acceptable and useful in diagnosing renal images formed by DSA. Second, these filters and parameters were then tested on medical images to assess their acceptance by radiologists. Third, display modes of windowing, positive/negative presentation, and magnification were varied for filtered and unfiltered images to assess preferences of radiologists. Fourth, filtered and unfiltered magnified images were used to test improved diagnosis. In the final experiment, 148 images from 33 renal studies (15 normal, 18 abnormal) were magnified, gray level windowed, and filtered. Diagnosis was not improved by the two edge sharpening filters tested.

An evaluation of a fluorescent screen-isocon camera system for x-ray imaging in radiology.

A large field format imaging system which utilizes a flat fluorescent screen rather than the traditional image intensifier as the primary x-ray detector is discussed in this paper. A low light level image isocon camera is optically coupled to a rare-earth screen. An overview of the isocon camera and its return beam mode of operation is included. Theoretical limitations to this approach to real time radiographic imaging are discussed in terms of system efficiency and signal-to-noise ratio (SNR) requirements. The viability of this concept for radiographic imaging is considered with respect to the image intensifier-camera unit. The merits of employing a CsI:Na screen as the primary detector and an isocon tube with an improved SNR are presented as potential areas for further investigation.

Magnetic resonance imaging of the perineum and pelvic floor.

The aim of this article is to review the magnetic resonance (MR) findings of pelvic floor descent and pelvic organ prolapse in women. In addition, a detailed grading system of pelvic organ prolapse and pelvic floor relaxation based on dynamic MR imaging is presented. The technique described here uses very fast MR sequences, is reproducible and easily learned by radiologists and technologists, is well accepted by patients, and provides as much information as traditional projectional X-ray imaging. Reference points are the pubococcygeal line and puborectalis muscle sling. The grading system is based on degree of organ prolapse through the hiatus and the degree of puborectalis descent and hiatal enlargement.

Improving the quality of care through routine teleradiology consultation.

RATIONALE AND OBJECTIVES: The hypotheses of this study were as follows: (a) University subspecialty radiologists can provide consultations effectively to general radiologists as part of routine clinical operations; (b) these consultations will improve the quality of the final radiologic report; and (c) the consultations will improve the care process and may save money, as well. MATERIALS AND METHODS: For 2,012 consecutive computed tomographic or magnetic resonance (MR) imaging studies, the initial interpretations provided by radiology generalists were subsequently reviewed by specialists, with a final consensus report available. "Truth" was established by final consensus reports. To control for potential bias, 150 adult MR imaging and 250 pediatric radiologic studies were interpreted initially by specialists and then by generalists. Again, truth was established by final consensus reports. RESULTS: There was disagreement between generalist and specialist radiologist interpretations in 427 (21.2%) of the cases reviewed. These disagreements were stratified further by independent specialists, who graded them as important, very important, or unimportant. Differences were considered important or very important in 99% of the cases reviewed. CONCLUSION: Consultations by subspecialty radiologists improved the quality of the radiology reports studied and, at least in some cases, improved the process of care by eliminating unnecessary procedures or suggesting more specific follow-up examinations. The consultation services can be provided cost-effectively from the payer's perspective and may save additional costs when unnecessary procedures can be eliminated.

Renal fascia in urinary tract disease.

The renal fascia is rarely detected on excretory urograms. When seen, it is usually associated with disease processes such as focal renal scarring, acute renal infection, renal calculi, and intrarenal and perirenal masses. In all cases of normal appearing kidneys with visualization of the renal fascia, undetected renal disease should be suspected.

Percutaneous nephrostomy for urinary tract obstruction.

Percutaneous nephrostomy is a very valuable radiologic procedure for providing temporary or permanent urinary diversion of an obstructed upper urinary tract. While changes in catheter and guide wire technology have allowed for marked enhancement of the indications for percutaneous nephrostomy, the classic indications remain, such as decompression in patients with urosepsis and azotemia, especially with concomitant medical problems that require time to bring under control.

Autonomic dysreflexia in patients with spinal cord lesions: complication of voiding cystourethrography and lleal loopography.

Autonomic dysteflexia is a pathologic reflex which occurs in patients with a spinal cord lesion above T7. The most dangerous manifestation of this reflex is marked increase in systolic and diastolic blood pressure. The trigger is the distension of the urinary bladder, urethra, rectum, or intestine. It can and does occur during radiological examinations such as cystourethrography, loopography, and probably during the barium enema. Because of possible deleterious consequences of marked hypertension, blood pressures in these patients should be continuously monitored during the examinations and appropriate measures immediately instituted should the reaction occur.

Imaging work-up: is it renal carcinoma and is it operable?

In detection and work-up of a renal carcinoma, imaging plays the most critical role. Differentiation of renal cell carcinoma from angiomyolipoma and complex cysts is highly accurate, but differentiation from benign oncocytoma is not. The most important discoveries regarding local staging are presence of venous tumor thrombus and its cephalad extension, followed by regional lymph node metastases. Biopsy of a renal mass is indicated when a concomitant primary malignancy is present elsewhere, but only if treatment will be influenced by findings. Preoperative embolization is reserved for the most difficult cases, and palliative embolization is useful in selected cases. Helical computed tomography is the most sensitive method for detecting small lung metastases.