Advantages of nonionic contrast agents in adult urography.

Nonionic radiographic contrast agents have a reported advantage of decreased contrast osmolality. Before clinical significance can be attributed to this lower osmolality, an observed difference must be documented. In a randomized double-blind study with 55 patients, Iohexol, a new nonionic contrast agent, is compared with Renografin 60 for use in adult urography. Hemodynamic parameters, serum and urine chemistries, including osmolality, were recorded before and after contrast injection. Radiographic quality and adverse reactions were recorded. This study focused on the change in urine osmolality (delta Osm) from pre- and post-injection urine specimens. The group receiving nonionic contrast agents had an average delta Osm of 65 mOsm/L while those receiving the ionic agent had an average delta Osm of 120 mOsm/L. This significant difference in urine osmolality is discussed with respect to the observed advantage in radiographic quality and the lower incidence of adverse reactions noted in the group receiving nonionic contrast material.

Establishment of TEST-yolk buffer enhanced sperm penetration assay limits for fertile males.

TEST-yolk buffer has been shown to enhance sperm penetration of zona-free hamster eggs. Review of sperm penetration assay (SPA) data from a fertile population was undertaken to determine a normal range for SPA with TEST-yolk buffer enhancement. Thirty-eight intrauterine insemination patients and 4 artificial insemination donors who had successfully initiated a pregnancy within 18 months of SPA analysis were examined. All 42 enhanced SPAs demonstrated penetration of greater than 10%, and 37 of these (88%) yielded SPA values of greater than or equal to 20%. Thirty-three percent (14/42) of these individuals achieved 0% penetration in the SPA without TEST-yolk buffer. The SPA performed with the TEST-yolk modification has fewer false negatives than the assay done with the original methodology.

Renal vascular injuries.

Fifteen patients with injuries to the renal arteries and/or veins have been treated in the past ten years. Nine injuries were the result of gunshot wounds, and six were from blunt trauma. Twelve patients presented to the emergency department in shock; two of these did not have a palpable blood pressure. Time from admission to time of operation averaged 6.4 hr for patients with blunt trauma and 1.25 hr for patients with penetrating trauma. Seven patients had ten associated abdominal vascular injuries, and two patients had injuries to both the right renal artery and left renal vein. Associated nonvascular abdominal injuries were found in all 15 patients. Efforts were made to repair renal vascular injuries with suture or grafting of the injured vessel in eight cases (53%). These efforts were successful in four patients, but in four the repair failed and a nephrectomy could not be avoided. Two patients died in the operating room or immediately postop in spite of successful repair of their renovascular injury. One injured left renal vein was ligated and nephrectomy was not necessary. In five patients, ligation of the injured renal artery and nephrectomy were necessary. There were five deaths (33%). Three of the deaths occurred in the operating room and two were postoperative deaths. Only one of the patients who died had a renal vessel injury without other major vessels involved. He did, however, have serious liver and kidney injuries. Multiple associated vascular, nonvascular, and head injuries were present in all four of the other deaths. We have continued to take an aggressive approach to exploration, isolation of the injury, and repair of the vessel whenever possible if a renal vessel injury is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Microsurgical replantation of an incompletely amputated penis.

The use of microvascular techniques in the replantation of one partially amputated penis is presented. The advantages of these techniques are discussed. A review of the literature is included; penis-replantation results prior to the introduction of microvascular techniques are compared to results achieved since the advent of these techniques. The superior results associated with microsurgical techniques are demonstrated, and it is concluded that microsurgical replantation is the procedure of choice in the repair of penis amputations.

Uriniferous perirenal pseudocyst. An unusual cause of a calcified abdominal mass in the neonate.

Radiologically visible calcification in the wall of a uriniferous perirenal pseudocyst is rare. This unusual finding was seen in a newborn infant who was found to have a left flank mass on the first day of life. When perirenal pseudocysts occur in infants, they are usually caused by congenital obstructive lesions of the urinary tract.

Ioversol for intravenous urography: a comparison study.

A new nonionic, low-osmolar iodinated contrast media, ioversol, was compared with another low-osmolar, nonionic contrast media, iohexol, in 80 patients undergoing intravenous urography. There were 40 patients in each contrast group. Patients were assessed for changes in vital signs, patient tolerance (heat and pain), and other adverse effects. Double-blind evaluation was also performed for comparison of the urogram image quality. There were no severe, life-threatening reactions for either contrast group. Ten patients (25%) receiving ioversol and seven (17.5%) receiving iohexol perceived body heat related to the injection of contrast material. Two patients (5%) in each group experienced mild nausea. Two patients (5%) of each group experienced noted unpleasant taste, and two patients (5%) of the iohexol group complained of headache. Vital signs remained stable without significant change in both groups, and image quality was considered equivalent. The results indicate that the two contrast agents are equivalent in image quality, safety, and incidence of adverse effects.

Treatment of carcinoma of the penis: the case for primary lymphadenectomy.

There were 65 patients with squamous cell carcinoma of the penis followed for a minimum of 5 years. Patients with stage I disease uniformly survived with local treatment only. Of the patients with stages II and III carcinoma of the penis 88 and 66 per cent, respectively, were free of disease if lymphadenectomy was performed shortly following treatment of the primary lesion, compared to only 38 and 0 per cent, respectively, if the primary lesion was treated locally and no lymphadenectomy was performed. These data support the concept that lymphadenectomy should be an integral part of the primary treatment in patients with stages II and III penile cancer.

Concurrent renal tuberculosis and contralateral transitional cell carcinoma of the renal pelvis: a case report.

We report a case of 2 concurrent serious renal problems in opposite kidneys. The patient presented with gross hematuria, which resulted in a diagnosis of transitional cell carcinoma of the renal pelvis and tuberculosis of the contralateral kidney. Intraoperative nephroscopy allowed for appropriate diagnosis and surgical therapy.

Practical experience with percutaneous nephrostomy: avoidance of common technical pitfalls.

In our 18-month experience with percutaneous nephrostomy (PCN) at Vanderbilt University Hospital and Veterans Administration Hospital (Nashville), a total of 47 PCNs were attempted with a success rate of 96%. The procedure is rapid, offers low morbidity, and has been readily accepted. Some variations of the standard procedure to avoid common technical difficulties include (1) using a combination of real-time ultrasonography and fluoroscopy as a guidance system, (2) maintaining the position of the Chiba needle during the entire procedure, (3) choosing the optimal puncture site, and (4) exercising care in tract dilatation.

Suboptimal treatment results with the Therasonics lithotriptor.

From July 1988 to August 1991, 174 stone treatments were attempted on 112 stones in 86 patients using a Therasonics lithotriptor. Mean stone diameter was 13 mm. (range 4 to 60). The success rate (defined as no debris or fragments less than 4 mm. in an asymptomatic patient) was 49% and the retreatment rate was 63%. Subjects reported moderate to severe pain during 70 treatment sessions (42%) despite sedation with parenteral narcotics (50 to 100 mg. meperidine and 50 mg. hydroxyzine intramuscularly). One patient had perirenal bleeding requiring a 7-unit blood transfusion. Of the treatments 24 (13%) were aborted, 10 due to pain and 13 because of inability of the operator to position the patient or localize the stone. These results appear to be inferior to those reported with alternative lithotriptors. Modifications that have been made in the Therasonics system may improve stone localization and treatment results.

Percutaneous nephrostomy in neonates, infants, and children.

In a 20-month period, 13 percutaneous nephrostomies were placed in 10 pediatric patients ranging in age from one day to six and one-half years. The procedure was successful in all cases with no significant complications. Final diagnoses included ureteropelvic junction obstruction, ureterovesical junction obstruction, posterior urethral valves, and pyonephrosis. Localization of the obstruction as detected on initial antegrade nephrostography was found to be incomplete or incorrect in three patients. In one patient, both ureteropelvic and ureterovesical junction obstruction were present. In the other two patients, the misdiagnosis probably related to the difficulty of filling a distended, obstructed ureter prior to drainage.

Bladder calcification in the prune-belly syndrome.

Calcification of the bladder wall is described in two neonates with the prune-belly syndrome. The radiological and pathological findings are discussed and four additional cases are reviewed.

Iohexol for excretory urography: a comparative study.

A new iodinated nonionic contrast agent (Iohexol) was compared to an ionic contrast agent (renografin 60) in a double-blind study. Fifty-five patients with normal renal function were studied for incidence of undesirable side-effects and quality of the resultant excretory urogram. No major adverse reactions occurred. Minor side-effects due to the contrast occurred more than two times as often with Renografin than when Iohexol was used. The quality of visualization of the collecting system on urography was considered excellent in 44% of the patients receiving Iohexol as compared to a 17% frequency when Renografin was used.

Renal carcinoma discovered incidentally by arteriography during evaluation for hypertension.

Since June 1, 1971 patients undergoing evaluation for hypertension have been evaluated with rapid sequence excretary urography, abdominal aortography and selective renal arteriography. Renal venous assays have been done in selected patients. Through July 31, 1974, 812 arteriographic studies in new hypertensive patients have been done. In 6 of these patients renal tumors were discovered by arteriography only and were not suggested by symptoms, urinalysis nor diagnosed on hypertensive excretory urography. This high incidence surprised us and we hope others will review their arteriographic series of hypertensive patients.