Clinical and magnetic resonance imaging findings in a French bulldog puppy with genetically confirmed congenital hypothyroidism.

A 7-month-old male French bulldog was referred for abnormal mentation and gait. Physical examination revealed a dome shaped calvarium and persistent bregmatic fontanelle. Neurological examination revealed proprioceptive ataxia, pelvic limb paraparesis and strabismus with moderate ventriculomegaly, thinning of the cerebral parenchyma, and widened cerebral sulci on magnetic resonance imaging. Masses were identified in the region of the thyroid, which appeared heterogeneous and hyperintense in T1-weighted and T2-weighted compared with the adjacent muscle signal masses were identified. Radiological diagnosis was hydrocephalus "ex vacuo" and goiter. Blood test revealed abnormally low total thyroxine (TT4), free thyroxine (FT4), and normal thyrotropin concentration. A diagnosis of congenital hypothyroidism was confirmed by positive genetic test for thyroid peroxidase mutation. Thyroxine supplementation treatment rapidly improved clinical signs.

Radiographic and CT features of zygomatic arch pneumatization in a Thoroughbred with a recurrent progressive ethmoid hematoma.

A 7-year-old Thoroughbred gelding presented with a history of mild unilateral right-sided epistaxis and facial swelling over the right caudal maxillary sinus and zygomatic arch. Eleven months previously a progressive ethmoid hematoma had been surgically removed from the right caudal maxillary and conchofrontal sinus. Computed tomography identified a large expansile soft-tissue attenuating mass in the right caudal maxillary sinus, with protrusion into the conchofrontal sinus, that extended into the zygomatic arch. Lytic expansion and thinning of the cortex with pneumatization of the zygomatic arch was present. The mass was surgically excised after a biopsy had confirmed the recurring progressive ethmoid hematoma.

Renal Papillary Necrosis (RPN) in an African Population: Disease Patterns, Relevant Pathways, and Management.

Renal papillary necrosis (RPN) is characterized by coagulative necrosis of the renal medullary pyramids and papillae. Multiple conditions and toxins are associated with RPN. Several RPN risk factors, or POSTCARDS, have been identified, with most patients presenting with RPN having at least two contributing risk factors. Currently, there is no specific test to diagnose and confirm RPN; however, several imaging tools can be used to diagnose the condition. RPN is currently underdiagnosed in African populations, often with fatal outcomes. In African clinical settings, there is a lack of consensus on how to define and describe RPN in terms of kidney anatomy, pathology, endourology, epidemiology, the identification of African-specific risk factors, the contribution of oxidative stress, and lastly an algorithm for managing the condition. Several risk factors are unique to African populations including population-specific genetic factors, iatrogenic factors, viral infections, antimicrobial therapy, schistosomiasis, substance abuse, and hypertension (GIVASSH). Oxidative stress is central to both GIVASSH and POSTCARDS-associated risk factors. In this review, we present information specific to African populations that can be used to establish an updated consensual definition and practical grading system for radiologists, urologists, nephrologists, nuclear physicians, and pathologists in African clinical settings.

Advantages of en bloc hilar ligation during laparoscopic extirpative renal surgery.

PURPOSE: By evaluating the technical challenges encountered during 123 laparoscopic nephrectomies, we have been able to modify the surgical technique to allow general urologists to effectively perform the procedure with minimal complications. DESIGN AND METHOD: A retrospective chart review was performed on 123 patients who consecutively underwent laparoscopic nephrectomy or nephroureterectomy. Using a modified dissection approach to the hilum and en bloc ligation of the renal pedicle with a vascular stapler, a new standard of laparoscopic nephrectomy was developed at our institution. In 30 cases, the conventional technique was used, whereas in 93 cases the en bloc technique was used. Operating time, blood loss, transfusion requirements, intra- and postoperative complications, and the incidence of arteriovenous fistula (AVF) were documented. Follow-up included serial clinical evaluation and computed tomography angiogram at 3 months and repeated at 3-monthly intervals where indicated. RESULTS: Operative and postoperative parameters were improved in the en bloc group compared with the conventional group. In the en bloc group, the average operating time was 56 minutes and the average blood loss was 32 mL. No patients required a blood transfusion and only two cases required conversion to open nephrectomy. No late vascular complications related to this method were observed with a mean follow-up of 28 months. There were no perioperative deaths. Postoperative complications were self-limiting and no patients developed postnephrectomy AVF. CONCLUSION: The results of using the en bloc ligation technique for laparoscopic nephrectomy have been favorable in terms of operating time, risk to the patient, and surgeon's surgical preference. The risk of AVF formation after en bloc ligation of the renal pedicle and ligation by the conventional method appears to be equal based on the clinical follow-up and radiological evaluation. Therefore, long-term radiological follow-up is not mandatory in most cases.

Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths.

OBJECTIVES: To evaluate the impact of the ureteral access sheath on intrarenal pressures during flexible ureteroscopy in light of the recent resurgence in their use. As such, using human cadaveric kidneys, we studied changes in intrarenal pressure in response to continuous irrigation at different pressures with and without access sheaths of various sizes and lengths. METHODS: This study was performed using seven cadaveric kidneys. In three kidneys the study was done in situ with a 7.5F flexible ureteroscope (URS) passed by itself and then passed through a 10/12F sheath (35 and 55 cm in length), whereas, in four kidneys, due to narrowing of the intramural ureter, the study was done ex vivo using the unsheathed URS and then passing the 7.5F flexible URS via the 10/12F, 12/14F, and 14/16F sheaths (all 35 cm in length). A 10F Cope loop pyelostomy was placed to measure intrapelvic renal pressure. Three sets of 3-minute readings (ie, flow and intrarenal pressure) were taken with the tip of the URS at the distal ureter, middle ureter, and renal pelvis (just above the ureteropelvic junction); the entire process was done at three different irrigant pressure settings: 50, 100, and 200 cm H(2)O. Irrigant flow and intrarenal pressures were measured at all three settings using the URS passed without a sheath and then with the URS passed through the various sheaths positioned at the distal ureter, middle ureter, and renal pelvis. RESULTS: With all of the sheaths, intrapelvic pressure remained low (less than 30 cm H(2)O), and there was a 35% to 80% increase in irrigant flow versus the control unsheathed URS. With the sheath in place, the majority of the irrigant drained alongside the URS and out the sheath. Flow and pressure with the 12/14F sheath were equivalent to the 14/16F sheath. CONCLUSIONS: The 12/14F access sheath provides for maximum flow of irrigant while maintaining a low intrarenal pelvic pressure. Even with an irrigation pressure of 200 cm H(2)O, renal pelvic pressure remained below 20 cm H(2)O.

Maximizing ureteroscope deflection: "play it straight".

We studied simple maneuvers to optimize active deflection of the flexible ureteroscope. Up to 61 degrees of active deflection is lost if the ureteroscope is not kept in a straight alignment. Holding the ureteroscope taut, placing a super-stiff guidewire in the working channel, or using an access sheath maximizes active deflection.

Effect of argon-beam coagulation on the integrity of suture material.

PURPOSE: To evaluate the effect of argon-beam coagulator (ABC) energy on suture materials. MATERIALS AND METHODS: Six absorbable and nonabsorbable suture materials (polyglactin, chromic catgut, polydioxanone, silk, poliglecaprone, and Gore-Tex) were placed under tension and exposed to ABC energy to determine breaking times. Subsequently, all suture materials were exposed to limited ABC energy, and tensiometry was used to determine decreases in breaking strengths. RESULTS: Among the suture materials tested, Gore-Tex was the most resistant to ABC energy. Although absorbable suture materials were less resistant than nonabsorbable suture materials, 2-0 polyglactin manifested the greatest resiliance to deterioration with ABC energy exposure. CONCLUSIONS: The ABC has differential effects on suture materials. Larger-gauge suture materials are more resistant to ABC than smaller materials. Similarly, nonabsorbable sutures are generally more resilient to ABC energy than absorbable materials. Among the suture materials evaluated in our in vitro model, 2-0 Gore-Tex was best suited for vascular ligation, and 2-0 polyglactin is optimal for renal collecting system closure if ABC is anticipated as an adjunct for hemostasis.