Modified method of diuresis renography for the assessment of equivocal pelviureteric junction obstruction.

Thirty-five hydronephrotic kidneys, in which diuresis renography showed either an equivocal (13) or non-obstructive (22) response pattern, were studied by a modified method in which intravenous frusemide was given 15 min before the start of the renogram so as to assess elimination during the period of maximum diuresis. Thirteen kidneys were identified as obstructed, including three in which the standard diuretic renogram appeared to exclude obstruction. These results indicate that the modified method increases the specificity of diuresis renography when used to assess patients with equivocal pelviureteric junction obstruction.

Ureteroureteric reflux. Pathological entity or physiological phenomenon?

The clinical, urographic and radionuclide examinations of 28 consecutive patients with incomplete duplication of the upper urinary tract are presented. Four possible types of urodynamic abnormality can occur in this condition and 3 of these were found in 8 of the 28 patients. The urodynamics of normal and duplex upper tracts are reviewed and the question of whether the abnormalities represent a pathological process requiring surgery or a harmless physiological variant is examined.

Isolation of ortho- and paramyxoviruses from wild birds in Western Australia, and the characterization of novel influenza A viruses.

As part of the World Health Organization's international programme on the ecology of influenza, cloacal swabs were collected from 3,736 birds belonging to 67 species over a 3-year period in Western Australia for the isolation of ortho- and paramyxoviruses. A total of 24 influenza A viruses were isolated from various species of ducks, shearwaters , noddies , terns and a coot , and were subtyped as H1N9 , H3N8 , H4N4 , H4N6 , H6N2 , H6N4 , H?N2, H?N6 and H? N9 . The H? haemagglutinins did not react in tests with reference antisera. Whether they represent a novel haemagglutinin subtype or atypical members of an established subtype remains to be determined, although preliminary results indicate that they may be atypical members of the H7 subtype. The H1N9 isolate is the first reported isolate of this particular antigenic combination. A total of 17 Newcastle disease viruses was isolated from ducks, noddies , terns and a black- fronted plover : preliminary results suggest that they are avirulent for domestic chickens. This study indicates that ortho- and paramyxoviruses are present in a variety of wild birds in Australia.

Regional renography in segmental renal disease.

Twenty-nine patients with symptomatic segmental renal disorders were studied by regional renography. Twenty-three patients had duplex kidneys and 6 had other segmental disease. Abnormal gamma camera findings included ureteroureteric reflux, vesicoureteric reflux, impaired function, obstruction and non-obstructive dilatation. Comparison between renography and radiology in duplex kidneys showed agreement in 10 cases. In 7 kidneys the gamma camera provided additional information and in 6 cases the X-rays alone were abnormal. It is concluded that regional renography should be performed wherever possible to complement conventional radiology in the functional and urodynamic evaluation of segmental renal disease.

The dilated non-obstructed renal pelvis.

This paper discusses 28 patients with renal pelvic dilatation in whom obstruction was excluded by excretion urography and diuresis renography. The clinical presentation and progress of the patients over a follow-up period of 1 to 5 years are presented. One patient required pyeloplasty, one developed 2 asymptomatic pelvic calculi and one showed some deterioration in function on the affected side. The remaining 25 patients remain well and their follow-up renograms show satisfactory renal function and excretion. Before the advent of objective means of assessing renal function and urodynamics, these patients would probably have been subjected to pyeloplasty. The present study confirms that the correct management of the dilated non-obstructed renal pelvis is conservative.

Radionuclide studies of the lower urinary tract.

The results of prospective experimental and clinical studies into the use of radionuclides in the evaluation of urinary flow rates and residual urine volume estimations are presented. The results indicate that the radionuclide estimation of flow rates is accurate, but complex and time-consuming compared with other available methods. The calculation of residual urine is simple and accurate where residual volumes are not extremely large. The opportunity for such lower tract studies after renography should not be missed where clinically appropriate, and the combined upper and lower tract studies provide a useful quantitative urological profile.

Diuresis renography and the results of pyeloplasty for idiopathic hydronephrosis.

Eighty-six kidneys in 82 patients have been assessed by diuresis renography after pyeloplasty. A non-obstructed diuresis renogram was found in 64% of kidneys. Ninety per cent of patients were clinically improved by surgery and 51% of cases studied had improved urographic features. Thirty kidneys (29 patients) were assessed both before and after pyeloplasty. An improvement in the diuresis renogram was found in 89% of cases postoperatively. Standard renography demonstrated improved drainage in only 33% of kidneys. These findings are discussed in relation to the value of diuresis renography after pyeloplasty.

Diuresis renography and morphology in upper urinary tract obstruction.

The results of a combined study of 25 patients with idiopathic hydronephrosis are presented. Diuresis renography was performed pre-operatively and surgically removed specimens of the renal pelvis and ureter were examined by light and electron microscopy. There was good correlation between the results of these 2 methods of assessment which have defined 2 broad categories of patients with renal pelvic dilatation. These findings are discussed with particular reference to the clinical value of diuresis renography.

Diuresis renography in equivocal urinary tract obstruction.

A trial of the value of diuresis renography in equivocal upper urinary tract obstruction is presented. Fifty-two patients were examined by standard renography and renography under a diuretic provocation. The results indicate that the technique is of considerable value in making the vital distinction between dilatation on the excretion urogram due to atonicity and that caused by a genuine obstruction. A quantitative index of the response to diuresis reflecting the degree of impedance to flow is described--the Diuresis Excretion Index. Diuresis renography is recommended in the evaluation of the patient with equivocal urinary tract obstruction.

Pelvi-ureteric obstruction due to renal pelvis cyst.

Intramural cysts of the renal pelvis are a separate clinical entity and must not be mistaken for neoplasms. Simple enucleation can result in complete restoration of renal function previously impaired by pelvi-ureteric obstruction.

Dynamic scintigraphy in clinical urology.

The technique of isotope renal scintigraphy using Technetium-99m labelled agents and a gamma camera system on-line to a digital computer is described. Its value in diagnosing renal space-occupying disease and renovascular abnormalities is emphasised. A method of measuring individual renal haemodynamics and the possible potential of such techniques are discussed. Radio-isotope studies are rapid, simple, non-invasive and non-toxic. They give information complementary to that from urography.