A comparison between diuresis renography and the Whitaker test in 64 kidneys.

Fifty-seven patients have provided 64 dilated pelvicaliceal units for study by diuresis renography and the Whitaker test. Of 45 kidneys showing a type I or type IIIa renographic response (unobstructed), 32 were, according to Whitaker's criteria, obstructed, 8 fell into an equivocal zone and only 5 were unobstructed. Thirty-five of these kidneys--33 of which were associated with moderate or severe loin pain--were operated on for presumed obstruction with generally excellent symptomatic and renographic result. Thus the detection of a type I or type IIIa response in a dilated, painful system cannot be taken to exclude obstruction. Better correlation was obtained between renography and the Whitaker test in patients exhibiting a type IIIb or type II renographic response. Diuresis renography is a sensitive indicator of urodynamic disturbance in the upper urinary tract and an ideal means of evaluating post-operative progress. The Whitaker test provides a reliable means of selecting patients who will benefit from pyeloplasty.

The internal auditory canal and sensori-neural hearing loss in homozygous sickle cell disease

The dimensions of the internal auditory canal were compared in patients with SS disease and with or without abnormal audiograms to investigate the role of auditory nerve compression by expansion of the petrous, temporal bone in hearing loss. There was no correlation between abnormal audiograms and narrowing of the internal auditory canals and it was concluded that this mechanism was not responsible for the hearing loss in SS disease (AU)

Diverticulosis of the fallopian tubes

Diverticulosis of the fallopian tubes is uncommon, but is 9 times as common in Negro women of Jamaican origin as in Caucasian women living in Bristol. 58 examples were encountered in 918 hysterosalpingograms done in Kingston, Jamaica (426) and in Bristol (492) from 1968-1972. In 41 cases (71 per cent) diverticulosis was bilateral. There are several possible predisposing causes, of which infection, including tuberculosis, is the most important. The radiological appearances are distinctive, but, with the possible exception of tuberculosis, do not give any indication of cause. Infertility was the commonest clinical association of diverticulosis. Among infertile patients, hydrosalpinx and tubal obstruction were slightly commmoner in the presence of diverticulosis and the significance of this is discussed. Ectopic pregnancy is the most important associated condition and diverticulosis predisposes to its occurence. Hysterosalpingography is indicated following ectopic pregnancy to show whether there is diverticulosis to the contralateral tube, as this may influence prognosis and management (AU)

Radiological changes in elderly patients with sickle cell anaemia

The survival of a relatively large group of patients with SS disease beyond the age of 40 years in Jamaica has enabled a number of studies defining the charcteristics of this group. These are important because this group may reflect extremes of pathological change consequent on the long duration of the sickling process. The present paper describes the pattern of bone involvement in patients over the age of 40 years as detected by skeletal surveys of the skull, lumbar spine, pelvis, shoulders, hands, femurs, tibia, fibulae and chest. Radiologial evidence of bone marrow expansion was common and included widening of the marrow cavities, large nutrient foramino, osteoporosis, and coarsencing of the remaining trabecular pattern. Calcified medullary infarction in long bones, which has been considered rare in SS disease, was common in this group. Changes consistent with avascular necrosis of the femoral and humeral heads occurred and were often unsuspected clinically, especially with humeral involvement. Factors leading to these changes are discussed (AU)