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Biomedical subjects

A J Segal

Publications and source records attributed to A J Segal.

17 recordsLinked to original sources
PubMed1992

Renal cell carcinoma: incidental diagnosis and natural history: review of 235 cases.

Two hundred thirty-five cases of histologically proved renal cell carcinoma (1976-1987) were reviewed to determine the impact of incidental tumor detection on the natural history of this cancer. One hundred sixty-eight patients (71.5%) presented with clinical signs and/or symptoms of renal pathology. Of these, 25 (18%) were investigated without consideration of renal cell carcinoma in the differential diagnosis. Sixty-seven cases (28.5%) were diagnosed as an incidental finding on diagnostic imaging for extrarenal symptomatology. Approximately 30 percent of patients were found to have metastatic disease on initial presentation regardless of incidental, or suspected discovery of these tumors. Stages A and B tumors were encountered with equal frequency in patient groups with both suspected and incidental diagnosis. Intravenous pyelography was the diagnostic modality used to detect the diagnosis in 83 percent of cases. While incidental detection of renal cell carcinoma has become more frequent than in previous years, it appears to have impacted minimally on the discovery of earlier stage tumors than those with presenting clinical symptoms. In contrast to prior reports, our data show that the natural history of renal cell carcinoma is not significantly altered by the incidental detection of tumor.

Carcinoma, Renal Cell↗
PubMed1992

Changes in serum magnesium during excretory urography. A comparison of ionic and nonionic contrast media.

RATIONALE AND OBJECTIVES: It is known that ionic contrast media (CM) bind magnesium and that patients with asthma often benefit from magnesium injections. Similarly, asthmatics have a higher incidence of CM reactions. This work tests the hypothesis that ionic CM alter serum magnesium more than nonionic CM. METHODS: Ten patients were divided into two groups; one group received iothalamate and the other received iohexol. RESULTS AND CONCLUSIONS: The total magnesium level changed significantly from baseline in the iothalamate-treated group (P less than .01). Iothalamate produced a significant decrease in protein-bound magnesium (P less than .01) with a significant increase in filterable magnesium (P less than .01). Iohexol did not produce significant changes for any of the magnesium fractions. The patient with the most clinically significant adverse reaction (though minor) had the lowest baseline magnesium level. Further studies with larger groups including patients with asthma are needed.

Azo Compounds↗
PubMed1988

Nondilated obstructive uropathy.

Four patients presented with severe renal failure secondary to urinary tract obstruction, yet ultrasonography and/or computed tomography revealed only minimal dilatation in 1 patient and no dilatation in the other three. Two patients had prostate cancer, one had bladder cancer, and one had retroperitoneal fibrosis. In all cases, relief of obstruction led to a dramatic improvement in renal function. These cases, and others in the literature, illustrate that in certain settings severe urinary tract obstruction may be present in the absence of dilatation and hence may be missed by noninvasive imaging techniques. Nondilated obstructive uropathy should be suspected in any elderly patient who presents with the acute onset of oliguria in the absence of an identifiable cause, especially if there is a previous history of malignancy in the pelvis. Left undiagnosed, this potentially reversible cause of renal failure can lead to end-stage renal disease.

Acute Kidney Injury↗
PubMed1985

'Page kidney'. Hypertension caused by chronic subcapsular hematoma.

Conditions analogous to an experimental model of hypertension described by Page in 1939 are called "Page kidney." In chronic subcapsular hematoma, the most common clinical counterpart to Page's model of renal parenchymal compression, a review of the literature reveals that hypertension is usually cured by nephrectomy, but is seldom cured by mere evacuation of the hematoma. To our knowledge, no patient remaining hypertensive after evacuation has undergone nephrectomy. In the patient described herein, a liquified subcapsular hematoma reaccumulated after it was drained percutaneously, and therefore it had to be evacuated surgically. Persistent renin-mediated hypertension, however, prompted curative nephrectomy. The response to more prolonged percutaneous drainage might have guided more effective initial surgery.

Adolescent↗
PubMed1985

Postpartum renal vein thrombosis.

Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

Angiography↗
PubMed1978

Urinary tract after abdomino-perineal resection.

Uroradiological examinations on 33 patients subjected to abdomino-perineal resection were analyzed. The most common finding was medial displacement of both ureters, with the right one frequently crossing the midline. Bladder deformity, sometimes severe, was present in all patients. Localized ureteral narrowing due to stricture or recurring neoplasm was found in 30% of the patients examined. Other common complications included retrovesical abscesses, periurethral abscesses, urethral fistulas and strictures, and bladder retention. All these findings were more prominent in men.

Abdomen↗
PubMed1978

Diagnosis of nonopaque calculi by computed tomography.

Computed tomography can aid in the distinction of calculi from both tumors and clots in the urinary tract. Its availability, simplicity of interpretation, and noninvasiveness establish it as an important diagnostic modality in selected cases when calculus is in the differential diagnosis of upper urinary tract filling defects.

Adult↗
PubMed1978

Intraoperative ureteral trauma: a radiologic approach.

Thirty-two patients with inadvertent intraoperative ureteral trauma or ligation are presented. One-third of the injuries were due to general surgical procedures such as lumbar sympathectomy, aortoiliac bypass and colectomy. Because of postoperative pain, discomfort and sedation, these injuries are frequently unrecognized for long periods. This delay in diagnosis results in significant morbidity and mortality. The usual radiologic approach is an excretory urogram supplemented if necessary by a retrograde pyelogram. Temporary percutaneous or operative nephropyelostomies have been employed in seven of these patients.

Adult↗
PubMed1977

Adult polycystic kidney disease: a review of 100 cases.

Herein we review 100 cases of adult polycystic kidney disease. Flank pain was the most common presentation in these cases. In 20% of the patients calculi were noted and 10% had obstruction. The average patient age at death was 57 years. The importance of tomography is emphasized with key radiographic features, such as bilateral large kidneys, inhomogeneous nephrogram, caliceal distortion and poorly defined renal margins. Cystic involvement of the liver and spleen may help to confirm the diagnosis. Differential diagnosis includes bilateral multiple simple cysts, angiomyolipomatosis and bilateral renal carcinomas.

Adolescent↗
PubMed1977

A rapid, simple method of delivering 1:10,000 epinephrine.

A rapid, simple method of delivering intravenous epinephrine 1:10,000 during anaphylaxis is described. It is injected through a disposable syringe needle designed for intracardiac injection, which is coupled to a butterfly needle and its tubing.

Anaphylaxis↗
PubMed1977

Urinary tract obstruction in polycystic renal disease.

The incidence and cause of urinary tract obstruction in 100 consecutive patients with polycystic renal disease are reported. Because of nonspecific symptoms, poor renal function, and calyceal distortion, obstruction may be difficult to detect. A number of patients had infundibular obstruction caused by a calculus, clot, or inflammation and edema of the pelvocalyceal wall.

Humans↗
PubMed1975

Delayed diagnosis of pituitary tumors.

Of 38 patients with presumed or proven pituitary adenomas, 24 first presented with ocular complaints. Of these, ten patients had a physician-caused delay in the formulation of the correct diagnosis. Reasons for the physician-caused delay in diagnosis include inadequate history evaluation, failure to perform adequate testing, provide follow-up examination, and recognize typical signs of pituitary adenomas.

Acromegaly↗