Macroscopic hematuria in a hemoglobin-S heterozygote with a concomitant chromosome with triple alpha loci: a possible pathophysiologic mechanism.
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Biomedical subjects
Publications and source records attributed to B Ody.
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Carcinoma of the urachus is a rare tumor with a poor prognosis. Only a few cases explored by CT have been reported until now. This report illustrates the value of CT in establishing the diagnosis and the tumor extension. Furthermore this patient has a probable biological tracer with positive dosage of carcino-embryogenic antigen (CEA).
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Renal oncocytoma, a benign tumour, is made up exclusively of oncocytes. These are large epithelial cells with granular eosinophilic cytoplasm extremely rich in mitochondria. Oncocytomas are very often mistaken for renal carcinomas, but due to their characteristic histological and ultrastructural features they are now diagnosed more frequently. We report a case of an unusual bilateral renal oncocytoma and describe briefly its clinical, radiological and pathological features.
Sonographic examinations of 17 patients revealed 21 kidneys with anechoic sonolucent areas within the renal sinus. Computerized tomography was obtained in 3 patients and the mass effects were proven to be multilocular parapelvic cysts. These parapelvic cysts simulated renal sinus lipomatosis.
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Ultrasonographic, arteriographic, and histopathological findings were compared in 45 patients with histologically-confirmed renal cancer. Ultrasound images clearly demonstrate the presence of a mass possessing similar echographic characteristics to those of the renal parenchyma (isoechogenic forms). Images are rarely homogeneous and are usually of a heterogeneous nature, either diffuse or including anechogenic zones (heterogenic lacunar forms). This latter appearance is almost specific for tumor necrosis, but a diffuse heterogenic image may be observed with or without the presence of necrosis. Necrotic cancers, with limited peripheral vascularization, present few diagnostic difficulties during ultrasonographic examination: the appearance is that of a solid mass, isoechogenic in the present series, heterogeneous, and with or without anechogenic zones. No correlation exists between the degree of echographic image alterations and the importance of vascularization, poorly vascularized cancers, of particular histological types, demonstrating hypo or hyper-echogenic changes more frequently than typical adenocarcinomas.
The authors studied using two echographies 90 kidneys in 53 patients free of known urinary tract pathology and not suffering from renal colic, the first immediately before intravenous urography (at a stage of relative fluid restriction) and the second before micturition (at a stage of higher urine output and filling of the bladder). Findings were as follows: - normal excretory cavities may be seen by echotomography, this being in contrast to a widely held view; - changes in the echographic appearance of the pyelocalyceal cavities may occur in the absence of any pathology merely as a result of changes in urine output. They draw attention to the possible errors inherent in echotomography performed alone. They emphasise the need, at least in the absence of renal insufficiency, to preceed any echography by intravenous urography.
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A retrospective study in 46 patients hospitalised with severe renal insufficiency of unknown origin, and investigated by means of a straight x-ray of the urinary system followed by bilateral renal ultrasonography, emphasises the importance of the latter examination for establishing the medical or surgical origin of the affection. Intravenous urography, which carries certain risks and does not supply supplementary information, can sometimes be avoided, but it is essential when dilated cavities are seen on ultrasonography. In the absence of the latter sign it should be performed when there is clinical evidence of an obstruction, or when the kidneys are of normal size of enlarged, depending on the results of biological tests or the clinical history. The only contraindication to its use is when ultrasonography has shown two small kidneys with thin cavities resulting from an acute episode of a pre-existing chronic nephropathy.
The radiological findings in three cases of multiple hamartoma syndrome (MHS) (Cowden disease) are reported. MHS was associated with a widespread distribution of polyps of varied morphology along the gastrointestinal tract. There was an isolated case of bladder carcinoma, and the one woman studied had breast masses. In view of the nonspecific clinical findings in this disease, which may also suggest carcinoma, the importance of the radiological recognition of MHS is stressed.
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Ultrasound recordings were conducted in 181 patients with renal tumors during a period of three and a half years. A precise diagnosis of a renal tumor mass had not been made in 4 cases, definition of the nature of the lesion requiring further explorations. It is emphasized that in these 4 cases an intravenous urography examination was either not performed (1 case), ultrasound being the initial examination, or was imperfectly conducted and interpreted (3 cases). It is concluded that a correctly performed and interpreted intravenous urography investigation should occupy a preliminary stage before any ultrasound imaging of the urinary tract.