Biomedical subjects
Publications and source records attributed to D B Reinke.
A ureteroileal stricture can be dilated through a percutaneous nephrostomy after antegrade catheterization of the ureter. The region of the stricture is kept open with a Gibbons ureteral stent.
We describe our technique for the antegrade insertion of the redesigned Gibbons ureteral stent. We have used this technique for 19 kidneys without failures or complications. The advantages of internal drainage and of antegrade stent placement are discussed.
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Single-tube nephrostomy drainage can be converted to U-loop drainage using percutaneous methods. Because only local anesthesia is required the technique can be used for patients who are poor operative risks.
An endourologic technique for a safe and adequate ureteral meatotomy has been devised. The ureter is catheterized anterograde through a percutaneous nephrostomy and a controlled ureteral meatotomy is done with a modified ureteral catheter. A silicone splint is then placed. The technique is safer than other techniques because repeated, more proximal incisions can be made and because the splint and proximal urinary division will prevent extravasation.
A percutaneous nephrostomy tract can serve both to decompress the renal pelvis and as a route for dissolving renal stones and assisting in basket retrieval of ureteral stones. These techniques are especially valuable in patients who are poor operative risks.
Patients in whom retrograde catheterization of the ureters has failed can have the Gibbons catheter placed by a new technique that requires no regional or general anesthesia. This technique entails antecedent percutaneous nephrostomy and passage of an angiographic catheter down the ureter. The catheterizing apparatus is attached to the angiographic catheter and then pulled into position.
A technique is described by which calculi can be removed from the distal ureters of patients with ileal conduit urinary diversions. A percutaneous nephrostomy is done and an angiogram catheter is manipulated down the ureter past the obstruction. After the angiogram catheter is retrieved from the loop with a Bumpus forceps a stone basket is attached, pulled up the ureter and opened. The stone can then be captured under fluoroscopic control and, by replacing the stone basket with a silicone splint, the ureteroileostomy also can be splinted. This may be important particularly if there is extravasation from the ureteroileostomy after stone manipulation or operation.
The various causes and differential diagnosis of carotid cavernous fistula are discussed as well as the description of the use of radionuclide angiography in the diagnosis and evaluation of patients with carotid cavernous fistulas. Radionuclide angiography has proven extremely useful in the diagnosis and follow-up of patients with carotid cavernous fistulas. The procedure is of maximum benefit in situations where repeat studies are required at frequent intervals. Five cases are described in which the nuclear medicine technique was instrumental in primary diagnosis and follow-up.
Increased uptake of 99mTc-sulfur colloid in vertebral bodies of two patients with vertebral compression fractures was noted on a liver-spleen scan. This finding has not previously been reported in the literature. The mechanism of localization of 99mTc-sulfur colloid in bone marrow depends on regional blood flow and increased reticuloendothelial and phagocytic cell activity. Both mechanisms are felt to be involved in these cases. In fractures, hyperemia and phagocytic activity are transient phenomena and therefore the above observations may be useful in determining fracture age.
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