Biomedical subjects
Publications and source records attributed to D B Spring.
A fluid collection within the retropubic space has a characteristic sonographic contour which, when combined with a partially distended bladder, resembles a yoke over a bell. The fluid conforms to the anterior convexity of the bladder. This configuration is distinct from that of ascites or a lymphadenectomy-related lymphocele.
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Magnetic resonance imaging (MRI) of the male pelvis was performed in 25 subjects: five normal volunteers; six patients with carcinoma of the bladder; nine with benign nodular hyperplasia (including five with concomitant bladder carcinoma); nine with prostatic carcinoma; and one with a lymphocele after radical prostatectomy. The display of normal anatomy is enhanced by the ability of the MRI device to provide images in direct transverse, sagittal, and coronal planes. Sessile and pedunculated types of bladder carcinoma are readily shown due to the superior ability of MRI for soft-tissue characterization. Direct sagittal scans are advantageous for evaluation of tumors at the bladder base, and by combining two different planes of images, the extent of the neoplasm is better delineated. In the analysis of the prostate, MRI displays the gland in three dimensions and therefore allows accurate volumetric measurements. The greatest potential of MRI seems to be its ability to detect pathology confined to the gland. However, it is not yet known if a neoplastic nodule can be differentiated from chronic prostatitis. Unlike x-ray CT, metallic clips produce no streaking artifacts, giving MRI a definite advantage in the evaluation of patients after radical surgery. These observations were made on a small number of patients. If the results are confirmed with a larger number of patients, MRI will assume a prominent role in the clinical evaluation of bladder and prostate cancer.
The syndrome of renal tubular acidosis has been categorized into three physiologic types that have different clinical findings and prognostic and therapeutic implications. We reviewed radiographs of the skeleton and kidneys in 92 patients (56 children and 36 adults) with renal tubular acidosis in order to determine whether the radiologic findings could be related to the type of syndrome. Forty-four patients had Type 1 renal tubular acidosis, 18 had Type 2, and 30 had Type 4. Evidence of skeletal abnormalities was uncommon (17 per cent) and was confined to patients who had the Type 2 disorder or azotemia. The children with Type 2 and skeletal abnormalities had rickets; the adults had osteopenia without pseudofractures. Nephrocalcinosis was evident in approximately one fourth of the group (29 per cent) and was restricted to patients with the Type 1 syndrome. In patients with Type 4, osteopenia was evident in 12 per cent, all of whom were azotemic. Our observations indicate that the radiographic manifestations of renal tubular acidosis are influenced by the physiologic type of renal tubular acidosis.
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A total of eight lymphoceles developed in six of 22 (27%) prospectively studied patients undergoing pelvic lymphadenectomy for prostatic carcinoma. Ultrasonic characteristics in these eight and in 14 retrospectively studied lymphoceles were evaluated. A location lateral to the urinary bladder was characteristic. The anterior surface of the fluid collections was usually within 3 cm of the anterior abdominal wall. No new lymphoceles developed after the first postoperative month; only one developed after the first 10 postoperative days. Small (cross-sectional area less than 30 cm2), echofree lymphoceles were most likely to result in long-term spontaneous resolution. Large (cross-sectional area greater than 30 cm2) or complex lymphoceles often resulted in complications ultimately requiring surgical intervention.
Massive prostatic enlargment may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the compouted tomographic findings, is offered. We discuss the differential diagnosis.
The authors describe the usefulness of prone positioning during hysterosalpingography in the evaluation of nonvisualized fallopian tubes in infertility.
To study the effectiveness of clot embolization in the control of renal hemorrhage, lower pole trauma was applied to 12 pigs, after which autologous clot at varying volumes was injected per catheter into the segmental artery. Renal infarction resulted in all animals and its degree clearly related to the volume of clot embolized. Embolized clot controlled hemorrhage in all cases regardless of volume used.
A simplified technique for hysterosalpingography, based on over 5,000 studies, is described. This method is quickly and easily performed. Patient acceptance is high.
Multiple renal arteries originating from the aortoiliac vessels were identified angiographically in 44% of 444 prospective renal donors. Bilateral multiple renal arteries were identified in 12%. With good immunological donor-recipient matching, 17 kidneys with multiple renal arteries were transplanted with excellent results; therefore, presence of multiple renal arteries should not be considered a contraindication to kidney transplantation. A high proportion (17%) of the prospective donors, acceptable by all other means of evaluation, had abnormmal angiographic findings that led to reconsideration of their acceptance. In addition to multiple renal arteries, neither renovascular atherosclerosis nor fibromuscular dysplasia proved to be an absolute contraindication to transplantation.
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