Imaging features of infiltrating renal lesions.
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Humans↗
Biomedical subjects
D G Assimos
Publications and source records attributed to D G Assimos.
Intraoperative renal ultrasonography: a useful adjunct to partial nephrectomy.
Several evolutionary changes in ultrasonographic instrumentation, including miniaturization of transducers and marked improvement in resolution, have made intraoperative renal ultrasonography a valuable adjunct for intrarenal surgery. We investigated its use in 6 patients undergoing partial nephrectomy for treatment of renal cell carcinoma. In addition, 14 kidneys with renal tumors were scanned immediately after radical nephrectomy and the specimens were subjected to simulated partial nephrectomy. Transverse and longitudinal real-time sonographic images were obtained with a 5 MHz. sector scanner or a 7.5 MHz. convex array transducer. With ultrasonography to define tumor extent and location, negative surgical margins were obtained in all 6 individuals undergoing partial nephrectomy. A negative surgical margin was obtained in 13 of the 14 radical nephrectomy specimens subjected to simulated partial nephrectomy. A small satellite lesion was not identified and not resected in 1 of the radical nephrectomy specimens. We found that intraoperative renal ultrasonography helps to identify the location and extent of deep intraparenchymal lesions. It also provides a guide for a more accurate nephrotomy, which facilitates the attainment of negative resection margins during partial nephrectomy.
Carcinoma, Renal Cell↗
Spontaneous perinephric hemorrhage: imaging and management.
We report on 10 patients with spontaneous perinephric hemorrhage associated with underlying disease, including renal cell carcinoma (5), angiomyolipoma (2), malignant melanoma (1), periarteritis nodosa (1) and severe portal hypertension (1). The etiology could not be identified with computerized tomography (CT) in 5 cases (50%), including 2 renal cell carcinomas, 1 angiomyolipoma, 1 periarteritis nodosa and 1 portal hypertension. Arteriography demonstrated underlying lesions in 4 of these 5 cases (80%) including the case of vasculitis. CT combined with magnetic resonance imaging is accurate for the diagnosis of spontaneous perinephric hemorrhage but the underlying pathological condition is often undetectable in the acute phase due to the perinephric blood. CT should be the first study performed if this diagnosis is suspected. Arteriography is recommended if a renal mass is not detected. If a mass is not identified with these 2 imaging studies and the patient is clinically stable, followup thin slice CT should be performed.
Adult↗
A comparison of anatrophic nephrolithotomy and percutaneous nephrolithotomy with and without extracorporeal shock wave lithotripsy for management of patients with staghorn calculi.
A retrospective study was conducted comparing anatrophic nephrolithotomy (10 cases), percutaneous nephrolithotomy alone (4 cases) or percutaneous nephrolithotomy combined with extracorporeal shock wave lithotripsy (23 cases) for the treatment of large staghorn calculi. A comparison based on collecting system anatomy demonstrated that anatrophic nephrolithotomy resulted in a greater stone-free rate, shorter hospitalization and lower costs while complication rates were similar. Anatrophic nephrolithotomy should still be considered a viable treatment option, especially for patients with large branched calculi in complex collecting systems.
Adult↗
Association of antisperm antibodies with chronic nonbacterial prostatitis.
Antisperm antibodies are significant in male factor infertility. The prevalence of antisperm antibodies in the infertile population is approximately 10 percent, and it is not cost-effective to test for these antibodies in every male partner of an infertile marriage. Earlier studies have demonstrated a higher prevalence of antisperm antibodies among men with a history of bacterial prostatitis or urethritis. Because of this established association, we measured the prevalence of serum antisperm antibodies, using a gel agglutination assay, in 28 men with chronic nonbacterial prostatitis and in age-matched control group of 69 men without a history of prostatitis. The prevalence was 25 percent (test subjects) and 7.2 percent (controls) (p less than 0.05). This finding indicates that nonbacterial prostatitis is a risk factor for the presence of serum antisperm antibodies and that subfertile men with a history of nonbacterial prostatitis should be tested for these antibodies.
Adult↗
A lack of coordination in the release of urinary lysosomal and brush border enzymes following renovascular surgery.
The urinary secretion of two lysosomal enzymes, N-acetyl-D-glucosaminidase (NAG, EC 3.2.1.30) and beta-glucuronidase (GLR, EC 3.2.1.31), and two brush border enzymes, alanine aminopeptidase (AAP, EC 3.4.11.2) and gamma-glutamyltransferase (GGT, EC 2.3.2.2), was examined in apparently healthy individuals and in patients before and after renovascular surgery for treatment of hypertension. Eight out of nine patients had elevated levels of at least one enzyme before surgery. The ranking in their frequency of elevation was NAG greater than AAP greater than GLR greater than GGT. In comparing the release of any two enzymes in apparently healthy individuals, the release was coordinated except for GGT and GLR. In individual patients following surgery the excretion of the lysosomal enzymes was highly coordinated whereas the release of the brush border enzymes was less coordinated. Comparisons of lysosomal to brush border enzyme activities revealed dissimilar release patterns between these two classes of enzymes. Analysis of variance over the entire hospitalization period showed that NAG/GLR (p = 0.42) and AAP/GGT (p = 0.12) did not vary significantly whereas all comparisons of lysosomal to brush border enzymes varied significantly (p less than or equal to 0.03). These results indicate that enzymes derived from different subcellular organelles, lysosomes or brush borders, have similar release patterns. However, the lack of a significant correlation between lysosomal and brush border enzyme excretion implies that the two processes are not interdependent. These studies further suggest that the transient pathophysiological changes that occur within renal cells following renovascular surgery affect these cellular components in different ways.
Acetylglucosaminidase↗
The role of open stone surgery since extracorporeal shock wave lithotripsy.
Of 893 stone procedures 37 (4.1 per cent) performed during the first 19 months after extracorporeal shock wave lithotripsy was instituted at our medical center were open operations. Procedures included ureterolithotomy in 23 patients (with simultaneous pyelolithotomy in 1), anatrophic nephrolithotomy in 8, pyelolithotomy in 3 (with concomitant pyeloplasty in 2), partial nephrectomy in 2 and nephrolithotomy with a bowel segment inlay in 1. The most common reasons for electing an open operation were unsuccessful endoscopic stone manipulation, presence of anatomical obstruction in the intrarenal collecting system or ureter, morbid obesity and underlying medical problems precluding lengthy repeated endourological procedures. Over-all surgical results were excellent. Our study indicates that patients who presently require an open stone operation have complex calculous disease associated with a variety of anatomical and physiological problems. Despite this finding good results may be attained.
Adult↗
Selective elevation of urinary enzyme levels after extracorporeal shock wave lithotripsy.
Urinary enzyme testing has been used by many investigators to diagnose and monitor various types of renal injury. Three urinary enzymes, N-acetyl-beta-glucosaminidase, beta-galactosidase and gamma-glutamyl transferase were monitored in 17 patients before and after a single, unilateral extracorporeal shock wave lithotripsy treatment. Stones were in the renal pelvis or calices except for 1 treated in situ in the proximal ureter. Urine specimens were collected before extracorporeal shock wave lithotripsy and at 1, 3, 5, 7, 10, 14, 21 and 28 days after treatment. N-acetyl-beta-glucosaminidase and beta-galactosidase levels increased significantly after treatment (p less than 0.05). Gamma-glutamyl transferase levels increased after treatment but this was not statistically significant. All enzyme levels were highest on days 1 and 3 after lithotripsy and returned to baseline by day 28. Factors associated with post-treatment enzyme elevation included female sex, a lower pre-treatment creatinine clearance and stone size greater than 1 cm. These findings indicate that there is a transient selective increase in urinary enzyme excretion after extracorporeal shock wave lithotripsy.
Acetylglucosaminidase↗
Effects of shock waves on the rat ovary.
The studies reported in this paper were undertaken to investigate the effect of shock waves on ovarian function. In an initial study, five female Wistar rats underwent general anesthesia. One ovary was then exposed to 1500 shock waves at 20 kV using the Dornier XL-1 experimental lithotripter. One week following this treatment, the animals were sacrificed and both ovaries were step sectioned. We counted all follicles that contained both an oocyte and antrum. These follicles in turn were classified further as being healthy or atretic. No statistical difference in these counts was observed between shocked and unshocked ovaries taken from the same animal. In the definitive study, thirty-one adult female Wistar rats underwent unilateral oophorectomy. These rats were then divided into treated, sham-treated and control groups. The eleven treated animals were given general anesthesia and received 1500 shocks at 15 kV directed at their remaining ovary using the Dornier XL-1 lithotripter. The ten sham treated animals received identical anesthesia and duration of waterbath immersion as the treated group. In contrast, however, sham treated animals were positioned outside the path of the focused shock wave. The control group received no treatment. Normal estrus cycle was maintained in all groups following shock wave exposure. Two weeks after this exposure, all three groups of animals were allowed to mate. All animals in each of the three groups became pregnant. There was no statistical difference in litter size or fetal weights at three weeks gestation. No gross teratogenic effects were observed. The rat ovary appears to be structurally and functionally resistant to the shock wave energy levels used in this experiment.
Animals↗
Neoadjuvant treatment of stages T2 to T4 bladder cancer with cis-platinum, cyclophosphamide and doxorubicin.
In an ongoing phase II study 17 patients with potentially operable transitional cell carcinoma of the bladder (stages T2 to T4, Nx, Mo) have been treated with intravenous cis-platinum (50 mg.per m.2), cyclophosphamide (400 mg.per m.2) and doxorubicin (40 mg.per m.2). They were to receive 3 treatments at 3-week intervals before cystectomy and 2 treatments at 3-week intervals commencing 5 weeks after cystectomy. Of 17 patients 14 (82 per cent) completed all 3 preoperative treatments but only 7 (41 per cent) continued on to complete the entire 5 treatments. In most cases incomplete therapy was due to patient refusal. Toxicity was low as measured by World Health Organization standards. Of the 17 patients 9 (53 per cent) exhibited objective tumor response (pathological downstaging or greater than 50 per cent reduction of tumor volume determined by either computerized tomography scan and/or endoscopic examination. When the determination was made by endoscopy the changes were dramatic and not borderline.) No patient demonstrated a pathological complete response. All 9 of the responders (100 per cent) remain clinically free of disease at a median follow-up of 19 months (range 4 to 30 months). The 8 nonresponders have done poorly with 5 dead of disease, 1 alive with pelvic recurrence and 2 free of disease at 4 and 12 months. These tumor response rates compare favorably with other cis-platinum-based combination regimens. The response to the chemotherapy appears to be an important prognostic indicator. Phase III trials must be conducted to determine whether this neoadjuvant chemotherapy regimen has a significant effect on long-term patient survival.
Aged↗
Pediatric urology.
Development of the genital and urinary systems is interwoven. Developmental abnormalities may cause problems in both systems, although the presenting problem may be ambiguous genitalia, hypospadias, undescended testis, or a urinary tract infection. The primary care physician must understand the underlying significance of pediatric urologic problems and seek appropriate consultation in a timely manner.
Child↗
Urethrovasocutaneous fistula.
We report a case of urethrovasocutaneous fistula in an elderly man. There were several possible etiologic factors in this case including: prior vasectomy and transurethral prostatectomy, urinary tract infection, and neurogenic bladder.
Aged↗
Ureteral obstruction secondary to a vena caval clip.
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Constriction↗
Radiologic contribution to the management of patients undergoing extracorporeal shock wave lithotripsy.
Since its first clinical application in 1980, the use of extracorporeal shock wave lithotripsy (ESWL) has dramatically changed the treatment of urinary tract stone disease. More than 80% of patients with urolithiasis will undergo ESWL as a first line therapy. Detection of stones, appropriateness of ESWL treatment, successful stone therapy, termination of the ESWL procedure, and evaluation of treatment complications are all dependent on radiologic input. The application of adjuvant interventional radiologic percutaneous techniques will extend the use of ESWL to an additional 15% of patients and reduce the need for surgical intervention. Additionally, percutaneous techniques can be used to improve success rates in problematic cases and to treat complications related to the ESWL procedure. This article discusses the pre- and postprocedural radiologic evaluation of patients undergoing ESWL. Adjuvant interventional radiologic techniques useful in the management of these patients are also discussed.
Humans↗
Urinoma detected by dual isotope renogram-cystogram.
A case is reported in which a urinoma developed following a renal transplant. Dual isotope renography-cystography using Tc-99m DTPA and Ga-67 citrate revealed the diagnosis after ultrasonography and radiographic cystography were nondiagnostic.
Cysts↗
Postoperative anatrophic nephrolithotomy bleeding.
We reviewed 530 patients treated with anatrophic nephrolithotomy during a 14.5-year period. Significant postoperative renal bleeding occurred in 34 cases (6.4 per cent). The average postoperative blood transfusion requirement in this group was 5,279 cc. Bleeding patients were significantly older and they had worse renal function compared to the nonbleeding group. If bleeding did not begin immediately it usually started 5 to 8 days postoperatively. Bleeding dyscrasias were identified in 6 patients and correction allowed nonoperative management in 4. Epsilon aminocaproic acid was helpful only in the treatment of patients with slow, lower volume bleeding. Eight patients required 9 open renal explorations to control bleeding. Two arteriovenous fistulas and 1 false aneurysm were identified. An attempt at angiographic embolization of an arteriovenous fistula was unsuccessful. Only 1 patient required a nephrectomy (1 of 34 or 2.9 per cent) and there was no mortality. A treatment plan for this complication is described.
Adult↗
Pediatric anatrophic nephrolithotomy.
A 15-year experience with pediatric anatrophic nephrolithotomy was reviewed. There were 11 procedures performed in 10 patients. Average patient age was 9.43 plus or minus 1.54 years (standard error of the mean). Preoperative urine cultures were positive in 6 of 11 cases. Metabolic or structural defects were identified in all patients. Postoperative morbidity was minimal. Adequate followup was available in 9 patients, for an average length of 4.6 plus or minus 0.96 years. Stones recurred in 7 of 9 patients (78 per cent) but in 2 the new calculi were small and asymptomatic. Anatrophic nephrolithotomy can be performed safely in children but a high incidence of structural and metabolic abnormalities predisposes these patients to recurrent stones.
Adolescent↗