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Biomedical subjects

E K Lang

Publications and source records attributed to E K Lang.

At least 55 records · Page 3Linked to original sources
PubMed1986

Management of urinomas by percutaneous drainage procedures.

The etiology and pathogenesis of urinomas are discussed. Different treatment protocols to correct the underlying cause are outlined, such as drainage by percutaneous nephrostomy or placement of a stent across a ureteral defect to promote drainage of urine from the kidney into the bladder as well as drainage of the urinoma by appropriately positioned catheters. Monitoring of renal function by means of radionuclide studies assessing plasma flow rate is advocated to ascertain effectiveness of management. Follow-up CT scans are used to affirm satisfactory resolution of the urinoma.

Cysts↗
PubMed1986

Transluminal dilatation of ureteropelvic junction strictures, ureteral strictures, and strictures at ureteroneocystostomy sites.

Ureteral strictures are categorized by age, etiology, location, and length of stricture. On the basis of history, the status of vascular perfusion of the involved ureteral segment and possible presence of devitalization are projected. Transluminal dilatation of ureteral strictures can be performed via a retrograde or antegrade approach. The age of the stricture and status of vascular supply to the involved and adjacent segments of the ureter are the most critical criteria influencing long-term results of transluminal dilatation. The technique of bougie dilatation and placement of balloons across strictures at various sites is discussed. The advantages of bougie versus balloon dilatation and the need for postdilatation stenting to preclude restricturing are analyzed. In fresh strictures, not complicated by devascularization, a 90 per cent salutary response to transluminal dilatation can be anticipated, regardless of location of the stricture, ureteroneocystostomy, or ureteroileostomy. Most poor results of transluminal dilatation occur in strictures compromised by severe devascularization attendant to surgical procedures, radiation therapy, fulminating inflammatory processes, neoplasms, or any combination of these. Decompression and drainage of the kidney by an internalized stent are advocated for the treatment of strictures caused by recurrent and uncontrolled neoplasm.

Dilatation↗
PubMed1985

Renal trauma: radiological studies. Comparison of urography, computed tomography, angiography, and radionuclide studies.

Excretory urography, computed radionuclide urography, angiography, and both conventional and dynamic computed tomography (CT) were compared with regard to accuracy, sensitivity, and specificity in 388 patients with renal trauma. Used as the triage examination, urography established the absence of significant renal injury with an accuracy of 87%, obviating further evaluation. Dynamic CT proved to be the best method of assessing parenchymal injuries, establishing the correct diagnosis in 129 out of 130 cases compared to 116/130 for conventional CT. Angiography was the procedure of choice for diagnosis and categorization of renal artery injuries, which were diagnosed correctly in all 43 cases. The choice between dynamic CT and angiography as the second examination rests upon careful evaluation of clinical and urographic findings for signs of renal artery injury which would mandate angiographic assessment.

Adolescent↗
PubMed1985

Streptokinase therapy: complications of intra-arterial use.

An inordinately high rate of renal complications was encountered among 35 patients treated for thrombotic or thromboembolic occlusion of the leg by injection of streptokinase into a bypass graft or native artery. Five patients demonstrated massive myoglobinuria following restoration of flow to ischemic and necrotic tissues; acute tubular necrosis developed in 2 of them, and 1 patient died as a result of renal shutdown, electrolyte imbalance, hypofibrinogenemia, and mediastinal and retroperitoneal hemorrhage. Massive myoglobinuria was also noted in 5 out of 13 patients with compartment syndrome but no evidence of ischemic necrosis. This complication could be lessened by fasciotomy and resection of the upper third of the fibula. Although myoglobinuria and complications such as acute tubular necrosis are only rarely reported, they are not unexpected following muscular ischemia. Attempts to salvage irreparably damaged tissues by re-establishing circulation appear to carry an unacceptably high risk of renal complications and may even threaten the life of the patient.

Adult↗
PubMed1984

Comparison of dynamic and conventional computed tomography, angiography, and ultrasonography in the staging of renal cell carcinoma.

A prospective study was carried out on 22 patients to assess the diagnostic ability to stage renal cell carcinoma by computed tomography, dynamic computed tomography, arteriography, ultrasonography, and radionuclide scanning. Dynamic computed tomography remedied the most consequential diagnostic shortcomings of conventional computed tomography and proved the most sensitive, specific, and accurate technique for staging of all types of contiguous extension of renal cell carcinoma. For the identification of bone metastases, radionuclide scintiscanograms were found most accurate and cost-effective.

Angiography↗
PubMed1984

Angio-computed tomography and dynamic computed tomography in staging of renal cell carcinoma.

Dynamic computed tomography and angio-tomography combine criteria generated by CT with those of angiography and are advocated by the author to improve staging of renal cell carcinoma. Dynamic CT was performed in 29 patients and angio-CT in 12 patients in this group. Rapid acquisition of data permits generation of a CT section in intervals of 1 to 6 seconds, which in turn reflects arterial, capillary, and venous transit of contrast medium through tissues. The propensity for dense enhancement of renal cell carcinoma makes possible positive identification of tumor elements. This feature proved accurate for the assessment of local extension of renal neoplasms in all 29 patients, involvement of the renal vein by tumor in 9/10, involvement of the inferior vena cava by tumor in 6/6, and involvement of regional nodes by tumor in 6/8.

Adenocarcinoma↗
PubMed1984

Antegrade ureteral stenting for dehiscence, strictures, and fistulae.

Percutaneous placement of ureteral stents is advocated as an attractive alternative to surgical procedures in the management of some ureteral dehiscence, strictures, and inflammatory ureteral fistulae. In 50 patients with partial dehiscence or fistulae, a stent could be placed percutaneously in 41. The method achieved a salvage rate of renal function (30 cases [60%]) similar to that of open surgical correction. Hospitalization time and costs, however, were far less. The method proved particularly successful (nine of 10 cases) for correction of pelvic ureters severed from the bladder during pelvic surgery, dehiscence of ureteroneocystostomies into boari flaps, and traumatic severance of the upper and mid ureters. The method is also highly recommended for the management of strictures occurring at ureteroileostomy sites and at the ureteroneocystostomy site of cadaver transplant kidneys. Although the ultimate salvage of renal function is lower than in the above-described conditions, the relative ease of placing percutaneous stent catheters across such strictures in comparison with highly complex surgical salvage procedures necessary to correct these conditions makes the former the first choice.

Humans↗
PubMed1984

Pulmonary manifestations of renal disease.

Many renal diseases have varied pulmonary manifestations. A pattern-recognition approach coupled with pertinent clinical findings can often lead to diagnosis of a specific disease entity. In this article, an attempt is made to categorize pulmonary manifestations of renal disease and to assign them to groups of customarily used recognition patterns as presented on chest radiographs.

Adenocarcinoma↗
PubMed1984

Transcatheter embolization of renal tumors with I-125 particles.

Remarkably improved survival rates are reported in patients treated for advanced stage renal cell carcinoma by 125I interstitial infarct implant (2y = 50%, 5y = 37% survival). The interstitial implants are seated by transcatheter embolization. The salutory results particularly in patients treated for advanced stage primary lesions and bone metastases suggest the added impact of improved host immune response. The method is recommended for the management of nonresectable neoplasms, neoplasms in a solitary kidney, in patients with medical contraindications to surgical management and to convert unresectable neoplasms into resectable ones.

Bone Neoplasms↗
PubMed1983

Work in progress: transcatheter embolization of renal cell carcinoma with radioactive infarct particles.

Treatment by radioactive infarct implant is advocated for patients who have renal cell carcinoma with distant metastases. The radioactive infarct implants were placed into the primary tumor, and when feasible into metastases, by transcatheter embolization. Metastases to the skeleton, liver, lungs, adrenals, and retroperitoneal muscles were also seeded; metastases to the central nervous system, pancreas, and spleen, as well as most pulmonary metastases, proved inaccessible to this approach. The effectiveness of this treatment modality was shown by improved cumulative survival rates (59% for patients with metastases and at risk at two years and 50% for those at risk at five years). The best results were obtained when treating patients who had skeletal metastases (90% survival of those at risk at two years and 60% at five years). Measurable palliation factors, such as decrease in the size of the primary lesion, weight gain, and control of bleeding and pain, were indicators of treatment response and were observed in the majority of patients. Remissions were signaled by weight gain, normalization of the erythrocyte sedimentation rate, and disappearance or decrease of tumor markers. Some evidence suggests that the salutary results may be based on significant reduction of tumor burden, temporary local control of tumor, and improved general immunocompetence.

Adenocarcinoma↗
PubMed1983

Redefinitions of indications for percutaneous nephrostomy.

An analysis of treatment response in 215 patients treated by percutaneous nephrostomy identified obstruction of the urinary tract, complicated by infection and sometimes gram-negative septicemia, as the single most important indication for this intervention. Percutaneous nephrostomy reduced the mortality from gram-negative septicemia from 40% to 8%. Similarly, the length of hospitalization for patients with severe infection complicating urinary tract obstruction was reduced by half in the group undergoing percutaneous nephrostomy. In 43 patients with longstanding obstruction, percutaneous nephrostomy was used to predict recoverable renal function based on the response of renal plasma flow rate to decompression. In 13 patients, percutaneous nephrostomies were used either for the introduction of solvents to dissolve calculi or to serve as pathways for their extraction. Percutaneous nephrostomies in 21 patients were expanded to serve as points of entry for the placement of stent catheters to treat fistulas or bougie catheters to dilate and subsequently catheterize ureteral strictures. While six serious complications were encountered, five of these might have been prevented by meticulous adherence to proper technique.

Emergencies↗
PubMed1981

Transcatheter embolization of advanced renal cell carcinoma with radioactive seeds.

Advanced renal cell carcinoma was treated by transcatheter embolization with radioactive seeds. There were 14 patients with nonresectable or metastatic disease (stage IV) and 8 with stage II tumors treated. In 8 patients the tumor was implanted with radon seeds, complemented by 2,500 rad of external beam therapy, and 10 were treated by embolization with 125iodine seeds. The total dose delivered ranged form 1,600 to 14,000 rad. Several patients also had intra-arterial chemotherapy. Survival was improved over previously reported studies: 13 of 22 (59 per cent) at risk for 2 years and 5 of 15 (33 per cent) for 5 years. Distant metastases did not resolve but significant local palliation was achieved. Tumor size decreased in all patients, 8 of whom subsequently underwent nephrectomy. Other local effects included pain control (10 per cent), weight gain (75 per cent) and control of hemorrhage (88 per cent). Toxicity was minimal and consisted of mild nausea or pain. This approach, using a low energy emitter, allows selective high dose radiation of the tumor, while sparing the adjacent normal tissues. In contrast to renal artery occlusion with inert embolic material, subsequent nephrectomy in patients with disseminated disease is not necessary. Transcatheter embolization with radioactive seeds should be considered a reasonable palliative procedure in patients with nonresectable primary renal cell carcinoma.

Adenocarcinoma↗
PubMed1981

The incidence of contrast medium induced acute tubular necrosis following arteriography.

Twenty-one patients slated for high-dose arteriography were studied to investigate the impact of predisposing medical conditions upon contrast medium induced acute renal failure. The study suggests that predisposing medical conditions are the most important factor determining the incidence of acute renal failure and the probability, speed, and degree of recovery of renal function. Patients with diabetes mellitus incur the highest risk of contrast medium induced acute renal failure. A dose relationship is also suggested. Contrast medium doses containing more than 100 g of iodine uniformly produced acute tubular necrosis in patients with predisposing medical conditions. Conversely, contrast medium doses containing less than 80 g of iodine produced clinically manifest acute renal failure in only one of 14 patients with predisposing medical conditions. Subclinical levels of acute renal failure were recognized in a large number of patients by routine measurement of radionuclide filtration fractions, serum creatinine levels, and urine osmolality and sodium concentration.

Acute Kidney Injury↗