Policy on monitoring and reporting results.
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Biomedical subjects
Publications and source records attributed to E Mazeman.
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Investigations in a patient with a multilocular cyst of kidney included urography, ultrasonography and computed tomography. Urography images showed a mass occupying the lower half of the left kidney with a lacunar image of pelvis, the association of these two elements suggesting a possible cancer of kidney. Ultrasound and computed tomography imaging demonstrated the fluid nature of the mass with absent partitioning. Findings were compared with data from the pathologic specimen which showed a main unilocular cyst with multiple satellite smaller cysts and a thick intrapyelic formation composed of microcystic aggregates. Pre-operative diagnosis of multilocular cyst was assisted by the use of modern imaging techniques: ultrasound and CT scan, which demonstrated a partitioned renal cystic lesion. Diagnosis is still difficult in atypical forms, however, and the relative frequency of an intrapyelic cyst protrusion is emphasized.
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Results and diagnostic value of computed tomography and ultrasound imaging in subcapsular hematoma of the kidney are discussed in relation to data from 9 cases. A positive diagnosis could be made in each case from CT scan images, but results of ultrasonography were less evident. An etiological diagnosis is difficult to establish and extreme caution is recommended before excluding a tumoral lesion, even in patients developing hematomas during anticoagulant treatment. Arteriography remains a valid examination since analysis of a large subcapsular hematoma by a CT scan is often risky, and a small cortical tumor may remain undetected.
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Pyelomanometry can be used in cases of ambiguous dilatation, to measure the pressure in the upper urinary tract during constant-flow perfusion through a percutaneous catheter (Whitaker's test). After recalling the principles of this method, and the technical procedure, the authors go on to discuss twenty six cases, analyzing the results, and comparing the advantages of this procedure with other methods of exploration.
Steroid therapy has been used as a treatment for idiopathic retroperitoneal fibrosis for the past ten years and more. In 14 out of a series of 19 patients, this treatment was well-tolerated and successful. It acts quickly. The results of medical treatment compare favorably with those of surgical ureterolysis. In the authors' view, steroid therapy is therefore the treatment of choice for this complaint, and surgical management should be confined to the relatively rare setbacks of medical treatment, and to patients who do not tolerate steroids.
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The authors report 3 cases of haematic cysts of the adrenal, discovered in young adults (3 female), presenting with lumbar or lumbo-abdominal pain, sometimes violent, and accompanied by fever. In each cases there was a palpable swelling in the hypochondrium and lumbar fossa. In two cases severe anaemia reflected the amount of haemorrhage which had taken place. IVU with a prolonged vascular nephrotomography time with several views and echotomography confirmed the diagnosis, avoiding the need for aortography whenever possible. The size of the cysts was such that adrenalectomy was necessary in two cases and the extent of adhesions required simultaneous nephrectomy. This is followed by a review of the literature, the dominant features being: the prevalence of haematic cysts which account for 40% of adrenal cysts, the absence of specificity of clinical symptoms and signs and the importance of radiological examinations, and finally the usual absence of any cause even though trauma may sometimes be possible.
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Renal angiomyolipomas are benign mesenchymal tumours. Whether isolated or associated with phacomatosis, they are histologically identical, but it is often difficult to distinguish an isolated angiomyolipoma from renal cancer. When it is combined with phacomatosis, it is frequently bilateral and can provoke retroperitoneal haemorrhages. These peculiarities qualify the therapeutical management which would a priori be conservative in the case of a benign tumour.