Biomedical subjects
Publications and source records attributed to H A Mitty.
During the last 20 years percutaneous nephrostomy has evolved as one of the basic procedures in the management of obstructive uropathy. This procedure is now widely available, it is relatively safe, and it offers rapid treatment of urinary obstruction regardless of underlying cause. Percutaneous nephrostomy is also the first step in a variety of antegrade ureteral procedures, including stent placement and ureteral dilation.
The Wallstent biliary endoprosthesis has recently been approved for treatment of malignant bile duct obstruction. Although minor changes in position have occurred, migration of these stents has been uncommon. The authors report a case in which migration occurred when stents were simultaneously deployed in the right and left bile ducts. Several mechanisms for this complication are postulated.
The so-called hypertrophic column of Bertin is a normal variation and simply represents unresorbed polar parenchyma of one or both of the two subkidneys that fuse to form a normal kidney. It contains renal cortex, pyramids, and columns (septa) of Bertin. (Since all elements of the tissue are normal, that is, neither hypertrophic nor a displaced or embryonic rest, it is referred to as "junctional parenchyma.") When a masslike lesion is suspected at sonography or excretory urography, diagnosis of junctional parenchyma can be made with a high degree of certainty when sonography shows that the structure (a) is located between the overlapping portion of two renal sinus systems, (b) is bordered by a junctional parenchymal line and defect, (c) contains renal cortex, pyramids, and columns of Bertin, and (d) contains renal cortex that is continuous with the adjacent renal cortex of the same subkidney.
Milk of calcium (MOC) in a small renal cyst or calyceal diverticulum is quite common. Ninety-one small renal cysts with MOC in 61 patients were found within a period of 4 years and 7 months. The main sonographic features are echogenic material layering in the dependent portion of a cyst, associated with reverberation echoes without shadowing. Shadowing was seen when MOC was present in larger amounts. Because MOC is usually asymptomatic and requires no treatment, differentiation from other lesions such as calculi or angiomyolipomas is important for proper patient management. MOC is detected more readily by ultrasonography than by radiography or CT.
Routine preoperative angiograms obtained in 97 consecutive patients with bone and soft-tissue tumors of the extremities were retrospectively reviewed to determine the role of angiography in surgical planning. Some degree of major vessel displacement was demonstrated in 51 patients. Encasement of major vessels, which precluded limb-salvage surgery, was seen in five of 76 bone tumors and in three of 21 soft-tissue tumors. All five patients with osteochondromas had associated vessel occlusion or compromise. For surgical planning, the demonstration of adequate anastomoses in the arches of the hands and feet is important, as branches of brachial and popliteal arteries may have to be sacrificed during limb-tumor surgery. Angiographic findings indicated or supported the need for a vascular surgeon in five cases in this series. Preoperative angiography provides important information with regard to the status of the vasculature and therefore is essential in the management of bone and soft-tissue tumors of the extremities.
Five cases of clinical stage B carcinoma of the prostate are reported. Bipedal lymphangiography showed unequivocal involvement of the pelvic nodes in 3 patients and was equivocal in the other 2. Percutaneous transabdominal fine needle aspiration biopsy of abnormal or suspicious iliac nodes was performed and a positive cytolocal diagnosis of metastasis was obtained in all 5 patients. Therefore, staging lymphadenectomy and an extensive radical operation were avoided. Percutaneous fine needle biopsy is a reliable, easy and safe technique that should be used in staging prostatic carcinoma whenever there is evidence of metastatic nodal involvement by lymphangiography.
The patterns of collateral circulation which develop following obstruction of the inferior vena cava have been classically divided into three groups depending upon the level of obstruction, i.e., infrarenal, middle caval, and upper caval. The portal vein can play an active role at all three levels. Multiple potential routes to the portal vein are described and 6 cases are presented.
Segmental tubular stasis and ectasia may be early signs of intrarenal obstruction. Case reports of 3 patients are presented. In arriving at a diagnosis, the possibility of significant underlying pathology such as calculi and neoplasm should be considered.
Sixteen patients with various lesions involving the brachiocephalic arteries were studied ultrasonographically. The examination was very useful in diagnosing aneurysms of the peripheral arteries and in differentiating an aneurysm from other causes of palpable pulsatile masses, such as a tortuous artery and tumor beneath an artery. The ultrasound technique used for evaluation of these lesions is described.
Transhepatic catheterization of the portal system was performed to obtain blood for RIA of insulin. This technique localized insulinomas in two patients after negative celiac, superior mesenteric, and subselective gastroduodenal arteriograms. The tumors were found in the predicted locations at surgery.
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Gray-scale B-scan was successful in delineating adrenal masses in 40 patients, all confirmed pathologically. Two patients with extra-adrenal pheochromocytomas, two calcified cysts, and two patients with bilateral adrenal hyperplasia are demonstrated. The usual ultrasonographic features are presented in this paper; they correlated well with urographic, angiographic, CT, and pathological findings. The smallest mass demonstrated was an aldosteronoma (1.3 cm in size).
Forty patients with pathologically-proved adrenal masses, and two patients with extra-adrenal pheochromocytomas, were examined with gray scale B-scan. The authors describe unusual echo patterns of adrenal masses due to necrosis or hemorrhage, variations in the effects of large adrenal masses on surrounding organs and vessels, and the differential diagnosis. The complementary role of computed tomography is also discussed.
Pain associated with a large hemangioma of the thigh was relieved by embolization of a portion of the lesion with Gelfoam. The branch to be occluded was selected when the distribution of the heat associated with the injection of contrast material corresponded to the distribution of the patient's pain.
The calcification which may follow renal vein thrombosis (RVT) has a virtually diagnostic radiographic pattern. Previous examples have been noted mainly in follow-up examinations of infants with a history of neonatal RVT. The case reported herein, with pathologic confirmation, illustrates that such calcification may be present even on the first day of life as a result of RVT occurring in utero.
The cobra-shaped distal ureter is not pathognomonic of a ureterocele. It may be seen with incomplete distal ureteral obstruction owing to tumor or calculus. The appearance of the wall surrounding the dilated distal ureteral segment is a more important finding to differentiate a ureterocele and a pseudoureterocele. The wall of a ureterocele is thin, while the lucency surrounding a pseudoureterocele is thicker and poorly defined.
Hyperfunctioning non-neoplastic adrenal glands may be associated with Cushing's syndrome, congenital adrenal hyperplasia, and aldosteronism. The problems in radiographic diagnosis may be resolved by correlation of the angiogram with the clinical and laboratory findings.
Gray scale B-scans in renal sinus lipomatosis show a variety of features which must be differentiated from clinically significant pathological processes. Normal kidneys show dense homogeneous central echoes. In renal sinus lipomatosis, however, the central echoes are divided and become more sparse (Type I), interspersed with small relatively echo-free areas (Type II), or outline a single relatively echo-free area resembling a mass (Type III). In contrast to similar features in hydronephrosis or multiple cysts, the relatively echo-free areas in lipomatosis are ill-defined and do present several weak internal echoes.