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Biomedical subjects

H M Pollack

Publications and source records attributed to H M Pollack.

At least 73 records · Page 4Linked to original sources
PubMed1987

Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation.

Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients. In three (6%) patients small subcapsular fluid collections of uncertain cause were seen. Treated kidneys showed a statistically significant mean increase in size (9%) after ESWL, as measured at the axial level of the major stone fragment. Perinephric soft-tissue stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae, with the changes ranging from mild to severe. The authors conclude that while most patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure appears to be associated with a low frequency of serious renal trauma.

Adult↗
PubMed1987

Prostatic disorders: MR imaging at 1.5 T.

Pelvic magnetic resonance (MR) images obtained at 1.5 T of 31 men with known genitourinary disease were reviewed retrospectively. In most, peripheral and central prostatic zones could be seen on axial images obtained with long repetition times/echo times (TRs/TEs). The prostate had no specific signal intensity that enabled differentiation between benign and malignant changes. Each patient with known extracapsular prostatic carcinoma had a peripheral zone defect--1 cm or greater in diameter with ill-defined borders and relatively lower signal intensity than that of the remainder of the peripheral zone--that correlated with the site of clinical-pathologic involvement. Correlation of a peripheral zone defect on long TR/TE images as a sign for extracapsular spread of prostatic cancer was 100% sensitive, yet 54% specific, with excellent interobserver agreement. Stage A2 and B1 prostatic carcinoma was not detected. Benign prostatic hyperplasia was seen as centrally located proliferation and nodularity, usually with discrete margins and a wide spectrum of low- to high-signal-intensity features. MR imaging may have a role in differentiating between intracapsular and extracapsular prostatic carcinoma.

Adult↗
PubMed1987

Normal prostate and adjacent structures: MR imaging at 1.5 T.

Pelvic magnetic resonance images obtained at 1.5 T of 29 male patients with no known genitourinary tract disease were retrospectively reviewed. Normal anatomic features of the prostate and its adjacent structures were studied with spin echo techniques with short and long repetition times/echo times (TR/TE). Long TR/TE (T2-weighted) images routinely showed differentiation of peripheral and central prostatic zones, as well as a separate periprostatic venous plexus. Guidelines were developed to optimize imaging of the relationship of the prostate to adjacent structures.

Adult↗
PubMed1987

Interstitial emphysema associated with epidural anesthesia for extracorporeal shock-wave lithotripsy.

Interstitial emphysema was noted on abdominal radiographs in 38 (15%) of the first 150 patients treated by extracorporeal shock-wave lithotripsy at our hospital. All 38 patients had undergone successful or attempted epidural anesthesia for the lithotripsy. This finding was not seen in any patient who had not undergone epidural puncture. The emphysema is the result of the introduction of air into the paraspinal and back muscles or subcutaneous tissues during attempted or actual puncture of the epidural space. This air was apparent on abdominal radiographs taken after lumbar puncture in 38 (23%) of 167 patients who underwent attempted or actual puncture of the epidural space. The emphysema decreases over the ensuing days, is of no clinical significance, and bears no direct relationship to extracorporeal shock-wave lithotripsy. This finding should not be mistaken for emphysema caused by gas-producing or gas-containing retroperitoneal diseases.

Anesthesia, Epidural↗
PubMed1986

Cystic renal mass evaluation: real-time versus static imaging.

Fifty consecutive cystic renal masses in 43 patients were evaluated by both static scanning and real-time scanning techniques. Various parameters were evaluated and compared to ascertain whether the strict static scan cystic criteria were always present in comparable real-time evaluations. Four (8%) of the 50 masses were not classic cysts on real-time examinations, although the criteria were present on the static scans. Two had minimal acoustic enhancement and two had low-intensity internal echoes. Possible reasons for this difference were detailed and discussed. The potential problems in this observation were enumerated. Based on these observations, in certain cases when a cystic renal mass demonstrates poor acoustic enhancement or low-level internal echoes in real-time examination, static scanning may be helpful and may obviate the need for further studies.

Diagnosis, Differential↗
PubMed1986

Magnetic resonance imaging of the adrenal glands.

Applications of nuclear magnetic resonance (NMR) to the adrenal gland have received considerable attention in recent years. Using high field strength magnets and surface coil technology, images of normal and abnormal adrenal glands have been obtained that compare favorably, and in some instances excel, computed tomography (CT) with respect to both image quality and, to a greater degree, differentiation of pathology. This article reviews the current state of magnetic resonance (MR) imaging of normal and abnormal adrenal glands, compares MR with CT imaging, and indicates where NMR spectroscopy has been of greatest value to date in the study of adrenal gland disease.

Adenoma↗
PubMed1986

Computed tomography in the diagnosis of renal pseudotumors.

If the initial evaluation of the urinary tract raises the possibility of renal mass, one must decide what study or studies to perform to confirm or deny its presence. Radionuclide imaging has been the study of choice in this situation. Six cases are presented in which computed tomography definitively demonstrated that a suspicious renal mass represented normal renal parenchyma. Comparison with other renal imaging modalities is discussed.

Adult↗
PubMed1986

Upper urinary tract calculi: extrusion into perinephric and periureteric tissues during percutaneous management.

While the goal of percutaneous management of renal and ureteral calculi is stone extraction or disintegration, perforation of the renal pelvis or ureter may allow stones or stone fragments to become extruded during endourologic manipulations. The authors have encountered six such patients: two with renal and four with ureteral calculi. Three stones were extruded into the perinephric or periureteric tissues during nephroscopy, two during attempted dislodgement with a balloon catheter, and one during antegrade passage of a ureteral catheter. All patients were managed conservatively by means of nephrostomy drainage and, in the four cases of ureteral laceration, ureteral stenting. Follow-up study, ranging from 12 to 24 months, has documented a benign clinical and radiological course. No ureteral strictures have ensued. In the absence of infected urine, urothelial laceration with calculus extrusion appears to be a benign occurrence and may be managed conservatively.

Adult↗
PubMed1986

Extracorporeal shock wave lithotripsy and the radiologist.

When a hospital acquires a lithotripter it is unlikely that the volume of interventional radiology performed by personnel in that institution will be reduced. On the contrary, a significant increase in workload will probably occur. This will encompass not only interventional procedures on the urinary tract, but will also involve abdominal radiographs, excretory urograms, and so forth. Additional demands on the radiology department in the form of space, equipment, and possibly technical personnel will go hand in hand with an increase in the professional responsibilities of the attending radiologists. Radiologists must prepare themselves and their departments to meet these new responsibilities so that high standards of patient care can be maintained.

Humans↗
PubMed1986

Selected endourologic techniques.

Specialized interventional radiologic techniques of use in the kidney and ureter are described in this article. Access via an antegrade percutaneous nephrostomy or in the retrograde direction via the urethra is considered. The use of sheaths and other specialized instruments is explained, as are ureteral manipulations as an adjunct to extracorporeal shock-wave lithotripsy. Interventional techniques used in the urethra and bladder are described.

Dilatation↗
PubMed1985

Bullet colic.

Ureteral obstruction by intramural bullet, buckshot, or related missle following penetrating abdominal trauma is rare; a search of the literature revealed only 4 previously described cases [1-4]. A fifth case of a bullet migrating from the renal pelvis to the ureter has been reported at autopsy [5]. We present 2 new cases of delayed symptomatic ureteral obstruction ("bullet colic") after abdominal gunshot wounds.

Abdominal Injuries↗
PubMed1985

New self-developing film for intraoperative renal stone localization.

The use of intraoperative radiography for localization of small renal calculi has been a valuable adjunct to surgery. Unfortunately, because of the considerable time required for mobilization of the kidney, the development of x-ray films and the not infrequent need for repeat exposures, considerable time can be added to the operation. We have found that the use of Polaroid film can give high-quality intraoperative radiographs. The main advantage of Polaroid film over the standard Kodak kidney film is that the film is developed in the operative suite and, in most cases, requires less than one minute.

Humans↗
PubMed1985

Self-limiting extravasation in the unused urinary bladder.

Patients being evaluated as potential renal transplant recipients routinely undergo voiding cystourethrography. Eight patients were encountered in whom extraperitoneal extravasation was noted from the region of the ureterovesical junction during voiding (seven patients) or during filling (one patient). Extravasation was bilateral in six patients and unilateral in two. The patients neither experienced symptoms related to the extravasation, required treatment, nor had sequelae. Five of the eight patients have subsequently received renal transplants and their bladders were observed to be normal at surgery. Cystoscopy was also performed in two of these five patients and was unremarkable. After transplantation, these patients' bladders functioned normally and gave rise to no symptoms.

Adult↗
PubMed1985

Technical refinements in percutaneous nephroureterolithotomy.

Percutaneous nephrostolithotomy and ureterolithotomy is now widely accepted as the preferred method of managing symptomatic upper urinary tract calculi. The success of these procedures depends on an optimally oriented, percutaneously established nephrocutaneous track. These nephrostomies are often technically difficult if the collecting system is unobstructed or if calculi interfere with percutaneous manipulations. Several technical refinements have been developed that have aided in the performance of over 200 such nephrostomies as well as percutaneous ureterolithotomy. These include the use of externally applied abdominal compression to distend the collecting system after intravenous administration of contrast material for renal puncture, distend the ureter beyond an obstructing ureteral calculus to aid in percutaneous extraction, and relocate ptotic kidneys back into the renal fossa to optimize renal access; targeting on an opaque caliceal calculus for nephrostomy puncture; use of a saline flush to confirm proper nephrostomy needle placement; and an accelerated method of track dilatation with semirigid fascial dilators. The value of air as contrast for postprocedural nephrostography is also discussed.

Dilatation↗
PubMed1985

Current status of excretory urography. A premature epitaph?

Although there can be no doubt that the once lofty stature of the IVU in clinical urology has been gradually eroded by many forces, the study still retains an important place in urologic diagnosis. In spite of inroads made by CT, ultra-sonography, radionuclide scans, and other modalities, there is still diagnostic information that is best supplied by the IVU. It appears safe to say that the IVU will be with us for many years to come. Indeed, it seems fair to add that the practice of urology and uroradiology would be very difficult without it.

Adult↗
PubMed1984

Percutaneous extraction of upper urinary tract calculi.

Renal calculi less than 8-9 mm in diameter and ureteral calculi of various sizes can be removed intact using fluoroscopic guidance without the need for endoscopy. Advantages of percutaneous stone extraction include a shorter hospital stay, decreased cost, and avoidance of general anesthesia. When compared with fragmentation techniques, percutaneous extraction appears to be the treatment of choice for urinary tract calculi amenable to this technique.

Anesthesia↗
PubMed1984

Renal hemangiopericytoma: surgical, radiological and pathological implications.

The first case of renal hemangiopericytoma presenting radiologically as a hypovascular mass is described. Preoperative diagnostic evaluation included ultrasonography, retrograde pyeloureterography, computerized tomography and angiography. Electron microscopy is helpful to distinguish this lesion from histologically similar juxtaglomerular cell tumors. Although renal hemangiopericytoma may appear benign on pathological examination it should be treated as a low grade malignancy and followed carefully.

Hemangiopericytoma↗