Biomedical subjects
Publications and source records attributed to P Fritzsche.
Antegrade pyelography is a diagnostic examination that is easily converted for therapy in the urinary tract. The applications of the antegrade approach discussed in this article include drainage in obstruction and fistulas, access for manipulations, and topical treatment.
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Unsuspected upper extremity venous thrombosis was observed in three patients undergoing excretory urography. Thoraco-abdominal collateral vessels were readily visible following an intravenous bolus injection of contrast material into a vein in the affected extremity. The increased incidence of upper extremity venous thrombosis is probably due to the frequent use of subclavian vein catheterization for parenteral nutrition, central venous monitoring, and cardiac pacing. The collateral pathways are characteristic and can easily be recognized.
The radiologic findings in 21 cases of renal lymphoma were correlated with the gross and microscopic pathologic findings. The gross morphology and consequent radiographic images depend upon the mechanism of renal involvement (hematogenous or direct extension); the pattern of intrarenal growth (interstitial or expansile); the size, number, and distribution of lesions; and the presence of extension beyond the kidney. Initially, the lymphoma grows between nephrons that may continue to function and, because this interstitial proliferation preserves gross morphology, radiographic detection may be difficult. With continued growth, the scaffolding along which the tumor infiltrates is destroyed, growth becomes expansile, and the lymphomatous mass resembles other renal neoplasms that enlarge by appositional growth. Continued growth and coalescence of small foci result in progressive parenchymal replacement and, rarely, in destruction of the entire kidney. Perinephric extension with subsequent vascular and ureteral encasement is common.
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A technique is described using angiographic guide wires and catheters in combination with endoscopy. Obstruction of 9 ureters in 7 patients was managed successfully with this technique. The ureters in these cases were inaccessible otherwise because of unusual ureteral position or severity of obstruction. The method allows placement of angiographic guide wires and catheters past ureteral obstacles when standard urological retrograde procedures are not feasible technically.
Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.
Inflammatory effusions and diffuse neoplasia in the fatty retroperitoneal space, which can alter the perirenal fat, can be recognized radiographically because of density differences. The opacity of fluid and tumor accentuates the remaining fat which conforms to the renal contour. This perirenal fatty border appears as a lucent strip when the perirenal fat is not violated and as abnormal perirenal streakiness when the perirenal fat is infiltrated by fluid or tumor. Six cases are described.
Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95 per cent of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81 per cent of the cases. Serum creatinine was unchanged or decreased in 75.7 per cent and the pyelogram was unchanged or showed decreased dilatation in 84.6 per cent of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5 per cent) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.
Ultrasound followed by aortography, if necessary, has been a useful approach in the diagnosis of suspected renal agenesis.
Percutaneous transcatheter arterial embolization was used to manage renal hemorrhage secondary to an angiomyolipoma in a solitary kidney. Angiography 3 months after the embolization showed a marked decrease in the mass and vascularity. There was no evidence of hypertension or renal failure following embolization.
Cases of adrenal and renal cell carcinoma were reviewed to evaluate vascular origin and architecture. All 9 cases of adrenal carcinoma showed fine, sparse neovascularity. Coarse or at least extensive, neovascularity was demonstrated in 40 of 45 cases of renal cell carcinoma. An analysis of the angiographic features correlated with the known anatomical variations will nearly always enable one to ascertain the origin of the tumor.
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A long-term retrospective evaluation was done on the preoperative and postoperative radiographic studies from patients who had undergone the ileal ureter operation. The comparative studies demonstrated decreased or stable pelviocaliceal dilatation, no measurable parenchymal loss, frequent high pressure vesico-ileac reflux and decreased number of renal calculi. Radiographically there was no evidence of renal morphological deterioration.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.