Paediatric isotope-renographic observations in upper urinary tract obstruction.
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Radiolucent filling defects within the renal pelvis are common findings in diagnositc urography, and because of their myriad causes the diagnostician is often faced with a challenging problem. Several of the more unusual causes of renal pelvis filling defects are described and their diagnosis, pathophysiology, and therapy discussed.
Milk-of-calcium stone is a rare finding in the kidney. It is diagnosed radiologically based on the fact that the opacity takes a semilunar shape and layers according to the position of the patient. An unusual observations is that layering may require some time to take place and that the semilunar configuration may be found incidentally in the supine position as well.
A case of pyeloureteritis cystica is presented. The incidental findings of an episode of hypertension focused attention on the urinary system. Urologic evaluation concluded a suspicious renal mass. The diagnosis was established only after histologic studies of the surgical specimen.
A case of chronic follicular pyeloureteritis is presented. This rare lesion, not previously published in the American literature, must be differentiated from primary renal lymphoma and generalized malignant lymphoma of the nonHodgkin type.
In 4 patients with cutaneous urinary diversion who underwent percutaneous ureteral stone removal, similar ureteral complications developed as a result of severe ureteritis at the site of the stone. Ureteral narrowing occurred within days of percutaneous ureteral stone removal, progressing to complete occlusion in 2 cases. These complications led to prolonged hospitalization and additional procedures for each patient. One patient with an occluded ureter was lost to followup. Two patients responded satisfactorily to repeated ureteral dilations and prolonged stenting. One patient underwent excision of the affected ureteral segment. The average interval between tube placement and removal of tubes and stents was 15 weeks in 4 patients. The average inpatient period was 24 days. Patients with a cutaneous urinary conduit diversion may be at increased risk for complications following percutaneous treatment of ureteral stones. This risk may be secondary to an intense inflammatory response due to infection and other local factors.
The surface of the bladder is lined by a layer of sulfonated glycosaminoglycans, of which the nonspecific anti-adherence effect is reproduced by synthetic sulfonated glycosaminoglycans. This mucous layer appears to be the most important line of defense between the transitional cells and all harmful substances in the urine. Many disease states may be associated with a deficiency in the anti-adherence activity of the glycosaminoglycan layer and may benefit from treatment with synthetic glycosaminoglycans. One such disease is interstitial cystitis. We administered oral sodium pentosanpolysulfate (Elmiron), a synthetic analogue of a sulfonated glycosaminoglycan, to 24 patients with interstitial cystitis. Within 4 to 8 weeks of initiation of treatment 20 patients experienced a decrease of at least 80 per cent in pain, urgency and nocturia, and 2 experienced a 50 to 80 per cent decrease in these symptoms. The 22 patients who responded continue to experience progressive improvement with time.
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A case is reported of ureteral obstruction that was owing to eosinophilic pyeloureteritis, a previously unrecorded entity. The microscopic findings of extensive fibrosis and a relatively mild eosinophilic infiltrate were similar to those found in a series of eosinophilic cystitis, which was reported recently from this laboratory. Also, local injury appears to initiate some examples of eosinophilic cystitis and in the present case there was a striking history of injury 1 month before the symptoms of ureteral obstruction.
The etiology of pyeloureteritis cystica has long been attributed to chronic infection and inflammation. A case is presented that is unique in that the acute onset and the rapid resolution of pyeloureteral filling defects in this patient were documented by radiography. There is no evidence of antecedent or concurrent infection in this patient. The disease occurred subsequent to the initiation of heparin therapy for suspected pelvic thrombophlebitis and cleared rapidly subsequent to its discontinuation. The rate of resolution of the radiographic findings may be helpful in distinguishing between true pyeloureteritis cystica and submucosal hemorrhage.
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