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[The posterior interparietoperitoneal spaces or retroperitoneal spaces. 1: Normal topographic anatomy].

The posterior spaces between the wall and peritoneum or extraperitoneal spaces are located between the visceral retrocolic and retro-duodenopancreatic fascias anteriorly and the parietalis fascia posteriorly. They were studied using an anatomic and computed tomographic comparison. The propria fascia (lateroconal fascia) divided into the anterior and posterior layers of the perirenal fascia. The fascias delimitate two anterior and posterior pararenal spaces around the kidney compartment and two anterior and posterior perirenal spaces in the compartment itself. These spaces extended above and below the renal compartment from the diaphragm to the pelvis. These large spaces composed of fat and organs can assume the guided migration of pathologic processes or their spread according to the importance of the fascias barriers. They below to the genito-urinary region. The extraperitoneal spaces are related anteriorly to the retroperitoneal alimentary organs: duodenum, pancreas, ascending and descending colon depending of the alimentary region. They are related posteriorly with the abdominal wall and its own fat. The individuality and the interdependance of these three territories (alimentary, genito-urinary and abdominal wall) and their consequences for pathologic CT scan imaging will be discussed in the second part of this paper.

Humans

[Computed tomographic anatomy of the kidneys and the retroperitoneal space].

The authors described the anatomy of the kidneys and retroperitoneal space in health on the basis of CT of 90 patients. Five typical levels in CT (ensuring all necessary data on roentgenomorphological traits of the kidneys and retroperitoneal space in the kidney area) were singled out. Some roentgenometric data on kidney cross-sections as well as the quantitative densitometric characterization of the parenchyma of the kidneys, renal sinus and adjacent tissues were presented. X-ray anatomy of the renal fascia, pararenal space and perirenal fatty space of the kidney with different parts of the retroperitoneal space was described.

Adult

[A case of hamartoma of the retroperitoneal space].

A case of hamartoma of the retroperitoneal space in a 59-year-old woman is reported. Excretory urography, computed tomography and adrenal angiography revealed a tumor with multiple calcification in the left retroperitoneal space. The tumor measuring 6.5 by 3.5 cm, and weighing 30 gm, was removed operatively. Removed specimen consisted of many cysts of various sizes containing mucous fluid and multiple small stones. Microscopically, the tumor was composed of a tubular structure lined by ciliated, epithelium-like tissue of the respiratory system or that of Fallopian tube. These tubules were occasionally dilated cystically. No atypical cells were found. The postoperative course was uneventful.

Female

[Effect of vaginal antibiotics suppository on retroperitoneal-space infection after hysterectomy and lymphadenectomy for uterine cancer].

Effects of vaginal antibiotics suppository on the retroperitoneal-space infection were studied in 42 patients who had hysterectomy and lymphadenectomy with diagnosis of uterine cancer stage I or II. All patients received intravenous administration of 1 g LMOX (3 times/day) for 7 days after operation. One group of patients (21 cases) received 0.5 g of ABPC vaginal suppository (twice/day) for 10 days immediately after operation. Another group of 21 patients did not received vaginal suppository. The LMOX concentrations in the exudate decreased rapidly from the 3rd day to the 7th day. The frequencies of bacterial appearance in the retroperitoneal-space in the vaginal suppository group were 33% on 5th day, 33% on 7th day and 20% on 9th day, while those in the control group were 100%, 100% and 76%, respectively. It was concluded that the administration of vaginal antibiotics suppository was easy to handle and effective for preventing the retroperitoneal-space infection after hysterectomy and lymphadenectomy.

Ampicillin

Computed tomography of the retroperitoneal space.

Computed body tomography is an easily accomplished method that precisely displays the normal and pathologic anatomy of the retroperitoneal space. Suspected retroperitoneal disorders, which are often clinically confusing or obscure, can now be detected or excluded with remarkable accuracy. Few innovations in radiology have more effectively fulfilled such a conspicuous need.

Abscess

Pharmacokinetics of cephem antibiotics in exudate of pelvic retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy.

Many cephalosporin antibiotics have recently been invented and attempts have been made to use them clinically. The choice of which of these drugs should be used has been difficult in gynecology. The efficacies of these drugs depend on their antibacterial spectra, potencies, and concentrations in tissues. This study was designed to investigate the pharmacokinetics of various cephem antibiotics in the exudate of the retroperitoneal space that is formed after radical hysterectomy and pelvic lymphadenectomy. These cephem antibiotics were cefoxitin, cefotiam, cefotetan, cefpiramide, cefminox, cefotaxime, ceftizoxime, cefoperazone, cefmenoxime, cefbuperazone, ceftazidime, cefpimizole, flomoxef, and cefuzonam. The maximum concentrations after administration of a 1-g dose in the exudate of the pelvic retroperitoneal space were 37.9 micrograms/ml with cefminox, 30.3 micrograms/ml with cefpimizole, 21.6 micrograms/ml with flomoxef, 21.5 micrograms/ml with ceftazidime, and 17.6 micrograms/ml with cefbuperazone, which were relatively high. When selecting antibiotics for prophylactic use against infections in the retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy, on the basis of drug transfer, flomoxef, cefminox, cefbuperazone, ceftazidime, and cefpimizole were considered to be the drugs of first choice at a dose of 1 g.

Biological Assay

[Repeated and combined operations in tumors of the retroperitoneal space].

Based on an experience with the treatment of 76 patients with tumors of the retroperitoneal space the authors show the expediency of operations of a "region resection" type with the intraoperative control of hemostasis. Such operations were performed in 18 patients with left-side tumors and in 7 patients with the right-side localization of tumors. The choice of the regional resection is considered by the authors to elevate the resectability in patients with tumors of the retroperitoneal space.

Adolescent

[Topographic anatomical interrelation of the lumbar triangles with the organs and adipose tissue formations of the retroperitoneal space].

The investigation has been carried out in 96 corpses of fetuses, newborns and mature persons by means of preparation methods, injection of fatty formations of the retroperitoneal space, superior urinary pathways and vessels with x-ray contrast masses and subsequent roentgenography. The area of the lumbar triangles is subjected to certain fluctuations and only in some cases they are absent. The kidneys, peritoneal part of the ureters, duodenum, pancreas, aorta and inferior vena cava in the projection of the lumbar triangles are not situated. The lumbar triangle can be used for performing drainage, when the organs and formations of the retroperitoneal space are operated on.

Adipose Tissue

[Multiple injuries involving the retroperitoneal space].

From 1971-1982, 598 polytraumatized patients had concomitant injuries of the retroperitoneal space. The mortality rate came up to 33.4%. Diagnostically abdominal lavage, laparoscopy, selective angiography and CT were carried out. Often life saving laparotomy had to be practised without further delay.

Abdominal Injuries

[Possibilities for nuclear medical investigation in the retroperitoneal space: (author's transl)].

The possibilities for nuclear medical investigation in the retroperitoneal space were extended by the introduction of the scintillation camera with an evaluation system. The diagnostic aid in diseases of the kidney (unilateral and bilateral nephropathies, shock kidney, stenosis of the renal arteries, aortic occlusion), suprarenals (Conn syndrome) and the skeleton of the entire body (diagnosis of metastases and non-malignant bone diseases) are reviewed. Scanning scintigraphy can be used in the identification of lymphnode metastases in negative (198 Au colloid) and positive (67 Ga) tumor contrast and in double radionuclide substraction techniques in pancreatic tumor and chronic pancreatitis. Clinical examples are demonstrated.

Adrenal Gland Diseases

[Osteoscintigraphy and dynamic studies of the kidneys using 99mTc-pyrophosphate in tumors of the retroperitoneal space in children].

Osteoscintigraphy and dynamic scintigraphy of the kidneys with 99mTc-pyrophosphate were used for investigation of 24 pediatric patients with tumorous involvement of the retroperitoneal space. Bone metastases were detected by osteoscintigraphy in 8 patients, pathological changes of the kidneys and urinary tract in 9 patients. Dynamic investigation of the kidneys with 99mTc-pyrophosphate performed in the first 20 min. after the drug injection showed disorders of renal evacuatory function of a varied degree of expression in all 24 patients. Dynamic investigation of the kidneys with 99mTc-pyrophosphate was not accompanied by an increase in radiation exposures therefore it was recommended at the first stage of radionuclide investigation of children with tumorous involvement of the retroperitoneal space followed by osteoscintigraphy.

Adult

[Combined surgical operations in the abdominal cavity and retroperitoneal space].

The authors discuss their experience in combined operations on the organs of the abdominal cavity and retroperitoneal space in 366 patients whose ages ranged from 16 to 81 years. In 96 patients (26.2%) the operations were carried out for emergency indications and in 270 (73.8%) in a planned order. The authors substantiate the expediency of performing combined operations by a low mortality rate (1.9%) (in carrying out the operations separately the mortality rate comes up to 15%) and by an economical effect.

Adolescent

[A comparison of computer tomography and ultrasound for the demonstration of vessels in the abdomen and retroperitoneal space (author's transl)].

The value of computer tomography and ultrasound for demonstrating vessels in the abdomen and retroperitoneal space was compared. The methods were equal in their ability to demonstrate the major vessels situated centrally, but computer tomography proved better at differentiating arteries and veins situated peripherally. On the other hand, sonography proved a simple means of differentiating intrahepatic vascular structures.

Abdomen

[Ultrasonographic diagnosis of the retroperitoneal space. A case history series and some selected clinical cases].

A personal series and some clinical cases of pathology of the retroperitoneal space observed by ultrasonography during routine and emergency investigations are reported. Although the limitations of this diagnosis compared to the more recent image techniques (CT and NMR) are recognised, it is still considered an indispensable first level diagnosis in this extensive pathology (in terms of site, type and extent) of retroperitoneally located organs, tissues and systems.

Aged

Lymphatic cysts of the retroperitoneal space. Could epiploplasty be the method of choice?

Lymphatic cysts of the retroperitoneal space among the rarest abdominal tumors. A very small number, usually single case reports, has been reported in the international literature. Symptoms vary according to the tumor size but usually are minimal so that they are discovered by chance, either during an ordinary abdominal examination or because the patient complains of discomfort due to the pressure of the cyst on adjacent organs and tissues. Surgical intervention is the only treatment. Total cystectomy with the treatment of choice is seldom feasible, because of technical difficulty. A case of a huge retroperitoneal lymphatic cyst is reported. Epiploplasty with drainage is proposed as a new method of surgical treatment.

Aged

[Diagnosis and treatment of pseudotumors of the abdominal cavity and retroperitoneal space].

The diagnosis and treatment of pseudotumors of the abdominal cavity and retroperitoneal space are discussed on the basis of 23 cases. It is pointed out that intraoperative morphological study is necessary for making a precise diagnosis. The use of the MK-14 antimicrobial glue improves the results of management of pseudotumors due to the creation of a depo of the antiseptic chlorhexidine in the abdominal cavity with simultaneous air-tightness of the wounds and hemostasis.

Abdominal Neoplasms