Percutaneous extraction of renal stones: experience in 100 patients

Recent developments in technology and instrumentation have made it possible to remove most kidney stones and many ureteral stones percutaneously. The first 100 cases at this institution were reviewed in which grasping, ultrasonic lithotripsy, basketing, and irrigation were used. In all cases, the follow-up was at least 1 year. The success rates were 92.4% for renal pelvic stones, 92% for caliceal stones, and 68% for ureteral stones. Ten of the 14 patients who required open operation after an unsuccessful percutaneous procedure were among the first 18 patients, whereas only one open operation was needed in the last 40 patients. Proper patient selection; the size, number, and location of stones; proper selection of the nephrostomy site; and the expertise of the operator are critical factors in determining the success rate. To date, the short-term results of percutaneous stone removal have been as good as those of open surgery.

Sonographic findings in leukemic renal disease

The ultrasonic findings in 10 patients with diffuse leukemic infiltration of the kidneys are described. The findings are analogous to those seen pathologically and include enlargement of the kidneys, diffuse leukemic infiltration of the renal cortex with sparing of the adjacent medullae, loss of definition and distortion of the renal sinus echo complex and a focal mass. The ultrasound findings correlated well with those seen with intravenous urography making it the preferable screening modality for the initial detection of renal involvement, subsequent follow-up and response to therapy in leukemic patients.

Percutaneous antegrade urethral catheterization of the traumatized urethra

A percutaneous approach for urethral catheterization and dilatation is described. This simple technique, which uses commercially available angiographic catheters, guide wires, and a dilator set, is effective, safe, and necessary when conventional retrograde dilatation fails.

Percutaneous stone removal procedures including irrigation

The authors review the indications, techniques, and complications of percutaneous stone removal. Step-by-step descriptions of each technique are provided.

CT and angiographic correlates: surgical image of renal mass lesions

Twenty-three consecutive patients with surgically proved renal mass lesions were examined preoperatively by means of computerized tomography (CT) and renal angiography. Histopathology of the 23 renal masses included the following: hypernephroma (17), transitional cell carcinoma (3), oncocytoma (2), benign cyst (1). Computed tomography was correct in the preoperative diagnosis of 21 of 23 masses (91 per cent); angiographic diagnosis was correct in 18 of 23 consecutive masses (78 per cent). Correlation of the findings on CT and angiography resulted in correct diagnosis in 22 of the 23 lesions (96 per cent). Independently, CT and angiography each contribute essential information for diagnosis and preoperative planning. CT discloses anatomic detail, tissue consistency, organ system relationships, and relatively precise estimates of tumor bulk. Angiography remains a necessary complement providing a surgical image of tumor vascularity and vessel origins.

Hydrops of the gallbladder in a child: diagnosis by ultrasonography

Hydrops of the gallbladder is a rare cause of right upper quadrant mass in children. A case of acute hydrops of the gallbladder in a 5-year-old child is reported. A specific and accurate diagnosis can be made preoperatively only by sonography. Characteristic sonographic findings are described.

Angiographic manifestations of renal hamartoma

Two types of renal hamartoma (angiomyolipoma) are presented with emphasis on angiographic findings. Careful analysis of the angiograms can suggest a specific diagnosis. Two important considerations other than angiographic findings are (1) multiplicity of tumors in patients with tuberous sclerosis, and (2) a solitary mass in 40-60-year-old women.

The lateral view in selective renal angiography

Use of the lateral view in selective renal angiography is helpful in differentiating cysts from tumors. The position of the cyst is better defined, facilitating aspiration if necessary, while in malignant masses this technique gives a better idea of the dimensions and vascularity of the tumor. Three illustrative cases are presented.

Mediastinal lipomatosis in simple obesity

A case of superior mediastinal widening due to unusual amounts of fat accumulations is reported in a patient with simple obesity, not associated with iatrogenic or primary Cushing's syndrome. The radiographic features included a smooth bilateral widening of the superior mediastinum, relative lucency, no definable mass in the lateral view, and no pressure effects on the trachea. Such mediastinal lipomatosis is a benign condition and may be related to general obesity. although rare, it should be considered in the differential diagnosis of mediastinal masses, particularly in obese individuals.