Biomedical subjects
Publications and source records attributed to G J Paul.
There are some subjects which cannot be reviewed often enough; and malpractice prophylaxis is one such subject. In spite of numerous articles which appear in our professional literature, the problem still haunts us.
A defect in the renal margin secondary to extrahilar entry of renal vessels was detected at urography in three patients. Extrahilar entry of renal vessels is not uncommon and is well known to anastomists and surgeons. It has not been previously reported as a radiographic finding. In the past these marginal defects may have been assumed to be persistent fetal lobulation or scarring from previous renal infarction or pyelonephritis. Arteriography may be necessary to distinguish between these possibilities and occasionally to exclude a renal tumor or cyst.
A brief review of TPN might more clearly point out and explain some of the major areas of this protocol. The use of subclavian vein catheterization for hyperosmolar solutions is the key to TPN. The tip of the catheter resides in the superior vena cava, so solutions with a concentration of 1,500-2,200 mOsm/l. (over five times the osmolarity of serum) can be infused at a rate of 2-3 ml./min. while being diluted by a blood flow of 2-5 l./min. (a dilution factor of a thousand). The site of the catheter is in a large vein. The cutaneous entry site of the catheter is in the pectoral skin below the clavicle; site must be kept scrupulously clean and dressed sterilely. Because of potential complications, the patient should be carefully observed and monitored.
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The authors describe a case of unilateral renal artery occlusion in which a thin, dense rim was seen on infusion pyelography with subsequent marked atrophy of the kidney. This "cortical rim sign" appears to be due to collateral blood supply from the renal capsule, preserving a thin rim of viable cortex.