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Biomedical subjects

L B Talner

Publications and source records attributed to L B Talner.

At least 55 records · Page 3Linked to original sources
PubMed1981

How accurate is ultrasonography in detecting hydronephrosis in azotemic patients?

Screening for hydronephrosis continues to be an essential part of the evaluation of patients with azotemia of unknown cause. To determine whether sonography is as reliable as nephrotomography for screening purposes, we carried out a prospective, comparative study. Sixty-two patients were evaluated. Mean serum creatinine was 4.3 mg/dl. Of 116 kidneys, 45 were obstructed according to urographic criteria and 42 of these were correctly called hydronephrotic by sonography. The 3 false negative sonographic studies occurred in 2 patients. All 3 kidneys contained radiopaque calculi visible on the plain abdominal film. Of the 71 nonobstructed kidneys, 5 were mistakenly called hydronephrotic by ultrasound, giving a false positive rate of 7%. We believe it is appropriate to use gray-scale ultrasound as a screening test for urinary obstruction in azotemic patients providing the plain abdominal radiograph shows no calcifications.

Adolescent↗
PubMed1980

Percutaneous nephrostomy: experience in 107 kidneys.

We were successful using percutaneous nephrostomy to relieve upper urinary obstruction in 98 of 107 kidneys. In two thirds of our patients obstruction was due to neoplasm, with prostatic cancer the leading cause. Percutaneous nephrostomy proved to be ideally suited for drainage of pyonephrosis and in azotemic patients. Its use can obviate surgical nephrostomy and prolonged ureteral catheter drainage. We also are encouraged by our early experience with extensions of percutaneous nephrostomy, including percutaneous ureteral stenting, renal stone dissolution, and percutaneous pyelolithotomy.

Angiography↗
PubMed1979

Congenital giant hydroureteronephrosis.

Four patients with giant hydroureteronephrosis are reported to emphasize the massive proportions attained by a dilated ureter. Ureteral obstruction was congenital in each case; duplication with ectopic insertion was present in three of the four patients. In three patients the massively dilated ureter caused partial obstruction of the contralateral ureter. If ultrasound and/or computed tomography demonstrate a huge, septate, cystic structure crossing the midline, massive megaureter should be suspected. Antegrade puncture can be used to confirm the diagnosis.

Adult↗
PubMed1979

Gray scale ultrasound and the genitourinary tract. A review of clinical applications.

Diagnostic ultrasound has many well established indications in the evaluation of genitourinary tract disease. Musch of this information complements or corroborates findings derived from other investigations. The role of ultrasound as a primary diagnostic modality is still evolving, but it appears to be useful in a variety of clinical situations, especially in azotemia, suspected hydronephrosis, and renal transplantation. Ultrasound also has a place in the evaluation of the retroperitoneum, the perirenal space, and the adrenal glands, and preliminary work suggests a role in prostatic and testicular abnormalities as well. State of the art prospective comparisons with computed tomography need to be made in many of these areas before the precise role of ultrasound can be defined.

Adrenal Gland Diseases↗
PubMed1978

99mTechnetium penicillamine scans: an index of differential renal function.

The relative renal accumulation of 99mtechnetium penicillamine was evaluated as an index of differential renal function. Regions of interest were assigned over each kidney with a computer and the renal uptake of 99mtechnetium penicillamine was determined. A simple background correction was made by subtracting the renal activity at 10 minutes from that at 25 minutes. The percentage of 99mtechnetium penicillamine accumulation in the left kidney was correlated with the percentage of the total effective renal plasma flow to the left kidney. Effective renal plasma flow was determined after the intravenous injection of 131 I hippuran using a highly sophisticated computerized technique that has been validated in patients by comparison with traditional split renal function studies. The correlation coefficient between the 2 measurements was 0.97. In addition to its use as an index of differential effective renal plasma flow 99mtechnetium penicillamine is an excellent cortical imaging agent and the relative distribution of 99mtechnetium penicillamine between the 2 kidneys and within a single kidney can be assessed qualitatively by visual inspection of the scan.

Adult↗
PubMed1978

Late sequelae of adult-onset acute bacterial nephritis.

The late manifestations of adult-onset acute bacterial nephritis were studied in four patients from 4 months to 5.6 years following initial infection. An unusual combination of generalized (global) wasting of the kidney and focal calyceal clubbing developed within a few weeks of the acute infection. The pattern of calyceal deformity strongly suggests papillary necrosis; it may develop during the acute phase, but go unrecognized during excretory urography at that time because of impaired contrast material excretion. The combination of a small, smooth kidney and papillary necrosis previously has been associated only with the more severe forms of analgesic nephropathy. Observations in these patients indicate that the same urographic findings may also occur as a result of a single earlier episode of acute bacterial infection of the kidney.

Acute Disease↗
PubMed1978

Furosemide-augmented intravenous urography: results in essential hypertension.

Giving an intravenous diuretic during urography (furosemide-augmented urography, vasodilated urography) causes renal swelling which is easily measured. Several investigators have used this observation as the basis of a screening test for renovascular hypertension. They found that normal kidneys enlarge in area by more than 10%, while kidneys with renal artery stenosis show a blunted size response, usually less than 5%. We used the technique in 46 patients with proven essential hypertension in order to further examine its potential usefulness in the hypertensive population. The 92 kidneys showed an average area increase of only 7.0% +/- 3.6% SD, and only 15% of the kidneys enlarged by more than 10%. Based on these observations we doubt that vasodilated urography will be valuable as a screening test for renovascular hypertension because of the high incidence of false positive and indeterminate results in patients without renal artery stenosis.

Adult↗
PubMed1978

Sensitivity of gray scale ultrasound in detecting urinary tract obstruction.

To determine the reliability of gray scale ultrasound in detecting urinary tract obstruction, a prospective study of 67 patients examined by both excretory urography and ultrasound was undertaken. The degree of hydronephrosis was defined by urographic criteria, and the corresponding echograms were analyzed without knowledge of the urographic results. Hydronephrosis was correctly diagnosed by ultrasound in 46 of 47 kidneys shown to be obstructed on urography, for a sensitivity of 98%. Our results show that when obstruction is the sole clinical question, ultrasound is an effective screening test. Thus many patients with a variety of medical diseases of the kidney can be spared excretory urography.

Adolescent↗
PubMed1978

Renal vasculature in essential hypertension: racial differences.

In an attempt to explain the greater morbidity from essential hypertension in the black as compared with the white race, we evaluated the intrarenal vasculature of 27 patients with hypertension (19 white and 8 black). All patients had mild-to-moderate hypertension (mean arterial pressure, 110 to 125 mm Hg), normal renal function, and minimal target-organ damage. All patients had selective renal angiograms, which were evaluated for arterial nephrosclerosis. Additionally, renal blood flow was estimated by the clearance of para-aminohippurate. Patient age, blood pressure, and plasma renin activity did not differ between the two races. Black hypertensives had significantly (P less 0.01) more severe nephrosclerosis than the white patients. Renal blood flow was lower (P less than 0.05) in black patients (390 +/- 35 ml/min - m2 body surface area) than white patients (473 +/- 19 ml/min - m2 body surface area). These findings may help to explain racial differences in morbidity and mortality from essential hypertension.

Adult↗
PubMed1978

Relative renal accumulation of Tc-99m penicillamine as an index of differential renal function: concise communication.

The relative renal accumulation of technetium-99m penicillamine (TPEN) was evaluated as an index of differential renal function. Using a scintillation camera interfaced to a computer, renal uptake of TPEN was determined for each kidney by subtracting the renal activity at 10 min from that at 25 min. This percentage of TPEN activity in the left kidney was compared with the percentage of total creatinine clearance contributed by the left kidney in six patients with ureteral obstruction and nephrostomy drainage. The two measurements agreed extremely well, with a correlation coefficient of 0.98. The relative renal uptake of TPEN and similar cortex imaging agents such as Tc-99m dimercaptosuccinic acid can probably be used to assess differential renal function.

Humans↗
PubMed1976

Uroradiology of diabetes mellitus.

Diabetes mellitus is a prevalent disorder, well controlled in many persons with prolongation of life. Several radiologic manifestations are sufficiently specific to suggest a diagnosis in the unidentified patient, but even more important is an awareness of the sometimes life-threatening complications of diabetes which can be diagnosed from uroradiologic studies. We review the following urinary tract manifestations and complications of diabetes: pyelonephritis, perinephric abscess, renal papillary necrosis, emphysematous pyelonephritis, emphysematous cystitis, fungus infections, calcification of the vas deferens, seminal vesicle, and intrarenal branches of the renal artery, neuropathic bladder, and renal failure.

Abscess↗
PubMed1976

Percutaneous nephrostomy.

A safe and effective method for long-term relief of renal obstruction is presented. This method has been successful in buying time for patients in stiuations in which other approaches are hazardous or more complex. Its use can be modified for short-term therapeutic drainage of the upper urinary tract.

Humans↗
PubMed1975

Analgesic abuse syndrome: a frequently overlooked cause of reversible renal failure.

The incidence of analgesic nephropathy in the United States is greater than previously reported. Because of the characteristic radiographic features of papillary necrosis, this diagnosis may be made while it is still clinically unsuspected. Early diagnosis is extremely important because cessation of analgesic abuse may avert progressive renal damage. Uncovering the diagnosis calls for special care in obtaining the telltale history. This must be sought in patients with radiographic evidence of papillary necrosis when a history of diabetes mellitus, obstructive uropathy, or sicle cell anemia is absent, or in patients with unexplained nephrocalcinosis or nephrolithiasis.

Adult↗