Biomedical subjects
M J Kellett
Publications and source records attributed to M J Kellett.
Sonographic features of renal obstruction mimicked by peripelvic cysts.
Peripelvic cysts can closely mimic the sonographic changes of renal pelvicalyceal dilatation. Three cases are described in which a particular feature was the presence of linear septations extending to the hilum which represented the walls of tubular peripelvic cysts. The cluster of cysts centrally in the renal sinus was originally interpreted as a dilated pelvicalyceal system. Excretion urography is usually necessary to exclude pelvicalyceal dilatation conclusively.
The misplaced double J ureteric stent: technique for repositioning using the nitinol 'gooseneck' snare.
An antegrade method for repositioning a prematurely released double J ureteric stent is described. The technique is applicable when the proximal pigtail is still within the renal parenchyma or in the perinephric space. A custom-made Nitinol gooseneck snare was used in this case, but suitable alternatives should be readily available in a standard interventional suite and these are described.
Staging renal cell carcinoma.
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Extrusion of calculi from upper urinary tract into perinephric and periureteric tissues during endourologic stone surgery.
We report on 11 patients in whom fragments of calculi were extruded into the perinephric or periureteric tissues at the time of endourologic stone surgery. All patients have been managed conservatively. In 2 patients ureteric strictures developed, but these were probably secondary to an electrical injury as a result of electrohydraulic lithopaxy. The remaining 9 patients have not experienced serious sequelae as a result of the calculus extrusion.
Case report: duodenal obstruction due to hydrocalycosis.
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Percutaneous nephrolithotomy and the solitary kidney.
We reviewed 53 patients with stones in a solitary kidney who had undergone percutaneous nephrolithotomy. Previous surgery on that kidney had been performed in 35.8%, and 50.9% had other medical conditions including 26.4% who had impaired renal function. Staghorn or partial staghorn calculi were present in 52.9% and an additional 18.8% had multiple stones. Postoperative complications in 18.8% of the patients included sepsis, the need for transfusion and 1 death of bronchopneumonia. Percutaneous nephrolithotomy alone resulted in a 77.3% rate free of stone or fragments of 2 mm, or less. This rate increased to 86.8% with the addition of extracorporeal shock wave lithotripsy, ureteroscopy or open surgery (2 patients). Only 1 patient suffered long-term deterioration in renal function. Percutaneous nephrolithotomy is a safe procedure in the solitary kidney. It should be considered in those patients with complex stone burdens and impaired renal function when reduction in stone bulk and improved renal function may allow other treatment modalities to be used.
Percutaneous nephrolithotomy for calculi in horseshoe kidneys.
Between 1983 and 1988, 15 patients (18 kidneys) underwent percutaneous nephrolithotomy at this unit for calculi in horseshoe kidneys. A standard 1-stage percutaneous access technique with minor modifications was used. In situ disintegration with ultrasound or electrohydraulic lithotripsy was necessary in 15 moieties (83.3%) and nephrostomy drainage was required in 12 (66.7%). Percutaneous access was not a problem and there were minimal perioperative problems. Blood transfusion was required postoperatively in 2 patients. A total of 14 kidneys (77.8%) were rendered free of stone with percutaneous nephrolithotomy alone and 2 kidneys were left with asymptomatic stone fragments of 2 mm. or less. Another 2 kidneys became free of stone after extracorporeal shock wave lithotripsy, thus giving an over-all stone clearance rate of 88.8%. We conclude that percutaneous nephrolithotomy is an acceptable treatment for stones in horseshoe kidneys and it is the treatment of choice for patients in whom imaging is difficult or impossible.
Percutaneous cholecystolithotomy: the first 60 patients.
OBJECTIVE: To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN: Prospective study of the first 60 patients treated. SETTING: The London Clinic. PATIENTS: 60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS: 56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS: The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact.
Balloon dilatation of the prostate: technique and early results.
Fourteen men with outflow obstruction were treated by balloon dilatation of the prostatic urethra using 25 and 30 mm balloon catheters. Significant improvement in objective measurement of outflow obstruction was noted in only 2 patients.
The changing practice of percutaneous stone surgery. Review of 1000 cases 1981-1988.
A review was carried out on 1000 cases of percutaneous nephrolithotomy (PCNL), Group 1 (500), 1981-1985, being compared with Group 2 (500), 1985-1988. Previous renal surgery had been performed in 17.4% of patients in Group 1 and 36% in Group 2. There were 17.2% complicated patients in Group 1 and 51% in Group 2. The stone burden included 30.2% multiple, partial staghorn and staghorn calculi in Group 1 and 47.2% in Group 2. The use of in situ stone disintegration increased from 22.2% in Group 1 to 73.4% in Group 2 and nephrostomy drainage was necessary in 29.6% compared with 75%. Post-operative complications increased from 13.6 to 24%. Stone-free rates decreased from 92 to 51%, but the addition of other methods of treatment and the inclusion of patients with stone fragments of 2 mm or less increased these figures to 98% in Group 1 and 83% in Group 2. More complicated patients with complex stones are now being referred for PCNL. These patients require multiple treatments, including extracorporeal shock wave lithotripsy (ESWL) and percutaneous surgery, in combination with other endoscopic and radiological procedures.
Percutaneous removal of "extra-renal" residual urinary calculus.
We report a case of an "extra-renal" calculus and associated perinephric abscess treated by endourologic techniques. The calculus could have fallen into the perinephric tissues at the time of open renal surgery.
The expansion of interventional radiology. Report of a survey conducted by the Royal College of Radiologists.
The Interventional Radiology Group of the Royal College of Radiologists sent a questionnaire to major hospitals in the United Kingdom in 1982 and 1987 in order to assess the impact of the introduction and growth of interventional procedures on patient management over the 5-year period and to consider the implications of these data for the future staffing and equipment requirements of radiology departments. In the 194 hospitals correctly completing the most recent survey, a total of 30,794 interventional procedures were performed in a 12 month period, representing an overall increase of 116% since the previous survey of 1982.
Gall-bladder stones: new roles for the radiologist.
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Clinical experience using the Wolf Piezolith device at 2 British stone centers.
Machines using the principle of piezoelectric extracorporeal shock wave lithotripsy have been developed. This has allowed the prospect of painless treatment for renal and ureteral calculi. The experience with use of 2 Wolf Piezolith machines for 1 year is presented. Different second generation lithotriptors have varying techniques of production of shock waves and different imaging methods. The Wolf Piezolith device uses ultrasound imaging and piezoelectric crystals for shock wave generation. Between June 1987 and May 1988, 545 patients 5 to 84 years old were treated with the Wolf Piezolith device. Of these patients 2-month followup data are available for 367 (398 renal units). Outpatient treatment was used routinely. For renal calculi complete fragmentation (into particles less than 2 mm. in size) was achieved in 94 per cent of the patients, with 53 per cent being completely free of stone at 2 months. For ureteral stones treated in situ the best results were obtained in the upper and lower ureter. Over-all, 62 per cent of the patients required more than 1 treatment, with the number of treatment sessions required increasing with the size of the stone treated. Morbidity was low. Ultrasound imaging has proved to be as effective as x-ray imaging. Compared to Dornier HM-3 lithotripsy, installation and running costs were low. The machine offers a favorable alternative to first generation lithotriptors.
Percutaneous cholecystolithotomy.
A single-stage method of percutaneous removal of gallstones is presented which was adapted from our experience with percutaneous nephrolithotomy. It is performed under general anesthesia using ultrasound and fluoroscopic control. The overall success rate of 90 per cent and the fact that any stone, irrespective of its size or composition may be treated, firmly establishes this method as an important addition to the modern methods of treating gallstones.
Percutaneous cholecystolithotomy.
A percutaneous method was used to remove stones from otherwise normal gall bladders, as assessed by cholecystography and ultrasonography. The procedure was performed in a single stage under general anaesthesia, adopting the method and instruments used for one stage percutaneous nephrolithotomy. A Foley catheter was left in the gall bladder and the system checked with contrast at 10 days to ensure free drainage and exclude residual calculi. Seven out of eight patients had a successful percutaneous cholecystolithotomy. An adequate track could not be secured in one man; he had an uneventful cholecystectomy under the same anaesthetic. Follow up at three months of the seven patients showed no calculi and no complications. Percutaneous cholecystolithotomy may prove complementary to extracorporeal shockwave lithotripsy in patients in whom there is difficulty focusing the shock waves on the gall bladder or who have had incomplete disintegration of stones.
1500 cases of renal and ureteric calculi treated in an integrated stone centre.
Fifteen hundred consecutive cases of renal and ureteric calculi were treated in an integrated stone centre; 1464 of these were treated by extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, ureterorenoscopy and ureteroscopic lasertripsy. Only 36 (2.4%) required open surgery.