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Biomedical subjects

R R Hattery

Publications and source records attributed to R R Hattery.

At least 37 records · Page 2Linked to original sources
PubMed1988

The association of nephrolithiasis and autosomal dominant polycystic kidney disease.

Despite the frequency and morbidity of nephrolithiasis in autosomal dominant polycystic kidney disease (ADPKD), this association has not been subject to a detailed study. One hundred fifty-one of 751 ADPKD patients seen at the Mayo Clinic between 1976 and 1986 had nephrolithiasis. Seventy-four had passed calculi or had stones surgically removed. Stone analysis was available in 30 patients: uric acid, calcium oxalate, calcium phosphate, and struvite were present in 56.6%, 46.6%, 20%, and 10%, respectively. Calculi were observed in 71 of 79 patients with excretory urograms available for review. Faintly opaque and bull's eye stones, probably containing uric acid, were present in 12.7% and 14.1% of these patients, respectively. Precaliceal tubular ectasia was observed in 15.5%. Ninety-seven patients had preserved renal function (serum creatinine less than 1.5 mg/dL) at the initial evaluation. Six were excluded because they had other known causes of stone disease. The most common metabolic abnormality in the remaining 91 patients was hypocitric aciduria (ten of 15 patients with measurements). The urine pH in the first voided morning specimens (5.66 +/- 0.05) was significantly lower than that of an unselected control population (5.92 +/- 0.03, P less than 0.001). Hyperuricosuria, hyperoxaluria, and hypercalciuria were observed in six of 32 (18.8%), six of 31 (19.4%), and three of 39 (9.7%) patients with preserved renal function. The composition of the stones, the frequency of hypocitric aciduria, and the low urine pH (possibly related to the defect in excretion of ammonia described in ADPKD), suggest that metabolic, along with mechanical, factors are responsible for the frequent occurrence of nephrolithiasis in this disease.

Adult↗
PubMed1988

Bilateral hemorrhagic parapelvic pseudocysts.

The development of bilateral parapelvic hemorrhagic pseudocysts with abdominal pain, systemic symptoms of malaise and fever, elevation of erythrocyte sedimentation rate and serum alkaline phosphatase, and decreased renal function is described in a patient taking anticoagulants. The symptoms and signs resolved with the resolution of the hemorrhagic pseudocysts. The bilaterality and selective localization of these hemorrhages suggest the existence of a specific pathogenesis. The advent of new imaging techniques in the last decade allows for a diagnosis and a better understanding of the pathologic processes that affect the renal sinus.

Cysts↗
PubMed1988

Intravenous urographic technique.

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.

Contrast Media↗
PubMed1984

Changing patterns in the evaluation of renal masses: economic implications.

This study compares the cost of evaluating renal masses at the Mayo Clinic before and after the use of sonography and computed tomography gained clinical acceptance. Two hundred two adult patients discovered to have renal masses in 1973 were compared with 204 patients discovered to have renal masses in 1980. After adjustment for inflation and differences in the frequency of the various diagnoses, the average cost of evaluating patients in 1980 was 30% less than the cost in 1973; this difference is statistically significant (p = 0.024). The reduction in cost is attributable primarily to a 77% decrease in the use of angiography. The largest reduction in cost occurred in the evaluation of malignant lesions. The study demonstrates that the clinical use of new imaging methods in the evaluation of renal masses can be associated with decreased costs for the patient.

Adenocarcinoma↗
PubMed1984

Pseudomyxoma peritonei associated with mucinous adenocarcinoma of the pancreas: CT findings and CT-guided biopsy.

Pseudomyxoma peritonei is a relatively unusual clinical entity in which a large amount of mucinous material slowly accumulates in the peritoneal space. It occurs in association with a ruptured primary mucinous adenocarcinoma, usually of the appendix or ovary but rarely of the colon, stomach, or uterus. The subject of this case report is the association of pseudomyxoma peritonei with a primary mucinous adenocarcinoma of the pancreas, which, to our knowledge, has not been previously recorded in the literature.

Adenocarcinoma, Mucinous↗
PubMed1984

Diagnostic imaging of urothelial cancer.

Technologic advances in diagnostic imaging offer new ways to evaluate urothelial tumors. Computed tomography, ultrasound, and magnetic resonance imaging each have potential to provide information previously unavailable without surgical intervention.

Adult↗
PubMed1983

Computed tomography and peritoneoscopy for detection of liver metastases: review of Mayo Clinic experience.

The effectiveness of computed tomography (CT) and peritoneoscopy in detecting liver metastasis was studied by review of 97 cases in which both of these procedures and also biopsy or autopsy were performed. Tissue examinations disclosed hepatic lesions in 45 cases. The sensitivity of CT and peritoneoscopy was 89 and 62%, respectively; and their specificity 94 and 96%. In 35% of biopsy-proven cases, CT detected lesions not visible at peritoneoscopy; and in 7% peritoneoscopy revealed lesions not shown by CT. The difference resulted from the more frequent occurrence of liver metastases in locations more suitable for CT detection. The results suggest that CT should be tried before peritoneoscopy (other considerations being equal), and that CT guidance for biopsy deserves more frequent use. The reliability of negative CT or peritoneoscopy findings remains uncertain, since autopsy has been obtained in only 3 of the 52 negative cases.

Adolescent↗
PubMed1983

Pheochromocytoma: value of computed tomography.

A review of 60 histologically proved pheochromocytomas confirmed the value of computed tomography (CT) in the evaluation of this tumor. CT was found to be an accurate means of locating the tumor in 52 patients presenting for the first time and 8 patients with evidence of recurrence.

Adolescent↗
PubMed1983

Spectrum of sonographic findings in 125 renal masses other than benign simple cyst.

The sonographic findings of 125 renal masses that did not meet the sonographic criteria of benign simple cyst were retrospectively reviewed and correlated with the pathologic diagnosis. Of the 125 masses, 102 were renal cell carcinoma. These carcinomas, two of nine angiomyolipomas, and the 14 other renal masses of various histologic types exhibited a broad spectrum of sonographic findings. Seven of nine angiomyolipomas and the one multiloculated cystic nephroma had a rather characteristic sonographic appearance. With the knowledge of this spectrum of sonographic findings and strict attention to scanning techniques and sonographic criteria, the radiologist should be able to define the characteristics of a variety of renal masses and suggest the correct diagnosis. It should be possible to make the diagnosis of angiomyolipoma confidently if the characteristic sonographic and computed tomographic appearance of these tumors can be demonstrated. In some cases, the correct histologic diagnosis of a renal mass can be made only with biopsy or surgery.

Adenocarcinoma↗
PubMed1982

The unreliability of CT numbers as absolute values.

The use of CT numbers as absolute values was examined by scanning a standard phantom on five CT scanners under a variety of conditions simulating those encountered in routine body CT scanning. The results show that: (1) There are significant differences in absolute CT numbers between most scanners (only one scanner produced CT numbers that were equal to zero for water); (2) There are significant differences in absolute CT numbers between two scanners of the same manufacturer and model that were examined; (3) There is a significant difference in CT numbers in a single phantom scan, dependent on location in the scan, and the format of this variability is not constant from one scanner to another; and (4) There may be a significant difference in absolute CT numbers depending on various physical factors (e.g., kilovoltage, phantom orientation in scan aperture, and position of the phantom in the scan aperture). The findings suggest that there is a wide range of CT numbers observed for a given tissue type as a result of scanner performance alone, and that if absolute CT numbers are to be used for diagnosis the user must document that these machine-related variations are less than the differences thought to be significant.

Technology, Radiologic↗
PubMed1982

Mortality during excretory urography: Mayo Clinic experience.

In a series of 300,000 consecutive patients who underwent excretory urography between January 1, 1964 and January 5, 1982, four deaths were recorded (a mortality rate of 1.3:100,000). All four patients who died were 50 years of age or older, all had a history of some type of hypersensitivity, all had a respiratory component to the reaction, all received a 1 ml test dose and had no reaction, and none had received a prior injection of contrast medium. The mortality rate in this series (1:75,000) is significantly lower than recently reported rates from multiinstitutional studies and is similar to the mortality rate resulting from the parenteral administration of penicillin. Differences in reported series may relate to methods of data collection, variations in patient population, and therapeutic management.

Aged↗
PubMed1981

Computed tomography and angiography of cavernous hemangiomas of the liver.

Cavernous hemangioma is the most common benign tumor of the liver. Eighteen patients were studied by both computed tomography (CT) and angiography. The angiographic features were classic, consisting of normal hepatic arteries, no tumor vessels, and densely stained blood-filled spaces producing a "cotton-wool" appearance. Before contrast infusion, CT scans showed roughly spherical, well-demarcated low-density masses; afterward there was a peripheral zone of enhancement which varied in thickness and sometimes had a corrugated inner margin, though the center remained low in density and the overall size of the lesion did not change. The authors feel that the CT findings are characteristic and that in some cases angiography is unnecessary.

Angiography↗