Biomedical subjects
Publications and source records attributed to S K Patel.
Percutaneous nephrostomy is a well-recognized procedure utilized by the radiologist both as a temporary drainage method for urinary tract obstruction and as the elective therapeutic modality in selected pathologies of the urinary tract. We report a complication not previously mentioned in the literature, urinoma formation.
We report two cases of an unusual cause of the acute onset of hypertension, a spontaneous dissecting aneurysm localized to the renal artery. Also reviewed are 16 reported cases from the literature. The mean age of the 18 patients was 52 years. The majority of these patients were males (78%). Hypertension was a presenting sign in 14 (78%), but was not usually a pre-existing feature. Loin pain, often severe, occurred in eleven patients (61%), whereas gross hematuria was recorded only in two (11%). The right renal artery was involved in ten cases (55%), the left in three (17%), and both in five cases (28%). Atherosclerosis of the renal arteries and the aorta was absent in 69%, and mild in 23%. There has been no report of renal artery rupture; however, vascular occlusion occurs frequently. Medical and surgical approaches to the management of this phenomenon have been reported and are reviewed.
A simple technique utilizing the post-void film of the bladder during excretory urography is proposed for the diagnosis of female urethral diverticula. This technique provides for the diagnosis of this lesion in patients without clinical manifestations who would not normally undergo cystourethroscopy, retrograde urethrography, or voiding cystourethrography.
Hirsute women pose a diagnostic dilemma when urinary 17-ketosteroid and serum testosterone levels are normal. To locate the site of androgen excess in 19 hirsute women, blood samples were collested from the left ovarian and adrenal veins via a catheter insertedinto the right femoral vein. Laparoscopy and bilateral ovarian biopsies were also preformed in 18 of the 19 patients studied. Nine women had elevated 17ketosteroid (fivepatients) and/or antecubital serum testosterone (five patients) levels. Fourteen womanhad elevated testosterone concentrations distributed as follows: ovarian vein (six), adrenal vein (one), adrenal and ovarian veins (seven). Androstenedione was elevated in theovarian vein (seven) and both adrenal and ovarian veins (11) in 18 patients. Laparoscopic examinations revealed that less than 50 per cent of the enlarged ovaries could be detected by pelvic examination. Histologic studies suggested that these patients comprised two groups: a group (six patients) who appeared to ovulate and a group (12 patients) who lacked evidence of ovulation.
The medullary rays are well-defined anatomic structures consisting of bundles of renal tubules which form in the renal cortex and continue through the renal medulla as the medullary striations. These structures are occasionally visualized during excretory urography in abnormal physiologic states characterized by tubular stasis and hyperconcentration of contrast material. Under these conditions, fine striations are visualized which correspond in position and orientation to these structures. The work of others has shown that in tubular stasis, contrast material is hyperconcentrated in the tubules. On microradiography in normal and obstructed kidneys, the highest concentrations of contrast material are seen in the lumen of collecting ducts. Lastly, retrograde injection of contrast material into the medullary rays produces a roentgen image similar to our illustrated cases.
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Hexafluorocyclobutene (HFCB) and derivatives have been used as fumigants, refrigerants and polymerization monomers. When inhaled they produce a potentially fatal pulmonary oedema similar to that induced by perfluoroisobutene (PFIB), a by-product of Teflon manufacture. This study determined the relationship between the chemical structure, respiratory retention and toxicity of HFCB and five analogues in rats and mice. Retention in the rat was determined using a flow-through system combining nose-only exposure and plethysmography. Structural changes to HFCB modified retention. At concentrations of ca. 1 ppm, where uptake was independent of exposure time, the rate of uptake was increased by halogen substitution in the order 3-Br = 1-Br = 1-Cl > 3-Cl = 1-H > HFCB, and was a function of volatility. At concentrations of 6 or 30 ppm, the percentage retained and rate of uptake decreased with time. The total mass retained (micromol kg(-1)) was not proportional to inhaled concentration and was best described by the calculated partition coefficient (octane-water). No clear relationship between retention and reactivity was apparent. The contribution of volatility, partition coefficient and reactivity to the uptake process depended on inhaled concentration. The toxicity of the fluorocyclobutenes agreed with reactivity relationships based on electrophilicity (lowest unoccupied molecular orbital energy), carbanion stability and leaving-group mobility. Toxicity is based principally on the number of successive alkylations (1, 2 or 3) that can occur with tissue nucleophiles.
PURPOSE: To present technical adaptations of percutaneous interventional techniques required for the small size vessels and ureters of "en bloc" transplanted pediatric kidneys. METHODS: Over a 4-year period, 12 adult patients received en bloc pediatric double renal transplants. Small system percutaneous interventional techniques were used in seven patients to approach the infantile renal arteries and urinary collecting systems for 11 percutaneous transluminal renal angioplasties, 4 antegrade pyelograms, and 3 nephrostomies. RESULTS: Prior to intervention, these patients averaged a creatinine of 2.5 mg%, which decreased to 1.4 mg% at 46 months (range, 22-68) following the first intervention. With a mean follow-up of 42 months (range, 5-47), 9 of 12 (75%) transplants are functioning with an average serum creatinine of 1.3 mg%. CONCLUSION: With the assistance of percutaneous management of postoperative arterial and ureteral lesions, the prognosis of en bloc renal grafts can approach that of the standard adult renal allograft.
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