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At least 505 records · Page 28Linked to original sources

Specific red cell adherence test applied to tumors of ureter and renal pelvis.

The specific red cell adherence (SRCA) test used previously as a prognostic indicator of bladder tumors was used in a retrospective review of 14 patients with transitional cell carcinoma of the ureter and renal pelvis. SRCA-positive individuals appear to have better survival and progress less frequently to metastatic disease. Of five patients with positive reactions, none had distant metastases. Conversely, in SRCA-negative individuals metastatic disease developed more frequently (4 of 9). The SRCA test can be as useful a test of the prognosis of ureteral and renal pelvis tumors as it is of urinary bladder tumors.

Adult↗

Transitional cell carcinoma of renal pelvis.

Sixty-eight patients with transitional cell carcinoma of the renal pelvis were studied with respect to clinical presentation, tumor grade, stage and location, subsequent development of other urothelial tumors, and patient survival. Of the 66 patients with adjacent mucosa available for evaluation, 63 (95 per cent) had abnormal findings with severe dysplasia and CIS common in the high-grade, high-stage tumors. Twenty-eight patients (41 per cent) had transitional cell carcinoma previously, concomitantly, and/or subsequently, and in 14 patients (21 per cent) subsequent bladder tumors developed. Because of the relatively high tumor recurrence rate in the ureter (16 per cent) in patients who underwent subtotal ureterectomies, nephrectomy and complete ureterectomy including a bladder cuff should be the operation of choice in patients with carcinoma of the renal pelvis.

Carcinoma, Transitional Cell↗

Humoral hypercalcemia due to squamous cell carcinoma of renal pelvis.

We describe an unusual and rare case of humoral hypercalcemia due to Stage D squamous cell carcinoma of the renal pelvis in a patient with no evidence of bony metastases. The literature on humorally mediated hypercalcemia associated with epithelial tumors of the renal pelvis is reviewed.

Adult↗

Severe hemorrhage secondary to primary, isolated in situ carcinoma of renal pelvis.

Primary transitional cell carcinoma in situ of the renal pelvis is usually found in association with ureteral or vesical neoplasms. However, a case of primary carcinoma in situ of the renal pelvis without previous or concomitant ureteral or vesical carcinoma is presented. Microscopic hematuria is a common finding in cases of carcinoma in situ. Gross hematuria is unusual, but not rare. However, severe hemorrhage (hematocrit 12.1, hemoglobin 3.3 g/dL) as the presenting feature is rare. Diagnosis of such microscopic isolated lesions can be difficult to make pre-operatively. Only after nephrectomy will such a lesion be diagnosed, as was the case in this patient.

Adult↗

Endourologic management of filling defect in renal pelvis: limited value of cold cup biopsy.

A fifty-six-year-old woman underwent transurethral ureterorenoscopy and cold cup biopsy for evaluation of a filling defect of the left renal pelvis. The pathology indicated a benign lesion, and percutaneous resection was done with the nephroresectoscope. However, the pathologic diagnosis of the resected tissue showed it to be transitional cell carcinoma, grade I. Consequently we performed a nephroureterectomy with excision of a cuff of bladder and the nephrostomy tract. Residual tumor was found in deep layer of the renal pelvis. The implication from this case in defining the indications for endourologic management of tumors is considered.

Biopsy↗

Colocalicostomy. A solution to an obliterated renal pelvis.

A thirty-nine-year-old paraplegic with an ileal conduit urinary diversion and long ureteral strictures bilaterally required urinary tract reconstruction to establish effective internal drainage. Reported techniques proved infeasible. Therefore, the right kidney with its small intrarenal pelvis was opened by anatrophic nephrotomy and anastomosed to a segment of transverse colon in two layers. The left kidney could not be anastomosed directly to the colon segment, so it was anastomosed end-to-side to an isolated jejunal segment. Colocalicostomy should be considered in the repair of an obliterated renal pelvis or an isolated, obstructed lower-pole calix.

Adult↗

Papilloma of renal pelvis in childhood.

A papilloma in the renal pelvis of a five-year-old girl is reported. The transitional cell tumors of the renal pelvis in the pediatric age group are reviewed, and this is found to be the first case of a benign papilloma in childhood. We believe this pathologic entity should be included in the differential diagnosis of hematuria in a child.

Child, Preschool↗

Inverted papilloma of renal pelvis: flexible ureteroscopic diagnosis and treatment.

A case is reported of inverted papilloma of the renal pelvis in a patient with previous transitional cell carcinoma of the bladder. The renal pelvic lesion was diagnosed and treated with a flexible ureteropyeloscope. Although nephroureterectomy was avoided, the patient must be carefully followed endoscopically and radiographically for recurrence of lesions throughout the urinary tract. This case represents the first report of the endoscopic diagnosis and treatment of an inverted papilloma of the renal pelvis. It demonstrates the vast potential for endoscopic diagnosis, treatment, and surveillance throughout the urinary tract.

Endoscopy↗

Composite and classified color display in MR imaging of the female pelvis.

Because of its superior soft-tissue-imaging capabilities, MRI has proved to be an excellent modality for visualizing the contents of the female pelvis. In an effort to potentially improve gynecological MRI studies, we have applied color composite techniques to sets of spin-echo and gradient-echo gray-tone MR images obtained from various individuals. For composite generation, based on tissue region of interest calculated mean pixel intensity values, various colors were applied to spatially aligned images using a DEC MicroVAX II computer with interactive digital language (IDL) so that tissue contrast patterns could be optimized in the final image. The IDL procedures, which are similar to those used in NASA's LANDSAT image processing system, allowed the generation of single composite images displaying the combined information present in a series of spatially aligned images acquired using different pulse sequences. With our composite generation techniques, it was possible to generate seminatural-appearing color images of the female pelvis that possessed enhanced conspicuity of specific tissues and fluids. For comparison with color composites, classified images were also generated based on computer recognition and statistical separation of distinct tissue intensity patterns in an image set using the maximum likelihood processing algorithm.

Color↗

Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: a dissection-based comparative study.

OBJECTIVE: The aims of this study were: (1) to define and classify those connective structures of the female pelvis that are of potential clinical interest, (2) to evaluate the adequacy of the Terminologia Anatomica (official nomenclature) and (3) to establish a correspondence between the official nomenclature and the most commonly used terms. STUDY DESIGN: The results of 30 macroscopic and laparoscopic dissections of fresh cadavers with and without vessel injection of colored latex solutions were compared with the descriptions and definitions in the Terminologia Anatomica and the most frequently cited English and non-English literature from 1890 to 2003. RESULTS: We identified 3 groups of fasciae, parietal pelvic fascia, visceral pelvic fascia, and extraserosal pelvic fascia, which could be divided into diverse clinically relevant anatomical structures characterized by different locations, spatial orientation, and consistency. These structures differed considerably with regard to number and nomenclature from those described in the Terminologia Anatomica and part of the literature. CONCLUSION: Our results suggest that the official terminology applied to the connective structures of the female pelvis could be profitably revised and expanded. We offer a complete description of these structures and suggest a classification that may be useful for teaching and clinical purposes.

Aged↗

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy.

OBJECTIVE: The objective of the study was to determine the most effective fetal renal pelvis anteroposterior diameter thresholds and the best gestational age in predicting significant neonatal nephrouropathy and neonatal nephrouropathy requiring surgery. STUDY DESIGN: Eighty-three newborns with prenatal ultrasound evidence of unilateral or bilateral fetal renal pelvis dilatation (anteroposterior diameter 4 mm or more) before the 26th week of gestation were systematically and prospectively investigated prenatally and postnatally. RESULTS: Receiver operating characteristic curve analysis showed that third-trimester anteroposterior diameter cut-offs were more reliable than second-trimester cut-offs in predicting significant neonatal nephrouropathy, the best threshold being 8 mm. No significant differences were found between the 2 trimesters in the screening of fetuses at risk of neonatal nephrouropathy requiring surgery. CONCLUSION: Significant neonatal nephrouropathy is better predicted at the third trimester, the best threshold being 8 mm, but the screening of patients at greater risk of surgery is also possible during the second trimester. An anteroposterior diameter of 11 mm or more, with an odds ratio of 128.33 (95% confidence interval 11.68 to 1408.98), is a very effective cut-off and a reliable prognostic indicator of neonatal nephrouropathy requiring surgery, even before the 26th week.

Adult↗

Laparoscopic colorectal surgery in the irradiated pelvis.

BACKGROUND: Heightened interest in minimally invasive surgery and the expanding use of radiation therapy presents surgeons with new challenges. While conventional surgery in the irradiated pelvis represents a significant technical obstacle, indications for laparoscopic colorectal surgery are currently being defined. The purpose of this study is to examine the efficacy of laparoscopic surgery in the irradiated field. METHODS: Forty-two patients underwent laparoscopic colorectal surgery after preoperative radiation therapy, mean dose of 5,644 cGy. All patients were assessed according to intraoperative issues and perioperative events. RESULTS: Eleven patients underwent diverting stoma formation whereas 31 patients underwent resections. The overall conversion rate was 7% (n = 3). Average blood loss was 378 mL. There were no perioperative deaths. Overall morbidity was 19% (n = 8). 78% of patients tolerated clear liquids by postoperative day 2, and 73% tolerated a house diet by postoperative day 4. Average length of stay was 5.5 days. CONCLUSIONS: With proper patient selection and laparoscopic experience, laparoscopic colorectal surgery can be performed in the irradiated pelvis without undue morbidity and mortality.

Adult↗

Interindividual variation in distribution of extramural ganglion cells in the male pelvis: a semi-quantitative and immunohistochemical study concerning nerve-sparing pelvic surgery.

OBJECTIVE: We examined distribution and numbers of extramural ganglion cells in the male pelvis, classifying them as sympathetic or parasympathetic. METHODS: Specimens were obtained from 14 formalin-fixed donated male cadavers. Semiserial sections were processed for histologic examination, and for immunohistochemistry using anti-tyrosine hydroxylase (TH) or anti-peptide histidine isoleucine (PHI). RESULTS: Like those along the sacral sympathetic trunk, most other pelvic ganglion cells were located in and along nerve components. Yet the ganglion cell clusters attached to pelvic viscera accounted for 22% to 38% of ganglion cells. These were seen at the dorsal aspect of the bladder, the bladder/prostate junction, the dorsal aspect of the seminal vesicle, and along the prostate, but not along the extrapelvic pudendal nerve, cavernous tissues including the penile hilum, the rhabdosphincter, retropubic fat or recto-urethral muscle. Two fold interindividual variation was seen for total ganglion cell number (3044 to 6522) in the pelvis. TH-positive and PHI-positive cells intermingled at various ratio in every ganglion cell cluster. Sympathetic TH-positive proportions tended to be site-specific. CONCLUSIONS: Pelvic autonomic cells exist not only in nerve components but also along viscera. Even nerve-sparing radical prostatectomy can compromise visceral ganglia. Simple classification of pelvic nerve components as sympathetic or parasympathetic would seem misleading given coexistence of both cell types in a ganglion.

Aged↗

Organ sparing by conformal avoidance intensity-modulated radiation therapy for anal cancer: dosimetric evaluation of coverage of pelvis and inguinal/femoral nodes.

PURPOSE: To describe a novel and straightforward conformal avoidance intensity-modulated radiation therapy (IMRT) technique for coverage of pelvis and inguinal/femoral nodes and to compare the dosimetry of the new method with that of other traditional methods of radiation treatment. METHODS AND MATERIALS: Data of 2 patients with anal cancer were used as example cases to illustrate details and advantages of conformal avoidance IMRT technique. Conventional photons with enface electrons design was created first, thereby providing "outermost boundaries" defined as planning target volume (PTV) for subsequent conformal avoidance IMRT design. Organs at risk (OARs), including femoral head and neck and external genitalia, were contoured as conformal avoidance structures. A step-and-shoot inverse IMRT planning was subsequently generated. For dosimetric comparison, a recently published technique by modified segmental boost was also generated. These treatment techniques were evaluated by dose-volume histogram (DVH) of PTV and OARs. Dose profiles at four different depths from each treatment planning were generated for comparison. RESULTS: The DVH of PTV showed that coverage of the PTV was comparable among three treatment techniques. Percent volume of PTV receiving more than 90% prescription dose was in the range 94-98% for the three treatment techniques, and all had only 0-2% of PTV receiving more than 110% of prescription dose. The DVH of OARs confirmed that both femoral head and neck and external genitalia could be spared well by conformal avoidance IMRT as compared with the other two techniques. Although greater inhomogeneity of dose distribution within the PTV was noted by conformal avoidance IMRT technique, as shown by dose profiles at four different depths, the maximum doses at different depths were less than 115%, which was comparable to those planned by modified segmental boost technique. Planning by photons and enface electrons technique, however, showed a greater dose variation up to 134% of the prescription dose at 1.5 cm depth along photon-electron match-line. CONCLUSIONS: To cover pelvis and inguinal/femoral nodes, conformal avoidance IMRT is technically simple to simulate, plan, and execute. Dosimetric study has demonstrated that it achieves comparable PTV coverage compared with other approaches while at the same time significantly sparing the surrounding OARs.

Aged↗

A novel acetabular alignment guide for THR using selective anatomic landmarks on the pelvis.

This paper presents a novel approach for acetabular alignment during the implant of a prosthetic hip joint in a natural pelvis. The alignment instrument uses selective anatomic bony landmarks on the pelvis, which are accessible in surgery, to guide the placement of the acetabular component in the appropriate orientation. A closed form solution, involving both a forward and reverse analysis, is presented to relate the parameters of the device with the abduction and anteversion angles. Using mathematical models, this device should allow the surgeon to place the acetabular component with an orientation between 10.9 degrees and 19.1 degrees anteversion and 35.7 degrees and 44.3 degrees abduction with 95% confidence in a male/left specimen for the commonly accepted target of 15 degrees anteversion and 40 degrees abduction. This device is currently being used successfully by one of the authors in THR surgery.

Acetabulum↗

Bilateral intrarenal pelvis Wilms' tumor with fibroepithelial polyp.

Intrarenal pelvis Wilms' tumor is rare in children. A case of a 28-month-old boy with bilateral intrarenal pelvis Wilms' tumor associated with a fibroepithelial polyp is reported in this article. The tumor was evaluated by ultrasonography, computed tomography, and intravenous pyelography. The boy underwent bilateral renal pelviotomies. Now he is being treated and followed up by pediatric oncologists.

Child, Preschool↗

Hydatid disease of the pelvis.

The clinical and radiological features of five patients with hydatid cyst of the pelvis are presented. The cysts were found in the following sites: the broad ligament, the pararectal soft tissues, the greater omentum, the ala of the sacrum and in the retrovesical space. Hydatid disease should be considered in the differential diagnosis of unusual cystic swellings in the pelvis, particularly in patients who have lived in endemic areas.

Adult↗

The role of transvaginal ultrasound in the assessment of the female pelvis.

Transabdominal ultrasound of the female pelvis has been compared with transvaginal ultrasound, using a 7.5 MHz transducer, in 80 women. Transvaginal ultrasound required less patient time and was preferred in 56% of patients. Image quality was superior in 72% of cases, and visualisation of the pelvic organs was equivalent with each technique. Transabdominal ultrasound gives a more global view of the pelvis, and is of more value in assessing large pelvic masses. Transvaginal ultrasound is of more value in assessing early pregnancy, ectopic pregnancy, ovarian abnormalities, and for visualising the ovaries following hysterectomy.

Abdomen↗