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PubMedDate not supplied

[Echotomography and excretory urography in the diagnosis of renal parenchymal "bridges"].

Sonographically detectable parenchymal 'bridges' in the median segment of the kidney may look atypical. The most incident parenchymal 'bridges' are asymmetric irregular ovoid incomplete connections, not reaching the parenchyma at the site of renal hilus; such 'bridges' may be compared to a 'humpbacked' overturned kidney. Besides that, double and Y-shaped connections were detected, occurring in different variants of fused kidneys. Clinical significance of atypical 'bridges' of the parenchyma consists in simulation by them of echomixed processes, of renal tumors first of all. Excretory urography should be the second stage of the diagnosis after initial ultrasonic examination of the kidneys; after it repeated pointed ultrasonography should be carried out, that will help rule out the diagnosis of a renal tumor.

Adult↗
PubMedDate not supplied

[The role of intravenous urography in the diagnosis of urinary tract lithiasis in the era of new therapeutical methods].

Urinary stones continue to be an interesting and major problem for both urologists and radiologists. The authors try to present the imaging diagnosis possibilities for this pathology according to the expectations of the urologists who have to deal with urinary tract lithiasis with the new methods (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy). Helical CT has certain advantages and in different centers in Europe appear to be less expensive than intravenous urography (IVU), but unfortunately, is not available in our medical center. So, for us, IVU remains the basic investigation for urinary stones. Echography helps a lot for correct strategy, but together with KUB cannot replace IVU if we want to avoid mistakes.

Contrast Media↗
PubMed1992

Granulocyte chemotaxis before and after urography. Influence of four different radiographic contrast media.

Granulocytes isolated from whole blood of 10 volunteers with Hypaque/Ficoll or Percoll gradient centrifugation showed a significant inhibition of their chemotactic response when incubated with diatrizoate. The influence of 4 different i.v. injected radiographic contrast media (CM) on granulocyte chemotaxis was evaluated using the under agarose assay. Each CM was injected in 10 consecutive outpatients referred for urography. Cells and serum were obtained before and 20 min after the injection of CM. Autologous serum was used as chemoattractive agent, and the cell suspensions from both samples were tested against serum drawn both before and after the injection of CM. No significant changes in granulocyte chemotaxis or the chemotactic potential of serum were seen. Furthermore, there was no change in the chemotactic response towards homologous serum or N-fmlp after injection of diatrizoate or iohexol. In conclusion, the investigation did not unveil any change in granulocyte chemotaxis 20 min after the injection of CM in the 40 subjects studied.

Cell Separation↗
PubMed1992

Intravenous urography in patients with transitional cell carcinoma of the bladder. The incidence and implications of ureteral obstruction.

In order to study the value of excretory urography in the diagnosis of transitional cell carcinoma of the bladder, and also the incidence and implications of ureteral obstruction, 100 consecutive patients were studied. Of 73 patients with superficial tumours (stages Tis, Ta, T1) only 1 (1,4%) had hydronephrosis as a result of the bladder tumour. However, 2 further patients had hydronephrosis secondary to synchronous ureteral tumours. Of the 27 patients with muscle-invasive tumours, 10 (37%) had hydronephrosis at the time of diagnosis. Four patients who had normal upper tracts initially, developed hydronephrosis during follow-up: 1 due to progression of a superficial tumour to stage T3, 1 due to the development of an ureteral tumour, and 2 due to fibrosis of the intramural ureter after transurethral resection of superficial tumours. The presence of ureteral obstruction at the time of diagnosis most often implies a muscle-invasive tumour, but the possibility of a synchronous ureteral tumour must also be considered. Fibrous strictures of the distal ureter can occur after transurethral resection of superficial bladder tumours.

Carcinoma, Transitional Cell↗
PubMed1992

Decision analysis to assess cost-effectiveness of low-osmolality contrast medium for intravenous urography.

Decision analysis was used to compare the cost-effectiveness of a conventional ionic high-osmolality contrast medium with that of a nonionic low-osmolality contrast medium when used for i.v. urography. The patient populations considered in the model were those with a low risk and those with a high risk of contrast medium-associated adverse effects. Mean toxicity rates for the contrast media were obtained from the literature. To estimate the average cost of adverse effects, the probability of a patient in each population developing a mild, moderate, or severe reaction was multiplied by the respective estimated cost for each level of severity, and the products were summed. The incremental cost of the low-osmolality medium per case of adverse effects prevented was calculated by dividing the difference between the average costs of the two media by the difference between the frequencies of toxicity associated with the agents. According to the 1990 cost data used, combined mean drug and toxicity costs were $68 and $13 for the low- and high-osmolality contrast media, respectively, per high-risk patient and $67 and $10 per low-risk patient. The incremental costs of the low-osmolality medium per case of severe adverse effects prevented was $17,974 in the high-risk population and $77,027 in the low-risk population. Sensitivity analysis showed the results to be stable over a range of data used in the model.(ABSTRACT TRUNCATED AT 250 WORDS)

Contrast Media↗
PubMed1991

Imaging of urinary tract malformations: intravenous urography and/or kidney ultrasonography?

We performed both kidney ultrasonography (KUS) and intravenous urography (IVU) in 56 children with urinary tract infections (UTI) to compare the effectiveness of these procedures in detecting urinary tract malformations (UTMs). In 7 patients where KUS findings were interpreted as normal, IVU detected the following UTMs: hydronephrosis (3), stenosis of the pelvi-ureteric junction (2), pelvi-ureteric duplication (1) and kidney dislocation (1). In 2 other patients, mild hydronephrosis diagnosed by KUS was not confirmed by IVU. With respect to IVU, KUS revealed a sensitivity of 77.4% and a specificity of 92%. In our experience, IVU is still irreplaceable in the diagnostic protocol of UTMs in children; KUS should be regarded as a useful complementary procedure.

Child↗
PubMed1991

[Spontaneous urine extravasation during intravenous urography. Apropos of 21 cases. Review of the literature].

Twenty one cases of spontaneous urine extravasation during an intravenous urography have been analysed in order to determinate the radiological signs and the causes of this rare phenomenon. Related to the increased pressure of the excretory tract, these extravasations usually disappear without complications. No specific treatment is required except the treatment of the obstacle due generally to calculi. No infection nor development of retroperitoneal fibrosis nor sinusal lipomatosis were observed in the patients we studied.

Adult↗
PubMed1991

[Spontaneous urine extravasation during intravenous urography. Apropos of 21 cases. Review of the literature].

Twenty one cases of spontaneous urine extravasation during an intravenous urography have been analysed in order to determinate the radiological signs and the causes of this rare phenomenon. Related to the increased pressure of the excretory tract, these extravasations usually disappear without complications. No specific treatment is required except the treatment of the obstacle due generally to calculi. No infection nor development of retroperitoneal fibrosis nor sinusal lipomatosis were observed in the patients we studied.

Adult↗
PubMed1991

[Urography: problems and errors in the diagnosis of renal masses].

New imaging modalities have gained a prominent role in both detection and diagnosis of kidney disorders. However, excretory urography (IVU) remains the screening examination of choice in everyday diagnostic routine, even though its value in characterising renal masses is poor. The search for more sensitive and less invasive diagnostic modalities has brought about some new dilemmas--e.g., which modality should be performed first when the clinical picture is suggestive of renal tumor, the presence of a malignancy with a negative IVU, small renal tumors as occasional findings--, and has enhanced previous problems,--e.g., technique, administration of i.v. contrast media. After defining the above problems, the authors discuss mistakes in the evaluation and interpretation of urograms. The problems are operator-dependent, or else they may be related to examination technique--e.g., inadequate preparation of the patient, poor image quality--, to the method of examination--e.g., inadequate injection of contrast agents (i.e., type, amount, method of injection)--, to kidney function and, finally, to lesion type. As for lesion type, errors can be related to the detection of the lesion itself--e.g., small renal masses (less than 3 cm phi)--and to lesion definition, due to atypical patterns or to difficult differentiation of tumors from normal findings, from anatomical variants or extrarenal structures.

Contrast Media↗
PubMed1991

Ultrasound versus intravenous urography in the initial evaluation of patients with suspected obstructing urinary calculi.

A consecutive series of 102 patients admitted to the radiology department for emergency intravenous urography (IVP) due to suspected obstructing urinary calculus, had an ultrasound scanning (US) performed immediately prior to the requested IVP. The scannings were performed by US-specialists who had access to all patient data except the IVP result. IVP diagnosed renal outlet obstruction in 53 of the 102 cases. This was correctly diagnosed by US in 50 cases. In three cases where IVP described acute obstruction ("white kidney") no dilatation was visible on US. The false negative rate concerning obstruction was thus 6%. No false positive US investigations occurred. Five cases of uretero-pelvic stenosis were correctly diagnosed at both investigations. 18 kidney stones--two being obstructing--were found at both investigations. IVP diagnosed 40 of 46 ureteral stones. The remaining stones were diagnosed by other means (retrograde pyelography, ureteroscopy). US only visualized 18 ureteral stones. The overlooked stones were all less than 5 mm in size, the major part being situated in the middle and lower ureter. We conclude that US plays a role in the initial evaluation of patients with suspected obstructing urinary calculi. If obstruction is diagnosed emergency IVP may be substituted by an elective investigation or even omitted. If no obstruction is diagnosed IVP must be performed in order to rule out non-dilated obstruction. IVP remains the gold standard for visualization of the urinary tract in patients with suspected acute obstruction.

Acute Disease↗
PubMed1991

[The evaluation of urinary NAG activity in patients undergoing urography].

A study has been carried out to verify the nephrotoxic effect of hyperosmotic substances used as a contrast medium in radiology employing the enzymuria technique (NAG). The research was carried out in 202 patients, some of whom diabetic, suffering from various pathologies and subjected to perfusion urography by inoculating an iodate contrast medium (isopaque). The result showed that NAG urinary activity grows significant in the 24-36 hours subsequent to X-ray examination in both diabetics and nondiabetics although the increase is greater in the former. After 5-7 days, enzymuria returns to normal in nondiabetic patients but remains high in the diabetic.

Acetylglucosaminidase↗
PubMed1990

Carcinoma bladder: comparative evaluation of urinary cytology, excretory urography and ultrasonography.

A total of 63 patients with 85 bladder tumors were evaluated with excretory urography (IVU), ultrasonography and urine cytology, before being subjected to cystosocopy and biopsy. An attempt was made to evaluate accuracy of detection by different modalities, individually and combined together. Untrasonography and IVU detected 90 percent and 75 percent of tumors respectively while cytology was positive in 63 percent patients. Ultrasonography was superior to IVU, and, Urinary cytology, despite its low catch, could detect few cases where both the previous mentioned modalities had failed. Larger tumors situated on posterior and lateral walls were consistently detected by ultrasonography. Tumor staging by ultrasonography correlated well with final staging in infiltrating tumors. Thus it is concluded that the two non-invasive procedures, sonography and urine cytology must be routinely used for evaluation of fresh cases and in follow up of bladder tumors.

Adult↗
PubMed1990

[Asymptomatic blood pressure and pulse rate changes during intravenous urography. Ionic contrast media vs. nonionic contrast media].

In 8,232 examinations of intravenous urography (4,832 examinations with ionic contrast media and 3,400 examinations with nonionic contrast media), systemic blood pressure and pulse rate were continuously monitored by an automatic blood pressure and pulse rate monitoring device before and after injection of contrast media. The intravenous injection of ionic contrast media caused mild to moderate hypotensive reactions (20%-39% decrease of systemic blood pressure) in 7 examinations (0.14%) and severe hypotensive reactions (greater than 40% decrease of systemic blood pressure) in 12 examinations (0.25%). There were no clinical symptoms other than hypotensive reactions in 8 of the 19 examinations (42.1%). On the other hand, the intravenous injection of nonionic contrast media did not cause severe hypotensive reactions but mild hypotensive reactions (20%-29% decrease of systemic blood pressure) in 3 examinations (0.09%). These 3 examinations did not have clinical symptoms other than hypotensive reactions. Of the 19 examinations using ionic contrast media, the hypotensive reactions with significant change of pulse rate (greater than 20%) was associated with increase of pulse rate in 17 examinations and decrease of pulse rate in 2 examinations. On the other hand, the hypotensive reactions had an association with a significant increase (greater than 20%) of the pulse rate in only one of the 3 examinations using nonionic contrast media. The pulse rate was unchanged after injection of contrast media in the remaining 2 examinations although there was mild hypotension. In conclusion, nonionic contrast media caused fewer and less severe changes in blood pressure and pulse rate without obvious clinical symptoms compared with ionic contrast media.

Adolescent↗
PubMed1990

Urography with spasmolytics.

The effects of glucagon (1 mg i.v.) and hyoscine butylbromide (Buscopan 20 mg i.v.) and placebo on the visualization of the pyelocalyceal systems and ureters was compared in a routine urography with abdominal compression in a double-blind, randomized trial comprising 189 kidneys and ureters. The visualization of the ureters in the supine position was highly significantly better than in the prone. In the prone position the ureteral visualization with Buscopan was marginally significantly better than with placebo or glucagon. Otherwise, neither Buscopan nor glucagon improved the pyeloureteral visualization. However, with glucagon the pyelocalyceal visualization was highly significantly poorer than with placebo, and marginally significantly poorer than with Buscopan.

Animals↗
PubMed1990

[Examination by densitometer on visualization of non-ionic contrast medium (iohexol) in excretory urography. 1. Visualization by bolus injection].

The visualization of non-ionic contrast medium (Omnipaque 300) in the excretory urography by bolus injection was examined with regard to the normal sided urinary tract in patients with urolithiasis using a densitometer and further compared with that of ionic contrast medium (60% Urografin). In relation to the photographing method, both contrast media showed an increasing frequency of high opaque site in the order of Tomo, A-P and P-A images, which tended to shift from the upper to the lower urinary tract. In relation to the site of determination, both agents showed a good image in the upper urinary tract by the each photographings, while P-A image was better than A-P image in the lower urinary tract, suggesting their high usefulness for the imaging diagnosis. The visualization in relation to the contrast medium used was better in Omnipaque 300 groups than in 60% Urografin group with a significant difference (P less than 0.05-0.01) in the calyx and pelvis of the kidney by the each photographings, suggesting a high usefulness of non-ionic contrast medium. A densitometer seemed to be a useful means for evaluation and examination of the visualization with excellent objectivity as compared with conventional macroscopic methods.

Absorptiometry, Photon↗
PubMed1990

[Examination by densitometer on visualization of non-ionic contrast medium (iohexol) in excretory urography. 2. Changes in visualization by DIP].

Changes in the visualization of non-ionic contrast medium (Omnipaque 300) in the urography by DIP were monitored for the normal sided urinary tract in patients with urolithiasis using a densitometer. In addition, changes of the visualization in relation to the dose of contrast medium used was examined and compared with that of ionic contrast medium (60% Urografin). The optimum photographing time was 15 minutes in the upper urinary tract (nephrogram, calyx, pelvis, upper ureter) and 20 minutes in the lower urinary tract (lower ureter, urinary bladder). Visualization of high usefulness appeared to be obtainable for the imaging diagnosis by DIP in subjects with normal renal function even when the photographing was completed 20 minutes after infusion of contrast medium. In relation to the doses of contrast medium used, no difference was observed in the variation pattern but a better imaging was obtained in the 100 ml group than 50 ml group with a significant difference (P less than 0.01) in the 15-20 minute images of the calyx and pelvis of the kidney and urinary bladder in particular, this suggested the high usefulness of 100 ml dosing for the imaging diagnosis. In the visualization of ionic contrast medium, some difference was observed in the variation pattern and the visualization was better in Ominpaque 300 groups than in 60% Urografin group with a significant difference (P less than 0.01) in the 15-20 minute images of the calyx and pelvis of the kidney and urinary bladder. This suggested the high usefulness of non-ionic contrast medium.

Absorptiometry, Photon↗
PubMed1988

[Intravenous urography with a nonionic low osmolality contrast medium (iopamidol) in elderly patients].

Intravenous urography was carried out with a nonionic low osmolality contrast medium, iopamidol (Iopamiron 300) in 30 elderly patients (aged 65 to 86; with the mean age of 75 +/- 6), and the safety for the aged and radiopacity were evaluated. Although no purgative was given and water was not restricted in consideration of dehydration and bad influence on renal function, the total urinary system was well visualized. Side-effect was observed in none of 30 patients. This method seems to be useful for patients with a risk of dehydration and elderly patients.

Aged↗