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PubMed1987

Squamous cell carcinoma of the renal pelvis with sarcomalike stroma: a light and electron microscopic study with immunohistochemical analysis.

Primary neoplasms of the renal pelvis are rare. Most are malignant, and most of these are transitional cell carcinomas. We report the unusual occurrence of a squamous cell carcinoma with sarcomatoid stroma arising from the renal pelvic mucosa in a patient with renal lithiasis. Immunohistochemical stains for keratin intermediate filaments failed to demonstrate their presence in the spindle cell portion of the tumor. Transmission electron microscopic study did not reveal structures of an epithelial nature in these same cells. Our findings support the contention that the spindle cells of the stroma are not squamous in nature, but represent either a reactive or a neoplastic transformation of these underlying stromal elements.

Carcinoma, Squamous Cell↗
PubMed2003

Value of a blood pool contrast agent in MR venography of the lower extremities and pelvis: preliminary results in 12 patients.

The purpose of this study was to determine the value of a blood-pool contrast media (NC100150, Nycomed Imaging (now Amersham Health) Oslo, Norway) for evaluation of venous thrombosis of the deep veins of the pelvis and lower extremities. Twelve patients were prospectively evaluated with conventional X-ray venography (XRV) and MR venography (MRV) after injection of NC100150 (2 ml/kg body weight). The source images and 3D maximum intensity projection (MIP) were viewed on an independent workstation. Diagnosis was made in consensus from two radiologists. Diagnostic image quality was achieved in 87 veins with XRV and MRV. As determined by XRV, thrombus was present in 30 out of 87 veins (34.5%). There was agreement concerning absence or presence of thrombi in 83 out of 87 veins (95.4%; kappa = 0.9 +/- 0.05). Compared to XRV, overall sensitivity and specificity of blood-pool MRV were 93.3% and 96.5%, respectively. Two venous thromboses of the popliteal and posterior tibial vein were diagnosed in MRV, but not in XRV. Conversely, two venous thromboses below the knee had been missed by MRV. NC100150 allows prolonged and improved visualization of the peripheral vasculature and may overcome some limitations of gadolinium contrast media. A more complete examination of the proximal venous tree may be possible than with conventional XRV. Arterial and venous enhancement and motion artifacts can limit image interpretation.

Artifacts↗
PubMed2003

Charts of fetal size: kidney and renal pelvis measurements.

OBJECTIVE: To construct new size charts for fetal kidney measurements and to define normal limits for renal pelvic antero-posterior diameter. METHODS: A prospective, cross-sectional study was carried out in the ultrasound department of a large hospital. Six hundred and sixty-three fetuses were scanned only once for the purpose of the study at gestations between 14 and 42 weeks. Centiles for kidney dimensions were estimated by combining separate fractional polynomial regression models fitted to the mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. Centiles for renal pelvic diameter were obtained using quantile regression. RESULTS: Size charts for fetal kidney dimensions [antero-posterior (AP), transverse, length and volume] and renal pelvis diameter are presented and compared with previously published data. CONCLUSION: We present new size charts for fetal kidney size that take into consideration the increasing variability with gestational age. These data should aid the prenatal diagnosis of renal pathology by defining renal size and the upper limits of normal pelvic dilatation. They may be particularly useful in the third trimester where there is limited data available. Our data confirm that it is reasonable to use an upper limit of 7 mm for the AP diameter in late pregnancy.

Adult↗
PubMed2000

Prognostic significance of lymph node metastasis and clear cell histology in ovarian carcinoma limited to the pelvis (pT1M0 and pT2M0).

BACKGROUND: The prognostic significance of lymph node (LN) metastasis in clinically early-stage (pT1M0 or pT2M0) ovarian carcinoma has not yet been fully elucidated. METHODS: From 1988 to 1997, 94 patients with ovarian carcinoma of pT1M0 (n = 78) or pT2M0 (n = 16) classification underwent surgery including systematic pelvic and paraaortic LN dissection. We investigated the prognostic factors of intraperitoneally determined early-stage ovarian carcinoma focusing on LN metastasis. RESULTS: LN metastasis was seen in 5.1% of pT1M0 and in 31.3% of pT2M0 tumors. Univariate analysis of grade, histology (clear cell vs others), size of primary tumor, peritoneal cytology, and LN metastasis revealed that histology (P < 0.01), size of tumor (P < 0.05), and LN metastasis (P < 0.0005) were related to patient survival of early-stage ovarian carcinoma. Peritoneal cytology (P = 0.053) and grade (P = 0.059) had marginal statistical significance. A multivariate Cox regression analysis showed that clear cell histology (P < 0.05) and LN metastasis (P < 0. 005) are significant independent prognosticators of patient survival. Three (two with clear cell adenocarcinoma and one with mucinous adenocarcinoma) of nine patients with LN metastasis had died of the disease by the time of the present analysis. Two of the three deceased patients had recurrent tumors in distant organs (bone and brain/liver), one had pleural and peritoneal carcinomatosis, and no patients had retroperitoneal recurrence. This suggests that LN metastasis indicates that tumor cells may have already spread systemically at the time of treatment and, at the same time, retroperitoneal lymph node dissection (RPLND) may be effective in eradicating retroperitoneal metastasis in some instances of ovarian carcinoma. CONCLUSION: Clear cell histology and LN metastasis are indicators of poor prognosis for patients with tumors limited to the pelvis. Therapeutic significance of systematic RPLND for pT1M0/pT2M0 ovarian carcinomas needs to be further investigated by randomized studies.

Adenocarcinoma, Clear Cell↗
PubMed2001

Initial clinical experience with intensity-modulated whole-pelvis radiation therapy in women with gynecologic malignancies.

OBJECTIVE: Our goal in this article to describe our initial experience with intensity-modulated whole-pelvis radiation therapy (IM-WPRT) in gynecologic malignancies. METHODS: Between February and August 2000, 15 women with cervical (9) or endometrial (6) cancer received IM-WPRT. All patients received a treatment planning computed tomography (CT) scan. On each scan, the target volume (upper vagina, parametrial tissues, presacral region, uterus, and regional lymph nodes) and normal tissues (small bowel, bladder, and rectum) were identified. Using commercially available software, an IM-WPRT plan was generated for each patient. The goal was to provide coverage of the target with the prescription dose (45 Gy) while minimizing the volume of small bowel, bladder, and rectum irradiated. Acute gastrointestinal (GI) and genitourinary (GU) toxic effects in these women were compared with those seen in 25 patients treated with conventional WPRT. RESULTS: IM-WPRT plans provided excellent coverage of the target structures in all patients and were highly conformal, providing considerable sparing of the bladder, rectum, and small bowel. Treatment was well tolerated, with grade 0-1 GI and GU toxicity in 46 and 93% of patients, respectively. IM-WPRT patients had a lower rate of grade 2 GI toxicity (53.4% vs 96%, P = 0.001) than those treated with conventional WPRT. Moreover, the percentage of women requiring no or only infrequent antidiarrheal medications was lower in the IM-WPRT group (73.3% vs 20%, P = 0.001). While grade 2 GU toxicity was also lower in the IM-WPRT patients (6.7% vs 16%), this difference did not reach statistical significance (P = 0.38). CONCLUSION: IM-WPRT provides excellent coverage of the target structures while sparing critical neighboring structures in gynecology patients. Treatment is well tolerated with less acute GI toxicity than conventional WPRT. More patients and longer follow-up are needed to evaluate the full merits of this approach.

Adult↗
PubMed1994

Evidence for a reflex provoking contraction of the renal pelvis (with some comments on its clinical implications).

The effect of swallowing a small quantity of water or of solid food (biscuit) on the renogram curve was observed in 177 patients. Swallowing provoked contraction of the renal pelvis in 63% of the kidneys with a pelvicalyceal system which was neither obstructed nor dilated, with expulsion of a substantial fraction of the contents within 30 s. This did not occur in obstructed or denervated kidneys, nor in patients with a high transection of the spinal cord. Evidence is adduced that this contraction is mediated reflexly. This effect may be used diagnostically to distinguish physiological dilatation from obstruction. The implications when performing and interpreting renography are discussed.

Adolescent↗
PubMed1990

Case report 594: Osseous sarcoidosis (osteolytic) of lumbar spine and pelvis.

A case of destructive osseous sarcoidosis involving the lower lumbar spine, sacrum, and pelvis has been presented. The pattern of multiple small lytic lesions without sclerosis in this distribution has not been described previously. Identification of these lesions was only possible by computed tomography and differentiation from metastatic disease required open biopsy.

Adult↗
PubMed1996

Verrucous carcinoma of the renal pelvis: case presentation and review of the literature.

Squamous cell carcinoma (SCC) of the renal pelvis is an uncommon tumour that has occasionally been associated with horseshoe kidney. The verrucous form of well-differentiated SCC has not been described previously at this site. We describe such a tumour in a 41-year-old man, who presented with gross haematuria and recurrent pyelonephritis caused by staghorn calculi within a horseshoe kidney. Histology showed extensive keratinising squamous metaplasia of the pelvic urothelium with an area of verrucous acanthosis and underlying invasion of the pelvic smooth muscle by broad tongues of squamous epithelium without atypia. Local lymph nodes were not involved by tumour. Immunohistochemistry and polymerase chain reaction revealed no evidence of human papillomavirus infection. The literature regarding verrucous carcinoma of the urothelial tract is reviewed.

Adult↗
PubMed1992

Evidence for genetic heterogeneity in hereditary hydronephrosis caused by pelvi-ureteric junction obstruction, with one locus assigned to chromosome 6p.

Hereditary hydronephrosis (MIM 143400) is an autosomal dominant trait that causes unilateral or bilateral pelvi-ureteric junction (PUJ) obstruction. Linkage analysis was undertaken in 5 families with hereditary PUJ obstruction using the major histocompatibility complex locus as a test marker. The data as a whole supported a hereditary hydronephrosis locus on 6p. Maximal lod scores were 3.090 at a recombination fraction of 0.1 with full penetrance, and 2.486 at a recombination fraction of 0.1 with a penetrance of 90%. However, analysis of two point lod scores using the HOMOG program revealed significant evidence for genetic heterogeneity with one locus on 6p in 4 of the families, and a different locus in one family. After exclusion of this unlinked family, two point analysis gave a maximal lod score of 3.9 at a recombination fraction of 0.05 with full penetrance, and 4.2 at a recombination fraction of 0.0 with 90% penetrance. These data support the assignment of one of the loci for hereditary hydronephrosis to chromosome 6p.

Chromosomes, Human, Pair 6↗
PubMed1992

Magnetic resonance imaging of tendon and ligament abnormalities: Part II. Pelvis and lower extremities.

Magnetic resonance imaging (MRI) has provided an ideal means, unmatched by other preexisting modalities, of examining musculoskeletal abnormalities, particularly those involving tendons and ligaments in the lower extremities. Lack of motion artifact, convenience of application of surface coil, and absence of overlying structures have made the lower extremities ideally suited to MRI. In addition, the abundance of adjacent adipose tissue provides a superb contrast background. Although evaluation of trauma remains the most common reason for MRI examination, many other conditions may also affect tendons and ligaments. As in other soft-tissue, chondral, and osteochondral lesions, MRI provides exquisite details of abnormalities in these structures. Part II of this review systematically reviews the abnormalities of tendons and ligaments in the pelvis and lower extremities.

Adolescent↗
PubMed1986

A simple electrode for stable recording of pacemaker potentials for ureteral peristalsis from the in vivo canine renal pelvis.

Pacemaker potentials for ureteral peristalsis were recorded in vivo with a fine, flexible acupuncture needle electrode inserted transparenchymally into the renal pelvis of anesthetized dogs. The recorded pacemaker potentials were quite similar, in every respect, to those shown in vitro, suggesting the availability of this electrode in recording and detailed analysis of the pacemaker activity in studies requiring in vivo preparations.

Action Potentials↗
PubMed1987

Studies on the influence of the flow field in the pelvi-calyceal system (PCS) on the formation of urinary calculi.

Following a morphological analysis of pelvi-calyceal systems (PCS) of healthy persons and urolithiasis patients, rheological studies from glass and rubber PCS-models are presented. In the PCS of urolithiasis patients morphological and geometrical differences were found, causing a flow pattern which favours calculus formation. In urolithiasis, the PCS is characterized by cavities with significantly reduced flow rates and stagnation of urine. The formation of urinary calculi is often promoted by a hypomotility of the muscles of the PCS, common in urolithiasis patients. Possible therapeutic and diagnostic consequences are discussed.

Humans↗
PubMed1987

Disturbed urinary transport in the pelvi-calyceal system in calcium-oxalate stone patients.

This study is intended to elucidate the process of urinary transport through the pelvi-calyceal system (PCS). PCS-motility of a total of 28 PCS was qualitatively and quantitatively determined in 9 stone patients and 14 control persons by examination of contrast medium excretion. From X-ray videograms recorded by means of Siemens urography, four different urinary transport types could be distinguished as well as the duration of the contraction periods and the intervals between the PCS-contractions. In stone patients physiological types of urinary transport are less common (33%) than in control subjects (81.25%). In stone patients the PCS is often characterized by reduced or even absent motility. Calyceal reflux is usually found in the systolic phase of PCS-contractions, which may apparently be regarded as a physiological process.

Biological Transport↗
PubMed1989

Stimulation of calcium uptake by norepinephrine or high external potassium in human calyces and renal pelvis.

The effects of stimulation with either 10 mumol/l norepinephrine or 85 mmol/l extracellular potassium concentration on calcium uptake were studied in muscle strips from human renal calyces and from the renal pelvis. The apparent uptake of calcium under control conditions was essentially complete after 30 min. Stimulation of the muscle strips with norepinephrine or high external potassium significantly (P less than 0.05) increased the calcium uptake over the control values at 30 and 100 min, whereas 45Ca efflux was virtually not affected. It is concluded that the mechanical responses of the muscle strips to norepinephrine or high external potassium correspond with an increased uptake of calcium suggesting that both types of activation are mediated by an increase of intracellular calcium concentration similar to that described in other smooth muscles.

Calcium↗
PubMed1985

Experimental study of the pressure-volume and pressure-time relations in the completely obstructed pelvis of the porcine kidney. Part 4: Instability and blow out.

In a series of experiments with pigs the completely obstructed renal pelvis was filled with Ringer's lactate at a constant rate of 2 ml/min until the pressure did not longer increase linearly. By means of continuous X-ray monitoring and histological examination of the infused kidneys it was found that blow out may occur at pressure levels individually varying from 60 to 180 mmHg. The histological features of this phenomenon are presented and the clinical significance is discussed.

Animals↗
PubMed1988

Patch grafting the renal pelvis and ureteropelvic junction. A comparative study in pigs using lyophilized dura mater and free peritoneum.

Lyophilized dura mater (Lyodura) and autogenous free peritoneum were compared in the replacement of the partially resected renal pelvis and uretero-pelvic junction (UPJ) in the pig. The Lyodura and peritoneum grafts were both progressively resorbed, and replaced by fibroblasts which formed a mature scar lined by transitional epithelium, but without smooth muscle regeneration. Lyodura was found to be superior to free peritoneum with a longer time before resorption of the graft, less intense inflammatory reaction, absence of metaplastic bone formation, less risk of urine leak and greater ease of surgical manipulation.

Animals↗
PubMed1976

Histochemical light microscopic study of catecholamine containing paraganglia in the human pelvis.

Histological and histochemical techniques have been employed to determine the structure and autonomic innervation of paraganglia located in the human pelvis. In foetal and early postnatal tissues, paraganglia formed rounded cellular masses which were frequently in company with the autonomic nerves and ganglia of the urinary bladder and other pelvic viscera. The constituent cells contained only small amounts of cholinesterase and were unrelated to enzyme positive autonomic nerves; acetylcholinesterase containing nerves were occasionally observed in the capsule and the fibrous septa of the pelvic paraganglia. In early postnatal specimens, pelvic paraganglia frequently contained single or multiple "pacinian-like" corpuscles, each possessing a central region which was rich in both acetyl and pseudocholinesterase. These structures were rarely observed within autonomic ganglia and were absent 4 1/2 years post partum. By means of a histochemical technique, pelvic paraganglia were found to contain catecholamine which was attributed to the presence of relatively large quantities of noradrenaline. These observations have been discussed with particular reference to the results of other studies on the autonomic innervation of paraganglia.

Child, Preschool↗
PubMed1985

Experimental study of the pressure-volume and pressure-time relations in the completely obstructed pelvis of the porcine kidney. Part 2: The relation between actual hydrostatic pressure, intrapelvic volume and time.

In a series of experiments with pigs the completely obstructed renal pelvis was infused with Ringer's lactate at a constant rate of 2 ml/min. At various pressure levels (lower than 50 mm Hg) the relations pressure vs infused volume and pressure vs actual intrapelvic volume and the effects on the intrapelvic pressure of rapid total or partial extraction of the actual volume were measured. At pressure levels lower than 15-20 mm Hg the P-V relation is exponential; at pressure levels between approximately 20 to 50 mm Hg this relation is linear. In the pressure range from 20 to 50 mm Hg the pressure decays, at a constant or increasing volume, asymptotically to a certain stabilisation value when the infusion is stopped. The relation between stabilised pressure and intrapelvic volume is linear.

Animals↗