[Urodynamics of the kidney calices].
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The pelvicalyceal echo complex has a characteristic appearance as an echo-filled cylinder in which minimal sonolucency may normally be seen. Alteration in the pelvicalyceal echo complex is a helpful guide in the diagnosis of a variety of pathological processes involving the kidneys. Reliable diagnosis of moderate and marked hydronephrosis may be made by the appearance of uniformly sized, sonolucent collections in the pelvicalyceal echo complex which show communication with the renal pelvis. An adjacent simple renal cyst produces a sharply defined crescent shaped deformity of the pelvicalyceal echo complex, and scalloping is seen with multiple impinging renal cysts. Gross deformity of the central echo complex is seen with polycystic kidney disease, as well as in neoplasia. Edema and infiltrating hypernephroma may result in diminution of the pelvicalyceal echo complex. Amputation or a "V"-shaped splitting of the pelvicalyceal echo complex may be seen with neoplasia.
Intrarenal vascular obstruction of the upper calyceal infundibulum has been distinguished by Fraley as an entity separate from an asymptomatic vascular impression. Clinically, this form of intrarenal vascular obstruction presents as nephralgia or hematuria. This infundibular obstruction is caused by normal renal vessels, usually the upper segmental artery: radiologically, the vessels produce a constant well-defined filling defect in the infundibulum at IVP, and, the upper calyx group is distended and shows delay in emptying. We found this condition in 14 children from 1968-1975. Control studies showed no progression in the radiological findings, even over a long period. In one of our cases angiography was indicated to exclude tumour or cyst; in another case, surgery was necessary. Complications are urinary tract infection or stone formation. Therefore, children with Fraley's syndrome require regular clinical examination.
Relying on their own observations, the authors describe nine patients in whom Fraley's syndrome was diagnosed and treated operatively. In six of them, calycopyeloneostomy was performed. In three of the patients, because of complications, the upper pole of the kidney was excised together with the changed calyx. In noncomplicated cases the calycopyeloneostomy with a transposition of the artery beyond the cervix of the upper calyx allows to retain the active parenchyma of the upper pole of the kidneys.
The literature on calyceal diverticula is reviewed, the embryological aspects and pathogenesis are discussed and commented upon, and the ""congenital vasocentric'' theory of the authors is elaborated. The study includes the analysis of 17 cases seen over twenty years at the Department of Urology, Semmelweis University Medical School, Budapest.
A case is reported in which diagnosis of a calyceal diverticulum, at the time of observation of cystic appearance, was made by ultrasonography, without requiring special roentgen diagnostic procedures of limited safety.
A case of milk of calcium renal stone was reported. It is an unusual condition in which there is suspension of calcium salt within a pyelogenic cyst. The diagnosis is difficult because of its rarity. Reviewing literature, plain abdominal X-ray in different positions were emphasized. We found that fluoroscopy with spot films in different positions is worthwhile. It has to be differentiated from gallstone and also from usual renal stone. Conservative treatment is advised if there is no suggestive malignancy.
Fibroepithelial polyp of the renal pelvis is an extremely rare entity. We report a case of multiple fibroepithelial polyps of the renal pelvis and calyces and discuss this rare and confusing condition with its clinical, radiological and pathological findings.
Surface fine structures of human distal nephron, papilla and calyx were studied by use of SEM. Tissue preservation was carried out by perfusion fixation and critical point drying. The various surface features of epithelial cells were visualized in the lower urinary tract.
A calyx which fails completely to opacify on excretory urography (phantom calyx) is often the harbinger of serious underlying renal disease. Causes of a phantom calyx include tuberculosis, tumor, calculus, ischemia, trauma, and congenital anomaly. The pathologic basis for the radiographic findings in each of these entities is described and an overall approach to diagnosis is set forth.
Eighty-three patients with radiographically opaque renal stones were evaluated prospectively with ultrasound and compared to KUB (kidneys, ureters, bladder) with tomograms (KUB/T) to further define the use of ultrasound in the evaluation of renal calculi. The presence or absence and the size, number, and location of stones were analyzed and correlated for each modality. Ultrasound detected the presence of renal stones in 77 of 83 (93%) patients. However, all of the stones were detected on ultrasound in only 60% of these patients. Thirty percent (80 of 269) of the papillary-calyceal stones seen on KUB/T were missed on US; 66% of the stones missed measured 2 mm or less. Although ultrasound can be used for detection of intrarenal stones, KUB/T is a more accurate imaging examination for determination of size and number of small stones.
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