0000000000025199
AUTHOR
Rolf W. Günther
Transrenal ureteral occlusion: results and problems.
Purpose The effectiveness of transrenal ureteral occlusion was evaluated. Patients and Methods Transrenal ureteral occlusions were performed in 83 ureters of 76 patients. Thirty-one ureters were occluded with use of tissue adhesive, which was secured in place with Gianturco coils in 21. Fifty-two ureters were occluded by means of silicone-filled, detachable latex balloons. Average follow-up was 3.6 months (range, 1 week to 38 months) for patients treated with the tissue adhesive and 7.9 months (range, 1 week to 61 months) for patients treated with the detachable balloons. Results Seventeen (55%) of the 31 ureters occluded with tissue adhesive and 36 (69%) of the 52 ureters occluded with det…
Real-time ultrasound of normal adrenal glands and small tumors.
The adrenals were studied prospectively with real-time ultrasound in a series of 60 healthy individuals and 13 patients with small adrenal masses sized 8-20 mm in diameter. In only one of the 60 healthy subjects was a normal adrenal gland delineated as a distinct hypoechoic structure. In all other instances only the highly echogenic suprarenal fat could be displayed. Visualization of small tumors was successful in 12 of 13 patients. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal and transverse scanning planes. The best access was through the 9th/10th intercostal space at the junction with the anterior and middle axillary lin…
Localization of small islet-cell tumors. Preoperative and intraoperative ultrasound, computed tomography, arteriography, digital subtraction angiography, and pancreatic venous sampling
A total of 42 islet-cell tumors were examined between 1972 and 1984. Problems of localization were only encountered in 31 tumors less than 2 cm in diameter. Of 31 small tumors, 27 were correctly localized using a combined diagnostic approach: ultrasound was successful in 12/20 tumors, CT in 9/21, angiography in 20/31, intraarterial digital subtraction angiography in 1/2, and pancreatic venous sampling in 13/16. The smallest tumor found by ultrasound and CT was 7 mm in diameter. Intraoperative ultrasound demonstrated all 9 insulinomas examined. Currently, the most useful techniques for localizing small islet-cell tumors are ultrasound, CT, and angiography. CT is particularly useful for tumor…
Percutaneous transrenal catheter retrieval.
Percutaneous transrenal catheter retrieval was successfully performed in 6 of 7 patients using the percutaneous transrenal access. Three broken nephrostomy tubes and 3 indwelling splints were extracted. The instruments used were deflecting guide wire in 1, grasping forceps in 2, and Dormia stone basket in 3 instances. No complications were encountered.
Transrenal Ureteral Occlusion with a Detachable Balloon
Transrenal ureteral occlusion using a detachable balloon was successfully employed to stop urinary flow in seven patients. The balloon was filled with low-viscosity silicone rubber and released in the distal ureter. Percutaneous nephrostomy provided external drainage. Indications were painful dysuria and large urinary fistulas in advanced pelvic malignancy. The method is preferable to ureteral embolization with tissue adhesive.
Die perkutane Harnleiterokklusion
One hundred and nineteen transrenal occlusions of 77 ureters were carried out in 71 patients. Thirty-one ureters were occluded by means of glue and in 21 Gianturco coils were introduced at the same time. Forty-six ureters were occluded by means of disposable silicone-filled latex balloons. Seventeen out of 31 ureters treated with glue (55%) and 32 out of 46 ureters with balloons (70%) were permanently occluded. On 42 occasions, re-occlusions had to be carried out, the average period from the initial occlusion being 2.5 weeks for glue and 19.5 weeks for balloons. In nine out of the 119 ureteric occlusions (7.5%), there were mild complications; these were easily treated and were of no consequ…
Ultrasonic demonstration of small pancreatic islet cell tumors.
In three patients real-time sonography successfully localized small pancreatic islet cell tumors measuring 7, 8, and 17 mm in size. Ultrasound is suggested as the initial radiologic examination for localization of endocrine pancreatic tumors. If ultrasound is negative or equivocal, computerized tomography, arteriography, and pancreatic venous sampling are indicated.
Transrenal ureteral occlusion using a detachable balloon
Percutaneous transrenal ureteral occlusion using a detachable balloon filled with silicone was performed in 20 patients. The main indications were palliation of large urinary fistulas and as a treatment of last resort for severe dysuria in patients with advanced pelvic malignancies. In 6 patients the contralateral kidney was rendered nonfunctional to obviate the need for bilateral nephrostomy. Due to frequent obstruction of the tube, ureteral blockage in 3 became insufficient. Two dislocated balloons were extracted percutaneously and replaced. In order to achieve effective interruption of urinary flow down the ureter, well-functioning external nephrostomy drainage is necessary.
Review article: Percutaneous transhepatic biliary drainage: Experience with 311 procedures
Percutaneous biliary drainage was performed in 296 patients on 311 occasions using a fine-needle puncture technique. In 59%, the procedure served as postoperative decompression, and in 35% for palliation of obstruction, particularly in malignant disease. Postoperative drainage for the management of postoperative complication accounted for 2.5%. In more than 80% of the patients treated, the underlying disease was malignant obstructive jaundice. In 257 retrospectively evaluated patients the following complications were observed: cholangitis (6.6%), sepsis (3.1%), bile leakage (1.6%) with two deaths (0.7%), and subcapsular hematoma and hematoma in the hepatoduodenal ligament (1.2%). Catheter d…
Ergebnisse und Komplikationen von 616 perkutanen transhepatischen Gallenwegsdrainagen
During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.
Sources of human plasma cyclic AMP. Examinations before and after beta 2 adrenergic stimulation.
Plasma cyclic AMP was measured in different vessels in seventeen volunteers before and after stimulation with terbutaline. Differences between arterial blood and blood from the hepatic vein, right ventricle, inferior vena cava and a cubital vein could not be demonstrated. Only in the renal vein was the concentration of cyclic AMP decreased. Our results indicate that cyclic AMP is not generated from any specific isolated organ and that changes in cyclic AMP after subcutaneous injection of terbutaline reflect a general influence of this drug.
Szintigraphie adrenerger Tumoren mit 131J-meta-Benzylguanidin
Pheochromocytoma scanning using 131J-meta-benzylguanidine was done in one patient with metastasizing paraganglioma, one patient with multiple endocrine neoplasia type IIb. No activity of tumour tissue could be demonstrated in the patient with metastasizing paraganglioma, whereas the pheochromocytoma could be clearly defined in the patient with multiple endocrine neoplasia type IIa. The female with multiple endocrine neoplasia type IIb showed a suspect space-occupying lesion of the left adrenal using computed tomography. Pheochromocytoma could be excluded by 131J-benzylguanidine scanning, selective estimation of catecholamines in adrenal venous blood as well as the glucagon stimulation and c…