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Purpose: To validate a method for calculating split renal function from computed tomography (CT) compared with gamma camera renography, and to test a new method for the measurement based on a volume-rendering technique. Material and Methods: Thirty-eight patients, aged 65.7 +/- 11.6 (range 37.8-82.1) years, who had undergone both CT angiography and gamma camera renography for a suspected renal artery stenosis were included in this study. Split renal function was calculated from the CT examinations by measuring area and mean attenuation in the image slices of the kidneys, and also by measuring volume and mean attenuation from a 3D reconstruction of the kidneys. Gamma camera renography with 99mTc-MAG3 with or without captopril enhancement was used as a reference. Results: The 2D CT method had good correlation with renography (r=0.93). Mean difference was 4.7 +/- 3.6 (0-12) percentage points per kidney. There was also excellent correlation between the two CT methods (r=1.00). Conclusion: CT is equivalent to renography in determining split renal function, and the measurement from the CT examination can be made more quickly and equally accurately with a 3D technique. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether three-dimensional rotational angiography (3D-RA) of the transplant renal artery performed with an extended angle of rotation can reduce beam-hardening artifacts in 3D reconstructed images without image quality being lost or side effects to the transplanted kidney being increased.Material and Methods: 3D-RA with a C-arm rotation of 180 degrees was performed consecutively in 12 renal transplanted patients with suspicion of renal artery stenosis. A 1.7-mm balloon occlusion catheter was placed using the crossover technique and this was compared to a protocol with 160 degrees rotation and a traditional 1.4-mm catheter in 10 patients. The occurrence of beam-hardening artifacts was registered and the effects of the reduced contrast load on image quality and of arterial occlusion on renal function were assessed.Results: The extended angle of rotation, from 160 degrees to 180 degrees, reduced the beam-hardening artifacts. Artifacts were observed in 4/11 patients (36%) in the study group and in all 10 (100%) of the controls. There was no statistical difference regarding image quality between the two protocols. Renal function was equally affected in both protocols.Conclusion: 3D-RA with an extended C-arm rotation reduced the beam-hardening artifacts. Image quality was not reduced despite the reduced contrast medium load. The different protocols had no effect on patient outcome. [ABSTRACT FROM AUTHOR]

Purpose: To develop and evaluate a method of calculating split renal function from computed tomography (CT) images based on the assumption that the accumulation of contrast medium is proportional to the renal function, and to compare the results with the renogram.Material and Methods: The study comprised a retrospective analysis of CT images and renograms from previous donors. Twenty-seven potential renal donors were studied using a technique for measuring the area and mean attenuation of the separate CT slices, and for calculating the volume and total attenuation of the whole kidney.Results: Correlation between CT and renography was moderate (r = 0.43), but the range of results was narrow. The ratio between the two kidneys was more even with CT (50 +/- 2.1%) than with the renogram (48 +/- 2.9%) (right kidney), and the mean difference between the two methods was 3 +/- 2.3 percentage points.Conclusion: The renogram can be replaced using calculations from the CT examination in estimating split renal function in potential renal donors. [ABSTRACT FROM AUTHOR]

Purpose: To develop a protocol for 3D rotational angiography (3D-RA) of the transplant renal artery.Material and Methods: 3D-RA was consecutively performed in 39 renal transplanted patients with suspicion of renal artery stenosis. A series of images were acquired while the C-arm of the equipment rotated around the region of interest. Contrast media in different concentrations were given through a 1.4 mm catheter with different sites of injection in the ipsilateral iliac artery. The 3D reconstructions were done at a workstation. Suspected stenoses were in most cases verified with pressure measurement, and a systolic pressure gradient of 10 mm Hg or more was regarded as significant.Results: 28 stenoses were found in 24/39 patients (62%); 21/28 (75%) were verified by pressure measurement. The 3D reconstructions gave a better description of the stenoses in 10 patients.Conclusion: 3D-RA is a helpful supplement in cases with complicated vascular anatomy, especially when intervention may be indicated. The best results were achieved with the catheter tip in the proximal iliac artery and 70-75 ml of a high concentration contrast medium at a flow rate of 8-10 ml/s. [ABSTRACT FROM AUTHOR]

Objective. Glomerular filtration rate (GFR) is generally accepted as the best overall index of renal function. Thus, all potential live kidney donors are tested to ensure that they have a normal GFR before they are eligible for kidney transplantation. The choice of GFR test is very much dependent on local traditions and may include iohexol, 51Cr-EDTA, inulin, or creatinine clearance based on urine collection, and creatinine clearance calculated from the Cockcroft-Gault or Modification of Diet in Renal Disease (MDRD) equation as well as cystatin C. The aim of this study was to compare the results of GFR measurements performed in all actual live kidney donors who have undergone live donor nephrectomy at the University Hospital in Uppsala, Sweden, between the years 2000 and 2004. Material and methods. The patients were selected from all parts of Sweden and the measurements were performed at their local hospital. Results. We found large discrepancies between repeated iohexol measurements in these presumably healthy individuals. There was also a poor correlation between iohexol clearance and calculated creatinine clearance using the Cockcroft-Gault (R2 = 0.046) or MDRD formula (R2 = 0.045). Conclusions. The study shows that the standardization and quality of GFR measurements in Sweden have to be improved. [ABSTRACT FROM AUTHOR]

Background: Hand-assisted laparoscopy (HALS) was introduced to increase the safety of living donor nephrectomies. Herein we evaluate the first HALS living donor nephrectomies performed at our center. Methods: Traditional laparoscopic nephrectomies (TLS) (n = 11) and HALS nephrectomies (n = 11) were included in the study. One patient from the TLS group was excluded because the operation was converted to open nephrectomy. We compared the operating times (OT) and warm ischemia times (WIT) for the two procedures and calculated the operating costs. Results: Mean OT was 270 min in the TLS group and 197 min in the HALS group; thus, there was, a significant reduction of 27% with HALS. WIT was 297 sec for the TLS group and 214 sec for the HALS group, for a reduction of 28%. Costs were also lowered for HALS. Conclusion: In addition to shortening both OT and WIT, HALS enhances the safety margin of the procedure, especially during trocar placement. It is further helpful in preventing torsion of the kidney and controlling potential bleedings, as well as during vascular stapling and kidney removal. [ABSTRACT FROM AUTHOR]

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Traumatic manipulation of the prostate can cause elevated prostatic acid phosphatase (PAP) values. To avoid falsely elevated PAP values after prostatic trauma we studied the serum half life of PAP and the time taken to return to preoperative levels in patients undergoing transurethral resection (TUR-P). Although we observed a broad variation in peak PAP values the half life of PAP is fairly constant at about 1.1-2.6 h. Preoperative values were reached within 30 h. We conclude that PAP determinations can safely be carried out 30 h after prostatic trauma without any risk of falsely elevated PAP values. [ABSTRACT FROM AUTHOR]