Search

We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.

P nmary hyperoxaluria type 1 (PH!) is a hereditary metabolic disease caused by a deficiency of the hepatic-specific peroxisomal enzyme, alanine-glyoxalate aminotransferase, and is characterized by an overproduction of oxalate. Renal deposition of insoluble calcium oxalate leads to urolithiasis or nephrocalcinosis and finally to chronic renal failure. At this stage of chronic renal failure, oxalate starts to accumulate in other tissues such as bone, constituting SyStemiC oxalosis [1]. Clinically, PH! is an cxtremely heterogeneous disease. Most commonly, symptoms and renal failure occur in childhood and early adulthood. Infrequently, the patient remains asymptomatic until late in adult life [1, 2]. Radiographic bone lesions of oxalosis in children and young patients have been extensively described [3, 4]. In older patients, radiographic bone lesions are less specific and can mimic those of renal osteodystrophy. The diagnosis is then difficult to make, and the symptoms can be attributed to secondary hyperparathyroidism, which may also complicate the course of the disease after long-term hemodialysis, superimposing radiographic abnormalities. Furthermore, it is important to distinguish patients with PH! and no associated secondary hyperparathyroidism from those with associated hyperparathyroidism, to avoid useless and harmful parathyroidectomy. In the present case, we report some radiographic features suggesting the diagnosis of oxalate osteopathy late in adult life.

Areas of increased echogenicity in the fetal abdomen are defined as abnormally bright areas with an echogenicity similar to that of surrounding bones. Such areas are encountered in various normal and abnormal processes. When increased echogenicity is discovered in the fetal abdomen, a careful search should be made for a potential cause. The causes to be considered depend on the location of the areas of increased echogenicity, which can be classified as intestinal, peritoneal, hepatic, retroperitoneal, and parietal. In each case, vascular, ischemic, infectious, tumoral, metabolic, and chromosomal abnormalities should be included in the differential diagnosis before considering the finding a normal variant. Therefore, in utero detection of fetal abdominal areas of increased echogenicity requires a complete sonographic survey of the fetus and placenta along with close sonographic follow-up, evaluation of familial factors, and testing for possible associated cystic fibrosis, infection, or a chromosomal anomaly. The prognosis depends more on the underlying disease than on the extent of the increased echogenicity.

Selective pudendal arteriography is indicated in selected cases of male impotence when there is a strong presumption that peripheral arterial lesions are responsible for it. These lesions are classified as: (a) traumatic; (b) obstructive in thrombo-angiitis or atheroma, and (c) dysplasic. Selective arteriography will confirm the diagnosis and indicate the nature of the obstruction, its degree and extension. Eur Urol

SCOPUS: ar.j, info:eu-repo/semantics/published

(mean, 51 years), were studied by arteriography. In the last 21 patients, digital subtraction angiography (DSA) was performed. The studies were done on an outpatient basis under local anesthesia without sedation. Intracavemous injection of 60 mg of papaverine was made through a lateral puncture of the penis by use of an intradermic needle. A tourniquet was placed at the base of the penis to avoid escape of papaverine into the systemic circulation. The corpus cavernosum into which the drug was injected was squeezed manually to diffuse the drug into the contralateral corpus cavemosum. The examinations were performed after the patient developed an erection. In all patients, both internal iliac arteries were catheterized by a right femoral approach and using 5-French catheters. Both internal pudendal arteries were selectively catheterized. In six cases, selective catheterization was not possible because of severe atherosclerosis. The contrast material was injected into the internal iliac arteries at the level of the inferior gluteal artery. The penile vascularization was studied in the contralateral 30#{176}-45#{176}

The ability of real-time sonography to demonstrate the liver venous network is well documented. Sonographic features of 21 cases of unsuspected portal vein thrombosis, detected by a screening sonography of the upper abdomen and subsequently confirmed by computed tomography, angiography, or surgery, are discussed. Sonographic features of portal vein thrombosis were an echogenic thrombus within the lumen of the vein (67%), demonstration of portal vein collateral circulation (48%), enlargement of the thrombosed segment of the vein (38%), and the so-called cavernomatous transformation of the portal vein (19%). Echogenic endoluminal thrombi were observed with the same incidences in malignant and benign disease. Sonography, unlike angiography, was unable to characterize neoplastic thrombi; only the combination of an echogenic thrombus and an adjacent hepatic mass was strongly suggestive of malignancy, especially hepatoma. The extensive use of sonography as a screening test in upper abdomen pathology will probably improve the detection of portal vein thrombosis, a diagnosis until now considered rare.

A patient with diffuse hepatic arteriovenous microfistulae suffered from secondary high-output right ventricular failure, pulmonary hypertension, and ascites, all of which could be managed by selective embolization of the hepatic artery. The vascular lesion of the liver seems to be essential, although hemorrhagic hereditary telangiectasia ,perhaps aggravated by administration of oral contraceptives, may be considered contributory factors in this case., info:eu-repo/semantics/published