Bruce A. Rodan

Fibrous Mass Complicating Epidural Morphine Infusion

The benefits of continuous epidural morphine infusion using an implanted pump delivery system to control intractable cancer pain have recently been described. Most articles on this subject relate to dosage, technique, degree of pain relief, and tolerance. There are some anticipated complications of the treatment related to the surgical implantation of the system and drug toxicity. We present a complication presumably related to the epidural catheter. A fibrous reaction that developed around the catheter tip progressed into a mass. This caused a significant displacement of the spinal cord with the development of long tract symptoms. Identification of this abnormality using myelography and computed tomography led to prompt surgical decompression resulting in improvement of the patients condition.

Calcification in pulmonary metastases

A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.

Balloon dilatation of urethral strictures

Balloon dilatation of the urethra in 9 male patients with either post-inflammatory or post-traumatic strictures was successfully performed. This procedure is primarily indicated in those patients with unsatisfactory results using conventional dilatation with metal sounds. A flexible endoscope was used for guide wire passage and fluoroscopic guidance for positioning the balloon and assuring complete dilatation of the urethral strictures or vesical neck contracture. In this manner, dilatation to 36 F can be performed in a relatively atraumatic manner with minimal discomfort.

Balloon dilation of prostatic urethra

Retrograde balloon catheter dilation of the prostatic urethra was performed for the management of bladder outlet obstruction secondary to prostatic hyperplasia. Of the 55 patients in our series, 43 were treated entirely as outpatients and 12 were inpatients for unrelated conditions. The patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Twenty-two of these patients had Foley catheters for relief of their outflow obstructions. The procedures were performed under local anesthesia or intravenous sedation. Successful results were noted in 46 of 55 patients with relief of symptoms for up to twenty-six months. In 9 cases the procedures were unsuccessful and transurethral resection of the prostate was required.

Computed tomography of oleothorax

Oleothorax as therapy for pulmonary tuberculosis was discontinued some 35 years ago. An oleothorax may expand and cause respiratory distress. Additional complications include bronchopleural fistula and cutaneous fistula. Computed tomography has not previously been used to evaluate oleothorax. This case report describes the use of computed tomography in a patient with a symptomatic oleothorax.

Pneumocalyx following percutaneous nephrostolithotomy.

We present an interesting and unusual case of persistent gas within the renal collecting system occurring two days after percutaneous nephrostolithotomy.

Forceps extraction of ureteral stones

Ureteroscopy and pyeloscopy in association with ultrasonic lithotripsy for extraction of ureteral stones has, in most instances, eliminated the need for open surgical intervention. Four ureteral stones were successfully extracted by the technique described using flexible cup biopsy forceps introduced through a Teflon sheath. This method was used when basket extraction, ureteroscopy, and other forms of endoscopic stone manipulation were unsuccessful. Two ureteral stones were removed by the transurethral route, and two were removed through a percutaneous nephrostomy tract. There has been little morbidity with this procedure, and patients have returned to normal activity within several days of hospital discharge.

Balloon Dilation of the Ureter: A Means to Facilitate Passage of Ureteral and Renal Calculi

Dilation of the ureter with a balloon catheter, 20 cm. long and 6 mm. in diameter, passed over a guide wire introduced into the ureter in a retrograde or antegrade fashion has been followed by prompt painless passage of calculi as large as 6 mm. in diameter in 3 patients. Limited radiographic evaluation has revealed no significant sequelae. Our limited experience indicates that it is a safe and expedient method to facilitate passage of ureteral and renal calculi.