Howard M. Pollack

Use of Endorectal Surface Coil Magnetic Resonance Imaging for Local Staging of Prostate Cancer

A total of 111 patients with clinically localized prostate cancer (stage A or B) underwent endorectal surface coil magnetic resonance imaging (MRI) for preoperative staging of the disease. Of the patients 43 with advanced disease on endorectal surface coil MRI (33 with stage C and 10 with stage D disease) received alternative therapy, as did 21 with stage B disease on MRI. The overall staging accuracy for the remaining 47 patients was 68%, with a 74% accuracy rate in staging advanced disease and a 91% accuracy rate for depiction of seminal vesicle involvement. Failure to recognize microscopic extracapsular disease was responsible for the majority of staging inaccuracies in this highly select group of patients. Endorectal surface coil MRI provides extremely high resolution images of the prostate and periprostatic structures, and is an exciting new modality for local staging of prostatic carcinoma.

Ultrasonic aspiration transducer.

Fluid-containing structures can be localized and aspirated by using a specially-designed ultrasonic transducer with a central hole. A needle is directed through the hole and into the tissue. The path of the needle tip can be followed ultrasonically as it enters the fluid. The same transducer is used to monitor the procedure continuously while the fluid is aspirated.

Ultrasonic Detection of Nonopaque Renal Calculi

Four patients with 5 nonopaque renal calculi composed of uric acid were examined by ultrasound. The calculi varied in size from a 1.5 X 1.5-cm intrapelvic stone to a staghorn calculus measuring 4 cm. All stones were satisfactorily imaged by ultrasound, allowing a diagnosis of nephrolithiasis to be made with confidence in each case. In 2 patients with poor excretion on urography, the diagnosis was not suspected prior to the ultrasound examination. The authors feel that ultrasound has great potential value in the investigation of nonopaque filling defects of the renal pelvis and in patients with urographic nonvisualization who have a high risk of uric acid lithiasis.

Extracorporeal Shock Wave Lithotripsy Treatment of Calculi in Horseshoe Kidneys

From June 1985 to November 1986, 17 patients with calculi in horseshoe kidneys presented to our hospital for evaluation and possible treatment with extracorporeal shock wave lithotripsy. Of these patients 14 were treated with extracorporeal shock wave lithotripsy; the calculi in 2 could not be localized and focused at the F2 focal point, and 1 was asymptomatic and has been followed conservatively. Four patients required repeat extracorporeal shock wave lithotripsy. Adjunctive procedures included preoperative retrograde catheter placement (5 patients), postoperative percutaneous nephrostolithotomy (1), ureteroscopy for ureteral fragments (2) and placement of a double pigtail stent (1). Of 14 patients 11 (79 per cent) have been rendered free of fragments with extracorporeal shock wave lithotripsy and adjunctive measures as needed. We conclude that most patients with calculi in a horseshoe kidney can be managed primarily with extracorporeal shock wave lithotripsy.

Hernias of the ureter.--An anatomic-roentgenographic study.

Four cases of herniation of the ureter are presented. A discussion of the various types of ureteral hernia is based on the roentgenographic features of each type as well as the anatomical considerations responsible for these radiographic signs. The use of erect and oblique projections in patients with hernias undergoing urography is urged. The sign of the curlicue ureter is felt to be pathognomonic for ureteral hernia.

Magnetic resonance imaging of the prostate gland

MRI, because of its multiplaner capability and high soft tissue contrast, is ideally suited for examination of the prostate. The normal prostatic zonal architecture and periprostatic anatomy can be visualized. The use of an endorectal surface coil greatly enhances resolution. Clinical application to the study of BPH, prostate carcinoma, prostatic cysts, and inflammatory disease is discussed. MRI appears to be emerging as the modality of choice for imaging the prostate.

Differentiation of renal masses using a-mode ultrasound

SummaryA unique property of ultrasound is its ability to differentiate between cystic and solid masses. Using nephrosonography, 150 renal masses were examined. In 144 of them (96 per cent), the physical state of the mass, that is fluid, solid or complex, was correctly predicted. Nephrosonography is uncomplicated, atraumatic and safe. It is used in conjunction with standard radiological methods of diagnosis such as IVP, nephrotomography and in selected cases with angiography, cyst aspiration and isotope scanning. Generally, when a solid ultrasonic pattern is obtained, arteriography is recommended. If a cystic pattern is obtained, nephrotomography followed by cyst puncture is usually all that is necessary. The treatment of masses producing complex ultrasonic patterns must be individualized. In this diagnostic setting, it should be possible to differentiate benign from malignant renal masses with an accuracy approaching 99 per cent.

Ureteroarterial Fistula: A Case Report

We report on a patient with a fistula between the right common iliac artery and the distal right ureter who had undergone pelvic exenteration for carcinoma of the uterine cervix. The patient also had received prior radiation therapy and was being treated with an indwelling ureteral stent at the time the fistula developed. Diagnosis was made by an occlusive ureterogram and the lesion was treated successfully with embolization of the common iliac artery.

Ultrasonic localization for renal biopsy.

B-scan ultrasound was used in 30 patients to localize the kidney prior to renal biopsy. The lower pole of the kidney was outlined in the longitudinal and transverase planes and the depth of the kidney was easily obtained from the ultrasonic tracings. The puncture site was marked on the skin and the angle of the needle pathway determined. Renal biopsy was performed successfully in 28 patients, which compares favorably with the results of other localization methods.

Roentgenographic Manifestations of Spontaneous Renal Hemorrhage

The causes of nontraumatic renal hemorrhage are reviewed and the roentgenographic criteria for distinguishing intrarenal, subcapsular and perirenal types outlined. A statistical analysis of 22 cases is presented: 10 were caused by tumors, some undetectable roentgenographically. Surgical exploration of the kidney is recommended in all cases of spontaneous renal and perirenal hematoma, if all medical causes for bleeding can be excluded.