Jeffrey H. Newhouse

Renal-Stone Dissolution Via Percutaneous Nephrostomy

Recurrent renal stones associated with urinary infection were treated in eight kidneys in six patients by percutaneous nephrostomy and irrigation with hemiacidrin, a commercially available solution of organic acids and magnesium. The stones, presumably composed of triple phosphates (magnesium, ammonium and calcium phosphate), were completely dissolved in six kidneys; in two they were partially dissolved and subsequently recovered by other methods. No serious complications were encountered. The technic requires special precautions against perinephric and intravascular dissemination of infection, but it offers potentially effective therapy for certain kidney stones without the use of general anesthesia or operation.

DEXAMETHASONE DOES NOT SIGNIFICANTLY CONTRIBUTE TO THE RESPONSE RATE OF DOCETAXEL AND ESTRAMUSTINE IN ANDROGEN INDEPENDENT PROSTATE CANCER

PURPOSE We evaluated the independent response rate of dexamethasone before docetaxel and estramustine administration as measured by changes in serum prostate specific antigen (PSA) in patients with androgen independent prostate cancer. MATERIALS AND METHODS A total of 12 patients received 20 mg. dexamethasone orally every 6 hours for 3 doses repeated every 3 weeks before starting cytotoxic therapy with estramustine and docetaxel. After progression on dexamethasone 280 mg. estramustine orally 3 times daily on days 1 to 5 and 70 mg./m.2 docetaxel intravenously for 1 hour on day 2 were given. RESULTS None of the patients initially treated with dexamethasone monotherapy (median 1 cycle, range 1 to 5) had a PSA decline of 50% or greater. Median PSA increase on monotherapy was 47% (range 0% to 22%). On estramustine and docetaxel therapy PSA decreased 50% or greater in 11 patients (92%, 95% confidence intervals [CI] 60 to 99) and 80% or greater in 7 (58%, 95% CI 29 to 84), and normalized in 5 (42%, 95% CI 16 to 71), with a median duration of response of 153 (range 42 to 371), 132 (range 84 to 287) and 84 (range 21 to 174) days, respectively. Median times to reach 50% and 80% decreases in baseline PSA were 21 (range 21 to 209) and 63 (range 21 to 138) days, respectively. In 9 patients (75%, 95% CI 43 to 93) PSA decreased at least 50% by week 9. Of 4 patients with bidimensionally measurable disease 3 had a partial response. Median time to progression was 263 days (range 91 to 378). CONCLUSIONS Administration of 20. mg. dexamethasone orally every 6 hours for 3 doses every 3 weeks does not significantly contribute to the PSA response rate of estramustine and docetaxel.

Fluid compartment distribution of intravenous iothalamate in the dog.

The distribution of 125I iothalamate between the intravascular and extravascular fluid compartments was determined after intravenous injection in dogs. Simultaneous measurements of total blood volume, blood iothalamate concentrations and urinary iothalamate excretion were made and permitted calculation of extravascular iothalamate. The drug diffused very rapidly to the extravascular space: more than half had reached the extravascular space one minute after injection. The ratio of extravascular to intravascular iothalamate rose to a plateau of 6.8. We conclude that the contrast material responsible for tissue opacification during radiography is primarily extravascular and that the levels of contrast in plasma during urography are affected less by renal excretion than by distribution between fluid compartments.

Expanded high iodine dose in computed cranial tomography: a preliminary report.

Fifty patients undergoing cranial CT had expanded-high-iodine-dose (EHID) scans. The EHID was given either as an additional bolus dose (37--40 g iodine) after a routine infusion contrast scan (42.3 g), or as a continuous infusion (total 74--80 g). Diseases presented include primary and metastatic neoplasm, pituitary neoplasm, and demyelinating disease. The results suggest that the primary usefulness of the EHID is in (a) detecting multiple rather than solitary brain lesions, (b) the definitive demonstration of an equivocal area of abnormal enhancement, and (c) differentiating solid histologically microcystic from frankly macrocystic neoplasms.

Evaluation of teleradiology for interpretation of intravenous urograms.

The diagnostic yield of a commercial teleradiology/picture archiving and communication system (ATT-Philips Comm View T/PACS) was evaluated for 100 urograms. A single image from each examination was digitized (2048×1684×12-bit pixels) and transmitted from a satellite hospital over a T-1 line using the T/PACS system. The video display of each digitized image was reviewed independently by four radiologists. The same four radiologists reviewed the original film images at a different time without knowledge of their T/PACS interpretation. There was no statistically significant difference in the sensitivity for clinical findings between T/PACS (86%) and film (89%). The false positive rate, however, was significantly higher with T/PACS than with film (44 versus 32 false positive findings per 100 films). We conclude that T/PACS of the type studied here demonstrates sufficient sensitivity for the detection of clinically important urographic findings in the emergency setting. A final reading of the original films is still necessary, however, to assure appropriate specificity.

Mn (III) hematoporphyrin. A potential MR contrast agent.

Manganese (III) hematoporphyrin (MnHP), a new and stable complex, was prepared, and its toxicity and magnetic resonance (MR) imaging properties were evaluated. In tests of acute and subacute toxicity, no deaths resulted from bolus intravenous injections of 13 or 19 mumols/kg of MnHP, but there was a 33% mortality when the dose was 38 mumols/kg. Laboratory results were normal in the surviving rats. Ultraviolet- visible spectroscopy of the urine and serum of two rats injected 24 hours previously with 38 mumols/kg MnHP revealed no free HP, suggesting in vivo stability of MnHP. Finally, using a standardized imaging protocol, there was a mean increase of 37% in the liver-to-muscle intensity ratios in four rats injected 24 hours previously with 25 mumols/kg MnHP when compared to paired controls (P less than .005). In addition, obvious visual increase in the signal intensity of the liver on T1-weighted images was seen in animals tested with 13 and 19 mumols/kg of MnHP. The results suggest that further evaluation of MnHP as an MR contrast agent for the liver is warranted.

MRI of multilocular cystic nephroma

We report the magnetic resonance imaging (MRI) findings in 2 patients with multilocular cystic nephromas. Both underwent MRI immediately prior to resection. The images accurately reflected the morphology of the tumors: in each, the capsule was hypointense on all pulse sequences. Varied intensities of signal from the fluid in the visualized locules presumably represented differing concentrations of old hemorrhage and protein. In one case soft tissue elements became hyperintense on T2-weighted images. We speculate that MRI of multilocular cystic nephromas will produce imaging features that are highly suggestive, but not always pathognomonic, of the disease.

Seminal vesicle tuberculosis: CT appearance.

We describe the CT findings of tuberculosis of the seminal vesicles and show how CT is useful to evaluate the extent and nature of the disease.

Sonography in transitional cell carcinoma of the renal pelvis

Real-time ultrasound examination of the kidneys was performed in 11 patients with transitional cell carcinoma of the renal collecting system. Each sonogram revealed a zone in the renal sinus which was less echogenic than the normal sinus and which corresponded to the extent of the tumor. Although the specificity and sensitivity of this finding are not yet known, this appearance should suggest the diagnosis of transitional cell carcinoma.

Castleman's disease

We present a case of retroperitoneal Castlemans disease of the hyaline vascular type, with unusual MR imaging findings, differing form reports to date, along with a review of the imaging findings in Castlemans disease.