Jon D. Shanser

Iodine absorption from the gastrointestinal tract during hypaque-enema examination.

Iodinated contrast agents administered intravenously or intra-arterially may cause serious reactions in hypersensitive patients. Oral administration of Hypaque (diatrizoate sodium) results in minimal absorption of iodine, but the amount of iodine absorbed with Hypaque-enema studies is unreported. Hypaque-enema examinations were performed in 20 normal, nonsensitive patients and increased serum iodine levels ten to 200 times base-line values, peaking after approximately one hour in patients who had measurements obtained for four hours. Therefore, before Hypague-enema studies, patients must be carefully questioned about their tolerance of iodinated contrast agents, and preparations should be made for possible serious hypersensitivity reactions.

Aspergillus Mycetoma of the Renal Pelvis Associated with Ureteropelvic Junction Obstruction

A case of aspergillosis of the kidney is described that could not be attributed to any of the factors that classically predispose to fungal infection (immunosuppressive, antibiotic or steroid therapy and diabetes). The patient did have severe obstruction of the ureteropelvic junction, which we believe caused stasis of urine and, in turn, the propagation of a colony of Aspergillus.

Multimodal approach to diagnosis of hamartoma of the spleen.

Splenic hamartoma is a benign, primary neoplasm which usually causes a mass in the left upper quadrant of the abdomen. If radionuclide studies show a space-occupying lesion in the spleen that appears solid on the ultrasonogram, and selective abdominal arteriography reveals a richly vascular splenic tumor, hamartoma of the spleen should be the preoperative diagnosis.

Xanthogranulomatous pyelonephritis in childhood.

Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.

Ureterosigmoidostomy: A 59-year Followup and Review of Long-term Urinary Diversion

This case report documents the efficacy of urinary diversion by ureterosigmoidostomy. Our patient has suffered minimal complications with the added advantage of urinary continence for nearly 60 years. While we would not advocate the Coffey I technique for creation of ureterosigmoidostomy, this case does illustrate the longest survival after any form of diversion with normal urinary function reported in the literature.

The Effect of Decreased Renal Artery Perfusion Pressure on Intrarenal Hemodynamics in the Dog

The role of decreased renal artery perfusion pressure in redistribution of renal cortical blood flow during acute hemorrhagic hypotension is unclear. Renal artery hypotension was produced in intact dogs by an intra-aortic balloon catheter placed cephalad to the origins of the renal arteries. Renal cortical perfusion was assessed using selective renal magnification arteriography, isotopically labeled microspheres, and xenon-133 washout. After 60 minutes of decreased renal artery perfusion pressure (40 to 50 mm Hg), no changes were noted in renal cortical perfusion arteriographically. Microsphaere distribution to each cortical zone was unchanged, despite a marked decrease in total renal blood flow and in flow to each zone. 133Xe washout curves permitted two interpretations: Either redistribution of blood flow away from the cortex occurred, or parallel decrease in flow to each zone occurred without redistribution. Results indicate decreased renal artery perfusion pressure does not cause redistribution of renal cortical blood flow in our model.

Controlled unilateral renal artery hypotension in dogs.

Unilateral reduction in renal perfusion pressure has been produced in dogs using selective renal artery catheterization with a balloon catheter. The effects of reduced perfusion pressure can now be studied by means of renal arteriography and excretory urography in the absence of systemic hypovolemia. The contralateral kidney serves as a convenient “normotensive” control for radiologic observation of physiologic alterations in the hypotensive kidney.

Hazards in interpretation of xenon washout studies of the canine kidney

Reduction in renal artery perfusion pressure in dogs resulted in a xenon washout curve that suggested loss of the rapid component thought to represent cortical flood flow. Correlation studies using renal arteriography and intrarenal distribution of labeled microspheres indicated a uniform reduction of flow to all renal compartments with no redistribution of flow away from the cortex. Exponential components of the xenon washout curve should not be assigned specific intrarenal compartments without independent supporting validation.

The nephrogram of normovolemic, renal artery hypotension.

Experimental hemorrhagic hypotension results in a prolonged nephrogram during excretory urography. We evaluated the effect of reduced renal perfusion pressure on the nephrogram in normovolemic dogs. Renal artery perfusion pressure to one kidney was reduced to 40-50 mm Hg by inflating a renal artery balloon catheter. Subsequent urograms were qualitatively assessed for nephrographic density. Plasma and urinary iodine concentrations were determined by fluorescent excitation analysis. Total renal blood flow (TRBF) and its intrarenal distribution were assessed with isotopically labeled microspheres. In the majority of dogs severe oliguria and a prolonged and increasingly dense nephrogram were produced in the kidney exposed to reduced perfusion pressure. The nephrogram of the contralateral, normotensive kidney rapidly diminished in density, associated with the excretion of a large volume of dilute urine. The total urinary iodine excreted in 60 min was significantly less than that excreted by both kidneys in control experiments. TRBF to the hypotensive kidney was significantly reduced from its control level, and the percentage of TRBF perfusing the outer cortex decreased.

Polycystic liver and other hepatic masses mimicking gall-bladder disease

Hepatic and biliary tract diseases can both present as pain or mass in the right upper quadrant of the abdomen. Occasionally, hepatic masses impress the gall-bladder, simulating gall-bladder disease both symptomatically and radiographically. Ultrasonography and computed tomography (CT) imaging have facilitated the preoperative differentiation between hepatic and biliary tract disease and, further, between cysts (polycystic liver disease) and solid tumours. We wish to report a patient with hepatic masses and review similar reports to illustrate that when filling defects are noted in the gallbladder on the cholecystogram, hepatic disease can then be differentiated from biliary tract disease without the need for laparotomy. A 45-year-old hypertensive woman was admitted to our hospital because of a six-month history of an enlarging abdominal mass and a sensation of pressure and fullness. She had no associated pain, jaundice, nausea, vomiting, or change in bowel habits.