Kerry K. Ford

Initial experiences with percutaneous and transurethral ablation of postoperative ureteral strictures in children

A transurethral or percutaneous procedure was used in 11 children and 1 young adult in an attempt to correct obstruction at the site of previous pyeloplasty, ureteroenterostomy or vesicoureteral reimplantation into the bladder. When a guide wire could be passed through the obstructed segment a balloon would always pass over the wire. The balloon could then be inflated to dilate the narrowed area. Five patients in whom the obstruction was detected and treated in this manner within a few months after the initial operation exhibited relief of obstruction and these good results have persisted. The exception to this generalization is a 5-year-old girl who did not experience durable improvement in obstruction when treated 3 months after ureteral implantation. Four additional children with ureteral strictures diagnosed 1 to 4 years postoperatively also were not improved by dilation, even when a post-dilation stent (usually a double-J catheter) was used for 6 to 8 weeks. Two boys with recurrent ureteropelvic junction obstruction after pyeloplasty underwent percutaneous resection of the ureteropelvic junction. In 1 boy the hook electrode and cautery were used and stenosis recurred, apparently due to thermal injury. In the other boy a sharpened hook electrode was used to incise the ureteropelvic junction, which has stayed open for 18 months, and he is our longest followup.

Transient Cerebral Ischemia as a Manifestation of Ruptured Intracranial Dermoid Cyst

Transient cerebral ischemia was the initial manifestation of a ruptured intracranial dermoid cyst in a young adult male. The ischemia could have resulted from vasospasm caused by release of the contents of the dermoid cyst into the subarachnoid space or from other local effects of the tumor. The role of computed tomography in the evaluation of patients with transient cerebral ischemia is discussed.

Percutaneous dissolution of renal calculi using ultrasonic litholapaxy.

The surgical treatment of renal calculi has been markedly changed by percutaneous manipulation and ultrasonic dissolution. The low morbidity and decreased cost of this procedure make it an obvious choice over classic surgical operations. We report our experience with percutaneous ultrasonic stone dissolution in 23 patients.

The role of seminal vesiculography in the evaluation of male infertility.

Although most cases of male infertility are the result of primary testicular abnormalities (either maturation arrest, decreased spermatogenesis, or germinal hypoplasia), obstruction of the genital tract is a well recognized and potentially correctable cause of infertility. Seminal vesiculography is an excellent method of evaluating the male genital tract not only for obstruction but also for other structural lesions that may cause infertility. In 27 patients undergoing vesiculography as part of an evaluation of infertility, obstruction was found in 25%. Three patients (11%) were found to have nonobstructing structural lesions as a possible cause of infertility. Patients with obstructive lesions were found to have significantly lower semen volumes than those with patent outflow tracts. The continued role of seminal vesiculography in the evaluation of male infertility is discussed.

Opacification of the gallbladder following intravenous contrast injection in patients with normal renal function

Gallbladder opacification from vicarious excretion of urographic contrast agents may indicate decreased renal function. Doses of contrast material greater than 12.5 g, however, provide enough iodine for visualization of the gallbladder in patients whose renal function is normal. Gallbladder opacification following the administration of urographic contrast material when renal function is normal has no pathologic significance.

Seminal vesiculography: Limited value in vesiculitis

Seminal vesiculograms were performed on 44 men being evaluated for chronic perineal pain consistent with seminal vesiculitis. The vesiculograms were performed prior to antibiotic instillation into the vas deferens. Vesiculograms were abnormal in 32 of the 44 patients (73%). The most common abnormality was the presence of multiple small diverticula producing a feathery appearance of the vas deferens (64%), a finding present in only 19 per cent of patients being evaluated for infertility and 20 per cent of normal patients. Asymmetry and incomplete filling of the seminal vesicles were less common abnormalities. Seventeen of these patients had seminal vesiculectomies for persistent or recurrent pain, and 15 have been followed long enough to assess the results. The histologic examination of the excised seminal vesicles was abnormal in only 3 patients (20%), despite radiographic abnormalities in 10 (67%) and improvement after surgery in 12 (80%). Seminal vesiculography may be useful to exclude anatomic abnormalities prior to instillation, but does not appear sufficiently specific to warrant use as the primary diagnostic examination for patients suspected of having seminal vesiculitis.

Percutaneous transluminal angioplasty in diabetic patients: an effective treatment modality.

Percutaneous transluminal angioplasty (PTA) was performed for nonhealing ulcers, severe claudication, or rest pain in 10 patients with diabetes mellitus. Twenty-two atherosclerotic lesions were dilated in 15 extremities, including 16 iliofemoral arteries and 6 superficial femoral arteries. The procedure was technically successful in all patients and 8 of 9 (89%) with clinical follow-up showed improvement clinically after the procedure. Diabetes is not a contraindication to PTA; rather this modality can be used effectively to control and treat peripheral vascular insufficiency in diabetic patients.

Technique to facilitate percutaneous nephrostomy in non-obstructed kidneys

A technique for performing antegrade pyelography during nephrotomy is described—puncture with a 21-gauge, 20-cm Cope needle, placement of a 0.018-inch SMG mandril, “coathanger”-shaped guidewire, with the needle exchanged for a 3-French multi-sidehole dilator. Use of the 3-French dilator provides more security and less trauma to the renal pelvis; nephrotomy time is also curtailed. In 25 patients the technique was used successfully with 2 minor complications.

COMPUTED TOMOGRAPHY AND EEG IN PATIENTS WITHOUT FOCAL NEUROLOGIC FINDINGS

We studied 136 patients without focal neurologic findings by EEG and computed tomographic (CT) scanning. Six patients (4.4%) had focal CT lesions. All six had abnormal EEGs, and in four the EEG findings were focal. The initial complaint did not influence the yield of focal CT lesions. The findings suggest that neurologic examination and EEG can be used to screen for focal CT abnormalities.

INTRACRANIAL TUBERCULOMAS: CORRELATION OF COMPUTERIZED TOMOGRAPHY WITH CLINICOPATHO-LOGICAL FINDINGS

Ten patients with intracranial tuberculomas, seen between 1976 and 1980, are described. Four Indian immigrants presented with features of space-occupation and responded well to supervised adequate combined anti-tuberculous chemotherapy. Six patients, four of whom were English, developed tuberculomas in the course of tuberculous meningitis; three of these six patients died, highlighting the dangers of this complication if infection is not promptly and adequately dealt with at presentation. The value of computerized tomography in the diagnosis and management of such patients is emphasized, and the persistence of intracranial tuberculous infection in Britain is stressed.