Morton Schneider

Observations on persistently dilated ureter after posterior urethral valve ablation

The persistent ureteral dilatation frequently seen months or even years after posterior urethral valve ablation, continues to present a dilemma to the urologist. We have classified these dilated ureters into 3 types: (I) unobstructed with either an empty or filling bladder, (II) unobstructed with an empty bladder but obstructed with a filling bladder, and (III) obstructed with either an empty or filling bladder. The majority of ureters with persistent dilatation were found to be of the type II variety where appropriate treatment is not obvious. Classic ureteral tailoring and reimplantation offers little advantage since in such cases a narrower ureter is passed through a new hiatus in an otherwise unchanged bladder. When high renal pelvic pressures are found only with bladder filling, then consideration must be given to not only reconstructing the ureter but also to affecting the dynamics of the bladder and the large urinary output characteristically found in these patients.

Ultrasonic evaluation of the scrotum.

Ultrasonography has proved to be a highly useful method for detecting testicular lesions, correlating them with clinical findings, and indicating whether scrotal masses are caused by fluid or by solid tissue. It has not been possible, however, to distinguish spermatic cord torsion from epididymitis.

Pancreatic pseudocysts involving the spleen

Pancreatic pseudocyst involving the splenic parenchyma itself is an unusual complication of pancreatitis. The diagnosis is best established by arteriography, isotopic studies, and sonography. Once confirmed, surgical intervention is mandatory because of the danger of secondary hemorrhage.

Ultrasound demonstration of an infected urachal cyst.

A 5-year-old child presented with a recurrent infraumbilical abdominal mass. Clinical and sonographic diagnosis was consistent with an infected urachal cyst. The clinical features and sonographic differential diagnosis are discussed.

Ultrasonically guided percutaneous fine needle aspiration biopsy of solid masses

Fine needle aspiration biopsy is a highly accurate cytologic technique in the differentiation of benign vs. malignant disease. After careful localization with the ultrasound beam, a 22 gauge 0.6 mm needle is used to obtain four to five cell samples. Seventy percutaneous fine needle aspiration biopsies were performed nodes, subcutaneous nodules, and other retroperitoneal masses. Ninety-three percent accuracy was obtained with no complications. Studies in four patients with carcinoma of the tail of the pancreas were falsely negative for malignant cells; all four patients had desmoplastic tumors. Complications of hemorrhage, tumor seeding, infection, fistula formation, and pain encountered with other methods and using larger bore needles have not been found with the fine needle technique. It is a safe, accurate method that can be performed as an out-patient procedure.

The complementary role of sonography and arteriography in the evaluation of the atheromatous abdominal aorta

Sonography was performed on 41 patients, 24 of whom were suspected of having abdominal aortic aneurysms and 17 of whom had symptomatic peripheral vascular disease. The accuracy of sonography in the diagnosis of aneurysms of the abdominal aorta was evaluated, and the instances in which angioggraphy contributed to the management of these patients was defined. Sonography is adequate for the diagnosis and management of many aneurysms of the abdominal aorta. Aortography is necessary when: (1) an inadequate study has been obtained, (2) the iliac arteries are not visualized, (3) renal or mesenteric artery involvement is suspected, (4) multiple or lobulated aneurysms are found, or (5) the aorta is very tortuous.

In Utero Diagnosis of Fetal Abnormalities

Sonographic examination of the obstetrical patient is well recognized as a valuable tool in evaluation of fetal age, number, status, presentation and placental localization. Further information available from this study is the in utero detection of fetal abnormalities, congenital or secondary to maternal systemic disease.