Peggy J. Fritzsche

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the Ileal Ureter in 89 Patients

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Long-Term Radiographic Changes of the Kidney Following the Ileal Ureter Operation

A long-term retrospective evaluation was done on the preoperative and postoperative radiographic studies from patients who had undergone the ileal ureter operation. The comparative studies demonstrated decreased or stable pelviocaliceal dilatation, no measurable parenchymal loss, frequent high pressure vesico-ileac reflux and decreased number of renal calculi. Radiographically there was no evidence of renal morphological deterioration.

Correlation of Transrectal Sonographic Findings in Patients with Suspected and Unsuspected Prostatic Disease

Previous reports describing the diagnostic accuracy of transrectal sonography have not documented the specificity of differentiating abnormal internal echoes of the prostate. To determine the specificity of the examination, a prospective study was designed to correlate sonographic findings with histological diagnoses. Gray scale transrectal sonography was performed on 228 patients and the scans were reviewed without clinical information. The sensitivity (true positive rate) was confirmed by histological evaluation in 121 cases to be 90 per cent. The specificity (true negative rate) was determined by histological evaluation as well as subsequent clinical followup to be 60 per cent. Our experience is similar to that of others showing transrectal sonography as a sensitive diagnostic tool. The relatively low specificity demonstrates the difficulty in differentiating the abnormal internal echoes of the prostate, representing malignant and nonmalignant prostatic disease processes.

Vascular Specificity in Differentiating Adrenal Carcinoma from Renal Cell Carcinoma

Cases of adrenal and renal cell carcinoma were reviewed to evaluate vascular origin and architecture. All 9 cases of adrenal carcinoma showed fine, sparse neovascularity. Coarse or at least extensive, neovascularity was demonstrated in 40 of 45 cases of renal cell carcinoma. An analysis of the angiographic features correlated with the known anatomical variations will nearly always enable one to ascertain the origin of the tumor.

Alteration of Perirenal Fat Secondary to Diffuse Retroperitoneal Infiltration

Inflammatory effusions and diffuse neoplasia in the fatty retroperitoneal space, which can alter the perirenal fat, can be recognized radiographically because of density differences. The opacity of fluid and tumor accentuates the remaining fat which conforms to the renal contour. This perirenal fatty border appears as a lucent strip when the perirenal fat is not violated and as abnormal perirenal streakiness when the perirenal fat is infiltrated by fluid or tumor. Six cases are described.

The Value of Aortography in Demonstrating Spinal Metastases From Renal Cell Carcinoma Prior to Neurological Localization

AbstractThe late phase of abdominal aortography has demonstrated vertebral metastases from renal cell carcinoma in 4 patients, 2 of whom later had progressive neurological deficits and none of whom survived more than 6 months. The vascular pattern of these osseous metastatic foci is described and the value of identifying vertebral metastases prior to the onset of neurological deficits is documented.