Philip J. Weyman

Percutaneous nephrostolithotomy: complications of premature nephrostomy tube removal

Nephrostomy tube urinary drainage is important in the initial postoperative period after 1-stage percutaneous nephrostolithotomy. We report 2 cases in which nephrostomy tube drainage was not used after rapid removal of simple upper urinary tract calculi. The complications incurred resulted in prolonged hospitalization and marked patient discomfort.

Management of Ureterointestinal Anastomotic Strictures: Comparison of Open Surgical and Endourological Repair

The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications. While the endoscopic procedure for ureteroileal anastomotic strictures is less successful than open revision, the lower morbidity, decreased cost and shorter hospital stay associated with the endourological approach favor its use over open revision. For elderly patients who fail initial endoscopic revision and for patients with metastatic transitional cell cancer, placement of an indwelling stent is a reasonable alternative. Given these guidelines, less than 30 per cent of the patients who suffer a ureteroileal anastomotic stricture will require open surgical revision.

Endourological Management of Ureteroileal Anastomotic Strictures: Is It Effective?

Ureteroileal stenosis represents a serious postoperative threat to the obstructed kidney and open revision in these patients often is difficult. We evaluated 9 patients with 10 ureteroileal strictures who were treated with semirigid fascial dilators (1), balloon dilation (4) or a combination of balloon dilation and percutaneous intraureteral surgery (4). All 5 patients who had semirigid fascial or balloon dilation alone had early recurrence of the strictures. However, in 4 patients dilation in conjunction with percutaneous intraureteral incision of the stricture through a flexible choledochonephroscope resulted in short-term resolution of each ureteroileal stricture. However, by 6 months these strictures had recurred in 50 per cent of the patients.

Emphysematous Pyelonephritis: Successful Management by Percutaneous Drainage

Emphysematous pyelonephritis is a life-threatening infection that usually requires open surgical drainage. We report a case of emphysematous pyelonephritis treated successfully with percutaneous drainage.

CT and MR imaging of radiation hepatitis

The authors describe two cases of radiation hepatitis evaluated by magnetic resonance imaging and CT with CT angiography (CTA) additionally performed in one patient. On CT the radiation hepatitis appeared as sharply demarcated region of lower attenuation than the adjacent normal liver. The region of radiation hepatitis demonstrated decreased perfusion in the portal venous phase of CTA. and 4 min delayed images following CTA showed increased density or relative increased accumulation of contrast. Magnetic resonance in both cases showed that the area of low density on CT had high signal on the T2-weighted image and had increased water content as determined by proton spectroscopic imaging method.

Computed tomography in malignant endometrial neoplasms

Malignant uterine neoplasms are the most common invasive gynecological malignancies. The prognosis depends on the history, the grade, and the stage. Recent reports have stressed that a small percentage of patients with clinically low stage disease have unsuspected metastases. We retrospectively reviewed 61 patients with known malignant uterine neoplasms. In 18 patients with preoperative computed tomographic examinations, these scans detected unsuspected omental metastases in two and pelvic adenopathy in three. There was one false positive and one false negative examination. Computed tomography was superior to the clinical examination in defining the extent of the tumor in five patients. Computed tomography was also helpful in evaluating patients with suspected recurrent disease.

Computed tomography and ultrasonography in the evaluation of mesonephric duct anomalies

Three cases involving developmental anomalies of mesonephric duct derivatives were examined by computed tomography and ultrasonography. Cases included an ectopic ureter inserting into a cystic seminal vesicle, an ectopic ureterocele, and agenesis of the seminal vesicle and vas deferens. Computed tomography and ultrasonography were valuable non-invasive methods, supplementing standard radiographic techniques, for evaluating these anomalies.

Computed tomography of the pancreas: three second scanning versus 18 second scanning.

Diagnostic accuracy of pancreatic computed tomography (CT) using a 3 s scanner was compared to our previously published results using an 18 s scanner. Technically unsuccessful examinations have decreased to less than 1%. Pancreatic masses were detected prospectively in 83% of patients with pancreatic carcinoma and retrospectively in all such patients. False negative diagnoses of normal pancreas in proven pancreatic carcinoma were reduced fourfold down to 6%. False positive diagnoses of pancreatic carcinoma remained less than 1% but were not significantly reduced compared to our second years experience using an 18 s scanner. Interpretation errors and errors due to limitations of CT as a diagnostic technique are discussed.

Choledochoscopic Stone Removal through a T-Tube Tract: Experience in 75 Consecutive Patients

Retained biliary stones remain a common clinical problem in patients after surgery. Since 1984, the authors have used choledochoscopy in the treatment of suspected retained biliary stones in 75 patients. These procedures were performed in the radiology department with use of local anesthesia supplemented by an intravenously administered sedative and analgesic. A 15-F flexible fiberoptic choledochoscope was used. Fifty-one of the 75 patients were treated as outpatients. Treatment was successful in 74 of 75 patients; in one patient, intrahepatic stones were not completely removed. Electrohydraulic lithotripsy was used to fragment calculi in 11 patients (15%). Biopsies were performed in four patients (5%). Five minor complications occurred; three required overnight admission. Choledochoscopic-assisted removal of retained biliary calculi is a highly effective and safe procedure. Advantages over standard fluoroscopic stone removal include the ability to directly visualize and fragment adherent or impacted stones and visualize noncalculous filling defects, such as air bubbles, mucus, and biliary tumors.

Resolution of radiographic-endoscopic discrepancies in colon neoplasms.

Fifty-one colon neoplasms larger than 1 cm were diagnosed by double-contrast barium enema (DC), but were not confirmed by initial endoscopy. Seventeen lesions were shown to be radiographic false-positive diagnoses by careful review of the original radiographs (10 cases) or repeat DC (7 cases). The presence of a neoplasm was confirmed in 21 cases (41%) by repeat endoscopy or surgery (15 cases) or by repeat DC alone (6 cases). Seven (47%) of 15 resected lesions were malignant. The results emphasize the complementary nature of the DC and endoscopy in detection of colon neoplasms. When discrepancies between the radiographic and endoscopic diagnoses cannot be explained by careful review of the DC, repeat radiographic or endoscopic examination should be performed.