Richard S. Lefleur

Auto-Injection of the Corpus Cavernosum with a Vasoactive Drug Combination for Vasculogenic Impotence

Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronies disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism.

Angiographie Patterns in Renal Oncocytomas1

Renal oncocytomas are benign tumors arising from proximal tubular epithelial cells. They appear radiographically as solid masses which are vascular on angiography. Angiograms of 13 cases of renal oncocytomas were reviewed, as well as those of 155 renal-cell carcinomas. The classic angiographic findings for the oncocytoma include a spoke-wheel pattern, a homogeneous nephrogram, and a sharp, smooth rim. The finding of a homogenous blush and/or a spoke-wheel pattern greatly increases the possibility of an oncocytoma, though a renal-cell carcinoma may have any or all of the classical findings described for an oncocytoma.

Involvement of the Inferior Vena Cava in Patients with Renal Cell Carcinoma

Inferior vena cavography plays an important role in the staging of renal cell carcinoma. The renal angiograms and inferior vena cavograms in a series of patients with renal cell carcinoma were reviewed to determine which patients require cavography. Our findings show that renal angiography is of great value in suggesting tumor involvement of the renal vein or vena cava, and that the decision to do cavography can be made from the angiographic findings. In the series of 172 patients with renal carcinoma, 15 or 9% had inferior vena cava involvement.

The Pear-Shaped Bladder

The tear-drop or pear-shaped bladder was originally described in cases of pelvic hematoma. It may also be seen, however, with a variety of other entities, including pelvic lipomatosis, inferior vena cava occlusion, lymphocysts, and enlarged pelvic lymph nodes. Pertinent radiographic findings of these conditions are reviewed.

Intralobar pulmonary sequestration: MR evaluation.

This report documents the use of magnetic resonance (MR) in evaluation of intralobar pulmonary sequestration. Because of its distinctive multiplanar capabilities and nonreliance on contrast media to visualize blood vessels, MR can be used to define and characterize the size and course of anomalous arterial feeding vessels. Furthermore, MR can be of value in detecting the presence of mucoid-impacted bronchi within abnormal segments of the lung. It is concluded that in select cases MR may obviate the need for more invasive procedures to establish the diagnosis of pulmonary sequestration.

The role of Chiba-needle cholangiography in the diagnosis of possible acute pancreatitis with cholelithiasis.

In patients with suspected severe acute pancreatitis and known or suspected cholelithiasis, it may be extremely difficult to exclude the diagnosis of gangrenous cholecystitis or obstructive choliingitis by nonopcrative means. Since early intra-abdominal surgery has, in our experience, led to markedly increased morbidity in patients with gallstone pancreatitis, non-operative visualization of the biliary tree by percutaneous transhepatic Chiba-needle cholangiography (PTCNC) has been evaluated in 14 patients with suspected acute pancreatitis in whom life-threatening acute biliary disease could not be excluded by other nonopcrative means. The final diagnosis was acute pancreatitis in nine patients (Group A) (mean scrum amylase 3242 SU%) and acute biliary disease with hyperamylasemia in five patients (Group B) (mean serum amylase 2084 SU%). PTCNC made visualization of the biliary system possible in all patients and excluded the diagnosis of cystic duct or common duct obstruction in each case. Following PTCNC, potentially hazardous early laparotomy was avoided in eight of nine Group A patients. Biliary surgery was undertaken on day 3 to 13 in four Group B patients. When early laparotomy may be needed to evaluate or treat possible life-threatening acute biliary disease but is considered undesirable because of possible acute pancreatitis, PTCNC appears to be a safe and effective nonoperative method of obtaining precise anatomical delineation of the biliary tree.

Renal emphysema secondary to traumatic renal infarction

Renal emphysema is most often due to emphysematous pyelonephritis in diabetics. The emphysema is the result of infection by gas-forming organisms. Intrarenal gas can also be seen under noninfective conditions. The report is a case of renal emphysema following traumatic renal infarction.

Ultrasonic features of cholangiocarcinoma.

Sonographic features in 12 cases of proven cholangiocarcinoma were analyzed and correlated with findings on direct cholangiography. Proximal bile duct dilation was present in all cases of cholangiocarcinoma of the intrahepatic ducts except one. A neoplastic bile duct segment was detected in nine of the 12 cases. The neoplasms were seen as narrowed, normal‐sized, or enlarged ducts, and contained intraluminal soft‐tissue echoes or echogenic bands across the lumens. The sonographic accuracy was greater for lesions involving the bifurcation and the common hepatic duct than for common bile duct lesions. Cholangiography was superior to sonography in determining the length of the involved segment, whereas sonography was superior in detecting hepatic invasion and lymphadenopathy.

Blood flow to the kidney via the gonadal-renal capsular artery

The gonadal artery is an important collateral pathway of blood flow to the kidney. Collateral routes may be from the gonadal artery to the inferior capsular artery (gonadal-renal capsular artery) or to the periureteric arteries. These pathways develop in cases of renal artery stenosis, or when a vascular renal tumor increases the kidneys need for blood. We present five cases in which the gonadal artery served as a source of blood supply to the kidney.

CT evaluation of pancreatic injury following splenectomy

A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst.