Robert G. Bernstein

Renal oncocytoma: angiographic features of two cases.

Two cases of renal oncocytoma (proximal tubular adenoma) with a similar angiographic appearance are reported. The vascular supply to the lesion tends to be arranged in spoke-wheel pattern with vessels radiating toward the center of the lesion; the angiographic appearance may help to differentiate renal oncocytoma from hypernephroma preoperatively.

Hematuria secondary to left peripelvic and gonadal vein varices

The nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery which results in renal vein and left gonadal vein varices. This is an unusual but well accepted cause of hematuria. We report a case of the nutcracker syndrome and present the radiologic workup including computerized tomography (CT) and renal venography with venous pressure measurements.

False positive liver scans caused by disease processes in adjacent organs and structures

Abstract As a result of its great pliability, the liver can change its shape and form when impinged upon by disease processes in neighbouring organs and structures. The resultant hepatic scan is quite confusing, since the picture portrayed is frequently indistinguishable from that of intrinsic space-occupying disease of the liver. Enlarged gall-bladders, kidney cysts and tumours, pancreatic lesions, dilated bile ducts and subdiaphragmatic fluid are examples of extrahepatic disease processes that can simulate intrahepatic defects. It is quite essential that the physician interpreting hepatic scans has an appreciation that such a situation can exist. In this manner, one may hopefully reduce the incidence of his “false positive” interpretations. When doubt exists on the hepatic scan, a careful consideration of the clinical and laboratory findings, as well as the employment of complementary radiographic techniques such as selective angiography, can help elucidate the problem.

Combined Adrenal Adenoma and Myelolipoma

Abstract A case of both adrenal myelolipoma and adenoma is presented. The diagnosis of myelolipoma was suggested preoperatively by computed tomography in which one of the masses had negative attenuation coefficients.

Adenocarcinoma arising in Crohn's disease: report of two cases.

Crohn’s disease of the colon and small bowel is associated with a greater-than-chance increased incidence of adenocarcinoma, which also differs from the norm in age and anatomic distribution. The cancer risk appears to rise with earlier age of onset and long duration of the granulomatous disease, and the prognosis is relatively poor, probably due to difficulty in diagnosis because of the overlapping Crohn’s disease. Two additional cases of adenocarcinoma arising in Crohn’s disease are described.

Diagnosis of Hepatic Hemangioma with Combined Scanning Technique

A combined liver-scanning technique with 198Au and 13lI-HSA permits the evaluation of both parenchymal and blood pool elements. It is suggested that this method may be helpful in differentiating hemangiomata from other benign and malignant hepatic masses, particularly hepatoma.

Rapid, sequential renal blood flow scintiphotography.

With use of the Anger scintillation camera, the injection of a small bolus containing a large amount of radioactive tracer makes possible visualization of major vascular pathways (11), as well as of the blood supply to certain critical organs (4, 10). We have had the opportunity of applying rapid sequential scintiphotographic technics to the study of renal blood flow in a wide variety of cases. In this report an attempt will be made to indicate the potential usefulness of the procedure in several different clinical situations. Method The Pho Gamma III scintillation camera2 was employed in this study. The patient is placed in the prone position with the cameras detector head situated over the renal area. One hundred microcuries of 197Hg-chlormerodrin is given intravenously, and ten to twenty minutes later sufficient activity is present in the renal cortex to collect 50,000 counts in five to seven minutes. Specific abnormalities are identified on the conventional chlormerodrin study, particularly in cases ...

The Value of Ultrasound in the Diagnosis of Popliteal Artery Aneurysms

Although popliteal artery aneurysms are among the most common type of peripheral artery aneurysm, 1,2,3,4 they may be difficult to diagnose until com plications such as peripheral embolization, acute thrombosis 6 and rupture occur. Pressure on adjacent structures may cause neurological symptoms and venous thrombosis. The diagnosis of peripheral artery aneurysms is usually made by physical examination and arteriography. Recently, ultrasound of the popliteal space has been found to be very useful in the diagnosis of popliteal artery aneurysms.5,6,7 It is therefore important to recognize the value of ultrasound for imaging popliteal artery aneurysms and to use this readily available non-invasive mod ality in patients in which physical examination and/or angiography of the popliteal fossa is equivocal. We present one case of a popliteal artery aneurysm which was missed by angiography and physical examination in which ultrasound was very important in diagnosing this aneurysm pre-operatively, and two cases in which the ultrasound examination confirmed the presence of the popliteal artery aneurysm but better delineated its size than did angiography.

Ileal segment replacement of ureter I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis

Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.

Ileal segment replacement of ureter II. Dynamic characteristics of refluxing, nonrefluxing, and totally tapered ileal ureter

The pressure characteristics and cinefluoroscopic appearances of a refluxing, nonrefluxing, and totally tapered ileal neoureter were compared in 22 dogs with normal bladder function. The totally tapered ileal segment with a reflux preventing ileovesicostomy simulates normal ureteral peristalsis most closely on cinefluoroscopic evaluation. Pressure gradients across the ileovesical junction though were similar in refluxing and nonrefluxing ileovesicostomies , as well as in totally tapered ureters.