Robert J. Stanley

Papillary renal cell carcinoma. A clinical, radiologic, and pathologic study of 34 cases

Papillary renal cell carcinoma (RCC) is known by its tendency to avascularity by angiography; however, data concerning its clinicopathologic spectrum and prognosis are not available. In a review of 224 renal cell carcinomas accesioned in our files, 34 were found to be papillary and 190 of other histologic types. A comparative analysis of these two groups revealed marked differences. The majority of papillary tumors (85.3%) were in pathologic stage I, whereas more than half of the nonpapillary tumors had extended beyond the limits of the kidney. Follow‐up data revealed that the survival for papillary RCC was significantly higher than that for nonpapillary tumors. This difference held true even when tumors in the same pathologic stage were compared. Many papillary tumors, particularly those with a favorable course, were massively necrotic, densely infiltrated by macrophages, or both. In view of these findings, the possibility that host mechanisms are involved in destruction and confinement of the tumor is discussed. Examination of kidney tissue distant from the tumor disclosed, in some cases, atypical hyperplastic changes of collecting tubules; this raises the possibility that some papillary tumors arise from distal tubular epithelium. Hypo‐ or avascularity was present in all papillary RCCapos;s studied by angiography.

Computed body tomography with MRI correlation

Chapter 1. CT Principles and Techniques, Including CTA Chapter 2. MRI: Basic Principles and Techniques Chapter 3. Interventional CT Technique, Including RF Ablation and CT Fluoroscopy Chapter 4. Neck Chapter 5. Thorax: Techniques and Normal Anatomy Chapter 6. Mediastinum Chapter 7. Lung Chapter 8. Pleura, Chest Wall and Diaphragm Chapter 9. Heart and Pericardium Chapter 10. Normal Abdominal and Pelvic Anatomy Chapter 11. Gastrointestinal Tract Chapter 12. Liver Chapter 13. Biliary Tract Chapter 14. Spleen Chapter 15. Pancreas Chapter 16. Abdominal Wall and Peritoneal Cavity Chapter 17. Retroperitoneum Chapter 18. Kidney Chapter 19. Adrenals Chapter 20. Pelvis Chapter 21. Trauma Chapter 22. Non-traumatic Acute Abdomen Chapter 23. Musculoskeletal Chapter 24. Spine Chapter 25. Pediatrics

Diagnostic Features of Clindamycin-Associated Pseudomembranous Colitis

DIARRHEA associated with antibiotics is not an unusual finding.1 Recently, clindamycin has been reported to cause a specific type of colitis with plaque-like elevations on the colonic mucosa.2 , 3 Proctoscopy showed characteristic lesions, and x-ray findings were specific in the three patients treated with clindamycin described below. These findings should facilitate the recognition of pseudomembranous colitis from all causes, since neither of these findings is specific for clindamycin. Over a two-month period, we have seen three patients with severe diarrhea associated with clindamycin. The salient features are outlined in Table 1. Diagnostic Procedures Two tests were found of great help in diagnosing .xa0.xa0.

Computed tomography in the staging of testicular neoplasms.

Twenty-six patients with primary testicular tumor were evaluated by computed tomography. It was highly accurate in differentiating lymph node metastases from testicular tumors. CT scanning may reveal tumor in lymph nodes not normally opacified during bipedal lymphangiography. It can also be used in treatment planning, follow-up, and in localizing sites of recurrence when serum tumor markers become positive. Some pitfalls of CT are also discussed.

Clinical Comparison Between Vascular and Avascular Renal Cell Carcinoma

Of 72 patients with renal cell carcinoma 19 were found to have an angiographic avascular neoplasm. These avascular tumors have a lower incidence of vein and capsule invasion than vascular tumors. Among these avascular cancers papillary adenocarcinoma was the predominant histologic pattern. Patients with papillary tumors seem to have a lower clinical stage and increased survival rate than patients with non-papillary tumors.

The Spectrum of Radiographic Findings in Antibiotic-Related Pseudomembranous Colitis

The radiographic findings in pseudomembranous colitis related to antibiotic therapy have previously been considered nonspecific and indistinguishable from those seen in other acute ulcerating colitides. A review of 9 such patients evaluated over a period of 6 months suggests a range of radiographic abnormalities including, in severe cases, an appearance which is strongly suspicious of this condition and may be diagnostic. While proctosigmoidoscopy is the preferable diagnostic tool, the barium enema will frequently precede it, enabling the radiologist to suggest the diagnosis. Early recognition is important, as this condition carries a significant morbidity unless the offending antibiotic is discontinued.

Computed Tomography of the Genitourinary Tract

Eighteen months of experience with computed body tomography have revealed that this radiologic modality is useful in the diagnostic evaluation and management of urologic patients. Renal masses, perirenal lesions, poorly functioning kidneys, pelvic tumors and associated retroperitoneal nodal spread and other diagnostic problems related to the urinary tract have been imaged successfully with computed body tomography. Accuracy is high in the differentiation of benign renal cysts from renal neoplasms. Tumor staging and computed body tomography is being explored currently.

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.

Utility of body computed tomography in the clinical follow-up of abdominal masses.

The value of follow-up body computed tomography was assessed in 101 patients with a known or suspected abdominal or pelvic mass. Computed tomography proved to be a useful noninvasive technique for evaluating progression, regression, or recurrence of such masses after therapeutic intervention. Computed tomography provided new or unique clinical information in 87% of these patients: it was not helpful in 2% due to technical difficulty and was misleading in 4%.

Selective Intraarterial Infusion of Vasopressin for Control of Gastrointestinal Bleeding: Experience with 35 Cases

Selective intraarterial infusion of vasopressin was performed in 32 patients for 35 episodes of gastrointestinal bleeding. Active bleeding was from esophageal varices in 11 cases and from an arterial site in 22 (stomach 11, duodenum 1, jejunum 2, colon 7, liver 1), including a jejunal diverticulum and a colonic ulcer in Behcets disease. Two patients, not actively bleeding, were infused for portal decompression before an elective mesocaval shunt. Active bleeding was controlled in 64% of patients with variceal hemorrhage and in 59% of those with arterial sources. Infusion periods ranged from 15 minutes to 70 hours. There were no significant complications directly attributable to this therapy.