Uresh Patel

Emergency Percutaneous Nephrostomy: Results and Complications☆

PURPOSE Percutaneous nephrostomy is a well-established standardized procedure in the management of patients with various urologic problems. The goal of this study was to evaluate the effectiveness and safety of percutaneous nephrostomy in an emergency setting. PATIENTS AND METHODS Emergency percutaneous nephrostomy was performed in 160 patients with ages ranging from 2 to 89 years (mean, 52 years). Access to the kidney was planned and achieved with C-arm fluoroscopic guidance. RESULTS The initial technical success rate was 98%. Overall complication rate was 34%; 6% were major and 28% were minor. Major procedure-related complications, including sepsis, occurred in 6% of patients. Hematuria requiring transfusion was noted in 2.4% of patients. Minor complications included catheter displacement or malposition (4.8%), pelvic perforation (4.3%), paralytic ileus (2.4%), pneumonia/atelectasis (1.8%), and pleural effusion (1.2%). High-risk patients included those with diabetes, hypertension, and obesity. No deaths or significant morbidity resulted from any complication. CONCLUSIONS Emergency percutaneous nephrostomy under fluoroscopic guidance is a simple, safe, and effective procedure and should be offered in all suitably equipped radiology departments.

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (cadasil)

Summary: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a recently described neurovascular disease affecting young to middle age individuals. The disease is caused by mutations in the Notch3 gene located in the short arm of chromosome 19. Clinically, the disease is characterized by migrainous headaches (with or without aura), mood disturbances, focal neurologic deficits, transient ischemic attacks, strokes, and dementia. Pathologically, the disease is characterized by a stereotypic degeneration of the arterial walls (especially in the intracranial compartments) with deposition in the media of a nonatheromatous, nonamyloidotic substance that under the electron microscope (EM) appears as a granular osmiophilic material (GOM), pathognomonic for the disease. The nature of the GOM is undetermined and the pathogenesis remains to be elucidated. A review of current literature in English language is presented on the clinical, radiologic, pathologic, and genetic features of CADASIL.

CT of infected bladder diverticulum.

A case in which pus within a bladder diverticulum simulated a deep pelvic abscess is presented. This pitfall in CT diagnosis should be considered in patients with bladder outlet obstruction with symptoms of infection.