Bilateral renal cell carcinoma in a horseshoe kidney: preoperative assessment with MRI and digital subtraction angiography

Renal cell carcinoma in a horseshoe kidney is an unusual entity. To our knowledge, only 123 cases have been published to date. We report the first bilateral case of two clear-cell carcinomas in an asymmetrically fused kidney. Optimum preservation of renal function after radical tumor removal requires accurate preoperative imaging. Since the vascular supply in fusion anomalies is extremely variable, angiography is mandatory. Magnetic resonance imaging was most suitable to predict the tumor extent and localization, because it simultaneously gave the most comprehensive anatomical overview of the malformation.     

Renal cancer: preoperative evaluation with dual-phase three-dimensional MR angiography

Using a highly sensitive allele-specific PCR amplification method, we have previously shown that maternal cells could be detected in all 10 cord bloods tested. This raised the question of whether maternal cells are released into cord blood during the process of delivery or whether they are already present during pregnancy. We have now used the same PCR method to detect the presence of maternal cells in nine fetal blood samples collected at different gestational ages. Maternal cells were detected in eight samples obtained between 24 and 35 weeks of gestation. They were estimated to amount between 10(-4) and 10(-5) of nucleated fetal blood cells. In two cases mononuclear and polymorphonuclear cell fractions were separated by Ficoll gradient centrifugation and maternal cells were detected as comparable levels in both fractions. Maternal cells could not be detected in the one fetal blood sample obtained at 20 weeks of gestation, suggesting that maternal cells could appear at detectable levels in fetal blood during the third trimester of pregnancy. These results are discussed in terms of materno-fetal immune tolerance and of transmission of viruses (and more specifically of the human immunodeficiency virus) from mother to child.     

Renal medullary cystic disease: assessment by MRI

Cat-scratch disease is a self-limited condition commonly causing a benign chronic lymphadenopathy in children. Osteolytic lesions are a rare complication, but have been previously reported. We report a case of a solitary osteolytic lesion of the skull whose clinical, radiographic and pathological features were initially interpreted as being consistent with Histiocytosis X. Subsequently, positive serological titers for Bartonella, a history of a cat-scratch antecedent to the onset of clinical symptoms and review of the original histopathology confirmed the diagnosis of cat-scratch disease. We reviewed the English language literature on osteolytic lesions associated with cat-scratch disease and compare the current case with those previously reported.     

Role of CT angiography in the preoperative evaluation for laparoscopic nephrectomy

Laparoscopic nephrectomy (LN) was recently introduced as a minimally invasive alternative to open nephrectomy in living related renal donation. Because of the limited field of view available with laparoscopic techniques, the role of preoperative radiologic evaluation in LN has expanded to include anatomic definition of the renal arteries, collecting system, renal parenchyma, and renal venous anatomy. Computed tomographic (CT) angiography has proved to be a minimally invasive alternative to conventional angiography in the preoperative evaluation of living related renal donors. CT angiography has been shown to have an accuracy comparable to that of conventional angiography in predicting renal arterial anatomy. In addition, CT angiography provides comprehensive definition of the renal vascular anatomy including the location, size, and length of the renal, adrenal, gonadal, and lumbar veins. Dual-phase spiral CT combined with three-dimensional CT angiography constitute a single, minimally invasive procedure that can provide a complete preoperative evaluation of potential living related renal donors prior to LN. Comprehensive anatomic depiction of the renal arterial and venous supplies aids in surgical planning and helps avoid potential complications.     

Nodal spread of squamous cell carcinoma of the oral cavity detected with PET-tyrosine, MRI and CT

The uptake of L-1-[11C]-tyrosine (TYR) in cervical lymph nodes of eleven patients with squamous-cell carcinoma (SCC) of the oral cavity was studied with PET to detect lymphogenic metastases. METHODS: The TYR-PET results were compared with clinical, MRI, CT, histopathologic findings and historical data of patients studied with FDG. Sensitivity, specificity, accuracy and the positive and negative predictive values were calculated. RESULTS: TYR-PET had sensitivity of 83% and a specificity of 95%. In contrast, the sensitivity and specificity for MRI were 33% and 96%, respectively. The sensitivity and specificity for CT were 55% and 91%, respectively. TYR-PET results compared favorably with FDG. CONCLUSION: With TYR-PET, SCC metastases of the oral cavity can be visualized with high sensitivity and specificity. TYR-PET can be an additional tool for further evaluation of neck malignancies.     

Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations

BACKGROUND: Although low arterial oxygen tension (Po2) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. AIMS: To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic characteristics. PATIENTS: One hundred and forty two patients with cirrhosis without significant hepatic encephalopathy (grades 0-I) (41 patients in Child class A, 57 in class B, and 44 in class C) and 21 patients with hepatic encephalopathy. RESULTS: Mean Po2 in kPa was 11.3 in Child class A, 10.8 in class B, 10.6 in class C, and 10.6 in patients with encephalopathy (p < 0.05). The fraction of patients with Po2 below the lower normal limit of 9.6 kPa was 10%, 28%, 25%, and 43%, respectively in class A, B, C, and in patients with encephalopathy (p < 0.05). Oxygen saturation (So2) in these groups was respectively: 96%, 96%, 96%, and 93% (NS). So2 was below the lower limit of 92% in 0%, 9%, 7%, and 24% (p < 0.05). In patients without hepatic encephalopathy, a multivariate regression analysis revealed that independent determinants of a low Po2 were a high arterial carbon dioxide tension, a low systemic vascular resistance, and a low indocyanine green clearance (p < 0.0001). CONCLUSION: The prevalence of arterial hypoxaemia in cirrhosis is about 22% in patients without encephalopathy, but it varies from 10-40% depending on the degree of hepatic dysfunction. Arterial hypoxaemia in patients with cirrhosis of differing severity seems lower than previously reported, and patients with severe arterial hypoxaemia are rare.     

Functional endoscopic sinus surgery: preoperative assessment and postoperative evaluation

Long-term success of dental implants depends largely on the continued health of peri-implant hard and soft tissues and an appropriate force distribution on the implants. Since dental implants are accepted as viable and, in some cases, ideal restorative options, all members of the dental team are faced with the task of maintaining implant health. This review outlines the current understanding of implant health and disease and presents recommendations for the treatment and management of diseased implants.     

CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease

OBJECTIVE: The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries. SUBJECTS AND METHODS: In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined. RESULTS: Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpreted, 14 of 15 high-grade (> 75%) stenoses were recognized. Sensitivity and specificity of CTA were 93% (range, 68-100%) and 99% (range, 97-100%), respectively. When maximum intensity projections alone were analyzed, sensitivity for the diagnosis of 15 high-grade stenoses was only 53% (range, 27-79%) because calcified plaques obscured six stenoses. CONCLUSIONS: CTA accurately reveals iliac artery occlusions. Observers of CT angiograms may overlook short stenoses in rare instances. Calcified plaques limit the use of maximum-intensity-projection images.     

A dental CT study for preoperative assessment of maxillary atrophy

According to a new technology in the planning of endo-osseous implantation, based on a new CT-software for evaluation of the bone structure of the jaws, anatomico-morphological changes after the loss of teeth are measured much more accurately than with conventional methods like the panoramic intraoral x-ray or conventional tomography. 30 mandibles and 22 maxillae of 36 patients were examined. Besides the topographic course of the mandibular canal and the location of the foramen mentale, the anatomic structures as the important aspects for planning endo-osseous implants are seen more accurately. It is now possible to recognise morphological changes with paraxial reconstructions in a very short time more clearly and precisely than with former techniques.     

Renal artery evaluation: comparison of spiral CT angiography to intra-arterial DSA

Activin, a TGF-beta family member, and follistatin, an activin antagonist, encode signaling proteins which have been implicated in fundamental events in early vertebrate embryogenesis, such as mesoderm and neural tissue induction, and axial patterning. In this study I examine the roles of activin and follistatin in gastrulation in the chick. Activin betaB is found to be expressed at the base of the primitive streak prior to its formation, consistent with a role in streak induction. Follistatin has a more complex and dynamic expression in Hensen's node, and exhibits a left-right (LR) asymmetry. Antagonizing endogenous activin by ectopic application of follistatin protein causes the partial dissolution of the primitive streak and node, both morphologically and as assayed by loss of expression of molecular markers. This suggests that activin is necessary for the maintenance of streak morphology, and that follistatin may be involved in termination of the anterior progress of streak growth or in suppression of supernumerary streaks. Cell ingression through the node following follistatin application is normal, suggesting that it does not depend on the pit-like morphology of the wild-type node. Finally, follistatin temporally extends the asymmetric pattern of expression of HNF3-beta, this, as well as the stronger right-sided expression of follistatin, suggests a possible role in LR patterning.     

Torsion of accessory spleen in an adult patient: imaging findings at CT, MRI and angiography

Last summer, within the pages of this journal, an essay described the uncertainty surrounding the future of our small but independent VNA ("Dissolution of Tradition into Fantasy: A Lament," May/June, 1996). Supposedly, harsh financial pressures bombarded us and our Board began an inexorable movement toward affiliation with a powerful local hospital. When professional staff became jittery, Board representatives soothed us. This anxious period, given the decidedly unromantic coinage "due diligence," was likened to a courtship phase, an arranged engagement of sorts. Cold feet, second thoughts, panic attacks, and troubled dreams--all were to be expected, considered perfectly natural. All would be forgotten in the bliss of connubial union. Be patient and trust, we were advised; the consummation would make it all worthwhile. And we tried. What has transpired between last summer and this spring, however, exceeded our most vivid nightmare. Betrayed and angry, we scrambled to save what we could of our VNA before it was consigned to obsolescence in this, the year of our centennial.     

Extracranial carotid stenosis: ultrasound, MRI, angiography

This paper reviews some of the recent discussions about public health policy in Europe. In particular it points to the interest in communicable diseases and the need to extend this interest into non-communicable fields. It draws attention to the consequential need for trained and continuously updated epidemiologists.     

Pleural invasion by peripheral bronchogenic carcinoma: assessment with three-dimensional helical CT

Cystic endometrial hyperplasia resembling that of normal early pregnancy was induced by the insertion of a silk suture into diestrous bitches. Intraluminal trauma (wire scratching) induced a similar but moderate change. Intraluminal olive oil and saline had little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence of fertilized ova is termed Loeb's deciduoma. A similar response was created in progesterone-stimulated canine uteri by various physical means when compared to the pregnant contralateral horn.     

Renal duplex scanning: correlation with angiography and isotopic renography

The purpose of this study was to assess the accuracy of Duplex scanning in detecting renovascular disease and to compare it with angiography, renal scintigraphy and captopril test for plasma renin activity and isotopic renography. A Duplex scan was performed in 92 renal arteries (46 patients) and compared to angiography. Three degrees of stenoses were established: 0-60%, 61-99% and occlusion. The peak systolic velocity (PSV) in the renal artery and its ratio to the peak velocity in the aorta (RAR) were used to discriminate stenoses > 60%. PSV in the interlobar arteries was used to assess the relative perfusion of both parenchyma. Angiography demonstrated a stenoses > 60% in 23 hypertensive patients. In all of the patients, plasma renin activity was measured and isotopic renograms (pre- and post-captopril) obtained in order to discriminate hypertension of vascular origin. A PSV in the renal artery > 210 cm/s and a RAR > 3.5 were found to be the diagnostic criteria with the best sensitivity and specificity in detecting stenoses > 60%. Based on these data, Duplex correctly identified 49/54 stenoses > 60%; 28/33 stenoses < 60%; and 5/5 occlusions (kappa 0.79). Sensitivity and specificity in detecting stenoses > 60% were 89.5 and 90.7%, respectively. The ratio between PSV in the interlobar arteries of both parenchyma accurately predicted the relative perfusion (ratio between DTPA uptake in both kidneys) in the isotopic test (n = 23, r = 0.91, p = 0.001). The captopril test (for plasma renin activity and isotopic renography) was positive in only five patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acinic cell Carcinoma of the parotid gland: CT and MRI

Skin permeation of amino acids through excised rat skin was measured at various pH values. The permeabilities varied with the donor pH and amino acid, indicating that each ionic species of amino acid may have a different permeability. The permeability coefficient of each ion was estimated from the permeability-pH profiles using the dissociation constants. The estimated values for mono-cation and uncharged zwitterion were not dependent on the lipophilicity but on the size of the amino acid, suggesting a porous mechanism of transport. The permeability coefficient was highest for di-cation, followed by mono-cation, positively charged, uncharged and negatively charged zwitterions. The electrical potential difference across the skin was too small to affect the permeation of ions. The permselective property of skin thus seems to be determined by the difference of diffusivity in aqueous pores of skin due to the hydration of ions and other factors.     

Renal cell carcinoma in a patient with Beckwith-Wiedemann syndrome

We report the case of a patient with Beckwith-Wiedemann syndrome (BWS) who developed renal cell carcinoma (RCC). At birth, this patient presented with macroglossia, diastasis recti, mild gigantism, hepatomegaly and hypoglycemia, and the diagnosis of BWS was made. At 22 months, an intrapelvic rhabdomyosarcoma was detected and resected. At 37 months, computed tomography (CT) demonstrated a small mass with high attenuation in the right kidney, which was surgically confirmed to be RCC.