Renal clubbing and scarring in adults: A retrospective study of 110 cases

A urographic pattern of renal clubbing and scarring was found in 182 scarred kidneys of 110 adult patients. Homolateral vesicoureteric reflux was demonstrated by reliable techniques in 90/135 scarred kidneys. Urinary tract infections occurred in 75 patients. Hypertension developed in 20 patients with normal renal function and was not related to the extent of scarring. Chronic renal failure occurred in 30 patients with diffuse bilateral scarring. Four patients showed histologic changes of chronic pyelonephritis. Two hypertensive patients had a typical histologic pattern of Ask-Upmark kidney (segmental hypoplasia). Development of renal scars in adulthood was demonstrated in 2 cases.     

Caliceal clubbing and adjacent parenchymal scarring (always reflux nephropathy?) as a cause of end-stage renal failure

Various clinical and laboratory aspects in 15 kidney transplanted patients with urographic evidence of caliceal clubbing and adjacent parenchymal scarring in their native kidneys are reported. These lesions were found in 16 per cent of our series of kidney transplantations; below 35 years of age it was the second most frequent disease. In 9 of these patients severe vesicoureteral reflux had been demonstrated. In the remaining 6 patients reflux nephropathy was only a tentative diagnosis based on a striking similarity in the radiographs and in several clinical findings. Nine patients had symptoms (mainly related to urinary tract infection) from 1 to 17 years before diagnosis/urography, in 5 as early as the first year of life. Recurrent urinary tract infection and renal impairment were the most frequent disorders leading to the diagnosis. Replacement therapy was initiated at an average age of 32.7 years. Following renal transplantation urinary tract infection was documented in 37 per cent of patients whether the patient had been bilaterally nephrectomized or not.     

颈动脉体瘤临床特点及诊治分析

 目的 总结颈动脉体瘤(carotid body tumor,CBT)的诊治经验.方法 回顾我科2000-11至2009-11颈动脉体瘤21例,对其临床特点、诊断方法、术前准备、手术方法及并发症的预防进行总结和分析.结果 21例中,男女比例1∶ 2.5;平均46.19岁;19例为单侧发病,双侧2例;11例行颈动脉多层螺旋CT血管成像(MSCTA)检查即明确诊断;12例术前行Matas法颈动脉阻断训练.14例全麻下行颈动脉体瘤切除术,单侧13例,双侧1例.4例术中出现不同程度的颈动脉分歧处破裂.1例术后死亡;1例术后出现进食呛咳,声音嘶哑;无复发病例.结论 多层螺旋CT血管成像(MSCAT)对确定诊断和制定手术方案非常有价值.术前了解肿瘤血供和累及颈动脉的程度,了解Willis环循环状况,综合评价颈动脉阻断脑耐受性是最重要的术前准备.术前应做好动脉分流、阻断及血管修复、血管重建术的充分准备.手术后主要是防止大出血及脑血管梗死发生.     

Renal duplication with associated complications in adults: CT findings in 26 cases

AIM: To review the computed tomography (CT) findings in 26 adult patients with complicated renal duplication, and to assess whether the complications were anomaly-related or superimposed by acquired disease. MATERIALS AND METHODS: Fifteen women and 11 men, aged 17-83 years took part in the study. All CT studies were reviewed to define the moieties affected. RESULTS: The duplication was unilateral in 18 cases and bilateral in six, one patient had a single left kidney and the remaining one a horseshoe kidney. In 14 patients the pathology was related only to the anomaly. Upper pole abnormalities were seen in 13 patients (seven related to the anomaly) and lower pole abnormalities in five (all related to duplication). Both systems were affected in eight cases, six of them by pathological processes unrelated to duplication. Hydronephrosis of the affected collecting system was the most common imaging finding. CONCLUSION: Computed tomography is often used to evaluate abdominal conditions in adults and may therefore be the first imaging modality to reveal a duplex kidney complicated by a pathological process. Involvement of only one moiety was frequently related to the duplication, with a predilection for the upper moiety, while involvement of both systems was used unrelated to the duplication. Zissin, R. (2001). Clinical Radiology, 56, 58-63.     

67例肺栓塞患者的回顾性研究

目的 回顾性分析肺栓塞的临床特点、诊断经验和治疗方法,减少误诊、漏诊,提高对肺栓塞患者的诊断率和治愈率.方法 总结解放军总医院第一附属医院67例诊断为肺栓塞的患者的临床表现、辅助检查结果及治疗方法.根据确诊患者各种症状及体征的出现频率,寻找肺栓塞临床表现的规律;辅助检查分为常规筛查项目及进一步确诊检查,着重比较CT肺动脉造影(CTPA)、核素肺通气灌注扫描(ECT)和肺血管造影检查的确诊率,并比较溶栓 抗凝治疗与单纯抗凝治疗的疗效及并发症发生率.结果 肺栓塞患者的主要临床表现有呼吸困难、咳嗽、胸痛、发热、咯血等.常规筛查项目中,D-二聚体测定可作为筛查肺栓塞的较敏感但非特异的指标;进一步确诊检查中,CTPA诊断的阳性率为90.32%(28/31);ECT显像的阳性率为76.47%(39/51),肺血管造影检查的阳性率(100%)虽然高,但是因其存在风险,不易被患者接受.溶栓 抗凝治疗的总治愈率为90.62%(29/32),其中以重组组织型纤溶酶原激活剂2h方案的治愈率(100%)最高.单纯抗凝治疗的治愈率(68.57%,24/35)较溶栓 抗凝治疗低,但是其出血并发症发生率(31.25%)较低.溶栓 抗凝治疗后复查,PaO2和CTPA两项检查可显示治疗前后差异有统计学意义(P＜0.01).结论 对于肺栓塞患者,CTPA是确诊的首选无创性检查;溶栓 抗凝治疗能取得较好疗效.长期卧床及外伤手术后的患者,建议适当给予肝素预防肺栓塞.     

重型颅脑损伤4462例诊治分析

目的 总结大宗重型创伤性脑损伤(severe traumatic brain injury,sTBI)患者的诊疗经过,以提高治愈率,减低残死率.方法 对1951年6月-2008年5月间我院收治的4 462例sTBI患者(GCS≤8分)的诊疗过程进行回顾性分析.其中男3 298例(73.9%),女1 164例(26.1%);致伤原因最常见为交通伤(1 583例,35.5%);闭合性损伤3 654例(81.9%),开放性损伤808例(18.1%);临床表现主要为意识障碍、瞳孔变化与生命体征改变等;1 158例(26.0%)有合并伤,1 356例(30.4%)有并发症.治疗方式包括急救、手术与非手术处理,尤其强调二次脑损伤的防治. 结果 手术治疗3 023例(67.7%),其中开颅血肿清除术856例,开颅血肿清除与去骨瓣减压2 167例,死亡540例(17.9%).非手术治疗1 439例(32.3%),死亡341例(23.7%).全部患者出院时COS评定结果 :良好2 462例(55.2%).中残508例(11.4%),重残339例(7.6%),植物生存272例(6.1%),死亡881例(19.7%). 结论 积极的诊断治疗、严格的诊疗制度与防治二次脑损伤是提高sTBI救治成功率,降低残、死率的关键.     

肠系膜损伤的CT、B超回顾分析(附8例报告)

目的探讨肠系膜损伤的cT、B超诊断价值。方法回顾分析8例经过手术证实肠系膜损伤的cT平扫资料，其中，4例有急诊B超资料。所有病例均因车祸人院。结果cT表现包括肠系膜密度增高8例，肠间积液6例，腹膜后积液3例，肠系膜血肿2例，肠壁增厚2例，3例表现为“夹心样”肝脏周围、脾脏周围积液。B超检查2例显示大量腹腔积液，2例少量腹腔积液。结论cT对于肠系膜损伤的诊断具有很好的敏感性，B超显示腹腔积液而无实质性脏器损伤时，高度提示肠系膜损伤可能。     

Plantar fasciitis: a retrospective analysis of 267 cases

Objectives: To gain a better understanding of the anthropometric, biomechanical and treatment statistics for a diversified population affected with plantar fasciitis. Design: A retrospective case review. Setting: The Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada. Subjects: Referral patients seen by attending physicians from 1998–2000. Age 43·1 years (±3·81), weight 72·2 kg (±14·7), height 1·61 m (±0·9), BMI 24·7 kg/m² (±5·16), number of years active 10·6 (±10·42), weekly activity 5·6 h (±8·6). Results: Over half (54·7%) of patients with plantar fasciitis were reported as having excessive pronation. The frequencies for other biomechanical variables include: genu valgum (20·2%), genu varum (16·9%), pes cavus arch (10·1%), and leg length inequality (6·7%). A prior history of injury to the ankle/foot area was reported in 21·7% of patients and training errors were felt to be the cause in 17·2% of cases. A majority of patients were prescribed stretching and strengthening exercises (76·8%), and orthotics and NSAIDs were given to 49·1% and 41·6% respectively. Of the 78 patients for whom follow-up data was available, 17·9% claimed to have complete resolution of symptoms, and 39·7% reported having 75% improvement or better.     

Superior mesenteric vein thrombosis with radiologically occult cause: a retrospective study of 43 cases

OBJECTIVE: Our purpose was to examine the clinical presentation, imaging appearance, etiology, and clinical outcome in patients who had acute thrombosis of the superior mesenteric vein with radiologically occult cause. CONCLUSION: The most common predisposing factors in superior mesenteric vein thrombosis with radiologically occult cause are recent abdominal surgery, infection, and hypercoagulable states. Although no correlation was noted between risk factor and outcome, the presence of bowel wall thickening and mesenteric congestion on CT or MR imaging was associated with the development of bowel ischemia. Prognosis is good in this group of patients, with a mortality of only 7%, although bowel ischemia was noted in 21%.     

Percutaneous image-guided needle biopsy of rib lesions: a retrospective study of diagnostic outcome in 51 cases

Objective

To assess the diagnostic yield and diagnostic accuracy of image-guided percutaneous needle biopsy of rib lesions and to analyse the diagnostic spectrum of rib lesions referred to a tertiary musculoskeletal oncology centre.

Materials and methods

A retrospective review of all patients that underwent image-guided rib biopsy and/or excision during the period from 1 January 2003 to 31 July 2011. A total of 51 consecutive subjects were identified and included in this study. Image-guided percutaneous biopsy was performed using either CT (n?=?43) or ultrasound (n?=?8).

Results

There were 28 males and 23 females, with a mean age of 49.9 years (range 10?C84 years). Forty-five of the 51 biopsies (88?%) yielded a diagnostic sample, and 6 (12?%) were non-diagnostic. Thirty-one of 45 (69?%) lesions were malignant, and 14 (31?%) were benign. The commonest malignant lesions were metastases, 16 of 31 (51.6?%), and primary bone or cartilaginous tumours, 15 of 31 (48.4?%). The commonest benign lesion was fibrous dysplasia (6 of 14, 43?%) followed by infection (5 of 14, 36?%). All non-diagnostic samples were from lesions which had no extra-osseous component, and all were subsequently confirmed as benign on rib resection. There was complete agreement between needle and surgical resection in 18 of 19 subjects (96?%).

Conclusion

Image-guided percutaneous rib biopsy has high diagnostic yield and accuracy. Intra-osseous lesions which have no associated extra-osseous component have a lower biopsy success rate.     

Electrocution in South Delhi: a retrospective study

One hundred and fifty three unselected autopsy cases of electrocution received from South Delhi were studied during the period 1996-2001. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.98% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, season of the year, site of the body, time of day, place of occurrence and presence of entry and exit wounds on the body. Death occurred at the scene of the fatal event in 150 cases and three cases died in hospital. Three cases showed no electric burn marks on the body; the cause of death in one of these cases was polytrauma due to a fall from a height and one case had committed suicide.     

Renal aspergillosis: a report of two cases.

Two cases of opportunistic aspergillosis of the kidney are presented. One patient, a child with unsuspected chronic granulomatous disease of childhood, presented with a renal mass which proved to be an abscess secondary to aspergillosis. The other patient, a terminal leukemic, had a renal vein thrombosis secondary to invasion of the renal vein by aspergillosis. Aspergillosis and other fungal diseases of the kidney should be considered in debilitated patients with an abnormal urogram.     

Renal oncocytoma. Ultrasonographic study of 4 cases

The authors report four cases of renal oncocytoma investigated by echography and proved by histology after surgery. Describing the clinical cases, after a brief review of the literature, the radiologic findings are analysed with particular regard to the sonographic signs that can preoperatively differentiate oncocytomas from carcinomas. The authors conclude that the only sonographic distinguishing feature is a quite characteristic central hyperechoic streak corresponding to the fibrous scar, frequently found in this benign tumor.     

A retrospective study of CT findings in cases undergoing appendectomy at a single hospital

The purpose of this study was to determine which clinical information or computed tomography (CT) features can distinguish perforated from nonperforated appendicitis. We collected data from 102 patients (62 men, 40 women; mean age, 49.6 years; age range, 16-85 years) who presented to the emergency department with acute abdominal pain or suspicion of acute appendicitis and underwent appendectomy. In the clinical information, there was no significant factor to predict appendiceal perforation. As for CT features, significant imaging factors for predicting appendiceal perforation included abscess, phlegmon, and thickening of lateroconal fascia. The treatment strategy of acute appendicitis varies according to the integrity of the appendiceal wall. Besides clinical findings, CT features can distinguish perforated from nonperforated appendicitis, facilitating proper decision making in ER.     

Imaging of intralabyrinthine schwannomas: a retrospective study of 52 cases with emphasis on lesion growth

BACKGROUND AND PURPOSE: Only a few case reports and small series of intralabyrinthine schwannomas (ILSs) have been reported. The purpose of this study was to assess prevalence, MR characteristics, location, clinical management, and growth potential/patterns of ILSs in the largest series reported.MATERIALS AND METHODS: Lesion localization, MR characteristics, lesion growth, and clinical management were reviewed in 52 patients diagnosed with an ILS between February 1991 and August 2007 in 2 referral centers. The number of ILSs and vestibulocochlear schwannomas in the cerebellopontine angle/internal auditory canal was compared to assess the prevalence.RESULTS: ILSs most frequently originate intracochlearly, are hyperintense on unenhanced T1-weighted images, enhance strongly after gadolinium administration, and are sharply circumscribed and hypointense on thin heavily T2-weighted 3D images. The scala tympani is more frequently or more extensively involved than the scala vestibuli. Follow-up MR imaging, available in 27 patients, showed growth in 59% of subjects. Growth was seen from the scala tympani into the scala vestibuli and from the scala vestibuli to the saccule and vice versa. Twelve lesions were resected, and the diagnosis of ILS histopathologically confirmed.CONCLUSION: ILSs can account for up to 10% of all vestibulocochlear schwannomas in centers specializing in temporal bone imaging, grow in more than 50%, and are most frequently found intracochlearly, often anteriorly between the basal and second turn. Cochlear ILSs most often originate in the scala tympani and only later grow into the scala vestibuli. Growth can occur from the cochlea into the vestibule or vice versa through the anatomic open connection between the perilymphatic spaces in the scala vestibuli and around the saccule.

Intralabyrinthine schwannomas (ILSs) are benign tumors arising de novo from the perineural Schwann cell sheath of the intralabyrinthine branches of the vestibulocochlear nerve (VCN) and initially have no component in the internal auditory canal (IAC).¹ Intracochlear schwannomas develop on the intracochlear branches of the cochlear branch of the VCN. Intravestibular schwannomas develop on the end branches of the vestibular branches of the VCN. They can develop on the saccular nerve, utricular nerve, lateral, superior, or posterior ampullary nerve and are then found in the corresponding part of the vestibular system. The first ILSs were found during autopsy in 1917.² During the 1970s, ILSs were found during labyrinthectomy performed for intractable vertigo or Menière disease.^3,4 Diagnosis of ILSs was difficult on CT, and only isolated cases were described.^5,6 With the advent of gadolinium (Gd)-enhanced MR imaging, an increasing number of ILSs were detected during screening for hearing loss and/or vertigo.⁷The use of heavily T2-weighted images for the detection of these lesions was reported a few years later.⁸ Further optimization of these MR techniques has gradually increased the number of reported ILSs and has made them more accessible in the clinical work-up of patients with ILS-related symptoms, such as hearing loss, vertigo, and tinnitus. A limited number of reports, mainly case reports and small series of less than 10 subjects, described the imaging findings of ILSs.^9–22 One larger series of 28 cases published by Kennedy et al²³ focused on management and classification of these lesions. However, only 15 cases of this series met the above-described stringent criteria of ILS.Little is known still about the prevalence of ILSs. In an extensive autopsy series, only 1 case in 893 petrous bone examinations was described (prevalence of 0.1%).²⁴ A more recent MR imaging study including 800 patients with Menière-like symptoms revealed 3 cases of ILS (prevalence of 0.4%).¹⁷ Even less is known about its occurrence and patterns of growth.Only a few studies reported on growth in ILSs and considered that growth is rare.²³ Tumor growth can result in progressive hearing loss and intractable tinnitus or symptoms due to involvement of other cranial nerves caused by extension toward the cerebellopontine angle (CPA). In these cases, surgery can be considered. Hence, detection of growth is helpful in triaging patients to treatment. In the series published by Kennedy et al,²³ only 3 (15%) of the 20 cases that had MR follow-up (FU) showed increase in size. These 3 lesions had an IAC component at presentation and, therefore, did not match the above-described stringent criteria of ILS.Fast improvement in MR technology led to increased image resolution, which made more precise localization of very small ILSs possible and resulted in a higher sensitivity to detect tumor growth. It is, therefore, probable that, with the use of these more sensitive MR techniques, the prevalence of tumor may be higher than reported previously.In this article, 52 cases of ILS, detected on MR, represent the largest series of ILSs reported. The clinical symptoms at presentation, lesion location, growth potential, growth pattern, and clinical management were evaluated.