Single ectopic ureter masquerading as ureterocele in incontinent male

A seven-year-old boy with diurnal and nocturnal incontinence was found to have a dysplastic left kidney and an associated ectopic ureter in a single system which opened beside the verumontanum. An intravesical bulge was identified which resembled a ureterocele but was, in fact, a dilated ectatic lower ureter proximal to the orifice of the ectopic opening bulging posteriorly into the bladder. This bulge masqueraded as a ureterocele.     

Magnetic resonance imaging of the dysplastic renal moiety and ectopic ureter

PURPOSE: We determined the role of magnetic resonance imaging (MRI) in symptomatic children with clinically suspected and radiologically occult dysplastic renal moieties and ectopic ureters. MATERIALS AND METHODS: We reviewed clinical, imaging, cystoscopic, surgical and histological findings in 6 symptomatic children 1 to 15 years old with dysplastic renal moieties. RESULTS: After multiple conventional imaging studies failed to delineate urinary tract anatomy MRI provided detailed multiplanar images of dysplastic renal moieties that were diagnostic and predictive of subsequent intraoperative findings. Dysplastic upper pole moieties identified in 4 children were associated with ectopic ureters inserting into the vagina, prostatic urethra, bladder neck and bladder neck ureterocele in each. A solitary kidney with contralateral blind-ending ectopic ureters inserted into the bladder base in 2 cases. Pelvic cystic structures visualized by ultrasound in 3 patients were tortuous distal ureters on MRI. MRI specifically identified ureteral insertion sites that were not evident in 3 of the 5 patients who underwent cystoscopy. CONCLUSIONS: MRI may facilitate diagnosis, guide cystoscopy and aid in preoperative planning in children with poorly functioning renal moieties and ectopic ureters.     

Identification of a retained surgical sponge using magnetic resonance imaging

We report a patient who had a spinal abscess due to a retained surgical sponge. Through the use of magnetic resonance imaging, the sponge was identified. Postoperative foreign body complications are discussed.     

Incompetent urethral sphincter in a girl with a unilateral single ectopic ureter

A rare case of an incompetent urethral sphincter associated with a unilateral single ectopic ureter is reported. Urinary incontinence persisted even after removal of a dysplastic kidney draining into the vagina. No neurological defect was found. Manual compression of the bladder elicited urine leakage from the urethra, and the urethral closure pressure was markedly low. Cystometry and voiding cystourethrography were normal. Continence was restored completely by a urethral sling operation.     

Identification of aortic thrombus by magnetic resonance imaging

The unique properties of magnetic resonance imaging result in the potential to differentiate various components of the diseased arterial wall. In this article four cases are presented in which magnetic resonance imaging showed mural aortic thrombus and its anatomic relationship to the visceral and renal arteries. Once thrombus is identified and localized specific operative strategies can be undertaken to prevent recurrent embolic events and/or avoid perioperative thromboembolic complications.     

Measuring hip development using magnetic resonance imaging

BACKGROUND: Abnormal hip development can have severe consequences if not detected and treated early. Previous studies have shown that if the abnormality is detected early, the outcome is good. Much is known about embryological hip development (weeks 1-10 after conception) from postmortem examination. For ethical reasons, information about hip development in the fetal stage of pregnancy (10 weeks to term) is less certain as it is largely gained from animal studies and from early radiograph studies. A few autopsy-based studies have been reported looking at hip development, but no one has shown, to our knowledge, that postmortem magnetic resonance is able to provide the same and possibly more information. The aim of this study was to assess the value of magnetic resonance imaging in providing information on fetal hip development. METHODS: Measurements of 30 patients (gestation, 17-42 weeks) were made regarding the width and depth of the acetabulum and the radius and diameter of the femoral head; volume and area were calculated. RESULTS: With the exception of the acetabular width, each dimension showed little development until week 20 when growth rose exponentially. The acetabular width showed a slow rate of growth, despite changes in the femoral head. Levels of observer agreement were high for all but depth (intraclass correlation coefficients, 0.90). CONCLUSIONS: The measurements were in line with previous postmortem studies. Magnetic resonance imaging is a valid alternative to postmortem in the assessment of hip development. Magnetic resonance imaging has the potential to alert clinicians to the possible abnormal development, allowing early intervention. STUDY DESIGN: Cross-sectional study with purposive sampling.     

Evaluation of Gaucher disease using magnetic resonance imaging

Magnetic resonance imaging was used to study the skeletal involvement in a series of twenty-four patients with Gaucher disease. Many sites in the marrow of these patients were characterized by an abnormally low signal intensity that reflected shortened T1 and markedly shortened T2 values in the replaced marrow. The abnormality was non-homogeneous in distribution. In the lower extremity, the proximal (femoral) areas were more frequently affected than the distal (tibial) sites. The epiphyses were generally spared unless the involvement of bone was extensive. Lack of epiphyseal involvement on the magnetic resonance images generally precluded any suspicion of osteonecrosis. The extent of involvement, as suggested by the magnetic resonance data, appeared to correlate well with the occurrence of musculoskeletal complications. Magnetic resonance imaging is more sensitive than computerized tomography in demonstrating the extent of abnormalities in patients with Gaucher disease, and it may have prognostic value.     

Evaluation of facial fat distribution using magnetic resonance imaging

Magnetic resonance imaging (MRI) provides noninvasive images of facial and neck fat for a variety of conditions. It accurately maps the soft tissues pre- and postoperatively, enabling surgeons to precisely and objectively assess results of soft tissue facial contouring and fat transplantation. The risks of MRI are few. It has the potential to provide aesthetic surgeons with a more scientific means of comparing various techniques of fat contouring.     

磁共振技术行移植细胞在体示踪

目的寻找一种能够对移植细胞进行在体示踪方法,为细胞的迁移、分布及心功能改善机制的研究提供更多的信息。方法将超顺磁性氧化铁(SPIO)和骨髓间充质干细胞(MSCs)共同孵育培养36h。普鲁士蓝染色评价细胞的标记效率;MTT比色实验评价SPIO对细胞生长能力的影响;台盼蓝染色检验标记后细胞的活性;应用Costar Transwell方法评价铁离子对细胞迁移能力的影响;用细胞分化诱导液培养标记后的细胞评价其分化能力。将标记的细胞移植到中华小型猪心肌内。通过心脏MRI进行连续的在体示踪观察。细胞移植后不同时期取动物心脏切片进行普鲁士蓝染色观察移植细胞。结果MSCs经铁离子标记后,普鲁士蓝染色标记效率>95%,此试剂不影响细胞增殖,标记后98%的细胞保持活性,可继续培养、传代,迁移能力和分化能力未受影响。动态观察显示SPIO标记细胞在MRI影像上表现为低密度灶影或信号缺失,并且在移植后4周仍可显影。病理学检查可以看到移植细胞呈普鲁士蓝染色阳性,与影像学有很好的一致性。结论磁共振对比剂SPIO可以安全、有效的标记骨髓间充质细胞,并可通过心脏MRI进行持续的在体示踪。     

Frameless stereotactic surgery using intraoperative high-field magnetic resonance imaging

This study evaluated the clinical validity of frameless stereotaxy using high-field intraoperative magnetic resonance (iMR) imaging combined with an in-room neuronavigation system. A 1.5 Tesla MR scanner in conjunction with a ceiling-mounted neuronavigation system was used during 32 frameless stereotaxy procedures consisting of 19 brain biopsies and 13 catheter placements between April 2002 and mid-October 2003. Evaluation of the procedure was based on either the rate of histological diagnostic yield or the ability to accurately position the catheter in the target region. This technique allowed successful registration with a mean error of 1.2 +/- 0.8 mm and resulted in successful placement of the instrument within the target tissue. Intraoperatively, frozen section analysis showed all biopsy samples contained pathological tissue and locations of sampling points were confirmed by iMR imaging. Specific final diagnosis was made in all 19 brain biopsies. The tip of the catheter was successfully placed into the target in all 13 patients confirmed by iMR imaging. The catheter was repositioned based on iMR imaging in four of 13 patients, increasing the rate of successful placement. There were no procedure-related neurological deficits or mortality, but we encountered two cases of wound infection, one needing surgical revision. Total additional procedure time related to the induction of iMR imaging was 76.7 +/- 23.3 minutes. This initial experience of the combination of conventional frameless stereotaxy and high-field iMR imaging improved the quality of frameless stereotaxy with low morbidity and mortality, but did not translate into a significant reduction of procedure-related time.     

The ectopic ureter in men

The ectopic ureter is less common in male than in female patients. It usually terminates proximally to the external sphincter in the seminal vesicle or vas deferens, and usually involves a nonduplicated drainage system of a dysplastic kidney. Men characteristically present with lower tract symptoms, often epididymitis, a cystic or boggy periprostatic mass on rectal examination and ipsilateral nonvisualization on excretory urography. The embryology, pathogenesis, diagnosis and treatment of this condition are discussed, and 4 illustrative cases are presented.