Stent placement for the diagnosis of upper tract obstruction

The aim of this study was to evaluate the effectiveness of ureteral stent placement in diagnosing ureteropelvic junction (UPJ) obstruction in patients with negative or equivocal radiographic/nuclear studies and to assess relief of symptoms following definitive surgical procedures to relieve the obstruction. Patients undergoing ureteral stent placements performed by two attending urologists over an 18-month period were reviewed. All patients with equivocal or negative radiographic evaluations for ureteral obstruction in whom the stent was placed for diagnostic purposes were selected. Preoperative and postoperative information was obtained from the medical record or by telephone interview. Five patients were found who had equivocal radiographic studies along with symptoms of flank pain and who underwent diagnostic stent placement. All patients were female (average age 40 years, range 20-52). All had pain relief following stent placement and, on this basis, underwent an operative procedure to remove the presumed ureteral obstruction. Three underwent Acucise endopyelotomy, one had laparoscopic resection of the right ovarian vein, and one underwent nephrectomy. The average preoperative creatinine level was 0.9 mg/dL (range 0.8-1.0), and the average postoperative creatinine level was 1.0 mg/dL (range 0.9-1.1). All patients had relief of flank pain at a mean of 17 months following the surgical procedure. Relief of pain following stent placement in patients with clinical suspicion of ureteral obstruction portends a favorable outcome from procedures to relieve the presumed obstruction. In unusual cases where ureteral obstruction is suspected despite negative or equivocal radiographic findings, diagnostic stent placement appears to be useful.     

The influence of upper respiratory tract surgery on respiratory function evaluated by oxygen saturation

To evaluate the influence of upper respiratory tract surgery on respiratory function, we used a pulse oximeter to measure the arterial oxygen saturation in 40 patients (ASA 1 or 2) during surgery under local anesthesia. The patients were divided into four groups: a control group of 10 patients who underwent surgery not involving the upper respiratory tract, and three upper respiratory tract surgery groups of 10 patients each underwent surgery on the nasal cavity alone (group 1), on the oral cavity alone (group 2), and on both the oral and nasal cavities (group 3). Groups 1 and 2 showed little desaturation compared to their baseline levels and the control group, while group 3 showed a mild desaturation even at the beginning of surgery and this gradually turned to a moderate or severe desaturation. This was due to both the extension of the surgical zone to the nasal and oral cavities and to ventilatory distress produced by massive bleeding and aspiration of secretions. Thus, the pulse oximeter is a useful monitor for upper respiratory tract surgery involving both general and local anesthesia. It allows the identification of hypoxia so that remedial therapy can be instituted.(Kinugawa H, Yahagi N, Amakata Y: The influence of upper respiratory tract surgery on respiratory function evaluated by oxygen saturation, J Anesth 5: 327–330, 1991)     

Diuretic ultrasound. A non-invasive technique for the assessment of upper tract obstruction

A study was made of the diagnostic reliability of renal ultrasound with a diuretic in the evaluation of upper tract obstruction. The test comprised an initial renal ultrasound examination followed by the intravenous injection of 250 ml physiological saline with 40 mg frusemide; further ultrasound scans were carried out from 5 to 150 minutes later. A total of 67 patients was studied and the results were compared with those of diuretic intravenous urography, diuretic renography and, in some cases, the Whitaker test. Dynamic ultrasound with a diuretic showed a sensitivity of 94%, specificity of 94%, positive predictive value of 91% (obstructive), negative predictive value of 96% (non-obstruction) and a total diagnostic capacity of 94%.     

下颌角截骨整形术后上呼吸道阻塞4例分析

目的：探讨下颌角截骨术后上呼吸道阻塞的原因和处理方法方法：对我科421例下颌角截骨整形术患者术后出现的4例上呼吸道阻塞患者的判断及处理进行回顾性分析。结果：4例患者均成功解除上呼吸道阻塞,未出现呼吸停止及行气管切开。结论：准确判断上呼吸道阻塞,及时气管插管是抢救成功的关键。     

Percutaneous removal of upper tract tumours

Summary The role of conservative treatment of tumours of the upper urinary tract is still debated. It is generally accepted as having a place in the treatment of tumours in solitary kidneys, when there are bilateral tumours or when total renal function is impaired. We reviewed 20 cases in which percutaneous pyeloscoy was used to investigate and treat tumours of the upper tract and, at follow-up, found the early results encouraging. Of 14 patients, 9 were free of recurrence in the treated kidney and 6 are currently disease-free. These results are comparable with those from other series and support the suggestion that percutaneous resection has a role in the treatment of all upper tract tumours.     

Anaesthesia for laser surgery of the upper airway

Anaesthesia for surgery of the upper airway presents the anaesthetist with the dual problems of sharing the airway and the concomitant diseases of the patient. The laser adds the problem of a potent source of ignition of any flammable substance in an atmosphere which encourages combustion.No single technique provides the answer for all situations, there being a number of different methods depending on the age and health of the patient and the site of the lesion. In general, children are best managed breathing spontaneously. Conversely adults are usually best managed with paralysis and IPPV, which is provided either by a protected endotracheal tube or by some form of jet ventilation.     

Extensive sarcoidosis involving the upper respiratory tract

Sarcoidosis is a multisystem granulomatous disease without pathognomonic symptomatology or pathology. It may involve the upper respiratory tract, but this manifestation is rarely threatening. A case is reported here, in which extensive destruction of the larynx due to involvement by sarcoidosis necessitated tracheostomy. A review of the literature and a discussion of the therapeutic considerations are presented.     

磁共振尿路造影在上尿路梗阻诊断中的应用

目的　评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。　方法　采用磁共振尿路造影术（ Ｍ Ｒ Ｕ） 诊断上尿路梗阻患者３５ 例。　结果　所有病例均清晰显示梗阻部位及尿路积水情况。　结论　 Ｍ Ｒ Ｕ 是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

磁共振尿路造影在上尿路梗阻诊断中的

目的 评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。方法 采用磁共振尿中造影术（ＭＲＵ）诊断上尿路梗阻患者３５例。结果 所有病例均清晰显示梗阻部位及尿路积水情况。结论 ＭＲＵ是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

经皮肾穿刺造瘘在上尿路梗阻性疾病的应用

目的:探讨经皮肾穿刺造瘘在上尿路梗阻性疾病(UUTO)的应用价值.方法:对42例UUTO患者,先行经皮肾穿刺造瘘引流,待肾功能改善、机体状况好转或经引流及造影确定诊断之后,12例行经皮肾取石碎石术,11例行开放肾、输尿管切开取石术,4例行开放肾切除术,4例行肾盂输尿管成型(3例加行取石)术,3例经造瘘管注射硬化剂治疗,3例行输尿管肾盏吻合术,3例行输尿管狭窄段切除端端吻合术,1例行输尿管松解术,1例行输尿管皮肤造瘘术.结果:38例患者一次穿刺成功.全部病例均及时解除了上尿路梗阻,肾功能得到改善,或为进一步诊治创造了条件.在保肾治疗的35例,31例治愈出院;4例肾功能改善,维持在轻度氮质血症水平;4例肾切除患者和3例注射硬化剂治疗患者均治愈出院.结论:经皮肾穿刺造瘘安全、有效,在UUTO的诊治中具有重要的应用价值.     

Dorsal lumbotomy for surgery of the upper urinary tract

Between July 1978 and December 1985, 100 patients underwent an operation on the kidneys and ureter through the dorsal lumbotomy approach. A total of 12 patients underwent dismembered pyeloplasty for ureteropelvic junction obstruction. Compared to patients who underwent an operation via the standard flank incision, these 12 patients had significantly shorter hospitalization and fewer doses of analgesics. The treatment demonstrated improved cost-effectiveness. Similar advantages were noted in the remaining patients in whom removal of calculi (78), open renal biopsy (5), simple nephrectomy (4) and removal of a foreign body in the ureter (1) were done through the dorsal lumbotomy approach. We appeal for a renaissance of the dorsal lumbotomy approach in urological teaching and practice.     

Reconstructive surgery for trauma of the upper urinary tract

In general, the authors surgically reconstruct kidneys with major parenchymal lacerations or vascular injuries, particularly when intra-abdominal injuries are present. Regardless of the mechanism of injury, roughly 90% of explored kidneys can be successfully reconstructed. Adherence to the principles of early proximal vascular control, debridement of devitalized tissue, hemostasis, closure of the collecting system, and coverage of the defect maximizes the salvage of renal function while minimizing potential complications. As to ureteral injuries, a high index of suspicion is crucial, especially because urinalysis and imaging studies can be unreliable. The majority of ureteral injuries can be successfully reconstructed by primary repair, ureteroureterostomy, or ureteral reimplantations, with or without a psoas bladder hitch.     

The advantages of bilateral simultaneous stone removal from the upper urinary tract

An anterior transperitoneal approach was used to remove the stones from both kidneys and/or ureters simultaneously in 18 patients. The morbidity of this type of surgery in our study was very low and there were no surgical difficulties in exposing the intrarenal structures. Furthermore, especially in secondary cases, this approach was easier and more time-saving than the classical flank approach. We recommend its use at least in selected groups of patients in whom peritoneal gross contamination is not expected.     

Paediatric isotope-renographic observations in upper urinary tract obstruction

The authors examined the diagnostic value of the isotope renogram (is. r.) in 50 children in whom the final diagnosis was upper urinary tract obstruction. Diagnostically informative is. r.-s were obtained in 42 cases. Positive is. r. was obtained in 20 of the 21 hydronephrosis cases. Based on these results the authors recommend the application of isotope renography both as a screening test and as a completion of urographic and other investigations when anamnestic data and certain symptoms are suggestive of obstructive uropathy.Is. r. performed before the operation of hydronephrosis does not seem to be in itself conclusive in deciding whether renal parenchyma can or cannot be preserved.The isotope renographic follow-up of patients suffering from upper urinary tract obstruction without hydronephrosis is a simple method to obtain continuous information about changes in the function of the kidney and the urine-conveying system.