The management of renal scleroderma: experience with dialysis, nephrectomy and transplantation.

In 25 of 100 patients with scleroderma seen over a five year period irreversible renal failure developed; renal support was instituted in 17. Ten of 17 received peritoneal or hemodialysis, one survived. The remaining seven received hemodialysis plus nephrectomy; three survived. Two of these three underwent renal transplantation; one survived. This experience is presented to encourage improvement of these and other technics to increase the survival rate in the otherwise uniformly fatal renal failure associated with scleroderma (systemic sclerosis).     

Angiographic ablation of parathyroid adenomas: lessons from a 10-year experience

Angiographic ablation of parathyroid adenomas with ionic contrast material was performed in 24 patients with persistent hyperparathyroidism who had undergone at least one prior unsuccessful surgical resection; 23 had mediastinal adenomas. The success rate was 83% at 1 month after ablation and 71% at both 5 and 9 years. Ablation was successful in 85% of the patients in whom the catheter could be wedged into the artery feeding the adenoma. Long-term success was achieved in 89% of the patients in whom contrast enhancement persisted in the adenoma on computed tomographic scans obtained 24 hours later. Acute complications were seen only in patients with glands supplied by the inferior or superior thyroid arteries. Long-term complications were limited to permanent hypocalcemia, present in 8% of patients. Even if unsuccessful for ablation, the procedure may provide localization and does not preclude surgical resection. It is recommended for most patients with persistent hyperparathyroidism and mediastinal adenomas, especially adenomas supplied by the internal thoracic artery.     

Indwelling ureteral stents: percutaneous management of complications

Complications of indwelling ureteral stents were managed percutaneously in 13 patients. These complications consisted of three fractured, three heavily encrusted, and seven migrated stents. While most ureteral stent malfunctions are routinely managed with retrograde techniques, the percutaneous approach allows effective clinical management in selected cases in which extensive renal stone material or brittle intrarenal stent fragments are present or when previous surgery or ureteral strictures do not permit a retrograde approach. Fluoroscopically guided removal of migrated stents and percutaneous endoscopic techniques, for complex cases such as those requiring stone removal, were successful and without complications.     

On-line computer storage, retrieval, and reporting of coded angiographic data

Interpretations of angiographic images have been coded and stored using an on-line computer terminal for seven years. Decoded angiographic information is incorporated in computer-generated reports which are printed on demand after completion of cardiac catheterization procedures. Currently, almost 5,500 cases are stored in an off-line data base which has been designed to help identify patterns with prognostic potential. Also, the program has helped standardize angiographic nomenclature, saved much clerical time, and virtually eliminated clerical errors. The program interacts with other software in the hospital, avoiding repetitious entries. The advantages and shortcomings of the program and commonly used approaches to computer storage/retrieval of radiographic information are described.     

Percutaneous lithotripsy

We have performed percutaneous extractions of renal pelvic stones in 194 patients via the Wolf percutaneous universal nephroscope. At 1 session, with the patient under general anesthesia, a percutaneous tract is dilated to 24F and the stone is removed immediately. We have removed 185 stones successfully by ultrasonic lithotripsy, basket retrieval and/or use of forceps. Average operating time was 54 minutes and mean hospitalization was 5 days. The advantages of this technique are that a skin incision of only 1 cm. is required to remove the stone, hospital days are fewer than with open procedures and postoperative morbidity is minimal. In selected situations this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones.     

Thoracic disk herniation: MR imaging

The authors undertook a retrospective study to assess the role of magnetic resonance (MR) imaging in thoracic disk herniation. The initial MR images were interpreted independently of other findings. These interpretations were compared with the findings of plain and computed tomography (CT) myelography and surgery, when available. Sixteen thoracic disk herniations were confirmed with plain and CT myelography and/or surgery. Plain myelography was performed on 14 patients and showed focal ventral filling defects in nine. Results of CT myelography were equivalent to those of MR imaging with three pulse sequences (sagittal T1 and T2 weighted, axial T1 weighted) in the identification of all the abnormal levels. In two patients, the signal from the herniated disk was so low on all sequences that thoracic disk herniation had to be inferred from the mass effect on the spinal cord. Precise location of the abnormal level with body coil MR images was achieved in six of 13 patients.