Feasibility and safety of laparoscopic nephrectomy for nonfunctioning kidney in patients with previous renal surgery

Abstract Purpose: Performing laparoscopic nephrectomy in the setting of previous renal surgery may be challenging and associated with a higher complication rate. We conducted this study to assess the feasibility and safety of laparoscopic nephrectomy among patients with a history of ipsilateral renal surgery. Patients and Methods: We reviewed the chart of 193 patients who underwent transperitoneal laparoscopic nephrectomy for nonfunctioning kidney between April 2007 and March 2011. The study population was divided into two groups: Group 1 comprised 37 patients with a history of ipsilateral renal surgery, and Group 2 consisted of 156 patients with no history of previous renal surgery. Results: Baseline characteristics and preoperative variables were similar in both groups. Mean operative time, complication rate, and hospital stay were comparable between the two groups. A nonstatistically significant trend toward a higher transfusion rate was noted in Group 1 patients. The operation was converted to open nephrectomy in 1 (2.7%) and 3 (1.9%) patients of Groups 1 and 2, respectively (P=.765). Conclusions: Laparoscopic nephrectomy of the nonfunctioning kidney is a feasible and safe procedure in the setting of previous renal surgery and is not associated with a significant increase in operative time and complication rate compared with patients with no prior ipsilateral renal surgery.     

Mammographic and CT detection of extrathoracic lung herniation

Herniation of lung through the chest wall is uncommon and previously reported cases have been found either clinically or by chest radiography. We recently discovered a case of herniated lung on screening xeromammography. These findings were correlated with thoracic CT.     

Radionuclide demonstration of a renopleural fistula following trauma

A renopleural fistula was detected on a Tc-99m DTPA renal study during evaluation for possible post-traumatic urinoma.     

Assessment of a technique for scintigraphic monitoring of pulmonary aspiration of gastric contents in asthmatics with gastroesophageal reflux.

Ten asthmatics with gastroesophageal reflux had scintigraphic evaluation of gastropulmonary aspiration. Five mCi of Tc99m sulfur colloid diluted in 50 ml of isotonic saline were administered by nasogastric tube at bed time and the lungs were imaged the following morning. Imaging in 20 studies yielded no evidence of gastropulmonary aspiration. Scintigraphic evaluation has previously been reported to demonstrate gastropulmonary aspiration in some patients with gastroesophageal reflux and pulmonary disease. This study indicates that the technique may lack adequate sensitivity or that gastropulmonary aspiration in asthmatics with gastroesophageal reflux occurs in only a small subgroup of these patients or at infrequent intervals and is difficult to detect.     

Hyperalimented lung diagnosed by perfusion scan

Injection of radiopharmaceutical through a catheter may be useful in localizing its placement. A case is described in which a central venous line had punctured to superior vena cava, delivering hyperalimentation solution into the right pleural space.     

Serum thyroglobulin levels predict total body iodine scan findings in patients with treated well-differentiated thyroid carcinoma

Forty-eight consecutive patients with treated thyroid carcinoma were studied with 131-I total body scans and serum thyroglobulin (hTg) levels. Serum hTg levels during thyroxine treatment accurately predicted scan results (chi square = 18.6, p < 0.001). All patients with negative scans (24 patients) had serum hTg levels (< 7 ng/ml whereas in patients with metastatic thyroid cancer (eight patients) they ranged from 11 to 690 ng/ml. In patients with iodine uptake confined to the thyroid bed (16 patients) serum hTg values ranged from 2 to 17 ng/ml. Serum hTg levels rose in patients with negative scans during hypothyroidism or after exogenous TSH suggesting that hTg levels are more sensitive than iodine scans in detecting residual thyroid tissue. Serum hTg levels could replace total body iodine scans in many patients with treated thyroid carcinoma.