Follow-up Radiographic Studies Research Articles

Efficacy and safety of retrograde laser endopyelotomy in the treatment of strictures of thepyeloureteral segment

Introduction: Retrograde endoscopic laser pyelotomy is a minimally invasive procedure that is increasingly used for the management of ureteropelvic junction (UPJ) strictures. Holmium laser has been recognized as having ideal qualities for cutting tissue, namely, precision and minimal thermal spread. Objective: The objective of our study is to evaluate the efficacy and safety of Holmium laser endopyelotomy in the treatment of ureteropelvic junction strictures. Material and methods: A retrospectively collected database of 14 patients who unederwent laser endopyelotomy for UPJ strictures between January 2017 and January 2020 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. The endopyelotomy was performed under direct vision using a semirigid or a flexible ureteroscope. The first postoperative and latest radiographic follow-up studies were compared with the preoperative studies to determine whether the obstruction was resolved, unchanged, or worsened. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 50.2±12.7 years and male-to-female ratio – 57.1%/42.9%. Congenital obstruction of the UPJ was observed in 5 patients(35.7%). Nine of the patients(64.3%) were with secondary strictures of the UPJ – 5 people(35.7%) had a previous open pyeloplastic, 4(28.6%) had an anamnesis of impacted stones in the UPJ in the past. Mean length of the UPJ stricture was 10.3±2.8 mm. Six of the patients (42.9%) were with severe degree of hydronephrosis, 7 (50%) were with moderate hydronephrosis and 1 (7,1%) were with mild degree of hydronephrosis There were no intraoperative complications. Mean hospital stay was 3.6±1.2 days. In all of the patients pyelostent Retromax Plus 7/14 Fr was put postoperatively. The pyelostent was removed 4 to 6 weeks (mean 5 weeks) after the procedure. The success rate after the endopyelotomy was 85,7% (12/14), while 2 cases (14.3%) needed the placement of stent JJ 5 months after the intervention. Conclusions: Ureteroscopic laser endopyelotomy is a minimally invasive, short-stay outpatient procedure associated with a good success rate that is a method of choice mostly for secondary UPJ strictures. It is a minimally invasive procedure with less morbidity for the treatment of UPJ obstruction.

Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography

BackgroundAttenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value. MethodsConsecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality. ResultsA total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%. ConclusionsThis study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.

Analysis of risk factors for poor prognosis in conservatively managed juvenile osteochondritis dissecans of the lateral femoral condyle

BackgroundThe purpose of this study was to examine factors affecting the prognosis of conservative treatment for stable juvenile osteochondritis dissecans (OCD) of the lateral femoral condyle based on review of our patient population. MethodsA consecutive series of 43 knees in 37 patients with stable OCD of the lateral femoral condyle with open physes undergoing conservative treatment were included in the study. The mean age of the included subjects was 10.7±2.5years (range, seven to 16years) with the mean follow-up period of 33.3±15.1months (range, 12 to 67months). Conservative treatment consisting of prohibition of sports activities and use of a brace locking the knee in full extension was applied to all included patients. Potential prognostic factors examined were the presence of discoid meniscus, radiographic stage, lesion size on radiographs, time period from onset of symptoms to evaluation/consultation, number of hours of sporting activity per week, and age at starting sports activities. Prognosis of a patient was deemed to be poor when an apparent healing response was not detected in follow-up radiographic studies within six months. ResultsThe prognosis was defined to be poor for 14 knees (32.6%). The presence of discoid meniscus was identified in 100% of the knees in the poor prognosis group and time-period from onset to consultation of six months or more was shown to be a risk factor with statistical significance. ConclusionsA majority of patients with juvenile OCD in the lateral femoral condyle could be managed with conservative treatment. The presence of discoid meniscus and longer time-period from onset to consultation were significantly related with poor prognosis. Level of evidenceIV (case series).

Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures.

To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time. In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan-Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected. Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management. Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up.

Medial Wall Orbital Reconstruction using Unsintered Hydroxyapatite Particles/Poly L-Lactide Composite Implants.

BackgroundPoly-L-lactide materials combined with hydroxyapatite (u-HA /PLLA) have been developed to overcome the drawbacks of absorbable materials, such as radiolucency and comparably less implant strength. This study was designed to evaluate the usefulness of u-HA/PLLA material in the repair of orbital medial wall defects.MethodsThis study included 10 patients with pure medial wall blow-out fractures. The plain radiographs were taken preoperatively, immediately after, and 2 months after surgery. The computed tomography scans were performed preoperatively and 2 months after surgery. Patients were evaluated for ease of manipulation, implant immobility, rigidity and complications with radiologic studies.ResultsNone of the patients had postoperative complications, such as infection or enophthalmos. The u-HA/PLLA implants had adequate rigidity, durability, and stable position on follow-up radiographic studies. On average, implants were thawed 3.4 times and required 14 minutes of handling time.ConclusionThe u-HA/PLLA implants are safe and reliable for reconstruction of orbital medial wall in terms of rigidity, immobility, radiopacity, and cost-effectiveness. These thin yet rigid implants can be useful where wide periosteal dissection is difficult due to defect location or size. Since the u-HA/PLLA material is difficult to manipulate, these implants are not suitable for use in complex 3-dimensional defects.

Radiographic fusion rate after implantation of facet bone dowels

Background contextAchieving a posterolateral fusion in conjunction with performing decompressive laminectomies can prevent recurrence of stenosis or worsening of spondylolisthesis. Facet bone dowels have been introduced and marketed as a less invasive alternative to pedicle screws. Surgeons have been placing them during lumbar laminectomy surgery and coding for intervertebral biomechanical device and posterolateral fusion. These bone dowels have also been placed percutaneously in outpatient surgery centers and pain clinics for facet-mediated back pain. PurposeTo describe fusion outcomes in patients who underwent facet bone dowel placement. Study design/settingRetrospective analysis of a single center's experience. Patient sampleNinety-six patients comprise the entire cohort of patients who underwent facet bone dowel implantation at our institution with adequate postoperative imaging to determine fusion status. Outcome measuresFusion rates as determined on postoperative computed tomography (CT) scans and dynamic lumbar X-rays if CT is not available. MethodsThreaded facet bone dowels in this study were placed according to the manufacturer's recommended methods. The bone dowels were placed after open exploration of the facet complex or percutaneously through a tubular retractor on the contralateral side from a microdiscectomy or synovial cyst resection. The most recent available postoperative imaging was reviewed to determine fusion status. ResultsOf 96 patients in our series, 6 (6.3%) had a fusion seen on CT and 4 did not exhibit any movement on dynamic lumbar X-rays for a total fusion rate of 10.4% (10/96). Eighty-six (89.6%) patients were shown on imaging to not have a solid fusion either by visualizing a patent facet joint on CT or measurable movement between the flexion and the extension lumbar X-rays. ConclusionsThis article is mainly intended to question whether the implantation of facet bone dowels can produce a solid fusion radiographically. In our experience, the placement of facet bone dowels does not equal the time, skill, or attention to detail that is necessary for a posterolateral lumbar arthrodesis, and our follow-up radiographic studies clearly demonstrate an inadequate fusion rate.

Primary Mature Cystıc Teratoma Mimickıng an Adrenal Mass in an Adult Male Patient

Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.

Giant mature primary retroperitoneal teratoma in a young adult: report of a rare case and literature review.

Teratomas are neoplasms of the embryonic tissues that typically arise in the gonadal and sacrococcygeal regions of adults and children. Primary adult retroperitoneal teratomas are rare and demand challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 28-year-old female patient. Complete resection of the mass was performed by a laparotomy approach. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient remains free of recurrence to date.

Percutaneous Drainage Combined with Hyperbaric Oxygen Therapy for Pyogenic Spondylitis with Iliopsoas Abscess

Study DesignA retrospective study.PurposeThe purpose of this study was to evaluate outcomes in patients with pyogenic spondylitis accompanied by iliopsoas abscess who were treated by percutaneous drainage combined with hyperbaric oxygen (HBO) therapy.Overview of LiteratureTo the best of our knowledge, there have been no previous reports of the use of percutaneous drainage combined with HBO therapy for the treatment of this condition.MethodsTwenty-three patients (13 men, 10 women; mean age, 69.0 years; range, 45-85 years) were treated with percutaneous drainage combined with HBO therapy in addition to commonly used conservative therapy. Mean follow-up duration was 27.7 months (range, 12-48 months). Clinical outcomes and imaging examinations were retrospectively investigated.ResultsSymptoms such as low back pain, radicular pain, and hip pain resolved in all patients immediately after treatment. Mean time from the start of treatment to the return of C-reactive protein levels to normal or baseline values recorded before the onset of spondylitis was 28.3 days (range, 8-56 days). In the final set of follow-up radiographic studies, all patients were free from progressive destructive changes. Follow-up magnetic resonance images or computed tomography with contrast enhancement confirmed the disappearance or near-total resolution of the iliopsoas abscess cavity with healing of the pyogenic spondylitis in all 23 patients. No recurrences were observed during follow-up.ConclusionsThe present study suggests that patients with pyogenic spondylitis accompanied by iliopsoas abscess can be cured without a prolonged period of therapy or recurrence using this treatment.

Clinical Manifestation of Necrotizing Pneumonia in Healthy Children

were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. Conclusion: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.

Anterior single-screw fixation in 24 patients with Type II odontoid fractures

BackgroundFractures of the odontoid process make up 9–15% of adult cervical fractures; Type II odontoid fractures are the most common type. Most patients with these fractures recover after early treatment utilizing the proper surgical approach. Purpose/AimsA retrospective study was performed to evaluate the bone union rate and to identify factors that might contribute to non-union in patients undergoing anterior single-screw fixation for Type II odontoid cervical fractures. MethodsFrom November 2000 to December 2008, 24 patients (16 males, 8 females) underwent anterior single-screw fixation for Type II odontoid cervical fractures. Prior to surgery, all patients had cervical spine radiographs and computed tomographic (CT) scans. Surgery to correct the fractures used the technique of Abfelbaum et al, and fluoroscopy was used to confirm spinal stability. At follow-up, bone fusion was considered successful if trabeculation across the fracture site was seen on lateral radiographic studies. Non-union was confirmed when the fracture line was visible on follow-up lateral radiographic studies. After surgery, all patients were followed at approximately 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, 9 months, and annually thereafter. ResultsAll 24 patients had odontoid fractures confirmed by radiographic films and CT scans. Twenty-three patients had Type II odontoid fractures that were posterior-oblique or horizontal, and one had an anterior oblique fracture. Twenty patients achieved successful fusion. The presence of a lag effect was significantly different between patients who had successful fusion and the four patients with fusion failure. All patients achieved immediate spinal stabilization after surgery and none experienced major neurologic sequelae. ConclusionsAnterior single-screw fixation is an effective and safe surgical approach for patients with Type II odontoid fractures. A satisfactory long-term outcome depends upon careful selection of patients for fracture orientation and attention to the technical aspects of surgery.

Abord mini-invasif de la charnière thoracolombaire du rachis par voie extrapleurale, rétropéritonéale. Étude prospective sur 40 cas

Study designProspective study. Background and purposeThe anterior spinal cord decompression and spinal interbody fusion is considered an effective therapeutic procedure for thoracolumbar spine junction (TLSJ) (T11 to L2) fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that neural elements decompression and anterior reconstruction at the TLSJ can be performed via a minimally invasive extrapleural retroperitonal approach (MIERA). MethodsThe authors studied prospectively the hospital records and radiological data obtained in 40 patients (mean age: 43.6 years, range: 16–74 years) who all underwent first a posterior fixation followed by a thoracic (T11 or T12) or lumbar (L1 or L2) corpectomy and spinal fusion via a MIERA. ResultsThe MIERA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. More than 2years follow-up record is available for 24 patients, a one year follow-up record for 14 others, and six months follow-up for the last two ones. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the 24patients for whom a minimum of 2years follow-up records was available. ConclusionsThe MIERA allows the surgeon to perform anterior thoracolumbar spine surgery via a less invasive approach. The authors demonstrate the efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery or thoracophrenolombotomy.

Pelvic Rotation and Tilt Can Cause Misinterpretation of the Acetabular Index Measured on Radiographs

BackgroundRadiographic diagnosis and followup studies of developmental dysplasia of the hip are commonly performed by measuring the acetabular index on radiographs using Hilgenreiner’s method. The outcome of the measurement, however, depends on the orientation of the subject’s pelvis relative to the xray source. The influence of pelvic rotation and tilt on the measurement error has been evaluated separately but not in combination.Questions/purposesWe asked whether (1) combinations of pelvic rotation and tilt introduced systematic error in acetabular index measurement in a reproducible way, and (2) ratios proposed to evaluate either pelvic rotation (Rrotation) or pelvic tilt (Rtilt) are influenced by pelvic tilt and rotation, respectively.MethodsRadiographic measurements of the acetabular index, Rrotation, and Rtilt were performed on digitally reconstructed radiographs of one high-resolution three-dimensional CT dataset with various combinations of pelvic rotation and tilt.ResultsFor rotations and tilt up to 12°, the average systematic errors in the acetabular index varied from −8.8° to 4.5°. Negative and positive error values can be interpreted as underestimations and overestimations of the acetabular index, respectively. Errors in acetabular index measurements were acceptable for Rrotation values between 1.0 and 2.0 and Rtilt values between 1.1 and 1.8.ConclusionsTo limit the systematic error in assessing the acetabular index caused by pelvic misalignment, we recommend only radiographs acquired with ± 4° rotation and ± 4° tilt be considered acceptable.

Minimally Invasive Extrapleural Retroperitoneal Approach to the Thoracolumbar Spine Junction: Clinicoradiologic Study of 29 Consecutive Cases

The anterior spinal cord decompression and spinal interbody fusion is considered an effective therapeutic procedure for thoracolumbar spine junction (T11 to L2) fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study is to show that neural elements decompression and anterior reconstruction at the thoracolumbar spine junction can be conducted through a minimally invasive extrapleural retroperitonal approach (MIERA). Hospital records and radiologic data were obtained prospectively in 29 patients (mean age 43.6 years, range 16 to 74 y) who all underwent first a posterior fixation followed by a thoracic (T11 or T12) or lumbar (L1 or L2) corpectomy and spinal fusion through a MIERA. The MIERA provided excellent exposure to facilitate neural decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. More than 1-year follow-up record is available for 23 patients, a 9-month follow-up record for 4 others, and 6-months follow-up for the last 3 ones. Radiography showed anatomically correct reconstruction in all patients, and a solid fusion or a stable compound union in the 20 patients for whom a minimum of 1-year follow-up records were available. The MIERA allows the surgeon to carry out anterior thoracolumbar junction spine surgery through a less invasive approach. The investigators report the safety efficacy of this technique and its reduced perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery or thoraco-phreno-lombotomy.

Diagnostic Value and Limitations of FDG-PET for the Staging of Childhood Lymphomas.

Abstract 3658Poster Board III-594 IntroductionPositron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) has the potential to detect malignant cells by their increased glycolysis. PET can detect early changes, before they are apparent on anatomic imaging. Whole-body PET can also detect lesions at unexpected sites. However, physiologic FDG uptake in non-malignant conditions limits the specificity of PET. PET is predominantly used in adult lymphoma patients, limited number of studies were published dealing with PET and PET/CT in childhood lymphomas. The aim of our study was to assess the usefulness of PET for initial staging of pediatric lymphomas and to evaluate benign pathologic causes of FDG uptake. Patients and methodsOver a period of 5 years 86 children and adolescents with lymphoma (58 with Hodgkin's lymphoma, 28 with non-Hodgkin's lymphoma) had complete staging work-up including FDG-PET or PET/CT and were included into this prospective study. Patients were aged 4-19 years, 57 (66%) were boys. No patient had CNS lymphoma infiltration. PET findings were correlated with conventional staging methods (CSM) including CT, ultrasound, and bone marrow examination. Discordant findings were verified by MRI and follow-up radiographic studies including PET. ResultsPET revealed 40 additional lymphoma manifestations in 34% (26/86) of studies and correctly upstaged 15% (13/86) of patients. Only 2% (2/86) of children were not accurately staged by PET, when PET failed to visualize diffuse bone marrow infiltration (extent of 15% cells) in 1 patient, and missed small pulmonary metastases (≤6 mm) in 1 child. Compared with CSM, PET had significantly higher sensitivity (97% vs. 83%), specificity (100% vs. 89%), and significantly higher accuracy (98% vs. 84%). Physiologic thymic FDG uptake was observed in 15% (13) of patients; diffuse increased FDG bone marrow activity had 22% (19) of children, and intense FDG activity in fatty tissue occurred only in 8% (7) of patients. ConclusionsPET imaging was highly sensitive in detecting all subtypes of pediatric lymphomas and has potential to accurately define the disease stage except the lungs, where CT has excellent sensitivity. Understanding of the physiologic FDG biodistribution and benign pathologic causes of FDG uptake is essential for accurate scan interpretation.Supported by grants: IGA NS/9997-4, NS/10480-3, MSM 0021620813 and MZO FNM 2005 Disclosures:No relevant conflicts of interest to declare.

Primary Retroperitoneal Teratoma Presenting as an Adrenal Tumor in an Adult

Primary teratomas in the retroperitoneum are rare in adults. Most teratomas in this region are secondary to germ cell tumors of the testes or ovaries. We describe a case of mature cystic teratoma that was clinically suggestive of an adrenal myelolipoma. Resection was attempted using laparoscopy but was converted to open adrenalectomy to ensure complete resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 18 months.

Ureteroscopic laser endopyelotomy: a single-center experience.

We review our experience with ureteroscopic endopyelotomy using a holmium laser for correction of ureteropelvic junction (UPJ) obstruction in order to further define the immediate and long-term results and complications. From 1999 to 2002, 11 men and 34 women (mean age 42 years) underwent 46 ureteroscopic holmium laser endopyelotomy procedures for treatment of primary (N=40) or secondary (N=5) UPJ obstruction. The inclusion criteria were a short (<2-cm) obstruction and absence of ipsilateral renal calculi. Demographic, intraoperative, and postoperative measures were obtained from a prospectively designed and updated database. The endopyelotomy was performed under direct vision using a semirigid (N=40) or flexible (N=5) ureteroscope with a laser setting of 1 J at 10 Hz. Radiographic confirmation of obstruction and the results of intervention was obtained by combinations of intravenous and diuretic urography, diuretic renography, ultrasonography, and CT. The first postoperative and latest radiographic follow-up studies were compared with the preoperative studies to determine whether the obstruction was resolved, unchanged, or worsened. Success was defined as symptomatic relief and radiographic resolution. The mean operative time was 65 minutes (range 10-153 minutes). There were no intraoperative complications, although 5 patients (11.1%) experienced postoperative complications consisting of subcapsular hematoma, pyelonephritis, sepsis, urinary retention, or dysrhythmia. Forty-two patients (93%) had a hospital stay of <23 hours. Stents were removed 3 to 8 weeks (mean 5 weeks) postoperatively. The mean length of follow-up was 23.2 months (range 5-43 months). Symptoms were resolved in 65.4% of patients, improved in 7.7%, unchanged in 11.5%, and worse in 15.4%. Radiographically, at latest follow-up, the obstruction was resolved in 73.1% of patients, unchanged in 23.1%, and worse in 3.8%. Primary UPJ obstruction was associated with a symptomatic success rate of 68% compared with only 50% for secondary UPJ obstruction. Ureteroscopic laser endopyelotomy is a minimally invasive, short-stay outpatient procedure associated with a 65.4% symptomatic and 73.1% radiographic success rate. In contrast to the findings in previous reports of results of retrograde or antegrade endopyelotomy, patients treated for primary UPJ obstruction experienced higher rates of success than those with secondary obstruction.

Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy

Objectives. To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review. Methods. We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999. Results. Follow-up was obtained at our institution for 87 patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE ± 0.75). Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had postoperative pain or obstruction on follow-up radiographic studies. Of 77 patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative obstruction. One third of patients with residual obstruction (4 of 12) complained of persistent pain versus 6% of patients without evidence of obstruction (4 of 65) ( P = 0.02). Twelve patients had residual stone fragments on their follow-up radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) of 65 patients who were stone free after surgery ( P = 0.002). The use of pain to predict either obstruction or residual fragments had a negative and positive predictive value of 83% and 75%, respectively. Preoperative obstruction and postoperative pain were combined as one indicator for the presence of residual fragments and postoperative obstruction. Patients who had preoperative obstruction and presented with postoperative pain had a 67% chance of having residual fragments and a 50% chance of residual obstruction, and 96% of patients without preoperative obstruction and no postoperative pain had no persistent obstruction or residual fragments ( P = 0.001). Conclusions. For patients who present for ureteroscopy with no obstruction and report no pain at follow-up, a plain radiograph may be sufficient. For patients who present with obstruction and report pain during follow-up, functional imaging studies are recommended.

Detection of relapse in non-Hodgkin's lymphoma: role of routine follow-up studies.

Complete remission can be achieved in 60-80% of adults with diffuse aggressive non-Hodgkin's lymphoma. However, 20-40% of them will subsequently relapse. Nevertheless, formal follow-up guidelines for recurrence detection have never been advocated. We analyzed the pattern of relapse in 30 patients with intermediate- and high-grade non-Hodgkin's lymphoma and the value of intensive protocol for relapse detection. This protocol includes frequent follow-up visits, complete blood count, and serum LDH tests along with annual chest, abdominal, and pelvic CT scans. The median duration of complete remission was 12 months. Twenty-five relapses (83%) were suspected after an interim history and/or physical examination, whereas only 5 relapses (17%) were detected by routine radiographic or laboratory follow-up studies. The majority of relapses (19/30) were detected in sites that included the sites of prior disease. For the first 12 months of complete remission, the estimated cumulative save in charge for a follow-up strategy, based on regular visits in the hematology clinic and performing laboratory and radiologic studies as clinically indicated, is 44% of the cost of a routine intensive evaluation. A reliable and cost-effective follow-up method for non-Hodgkin's lymphoma patients in complete remission should include frequent history and physical examination. Complementary studies should be performed according to clinical indications.

Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications.

Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife. From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions. The tumor type distribution was 29 pituitary adenomas, 35 meningiomas, 4 schwannomas, and 1 paraganglioma. The median follow-up was 122 weeks. Lesions were stratified according to a five-level surgical grade. The grade distribution of the tumors was as follows: Grade I, 13; Grade II, 21; Grade III, 19; Grade IV, 12; Grade V, 4. Median tumor volume was 4.7 cm3. The median radiation dose was 15 Gy to the 50% isodose line. Median maximal radiation dose was 30 Gy. Analysis of tumor characteristics and radiation dose to optic nerve and pontine structures revealed a significant correlation between distance and dose. Much lower correlation coefficients were found between tumor volume and dose. One lesion in this series had evidence of transient progression and later regression on follow-up radiographic studies. No other lesions in this series were demonstrated to have exhibited progression. Complications after radiosurgical treatment were uncommon. Two patients had cranial nerve deficits after treatment. One patient with a surgical Grade III pituitary adenoma had VIth cranial nerve palsy 25 months after radiosurgical treatment that spontaneously resolved 10 months later. A patient with a bilateral pituitary adenoma experienced bilateral VIth cranial nerve palsy 3 months after treatment that had not resolved at 35 months after treatment. Six patients with preoperative cranial nerve deficits experienced resolution or improvement of their deficits after treatment. One patient with a prolactin-secreting adenoma experienced normalization of endocrine function with return of menses. Radiosurgical treatment represents an important advance in the management of cavernous sinus tumors, with low risk of neurological deficit in comparison with open surgical treatment, even in patients with high surgical grades.