Renal Fossa Research Articles

Carcinoma of the kidney in children. Results of an interdisciplinary approach to management.

The results of an interdisciplinary program utilizing surgery, irradiation and chemotherapy in the treatment of 8 children with carcinoma of the kidney are presented. Hematuria, seen in 4 of 8 children, was the most common presenting symptom. Nephrectomy was performed by a transperitoneal approach. In 2 of 3 survivors with regional node involvement, a retroperitoneal node dissection was performed. Postoperative irradiation (3,000-4,000 rads) to the renal fossa and node-bearing areas coupled with intravenous actinomycin D (70 γ/kg) was administered to all patients. Seven of 8 children are currently living without evidence of tumor six months to thirteen years and five months after their initial hospital visit. Details of clinical presentation, diagnostic evaluation and therapy are discussed.

Malposition and displacement of the bowel in renal agenesis and ectopia: new observations.

Agenesis or ectopia of the kidney is frequently accompanied by characteristic malposition of specific portions of the bowel. On the right, the descending duodenum and proximal jejunal loops and on the left, the distal transverse colon and anatomic splenic flexure may occupy the area of the renal fossa. Renal ectopia, particularly in the iliac fossa or lower abdomen, may result in a characteristic mass effect upon or displacement of the ascending or descending colon.These observations are of clinical significance both in uncovering the renal anomaly and in distinguishing these bowel changes from such conditions as internal hernia, malrotation of the intestines, and displacement by a tumor mass or organomegaly.It appears that development of portions of the intestinal mesenteric fixation as well as of the extraperitoneal perirenal fascia are embryologically dependent upon normal ascent of the kidney.

Reversal of Liver Scan Image After Right-Sided Renal Radiotherapy

Fourteen children who received postoperative radiation therapy for Wilms' tumor were given serial liver scans. There was progressive alteration of the shape of the liver following radiation therapy to the right renal fossa, producing a reversal of the usual liver image. After left renal fossa irradiation there was little alteration in liver configuration. In light of this evidence, greater attention must be paid to shielding the liver from undesired irradiation.

Compartment analysis of the radiorenogram and distribution of Hippuram I-131 in dogs.

Radioiodinated Hippuran was injected into the inferior vena cava of three unilaterally and three bilaterally nephrectomized dogs. Radioactivity was recorded over the precordium and remaining kidney in the former group and the precordium and renal fossa in the latter. The disappearance of I131 from plasma was analyzed and interpreted by two-compartment and three-compartment systems. Theoretical curves for cardiac and renal areas (constructed from analysis of arterial plasma samples) agreed well with curves from in vivo counting. Analyzed by either model, the first compartment exceeded the plasma volume severalfold, part seeming to be in the kidney. Extravascular compartments, impossible to sample, were not identified. About 15% of whole-blood radioactivity was in erythrocytes. Biliary excretion of Hippuran I131 was insignificant unless nephrectomy was bilateral; then up to 60% was excreted in the bile in 24 hr. Protein binding could not be demonstrated. Radiorenograms converted to fairly accurate rate constants may prove more useful than descriptive methods currently employed. Understanding the distribution and excretion of Hippuran appears helpful to accurate interpretation of the radiorenogram.

Radiation Nephritis in Adults and Children; Effects Ofradiation on Growing Bones

With the increasing use of megavoltage radiation therapy, malignant tissues and adjoining normal structures deep within the body are being subjected to much higher doses of radiation than was previously possible with orthovoltage techniques. To evaluate this problem, two groups of patients were compared to determine what effects x radiation had upon the kidneys of adults and the growing spine and kidneys of children. The groups were adult males (66) given radiation therapy to the upper and lower abdomen and the ingunal regions in the treatment of testis tumors, and children (15) with Wilms tumor surviving more than 1 yr after radiotherapy was administered to the corresponding renal fossa. In 23 adult cases (34%), urinary abnormality or hypertension developed following radiotherapy after a latent period varying from 1 month to 1 yr. In the children irradiated, abnormal urinary findings subsequent to irradiation and nephrectomy developed in 5 (33%), after a latent period of several months to a year. Radiation injury to growing bones developed in two children (11%). This complication became manifest only after a latent period of more than a year. The literature relating to clinical and experimental aspects of renal radiation injury is discussed, and findings in previousmore » clinical reports are compared with the present findings. (BBB)« less

Urologic problems in postpoliomyelitic patients in respirators; with special emphasis on major urology surgery.

• Urinary calculi occurring in postpoliomyelitic patients in respirators present important problems of prevention and treatment. No dependable methods of prevention have been developed; methods of treatment may be classified as either conservative or surgical. The possibilities of conservative treatment are illustrated in the case of a 9-year-old girl with bilateral obstruction by ureteral calculi; after cystoscopy and bilateral ureteral catheterization, the calculi passed down the ureters over a period of three weeks and were eventually passed by the urethra with minimal symptoms. Details are given of two other cases in which surgical treatment became necessary. Major urologic surgery in the renal fossa was performed successfully seven times in five patients. The lateral nephrectomy position was used; it was formerly thought that these patients would not tolerate this position. Resection of the 12th rib facilitated the approach to the kidney. Since much of the patient's muscle is replaced by fibrous tissue, dissection may be hard and hemostasis requires special attention. The use of the endotracheal tube during anesthesia, of special forms of respirators, of induction with thiopental given intravenously, of antibiotics, and of the nasogastric tube to prevent gastric dilatation, all contributed to the success of the surgery, which these patients tolerated surprisingly well.

Aplastic kidneys: Case report

Abstract In favor of the diagnosis of a functionless tuberculous kidney on the left were: (i) the history of previous pulmonary tuberculosis; (2) absence of function from the left kidney; (3) calcified areas in the left kidney region. Against the diagnosis of tuberculosis were: (1) the absence of urinary symptoms; (2) the normal bladder mucosa; (3) failure to find tubercle organism in the urine. In favor of aplasia of the kidney were: (1) the presence of a bicornuate uterus; (2) absence of the left ureteral orifice and smooth deformity of the left side of the bladder; (3) absence of function from the left kidney. The diagnosis of aplasia was made and confirmed by operation and pathologic examination. Injection of air into the renal fossa was used as an additional aid in diagnosis. This procedure carries with it the danger of air embolism and is open to criticism on that ground. The patient has experienced no pain since operation. It is difficult to explain this happy circumstance by nephrectomy. It is also too early after operation to be sure that the pain will not recur. In the meanwhile we have dilated the right ureter.