Unilateral Dilatation Research Articles

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: Second versus third trimester of pregnancy

The objective of the study was to determine the most effective fetal renal pelvis anteroposterior diameter thresholds and the best gestational age in predicting significant neonatal nephrouropathy and neonatal nephrouropathy requiring surgery. Eighty-three newborns with prenatal ultrasound evidence of unilateral or bilateral fetal renal pelvis dilatation (anteroposterior diameter 4 mm or more) before the 26th week of gestation were systematically and prospectively investigated prenatally and postnatally. Receiver operating characteristic curve analysis showed that third-trimester anteroposterior diameter cut-offs were more reliable than second-trimester cut-offs in predicting significant neonatal nephrouropathy, the best threshold being 8 mm. No significant differences were found between the 2 trimesters in the screening of fetuses at risk of neonatal nephrouropathy requiring surgery. Significant neonatal nephrouropathy is better predicted at the third trimester, the best threshold being 8 mm, but the screening of patients at greater risk of surgery is also possible during the second trimester. An anteroposterior diameter of 11 mm or more, with an odds ratio of 128.33 (95% confidence interval 11.68 to 1408.98), is a very effective cut-off and a reliable prognostic indicator of neonatal nephrouropathy requiring surgery, even before the 26th week.

RENAL PELVIS VOLUME DURING DIURESIS IN CHILDREN WITH HYDRONEPHROSIS: IMPLICATIONS FOR DIAGNOSING OBSTRUCTION WITH DIURETIC RENOGRAPHY

We measured the volume of the renal pelvis during diuretic renography (DR) in children with normal and hydronephrotic kidneys to determine if changes in pelvic volume could affect the accuracy of DR in diagnosing obstruction. We studied 18 patients 1 month to 10 years old with unilateral hydronephrosis ultimately proved to be either obstructive or nonobstructive. Simultaneous DR and ultrasound were performed with patients supine using the gamma camera. Ultrasound measurements of the renal pelvis in 3 dimensions, obtained before and at intervals after diuretic injection, were used to calculate renal pelvic volume. The contralateral normal kidneys were used as controls. Between 15 and 60 minutes after diuretic injection the renal pelvis enlarged to a maximum volume in all hydronephrotic and normal kidneys and then gradually decreased in size. Mean average increase in volume for hydronephrotic kidneys ranged from 46% in obstructed kidneys to 88% in nonobstructed kidneys. Volume expansion caused dilution of isotope within the renal pelvis, which resulted in prolongation of elimination half-time (T1/2) in 42% of nonobstructed hydronephrotic kidneys sufficient to register an obstructed washout pattern. However, there were no differences in the initial pelvic volume or the rate or extent of increases or decreases in pelvic volume that would permit nonobstructed hydronephrotic kidneys to be distinguished from obstructed ones. The renal pelvis enlarges during diuresis in children with hydronephrosis. This enlargement causes dilution of isotope within the renal pelvis during DR, which prolonged the isotope washout rate or T1/2 sufficiently to produce an obstructed washout pattern in more than 40% of hydronephrotic kidneys that were ultimately proved to be nonobstructed. This misdiagnosis of obstruction is particularly likely to occur in children younger than 2 years because pelvic volume expansion is so exaggerated. Consequently, T1/2 appears to be particularly vulnerable to inaccuracy in diagnosing obstruction in this age group, and, therefore, it should not be relied on as an operative determinant.

Measurable changes in hydronephrosis during pregnancy induced by positional changes: ultrasonic assessment and its diagnostic implication.

Unilateral or bilateral dilation of the ureters occurs commonly during pregnancy. Ultrasonography is a suitable diagnostic method for hydronephrosis; however, it cannot differentiate obstructive from nonobstructive hydronephrosis. Our aim was to evaluate measurable changes in hydronephrosis induced by a mother's positional changes using ultrasonography to differentiate hydronephrosis during pregnancy from pathologic etiologies. Pregnant women presenting for routine ultrasonography were enrolled in this study. A patient history was taken, and a physical examination was performed. Ultrasonography was performed to determine gestational age, parity, fetal presentation, presence or absence of hydramnios, and hydronephrosis and its severity. Thirty minutes after changing position (flank position or on all fours), patients were reevaluated by ultrasonography to determine the severity of hydronephrosis. Of 59 pregnant women with an average age of 25.4 years, 33 (55.9%) had no urinary complaint during pregnancy. Forty-one women (69.5%) had hydronephrosis, 24 (58.5%) of whom only in right kidney. The severity of hydronephrosis in one kidney was related with the severity of hydronephrosis in the other kidney (P = 0.007). Fetal presentation and gestational age were not associated with hydronephrosis. Risk of hydronephrosis was higher in the first pregnancy (likelihood ratio = 6.8, P = 0.009). Thirty minutes after changing positions, the anteroposterior pelvis diameter significantly decreased in the right and left kidneys (P = 0.004, P = 0.001). Ultraonography in two steps with positional change (dynamic ultrasonography) may be used to differentiate hydronephrosis of pregnancy from other pathologies.

Prenatally diagnosed unilateral renal pelvic dilatation: a dynamic condition of ultrasound and diuretic renography

Prenatally diagnosed unilateral renal pelvic dilatation: a dynamic condition of ultrasound and diuretic renography

PRENATALLY DIAGNOSED UNILATERAL RENAL PELVIC DILATATION: A DYNAMIC CONDITION ON ULTRASOUND AND DIURETIC RENOGRAPHY

Imaging characteristics obtained from serial scintigraphic and ultrasonographic studies in children with the prenatal diagnosis of unilateral pelvic dilatation are presented. Serial ultrasonographic and scintigraphic findings in 101 children with unilateral pelvic dilatation collected during followup were reviewed. Changes in hydronephrotic kidney in terms of renal pelvis diameter, kidney size, differential renal function and drainage were noted. A total of 42 children underwent surgery at a mean age of 15.6 months (range 3.1 to 69.2, median 8.2), while 59 were treated nonsurgically. Mean age at presentation was 5.6 months (range 0.8 to 36.4, median 3.5). Mean followup was 35.5 months (range 6.4 to 78.4, median 29.6). Differential renal function remained stable (46.4% vs 47.3%) but improved drainage (68.4% vs 81.2%) and decreased renal pelvis size (22.2 vs 18.3 mm) was noted in the 2 groups. With age drainage function improved, especially between the younger than 12-month and 12-month or older groups. The mean affected-to-unaffected kidney length ratio at presentation was significantly greater than the ratio at the final followup (paired t test p <0.05). In this retrospective review drainage function was prolonged in infants. During followup drainage, dilatation and relative renal size improved in the surgery and nonsurgery groups. There was no change in renal function in either groups during followup. These data support the benign nature of prenatal unilateral hydronephrosis.

Periventricular and Subcortical Leukoencephalopathy in two Dachshund Puppies

Two wirehaired dachshund puppies were presented with generalized tremor and gait abnormalities characterized by mild ataxia, tetraparesis and slightly abnormal proprioception. Neurological examination led to the suspicion of a diffuse generalized white matter lesion. Computerized tomography and pathological examination revealed a remarkable unilateral dilatation of the lateral ventricles in each dog. Histopathological examination showed a severe reduction of stainable myelin, widespread mild perineuronal oedema with vacuolations and multifocal reactive astrocytosis affecting the subcortical and deep periventricular white, and to a lesser degree, grey matter of the cerebral hemispheres, most prominently at the level of the optic chiasm. Axons showed a moderately reduced packing density; some axons were irregularly shaped and slightly thickened. There was no evidence of myelin breakdown products and neurones appeared to be well preserved. Brain stem, cerebellum and spinal cord were normal, as was the peripheral nervous system. This leukoencephalopathy in two dachshund puppies most closely resembles human periventricular leukomalacia caused by pre- or perinatal hypoxia-ischaemia.

Pupil blown by a puffer

Nebulised but not inhaler administered ipratropium bromide has been reported to precipitate angle closure glaucoma and cause transient unilateral pupil dilation. We report a case of two separate episodes of transient pupil dilation in a child after spacer inhaler use of a combination of ipratropium bromide with salbutamol.

Diagnostic value of attenuation measurements of the kidney on unenhanced helical CT of obstructive ureterolithiasis.

The objective of this study was to assess the diagnostic value of attenuation measurements of the kidney on unenhanced helical CT in patients with obstructive ureterolithiasis. Consecutive unenhanced helical CT scans of patients referred for acute unilateral renal colic were retrospectively reviewed. Patients with CT evidence of other urinary system diseases were excluded. Included scans (n = 145) were assessed for ureteral stone and secondary signs of obstruction such as unilateral collecting system or ureteral dilatation, perinephric stranding, and periureteral edema. Renal attenuation in Hounsfield units was measured in the upper, middle, and lower portions of the parenchyma, and a mean value was determined for each kidney. Ureteral stones were present in 76 patients. Renal attenuation on the side with lithiasis was lower than on the opposite kidney: 27.2 +/- 3.9 H vs 32.6 +/- 3.4 H (p < 0.001). Attenuation differences between kidneys were higher for patients with ureterolithiasis: 5.4 +/- 3.2 H (range, -3.3 to 13.0 H) versus 1.2 +/- 1.0 H (range, 0-4.7 H) (p < 0.001). An attenuation difference between kidneys greater than or equal to 5.0 H had 61% sensitivity, 100% specificity, 100% positive predictive value, 69% negative predictive value, and 79% accuracy for diagnosis of ureteral lithiasis. Attenuation difference between kidneys greater than or equal to 5.0 H was a valuable sign and had diagnostic performance similar to other secondary signs of obstructive ureterolithiasis. Furthermore, attenuation difference had the advantage of being an objective, measurement-based indicator.

Unilateral dilatation of the kidney. Which children profit from the procedure?

Die Entscheidung darüber, welche Kleinkinder von einer operativen Korrektur bei einer subpelvinen Stenose profitieren würden, ist nicht so einfach zu beantworten wie gedacht - zumindest in den Fällen, in denen bei der pränatalen Diagnostik eine unilaterale Dilatation des Nierenbeckens festgestellt wurde. Bei asymptomatischen Kindern scheint die Halbwertzeit im Nierenfunktionsszintigramm als Kriterium einer gestörten Ausscheidung eher ungeeignet.

Impaired Drainage on Diuretic Renography Using Half-Time or Pelvic Excretion Efficiency is not a Sign of Obstruction in Children with a Prenatal Diagnosis of Unilateral Renal Pelvic Dilatation

Delayed drainage on diuretic renography is an accepted sign of obstruction in adults and symptomatic children. We investigated how to analyze the diuretic challenge as well as assess the significance of impaired drainage. We followed 24 children with a unilateral prenatal diagnosis of pelvic dilatation up to a minimum of 2 years. A total of 91 diuretic renograms were performed. All children had stable differential renal function and renal pelvic diameter did not change by greater than 9 mm. on sequential ultrasound. Kidneys with stable differential function and no increase in dilatation were considered not obstructed. Analysis of the diuretic challenge included half-time, a post-void image with a change in posture, that is the child erect for 5 to 7 minutes, and drainage considering renal function using the pelvic excretion efficiency. Prolonged drainage was defined as a half-time of greater than 20 minutes or a post-void pelvic excretion efficiency of less than 71%. Median patient age at presentation was 0.32 years and median followup was 3.07 years. The affected nonobstructed hydronephrotic kidney showed impaired drainage in 68% of the children using the half-time parameter, and in 80% and 44% using pelvic excretion efficiency before and after voiding, respectively. Variability in drainage was documented on sequential diuretic renography. Using the guidelines for data acquisition and processing of diuretic renograms we nevertheless noted impaired drainage in 44% of this young group with nonobstructed kidneys. The half-time parameter was an inappropriate parameter. The diagnosis of obstruction cannot be simply based on delayed drainage in this group of asymptomatic children with a prenatal diagnosis of unilateral renal pelvic dilatation.

Experiences with the entero-ureteral anastomosis via the extramural serous-lined tunnel: procedure of abol-enein

Objectives. Ureteral reimplantation in any urinary diversion setting should be easy, reproducible, nonrefluxive, and without complications. In this study, we present our experiences with the entero-ureteral anastomosis via the extramural serous-lined tunnel, a technique introduced by Abol-Enein. Methods. In the period between 1995 and 1998 we performed the Abol-Enein technique in 50 patients who underwent radical cystectomy and ileal neobladder construction. Preoperatively 10 patients had unilateral ureteral dilatation. Results. The technique was performed easily, and any serious complications did not occur in the early postoperative period. Leakage of the urethral-intestinal anastomosis was seen in 2 patients and transient hydronephrosis in 2 patients. Among the most serious late complications were two strictures of the urethral-intestinal anastomosis and four unilateral strictures of the ureteral-intestinal anastomosis. Only 1 patient presented with unilateral grade IV urinary reflux. Four patients developed metabolic acidosis. In all cases, renal function was stabilized or improved, and preoperative dilatation of the ureters was alleviated. Conclusions. The low stricture rates of the uretero-intestinal anastomosis, as well as the low reflux rates of the procedure of Abol-Enein, render this procedure a safe method of uretero-intestinal anastomosis when an orthotopic ileal neobladder is formed. The method can be performed with equal or even greater ease in very dilated ureters that in many situations other techniques either cannot deal with or require ureteral tailoring. Although this technique seems to meet most of the criteria for an ideal uretero-intestinal anastomosis, further studies that involve longer follow-up periods are necessary to allow a definitive value of this method.

ADRENAL CORTICAL CARCINOMA PRESENTING AS RIGHT VARICOCELE

A 39-year-old man was referred to us for a 3-month history of rapid onset right hemiscrotal discomfort and swelling that decreased when he was supine. Medical history included vasectomy 5 years earlier. He denied abdominal pain, flushing, headaches, weight loss or other constitutional symptoms. Physical examination of the abdomen was remarkable for fullness in the right upper quadrant and right grade III varicocele. Ultrasound demonstrated subclinical left varicocele and confirmed dilatation of the right pampiniform plexus venous channels from 1.8 to 6 mm. with a Valsalva maneuver. Computerized tomography (CT) of the abdomen and pelvis with contrast medium revealed a 12 cm. right adrenal mass. There was evidence of central necrosis with peripheral calcifications and compression of the inferior vena cava just cephalad to the right renal vein (see figure). Urinalysis, complete blood count, serum chemistry studies, liver function tests and urinary catecholamines were normal. Urinary cortisol was modestly increased at 56.7 mg./24 hours (normal less than 50). Serum dehydroepiandrosterone sulfate was increased at 562 mg./dl. (normal 88 to 305). Metastatic evaluation, including CT of the chest and a bone scan, was normal. Magnetic resonance imaging was performed to exclude thrombus involving the inferior vena cava, which was equivocal and a subsequent inferior vena caval venogram revealed external compression without evidence of thrombus. Right adrenalectomy through a thoracoabdominal approach was performed without complication. Pathological examination revealed a 730 gm. poorly differentiated adrenal cortical carcinoma with 1 focus of capsular penetration into peri-adrenal fat. Pathological stage was T3M0N0 (American Joint Committee on Cancer criteria) with greater than 6 mitoses per high power field, extensive tumor necrosis and dystrophic calcifications. DISCUSSION Varicoceles are most common as unilateral dilatation of the pampiniform plexus of veins above the left testis. Left varicoceles are present in approximately 10% to 20% of men and are believed to be secondary to the venous anatomy of the left testis. Right varicoceles usually occur as bilateral processes and are apparent in 10% of clinical cases and as many as 50% of subclinical cases. Unilateral right varicocele may be attributed to the presence of situs inversus, persistence of embryological ve

Atrofia cortical posterior

Posterior cortical atrophy (PCA) is a dementing syndrome characterized by an early alteration of higher visual functions. Patients usually develop a perceptive visual agnosia related to Balint syndrome. Verification showed Alzheimer s disease (AD) in most PCA observations (13/14 cases), and it can be concluded that there is a posterior variant of AD with prominent visual symptomatology. However, most PCA cases have not been verified and the nature of the disorder remains unknown in these observations. An early and severe unilateral occipital horn dilatation was found in one out of every six cases with non verified PCA. To the best of our knowledge, this image has not been described in AD and these observations could be of different nature. On the other hand, some non verified PCA cases have occasionally manifested as an associative visual agnosia. The nature of this type of associative disorder is unknown, but it could be similar to the nature of semantic dementia, a non Alzheimer s syndrome related to unspecific lesions of temporal lobes.

Fenestración endoscópica como tratamiento de la hidrocefalia asimétrica por obstrucción del foramen de Monro

Unilateral dilatation of the lateral ventricle is a rare condition. The most common causes are tumors of the lateral ventricles or in the area of the third ventricle, acute or chronic inflammatory gliosis, cysticercosis or congenital atresia of the foramen of Monro. We report a case of asymmetrical dilatation of the lateral ventricle in an adult patient presenting with a raised intracranial pressure syndrome caused by narrowing of the foramen of Monro which was occluded by a thin membrane. The patient underwent successful endoscopic fenestration of the Foramen of Monro.

Hallazgos por resonancia magnética en la parálisis cerebral espástica

To study the types of lesion found on magnetic resonance (MR) in cerebral palsy (CP) and their correlation with a the type of CP, gestational age at birth and aetiology. We made a retrospective review of all patients over one year in age, diagnosed as having spastic CP, who were seen in a paediatric neurology clinic between 1987 and 1998. The MR were evaluated blindly using data from the clinical history. Seventy two patients fulfilled criteria for inclusion in the study. The following results were obtained (all associations were statistically significant with p<0.01):1. Patterns of lesion: MR findings were classified into one of the following patterns: parasagittal lesion (7), diffuse multicystic encephalomalacia (4), periventricular leukomalacia (PVL) (26), bilateral dilatation of the basal ventricles without alteration of the signal from the periventricular white matter (5), bilateral lesions in the basal ganglia (5), focal multicystic encephalomalacia (limited to one vascular area) (4), unilateral lesions of hypersignal in the white matter (4), unilateral dilation of a lateral ventricle with or without homolateral cortical atrophy (3), malformations/disorders of migration (7), normal (7). 2. Correlation of the findings with the gestational age and type of CP: a) Spastic tetraplegia: 64% of the premature babies showed PVL. In newborn babies at term the lesions were more varied. b) Spastic diplegia: 80% of the premature babies had PVL and 83% of newborn babies at term had normal MR. c) Spastic hemiplegia: 81% had unilateral lesions. 3. Correlation with the aetiology: 62% of the cases of parasagittal lesions, diffuse multicystic encephalomalacia and bilateral lesions of the basal ganglia were due to hypoxic-ischemic encephalopathy. The MR findings in CP show good correlation with gestational age, type of CP and aetiology.

Tortuosity of the vertebral artery resulting in vertebral erosion

Objective: To discuss the case of a patient with unilateral vertebral artery tortuosity and dilatation resulting in vertebral body and transverse foramen erosion. An emphasis is placed on diagnostic imaging.Clinical Features: A 45-year-old man had a frozen shoulder and headaches. Previous arm pain, numbness, and a cold extremity were the result of occlusion of the subclavian artery and had been treated with a subclavian-carotid bypass procedure.Intervention and Outcome: As a result of the angiographic detection of the left vertebral artery dilatation and tortuosity and the concomitant hypoplastic right vertebral artery, high-velocity, low-amplitude manipulation of the cervical spine was contraindicated. However, the patient's symptoms were not related to these findings. Alternatively, low-force manipulation of the cervical spine, shoulder range of motion and muscle techniques were used. and the patient's symptoms diminished significantly with improved shoulder range of motion.Conclusion: Clinicians need to be alert to clinical presentations and appropriate imaging protocols in cases of suggested vertebral artery anomaly.

Hematospermia: an investigation of the bleeding site and underlying lesions.

The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance. Twenty-one patients aged 26-75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS). Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient. Puncture of the seminal vesicles and/or mullerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.

In Utero Progression of Isolated Renal Pelvis Dilation

The objective of this study to determine the risk of in uteroprogression of renal pelvis dilation when detected on antenatal ultrasound examination. We reviewed 230 fetuses with evidence of renal pelvis dilation. At least one exam was subsequently performed prior to delivery in all cases. Renal pelvis dilation was defined as an anterior-posterior renal pelvis measurement > 4 mm at 7 mm at > or = 32 weeks' gestation. Hydronephrosis was considered to be present when the renal pelvis measured +10 mm independent of gestational age. Multiple gestations and fetuses with additional congenital anomalies were excluded. The mean gestational age at diagnosis was 24 weeks. Renal pelvis dilation progressed to hydronephrosis in a total of 10.9% (25 of 230) of fetuses. There was a 3.3% chance of unilateral renal pelvis dilation progressing to hydronephrosis versus 26.0% in bilateral dilation (OR 10.4 [95% Cl 3.5-33.3]). Of those fetuses with progression, 80% had bilateral dilation (p < 0.0001). There was no difference in progression between right and left kidneys. Additionally, gender, gestational age at diagnosis and delivery, and birth weight did not differ between those fetuses with and without progression. The hydronephrosis in 7 of 25 (28%) regressed to pyelectasis on a subsequent ultrasound exam. Thus, the overall rate of progression of renal pelvis dilation to persistent hydronephrosis was 7.8% (18 of 230). In conclusion, the risk of isolated renal pelvis dilation progressing to hydronephrosis is low. Although bilateral pelvis dilation carries a higher risk for progression, no fetus in our study required in utero intervention. A follow up scan prior to delivery may be considered to identify those fetuses who will require postpartum intervention.

MRI features of choroid plexitis.

Four cases of choroid plexitis of the brain (two with cryptococcosis and two with tuberculosis) are presented. The four patients showed either unilateral enlargement (3) or bilateral enlargement (1) and dense enhancement of the choroid plexus in the lateral ventricles (4) and fourth ventricle (1) in association with clinical findings of leptomeningitis. All patients had unilateral cystic dilatation of the temporal horn of the lateral ventricle presumably secondary to entrapment of the temporal horn and extensive oedema around the ipsilateral ventricle.

Assessment of drainage in PUJ dilatation: pelvic excretion efficiency as an index of renal function.

Renal function is important when assessing the response of a dilated renal pelvis to a diuretic stimulus. Yet there is little in the literature to suggest how this should be undertaken. Our aim was to develop a model which we have called pelvic excretion efficiency (PEE). The PEE, which may be used to assess drainage, is a mathematical model of the ratio of the total kidney excretion to the total amount of isotope extracted from the blood by the kidney. Thirty-three children with a prenatal diagnosis of unilateral renal pelvic dilatation (PUJ) were treated conservatively after birth. As a group, they underwent a total of 164 diuretic DTPA renograms up to the age of 72 months. Drainage was assessed as the response to frusemide (defined as the time for the corrected renal curve to fall to 75% of the maximum value in the frusemide part of the study; T75), response to bladder emptying, a change of posture after frusemide (PM), and PEE. The contralateral normal kidney showed a combination of both 'good' T75 and PM drainage in 51% of renograms while the PEE showed drainage in all. The affected kidney with renal pelvic dilatation showed a combination of both 'poor' T75 and PM drainage in 42% of renograms. The PEE was low in 99% of these 'poor drainage' renograms. The PEE, the ratio of the mathematical model of renal uptake to excretion, is readily calculated and may be a more accurate and specific technique to assess drainage on diuretic renography.