1/10. Laparoscopic retroperitoneal nephrectomy for aspergillus-infected polycystic kidney.BACKGROUND AND PURPOSE: The management of polycystic kidney disease is mostly restricted to conservative measures. However, nephrectomy may be indicated in particular cases, especially when there are infective complications. To decrease the morbidity of the procedure, the laparoscopic approach has become appealing. We present a laparoscopic retroperitoneal approach to complicated polycystic kidney disease in a high-risk patient. CASERESPORT: We performed right retroperitoneal laparoscopic nephrectomy in a 39-year-old man who had autosomal polycystic kidney disease and had undergone heart transplantation. The immunosuppressed patient presented with severe flank pain, generalized signs of infection, and acute renal insufficiency. With the patient in the right lateral decubitus position, the retroperitoneal space was entered by the open technique, and the posterior pararenal space was developed with finger dissection. Five trocars were used. After the renal vessels had been secured and divided, the cysts were successively punctured, gradually shrinking the operative specimen. The kidney was placed in an Endo-catch and removed after morcellation, with no need to enlarge the 2-cm lumbotomy. The operating time was 80 minutes, and the hospital stay was 4 days. Histologic examination revealed a polycystic kidney with aspergillus infection. CONCLUSION: The laparoscopic approach is a less-invasive option for removing a polycystic kidney when nephrectomy is indicated. The retroperitoneal route has the advantage of minimizing infection risks because of the absence of peritoneal opening.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/10. Stridor and Horner's syndrome, weeks after attempted right subclavian vein cannulation.A 23-year-old woman presented with renal failure resulting from polycystic kidney disease (PKD) aggravated by tubulo-interstitial nephritis. Emergency haemodialysis was planned, and cannulation of the right subclavian vein was attempted, but failed. During this procedure, inadvertent arterial puncture occurred. Transient mild ischaemia of the right arm, and a transient Horner's syndrome were noted. Seven weeks later she presented with severe stridor with impending respiratory failure necessitating emergency intubation; the right-sided Horner's syndrome had recurred. CT imaging showed a large pseudo-aneurysm of the brachiocephalic artery resulting in severe compression of the trachea. Using a prosthetic graft, the operation for the pseudo-aneurysm was successful; there were mild neurological sequelae. Although her family history was negative, autosomal dominant PKD should be considered, and we discuss the possible role of a pre-existing PKD-associated aneurysm.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/10. Ultrasonic evaluation of the unilateral nonvisualized kidney.There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/10. Percutaneous cyst puncture in the treatment of cyst infection in autosomal dominant polycystic kidney disease.Cyst infection in autosomal dominant polycystic kidney disease (ADPKD) poses a difficult diagnostic and therapeutic problem. We describe a serious indolent cyst infection due to staphylococcus aureus, which was successfully diagnosed and treated with repeated percutaneous cyst drainage and intravenous (IV) antibiotic therapy. Cyst aspiration also permitted monitoring of cyst antibiotic levels and evidence of active infection.- - - - - - - - - - ranking = 4keywords = puncture (Clic here for more details about this article) |
5/10. A new approach to the treatment of polycystic kidneys.Maximum conservativism was the watchword up to 1979 in dealing with polycystic disease. In the period 1979 to 1985 a total of 45 patients were subjected to 80 instances of polycystic resection whereby larger cysts were removed by excision, smaller ones by ignipuncture, with particular attention to extirpation of the perihilar cysts. Post-operative incidence of hypertension dropped from 33 to 3%. The method described is rated as one of the feasible expedients to deal with polycystic disease in the early compensated stage.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/10. Percutaneous puncture of abdominal cystic masses in children.A technique of percutaneous puncture and opacification of cystic abdominal masses is outlined, and its diagnostic and therapeutic potential demonstrated in a series of 16 masses in 15 children. It is suggested as an alternative to ultrasound and computed tomography in certain situations.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
7/10. Preoperative diagnosis of unilateral multicystic kidney with hydropelvis.We present 2 patients with congenital unialteral multicystic kidney disease with hydropelvis. In the first patient the diagnosis was made by precutaneous puncture of a renal cyst followed by injection of contrast medium; in the second the diagnosis was confirmed by percutaneous puncture of the renal pelvis and injection of contrast medium, although an earlier ultrasonic examination had been strongly suggestive. Since in this condition the cysts and the renal pelvis communicate, either can be punctured to make the diagnosis. The procedures herein described are definitive for the diagnosis and should be followed whenever the urologist desires such a diagnosis.- - - - - - - - - - ranking = 3keywords = puncture (Clic here for more details about this article) |
8/10. Diagnostic puncture in renal cystic dysplasia (multicystic kidney). Evidence on the aetiology of the cysts.Five cases of cystic dysplastic (multicystic) kidney occurring in infancy are described, in whom diagnostic puncture was used to confirm the suspected diagnosis. The characteristic finding on contrast injection was that the cystic spaces communicated via tubular structures, presumably nephronic, so ruling out the possibility of hydronephrosis. This finding also supports the view that cysts in multicystic kidney derive from nephrons and are not due to dilated calices. Although urography and ultrasonography both give appearances highly suggestive of multicystic kidney, the appearances on renal puncture are pathognomonic. When such appearances are demonstrated there is no urgent need for operative removal, except when necessitated by the size of the mass.- - - - - - - - - - ranking = 6keywords = puncture (Clic here for more details about this article) |
9/10. Renal cell carcinoma: unusual systemic manifestations.A series of cases is presented which illustrates unusual aspects in the presentation, diagnosis, and management of renal cell carcinoma. The entire "classic triad" of flank pain, gross hematuria, and palpable mass was not present at the time of diagnosis in any of the patients. Moreover, in only three patients did the initial clinical findings raise the suspicion of renal cell carcinoma. A diagnosis of polycystic kidney disease, cardiac failure, glomerulonephritis, analgesic abuse, and perirenal hemorrhage obscured the primary diagnosis in the other five patients. In four patients the tumor was probably present from 3 to 12 years before detection. These findings emphasize that knowledge of the hematologic, humoral, immunologic and vascular abnormalities induced by this tumor may provide a clue to early diagnosis. The systematic use of excretion urography, nephrotomography, ultrasonography, renal scanning, renal arteriography and cyst puncture then may allow the accuracy of radiologic diagnosis of this tumor to approach 100%. Lastly, the therapy of choice for this tumor is radical nephrectomy. Excision of apparently solitary metastases also may sometimes be feasible. However, partial nephrectomy to remove tumor in a solitary kidney was performed in one patient to avoid the need for end-stage kidney treatment. Where nephrectomy renders the patient anephric, chronic hemodialysis and renal transplantation should be considered as potential measures to sustain life. While hormonal agents, chemotherapy, and radiation therapy sometimes provide palliation, their use generally has been disappointing.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/10. Avascular renal adenocarcinoma: variations and characteristics.Six cases (men ranging in ages from thirty-seven to seventy-seven years) illustrate the varied characteristics of avascular renal adenocarcinoma. These tumors frequently stimulat benign lesions. All modalities including intravenous pyelography, nephrotomography, ultrasonography, cyst puncture with cystic fluid assessment, angiography, and operation with tissue specimens submitted for pathologic examination may be required before diagnosis is established. An orderly approach to the evaluation of lesions will allow accurate diagnosis approaching 100% with minimum morbidity. attention to the finer details of vascular patterns on angiography has proved to be a most helpful diagnostic aid. Cyst puncture with histochemical, cytologic, and radiographic examinations appears to offer additional help in diagnosing these elusive lesions.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
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