Cases reported "Kidney Diseases"

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1/10. Prenatal puncture of a unilateral hydronephrosis leading to fetal urinoma and postnatal nephrectomy.

    Fetal pelvicaliceal dilatation due to ureteropelvic junction obstruction is the most common cause of antenatal hydronephrosis; it rarely leads to a spontaneous rupture resulting in urinoma formation. Antenatal intervention has been recommended only in those cases of large urinomas that seem to interfere with the function of other organ systems (eg, pulmonary hypoplasia secondary to diaphragmatic elevation). We report the case of a fetal intervention (transuterine puncture) in a unilateral massive hydronephrosis leading to a perirenal urinoma and the preterm birth of a female infant. Postnatally, mechanical ventilation and oxygen were required, as was forced percutaneous urinoma drainage. Evaluation revealed a fistula formation between the perirenal space and the kidney's collecting system, possibly due to the fetal intervention. Unfortunately the kidney function was very poor, and surgery to remove the impaired kidney and the urinoma was performed. We discuss the possible effects of fetal intervention in cases of obstructive uropathy and the postnatal risks associated with it.
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2/10. Immediate postimplant hemodialysis through a new "self-sealing" heparin-bonded polycarbonate/urethane graft.

    BACKGROUND: Immediate accessibility of a newly implanted dialysis graft is desirable to avoid temporary catheters. The most commonly used dialysis graft, expanded polytetrafluorethylene (ePTFE), does not allow early access. This report presents the first clinical data regarding the immediate puncturability of a newly introduced "self-sealing" polycarbonate urethane graft (PUG). methods: patients implanted with a PUG due to the need for immediate vascular access through their new grafts were followed prospectively for early and late complications. RESULTS: Five patients who were implanted with a PUG were dialyzed through their grafts within hours after surgery. dialysis was continued three times per week in each patient, without a puncture-related problem. CONCLUSION: The availability of a self-sealing graft allowing immediate vascular access on the same day of the implant was achieved with the PUG system. Decreasing the need for temporary catheters may initiate some of the complications associated with hemodialysis.
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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.
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4/10. Percutaneous endoscopic fulguration of a large volume caliceal diverticulum.

    Currently, the optimal approach to a caliceal diverticulum appears to be direct puncture into the diverticulum with subsequent dilation and stenting of the narrow ostium with a large nephrostomy tube. However, further maneuvers might be necessary in cases of large volume caliceal diverticula. We describe a patient with a large caliceal diverticulum (7.5 cm.) in whom percutaneous endoscopic fulguration was used successfully as an additional technique to assure obliteration of the diverticulum.
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5/10. 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.
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6/10. Renal hydatid disease: report of 9 cases and discussion of urologic diagnostic procedures.

    Nine cases of renal hydatid disease are reported. All diagnostic procedures are discussed and the important role of ultrasound renal scan and cyst puncture is emphasized. Although it is rare, renal secondary location has to be suspected in cases of hepatic echinococcosis and conservative surgical treatment is required to preserve renal function.
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7/10. Unusual complications of renal cyst puncture.

    The authors present a case of subcapsular hematoma with compromise of renal function and a case of arteriovenous communication as two infrequent complications of renal cyst puncture.
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8/10. Whitaker test: differentiation of obstructive from nonobstructive uropathy.

    The Whitaker test, a urodynamic study, combined with antegrade pyelography has been used recently to evaluate persistent upper urinary tract dilatation after operative correction of obstruction. This test will differentiate patients with residual or recurrent obstruction from those with dilatation secondary to permanent changes in the musculature. It is useful in evaluating patients with questionable ureteropelvic or ureterovesical junction obstruction, or primary defects in the ureteral musculature, such as prune-belly syndrome. It also will establish when urinary diversion safely can be discontinued in postoperative patients. Percutaneous puncture of the renal pelvis is performed or an indwelling nephrostomy tube is used. The upper urinary tract is then perfused at a constant rate of 5--10 ml/min with saline or diluted contrast media, and a serial pressure recording is made in the renal pelvis and bladder. The high flow rate used will be tolerated easily in a nonobstructed system without a progressive rise in renal pelvic pressure. In obstructed systems abnormally high pressure above 12 cm water or a constant rise in pressure will be recorded. Videotaping of ureteral peristalsis and spot films of the upper urinary tract complete the evaluation.
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9/10. diagnosis and treatment of fluid-filled renal structures in children with ultrasonography and percutaneous puncture.

    The application of ultrasonographic and percutaneous needle puncture techniques in the diagnosis of various fluid-filled renal anomalies has permitted rapid delineation of anatomic detail, more definitive physiologic evaluation, and drainage, when necessary, in a safe and cost-effective manner. Its usefulness in children is emphasized in 6 illustrated cases of male infants with minimally or nonopacified renal anomalies, one of the more difficult diagnostic problems in pediatric urology.
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10/10. Renal cyst puncture and abscess formation.

    Percutaneous needle puncture and aspiration of suspected cystic renal masses may provide accurate diagnosis in selected cases. However, renal cyst puncture is not a totally innocuous procedure and certain complications may be encountered. Report is made of 2 cases of renal cyst puncture followed by abscess formation, necessitating surgical intervention. An improved technique involving surgical preparation of the operative area and utilization of double-needle method of cyst puncture is advocated.
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ranking = 1.6
keywords = puncture
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