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Renal allograft bruit
MAYO CLINIC PROCEEDINGS by A. Thomas,
M.D.
Survival of Patients with End-Stage Renal Disease, William J. Johnson, Hugh 0. O’Kane, John E. Woods, and Lila R. Elveback, (48: 18, 1973) -One hundred and thirty-two patients with advanced renal disease were studied. Despite recent advances in the medical management of renal failure, the prognosis without hemodialysis or transplantation remains uniformly poor. The authors suggest that the prognosis in patients with advanced renal failure can be improved by the early institution of dialysis and renal transplantation. Definitive treatment is strongly recommended for patients with serum creatinine values of 15 mg., or greater, per 100 ml. Interestingly, their data indicate little difference in survival rates between patients undergoing long-term hemodialysis therapy and patients who have undergone transplantation of the kidney from a living related donor. Significantly lower survival rates were recorded among recipients of cadaver kidneys. Renal Allograft Bruit, Carl F. Anderson, John E. Woods, Peter P. Frohnert, James V. Donadio, Jr., Juan Buros, David T. Sung, and William J. Johnson, (48: 13, 1973)-The authors analyze the association between the findings on palpation and auscultation with laboratory investigations in 81 renal allograft recipients. They believe that the renal allograft bruit originates in the region of the arterial anastomosis. Also there is a combination of increased blood and inequality of vessel size, producing nonlaminar blood flow. The persistence of the bruit indicates continued increased blood flow through the internal iliac and allograft renal arteries that are slightly unequal in size. In their experience, the combination of the disappearance of the renal allograft bruit and decreased renal function may reflect increased intrarenal vascular resistance. The recipients without a bruit had higher mean serum creatinine and the suboptimum blood flow was the common cause of the lack of a bruit. Other possible physiologic explanations are discussed, as is a classification of the grades of bruits heard.
by W. Keiserman,
M.D.
Cryptorchidism Reassessed, Robert P. Myers, and Panayotis P. Kelalis, (48: 94, 1973)-The literature is reviewed in an attempt to answer the question: Is there an optimal time for surgical correction? In the authors’ opinion, the existing data suggest that there are many opinions which conflict as well as confuse, and that the answer to the question remains elusive. They, therefore, suggest that a study be undertaken in an effort to answer this question. They further recommend that in any such study the precise anatomic localization of the testis, when the patient is first seen and on subsequent visits, be recorded to help differentiate between cryptorchidism
UROLOGY
/
MAY 1973
/
VOLUME I, NUMBER 5
and an ectopic testis. Early testicular biopsy is recommended together with a random-treatment program. Serial testosterone levels and postpubertal testicular biopsy and fertility studies are also recommended for inclusion in the proposed study. Malignant Tumors of Solitary Kidneys, R. Malek, D. Utz, 0. Culp, P. Kelalis, and M. Warren (47: 180, 1972) -Eighteen original cases of anatomically or functionally solitary kidneys with carcinoma are presented and discussed in relation to the previous literature. Five patients had congenitally solitary kidneys, and 5 had previous nephrectomy for malignancy. There is no side preference for hypernephroma, and this series had a 5: 10 male to female ratio. A significant number of patients with hypernephroma were in the fourth and fifth decades, while those with transitional cell were in the sixth and seventh decades. Partial nephrectomy is considered the operation of choice for “cure” of renal cell carcinoma. Of the transitional cell carcinoma in solitary kidneys, the literature shows 54 per cent had previous nephroureterectomy for a similar lesion. Operation for cure is more difficult.
RADIOLOGY by Robert
Littmann,
M.D.
Herniation of the Bladder, Arie L. Liebskind, Milton Ekin, and Stanford Goldman, (106: 257, 1973) -The authors report on diagnosing 50 cases of bladder hernia in a two-year period. Sixty per cent of the cases were in patients under fifty years of age, and 62 per cent of the patients were women. In general, no specific symptoms were attributed to hernia of the bladder, but with large bladder hernias, the patients occasionally complained of two-stage urination. Bladder herniations have rarely been identified in the past by excretory urography because of the failure to obtain proper views during this study; they recommend routine use of erect and cone films, particularly with the bladder distended to improve the radiographic recognition of bladder hernias. Although the majority of the patients studied were under fifty years of age, the larger hernias were demonstrated in the elderly. It was not possible to differentiate direct from indirect hernias by the usual radiographic studies. The authors describe three categories of bladder hernias but do not seem to distinguish between the protrusion of the bladder into a hernia sac and the urologically more significant protrusion of bladder diverticulum into a hernia sac. Salivary Secretion of Iodine after Urography, Lee Talner, Marc Coel, and Joseph Lang, (106: 263,1973) This article is a continuation of other studies and attempts to offer further evidence for in vivo deiodinization and salivary secretion of contrast media. The authors suggest that although general opinion holds that most adverse reactions associated with contrast material are probably not caused by iodine or iodide, at least one adverse reaction, such as sialadenopathy
485
M.D.
Survival of Patients with End-Stage Renal Disease, William J. Johnson, Hugh 0. O’Kane, John E. Woods, and Lila R. Elveback, (48: 18, 1973) -One hundred and thirty-two patients with advanced renal disease were studied. Despite recent advances in the medical management of renal failure, the prognosis without hemodialysis or transplantation remains uniformly poor. The authors suggest that the prognosis in patients with advanced renal failure can be improved by the early institution of dialysis and renal transplantation. Definitive treatment is strongly recommended for patients with serum creatinine values of 15 mg., or greater, per 100 ml. Interestingly, their data indicate little difference in survival rates between patients undergoing long-term hemodialysis therapy and patients who have undergone transplantation of the kidney from a living related donor. Significantly lower survival rates were recorded among recipients of cadaver kidneys. Renal Allograft Bruit, Carl F. Anderson, John E. Woods, Peter P. Frohnert, James V. Donadio, Jr., Juan Buros, David T. Sung, and William J. Johnson, (48: 13, 1973)-The authors analyze the association between the findings on palpation and auscultation with laboratory investigations in 81 renal allograft recipients. They believe that the renal allograft bruit originates in the region of the arterial anastomosis. Also there is a combination of increased blood and inequality of vessel size, producing nonlaminar blood flow. The persistence of the bruit indicates continued increased blood flow through the internal iliac and allograft renal arteries that are slightly unequal in size. In their experience, the combination of the disappearance of the renal allograft bruit and decreased renal function may reflect increased intrarenal vascular resistance. The recipients without a bruit had higher mean serum creatinine and the suboptimum blood flow was the common cause of the lack of a bruit. Other possible physiologic explanations are discussed, as is a classification of the grades of bruits heard.
by W. Keiserman,
M.D.
Cryptorchidism Reassessed, Robert P. Myers, and Panayotis P. Kelalis, (48: 94, 1973)-The literature is reviewed in an attempt to answer the question: Is there an optimal time for surgical correction? In the authors’ opinion, the existing data suggest that there are many opinions which conflict as well as confuse, and that the answer to the question remains elusive. They, therefore, suggest that a study be undertaken in an effort to answer this question. They further recommend that in any such study the precise anatomic localization of the testis, when the patient is first seen and on subsequent visits, be recorded to help differentiate between cryptorchidism
UROLOGY
/
MAY 1973
/
VOLUME I, NUMBER 5
and an ectopic testis. Early testicular biopsy is recommended together with a random-treatment program. Serial testosterone levels and postpubertal testicular biopsy and fertility studies are also recommended for inclusion in the proposed study. Malignant Tumors of Solitary Kidneys, R. Malek, D. Utz, 0. Culp, P. Kelalis, and M. Warren (47: 180, 1972) -Eighteen original cases of anatomically or functionally solitary kidneys with carcinoma are presented and discussed in relation to the previous literature. Five patients had congenitally solitary kidneys, and 5 had previous nephrectomy for malignancy. There is no side preference for hypernephroma, and this series had a 5: 10 male to female ratio. A significant number of patients with hypernephroma were in the fourth and fifth decades, while those with transitional cell were in the sixth and seventh decades. Partial nephrectomy is considered the operation of choice for “cure” of renal cell carcinoma. Of the transitional cell carcinoma in solitary kidneys, the literature shows 54 per cent had previous nephroureterectomy for a similar lesion. Operation for cure is more difficult.
RADIOLOGY by Robert
Littmann,
M.D.
Herniation of the Bladder, Arie L. Liebskind, Milton Ekin, and Stanford Goldman, (106: 257, 1973) -The authors report on diagnosing 50 cases of bladder hernia in a two-year period. Sixty per cent of the cases were in patients under fifty years of age, and 62 per cent of the patients were women. In general, no specific symptoms were attributed to hernia of the bladder, but with large bladder hernias, the patients occasionally complained of two-stage urination. Bladder herniations have rarely been identified in the past by excretory urography because of the failure to obtain proper views during this study; they recommend routine use of erect and cone films, particularly with the bladder distended to improve the radiographic recognition of bladder hernias. Although the majority of the patients studied were under fifty years of age, the larger hernias were demonstrated in the elderly. It was not possible to differentiate direct from indirect hernias by the usual radiographic studies. The authors describe three categories of bladder hernias but do not seem to distinguish between the protrusion of the bladder into a hernia sac and the urologically more significant protrusion of bladder diverticulum into a hernia sac. Salivary Secretion of Iodine after Urography, Lee Talner, Marc Coel, and Joseph Lang, (106: 263,1973) This article is a continuation of other studies and attempts to offer further evidence for in vivo deiodinization and salivary secretion of contrast media. The authors suggest that although general opinion holds that most adverse reactions associated with contrast material are probably not caused by iodine or iodide, at least one adverse reaction, such as sialadenopathy
485