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Roentgenographic manifestations of spontaneous renal hemorrhage
Tuberculosis varitas hominis (H,,Rv) into the left epididymis (Group I), left epididymis postvasectomy (Group II), left seminal vesicle (Group III), and left seminal vesicle postvasectomy (Group IV). The animals were sacrificed after three to eight weeks, and their organs subjected to histologic and bacteriologic study. Results were as follows: Groups I and II exhibited prostatic spread of tuberculosis in 2 animals. The most striking finding was the presence in Groups III and IV of greyish streaks joining the epididymis with the seminal vesicle. These streaks were thought to represent lymph vessels altered by inflammatory changes. In the literature it is usually claimed that the tuberculous organisms invade the epididymis and then spread to the prostate and seminal vesicles. More recent investigations as well as this study show that the primary infection is usually in the pelvic genitalia, and there is late spread to the epididymis. Their experiments documented the fact that Mycobacterial spread occurred more often from the seminal vesicles and the prostate toward the epididymis than in the opposite direction. This is made tenable by the dense network of lymphatic channels interconnecting the prostate and seminal vesicles to the ampulla of the vas.
RADIOLOGY by B. Lazarus, Renal
M.D.
Ultrasonography:
the Diagnosis
An Updated Approach to of Renal Cyst, George R. Leopold, Lee
B. Talnes, W. Michael Aster, Babara B. Gosink, and Ruben F. Gittes (109: 671, 1973)-Following excretory urography, the diagnostic evaluation of a renal mass has included nephrotomography, cyst puncture, and selective renal angiography. The authors contend that the maximum diagnostic accuracy with the least risk and cost to the patient can be obtained by using ultrasonic B-scanning of the kidney after urography, to be followed by cyst puncture when the ultrasonic findings are typical of a benign cyst. Patients are scanned in the prone and transverse positions. Features indicating a benign renal cyst include: (1) absence of internal echoes, indicating homogenous cyst fluid; (2) the anterior margin of the lesion is smooth and sharply defined; and (3) increased amount of sound energy that appears beyond the mass as a result of the ease of transmission through the cyst fluid. Eighty-four of 105 patients studied had proved diagnoses. Ultrasonography successfully diagnosed renal cyst in 56 of 58 patients for 96 per cent accuracy, and 24 of 26 solid masses for 92 per cent accuracy, giving an over-all success rate of 95 per cent. The consequences of diagnostic error are not great because if a tumor is misdiagnosed as a cyst, cyst puncture will reveal bloody fluid, a dry tap, or positive cytologic results. However, if a cyst is misdiagnosed as a tumor, renal angiography will confirm that a benign
230
mass is present, and a decision to do a cyst puncture or surgical exploration will then be made. The authors feel that the protocol with the high accuracy of ultrasonography will spare unnecessary renal arteriography with its greater expense and occasional morbid outcome. They also make clear that excretory urography is an essential prerequisite to ultrasonography; to determine the presence or absence of a mass, nephrotomography rather than ultrasonography is the procedure of choice.
Roentgenographic Manifestations of Spontaneous Renal Hemorrhage, Howard M. Pollack and George L. Popky (110: 1, 1974)-Spontaneous renal hemorrhage without trauma or hematuria may occur. It will manifest itself as an intrarenal hematoma, subcapsular hematoma, or perirenal hematoma. Intrarenal hematoma exhibits characteristics of any intrarenal mass, including distortion of the calyces and interruption of the contour of the kidney. Nephrotomography will reveal lucency but without the thinwalled characteristics of a simple cyst. Angiography will not demonstrate neovascularity. The most common cause is a coagulation defect. The authors recommend no surgical intervention and follow-up studies to determine if the mass has resolved. Small neoplasms should be considered if resolution has not occurred in two months. Flattening of the kidney, elevation of the renal capsule, and proximity of capsular arteries to the capsule are consistent with subcapsular hematoma. Surgical intervention is indicated to relieve the pressure on the renal parenchyma. Close visual inspection for occult tumors is recommended; in 5 of 7 cases, surgical exploration demonstrated a renal tumor as the cause of spontaneous subcapsular hematoma. Perirenal hematoma causes displacement of the kidney, a lack of mobility, and some impairment of excretory function. The capsular vessels are displaced away from the capsule. Surgical intervention is indicated to evacuate hemorrhage. The authors again stress the importance of close inspection for occult neoplastic disease.
REVISTA
CLiNICA
by E. Cid,
M.D.
ESPANOLA
Histiocytes in the Urine, M. F. Rivas Manga and L. Cifuentes Delatte (131: 293, 1973)-The authors describe their experience in the study of fresh urinary sediments by both phase and electron microscopic means. They describe cells not previously seen which bear an irregular polygonal shape with finely granular and darker gray-tan cytoplasm than that of the usual polymorphonuclear cell. These cells seem to be specific in the presence of urinary tract infection. On the basis of their studies, they believe these to be histiocytes.
UROLOGY
/ AUGUST1974
/ VOLUMEIV,NUMBER2
RADIOLOGY by B. Lazarus, Renal
M.D.
Ultrasonography:
the Diagnosis
An Updated Approach to of Renal Cyst, George R. Leopold, Lee
B. Talnes, W. Michael Aster, Babara B. Gosink, and Ruben F. Gittes (109: 671, 1973)-Following excretory urography, the diagnostic evaluation of a renal mass has included nephrotomography, cyst puncture, and selective renal angiography. The authors contend that the maximum diagnostic accuracy with the least risk and cost to the patient can be obtained by using ultrasonic B-scanning of the kidney after urography, to be followed by cyst puncture when the ultrasonic findings are typical of a benign cyst. Patients are scanned in the prone and transverse positions. Features indicating a benign renal cyst include: (1) absence of internal echoes, indicating homogenous cyst fluid; (2) the anterior margin of the lesion is smooth and sharply defined; and (3) increased amount of sound energy that appears beyond the mass as a result of the ease of transmission through the cyst fluid. Eighty-four of 105 patients studied had proved diagnoses. Ultrasonography successfully diagnosed renal cyst in 56 of 58 patients for 96 per cent accuracy, and 24 of 26 solid masses for 92 per cent accuracy, giving an over-all success rate of 95 per cent. The consequences of diagnostic error are not great because if a tumor is misdiagnosed as a cyst, cyst puncture will reveal bloody fluid, a dry tap, or positive cytologic results. However, if a cyst is misdiagnosed as a tumor, renal angiography will confirm that a benign
230
mass is present, and a decision to do a cyst puncture or surgical exploration will then be made. The authors feel that the protocol with the high accuracy of ultrasonography will spare unnecessary renal arteriography with its greater expense and occasional morbid outcome. They also make clear that excretory urography is an essential prerequisite to ultrasonography; to determine the presence or absence of a mass, nephrotomography rather than ultrasonography is the procedure of choice.
Roentgenographic Manifestations of Spontaneous Renal Hemorrhage, Howard M. Pollack and George L. Popky (110: 1, 1974)-Spontaneous renal hemorrhage without trauma or hematuria may occur. It will manifest itself as an intrarenal hematoma, subcapsular hematoma, or perirenal hematoma. Intrarenal hematoma exhibits characteristics of any intrarenal mass, including distortion of the calyces and interruption of the contour of the kidney. Nephrotomography will reveal lucency but without the thinwalled characteristics of a simple cyst. Angiography will not demonstrate neovascularity. The most common cause is a coagulation defect. The authors recommend no surgical intervention and follow-up studies to determine if the mass has resolved. Small neoplasms should be considered if resolution has not occurred in two months. Flattening of the kidney, elevation of the renal capsule, and proximity of capsular arteries to the capsule are consistent with subcapsular hematoma. Surgical intervention is indicated to relieve the pressure on the renal parenchyma. Close visual inspection for occult tumors is recommended; in 5 of 7 cases, surgical exploration demonstrated a renal tumor as the cause of spontaneous subcapsular hematoma. Perirenal hematoma causes displacement of the kidney, a lack of mobility, and some impairment of excretory function. The capsular vessels are displaced away from the capsule. Surgical intervention is indicated to evacuate hemorrhage. The authors again stress the importance of close inspection for occult neoplastic disease.
REVISTA
CLiNICA
by E. Cid,
M.D.
ESPANOLA
Histiocytes in the Urine, M. F. Rivas Manga and L. Cifuentes Delatte (131: 293, 1973)-The authors describe their experience in the study of fresh urinary sediments by both phase and electron microscopic means. They describe cells not previously seen which bear an irregular polygonal shape with finely granular and darker gray-tan cytoplasm than that of the usual polymorphonuclear cell. These cells seem to be specific in the presence of urinary tract infection. On the basis of their studies, they believe these to be histiocytes.
UROLOGY
/ AUGUST1974
/ VOLUMEIV,NUMBER2