Bilateral ureteritis cystica with unilateral ureteropelvic junction obstruction.

Ureteritis cystica is a rare, benign, proliferative disorder characterized by multiple ureteral cysts and multiple filling defects noted on contrast ureteral imaging. A unique case of bilateral ureteritis cystica coincidental with chronic, congenital, unilateral ureteropelvic junction obstruction presenting with microscopic hematuria and lower urinary tract symptoms is described. The characteristic presentation as well as the diagnostic radiographic, ureteroscopic, and histologic features of pyeloureteritis cystica are reviewed.

Cushing's syndrome associated with a pheochromocytoma.

A norepinephrine producing right adrenal pheochromocytoma was associated with bilateral adrenal hyperplasia and clinically and biochemically evident Cushing's syndrome. Ectopic adrenocorticotropin production was suspected, but the six criteria for proof of ectopic adrenocorticotropin production could not be demonstrated. The diagnosis of Cushing's syndrome from ectopic hormone production by a pheochromocytoma requires a high index of suspicion and extensive biochemical and radiographic testing to confirm Cushing's syndrome, identify the cause of Cushing's syndrome, and localize the pheochromocytoma.

The utility of video-assisted thoracic surgery in the diagnosis of pulmonary metastases from renal cell carcinoma.

The definitive diagnosis of pulmonary metastases requires histologic confirmation. Traditional methods of obtaining tissue for histologic review include transbronchial approaches, percutaneous transthoracic needle biopsy, and open lung biopsy. The purpose of this study is to identify the most effective methods of obtaining histologic confirmation of pulmonary metastases. The utility of video-assisted thoracic surgery in diagnosing pulmonary metastases is demonstrated in 2 patients with metastatic renal cell carcinoma. The diagnostic yields and complication rates of transbronchial approaches, percutaneous needle biopsy, open lung biopsy, and video-assisted thoracic surgery are compared. Finally, an algorithm for the evaluation of pulmonary lesions is presented.

Results of lower extremity amputations in patients with end-stage renal disease.

PURPOSE: The purpose of this study was to determine the impact of end-stage renal disease (ESRD) on the outcome of patients undergoing lower extremity (LE) amputation. METHODS: Hospital charts and vascular surgery registry data were reviewed for all patients who underwent LE amputation over a consecutive 56-month period. The results of 84 patients with ESRD (137 amputations) were compared with 375 patients (442 amputations) without ESRD. RESULTS: Hospital mortality rate was significantly greater in patients with ESRD than patients without ESRD, 24% versus 7% (p = 0.001). Patients with ESRD undergoing minor amputations had mortality rates three times greater than patients without ESRD undergoing major LE amputations. In patients with ESRD requiring bilateral or unilateral above-knee amputation hospital mortality rates were 43% and 38%, respectively. In addition, patients with ESRD were seven times more likely to undergo bilateral amputation than patients without ESRD over a mean follow-up period of 17 months. No kidney transplant patients died after amputation. CONCLUSION: ESRD has a profound negative impact on morbidity, mortality, and survival rates after LE amputation. Attempts at prevention of amputation with aggressive foot care and patient education in this high-risk group should be the focus of therapy.