Transvenous renal biopsy in an ex vivo swine kidney model: a comparison of five devices.

PURPOSE: To compare the efficacy of end-cut and side-cut devices in transvenous renal biopsies of ex vivo swine kidneys and to examine the use of the swine kidney as an animal model in this setting. MATERIALS AND METHODS: Biopsy specimens of ex vivo swine kidneys were obtained after selective renal vein cannulation with use of five separate biopsy devices (Quick-Core 16 gauge and 18 gauge, Colapinto 16 gauge, Mansfield biopsy forceps, Flexi-Temno 16 gauge). Biopsy specimens were defined as the material obtained from three separate passes at a given site, with 30 biopsy specimens obtained per device. Capsular perforation was examined for each pass. A blinded pathologist recorded the presence of tissue and the number of glomeruli present for each pass. A diagnostic biopsy was defined as six or more glomeruli obtained. RESULTS: The median number of glomeruli obtained for each device per biopsy was Colapinto 0.0 (range, 0-13), Mansfield 0.0 (range, 0-19), Flexi-Temno 2.0 (range, 0-13), 18-gauge Quick-Core 8.5 (range, 0-30), and 16-gauge Quick-Core 16.0 (range, 0-52). The Quick-Core 16-gauge and 18-gauge devices obtained diagnostically adequate biopsy specimens 83% and 77% of the time, respectively, compared to 20% or less for the other devices. CONCLUSION: The Quick-Core 16-gauge and 18-gauge side-cut biopsy devices are the most efficacious for obtaining diagnostic quality biopsy specimens in the ex vivo swine kidney model.

Three-dimensional computerized tomography in the evaluation of laryngeal injury.

A comparison of diagnostic information obtained from the physical examination, conventional two-dimensional axial computerized tomography scanning (2-D CT), and three-dimensional display computerized tomography (3-D CT) was performed in five patients sustaining laryngeal trauma. Four patients had laryngeal fractures and one patient had an incompletely ossified thyroid cartilage (normal variant) simulating a fracture by 2-D CT. Three-dimensional display computerized tomography was found superior to conventional 2-D CT in assessing the presence and nature of the laryngeal injuries while correctly identifying the anatomic variant.

Cloacal exstrophy: radiologic findings in 13 patients.

Cloacal exstrophy is a complex, multisystem malformation that has not received much attention in the radiologic literature. The clinical histories and imaging studies of 13 cases of cloacal exstrophy proved surgically or at autopsy were reviewed. Radiologic observations were based on skeletal plain films (13), contrast-enhanced examinations of the genitourinary system (12), abdominopelvic sonograms (nine), gastrointestinal studies (seven), CT scans of the pelvis and CNS (seven), MR images of the pelvis and CNS (six), renal nuclear medicine scans (three), myelography (three), and three-dimensional scans of the pelvis (two). Genitourinary and gastrointestinal abnormalities identified in our 13 patients included bladder malformations (13), hindgut anomalies (13), undescended testes (five), malrotation (five), duplicated müllerian structures (four), and renal ectopia (four). Skeletal abnormalities included symphysis pubis diastasis (13), posterior element dysraphism (12), vertebral segmentation anomalies (12), clubfeet (six), and hip dislocations (five). CNS anomalies included meningocele (nine) and Chiari malformation (one). Immediate surgical closure of the defect with maximal bowel preservation and diverting colostomy offers optimal chances for survival. Appropriate preoperative gastrointestinal and genitourinary evaluation is essential.