Retrograde balloon dilatation for pelviureteric junction obstruction.

A total of 49 retrograde balloon dilatations for pelviureteric junction (PUJ) obstruction were carried out on 43 pelviureteric junctions in 42 patients from 1986 to 1991. The majority (34/43) were performed as primary treatment for PUJ obstruction, with 9 patients having a history of previous open pyeloplasty. Follow-up ranged from 3 months to 4 years (mean 18 months). Clinical improvement, as assessed by absence of symptoms, was seen in 34 cases (80%). There was either no change or an improvement in renographic findings (t1/2 time and/or split function) in 40 patients (93%). Of the 9 patients who were undergoing secondary treatment, 5 showed clinical improvement and 8 showed no change or renographic improvement. Nine patients required 12 further procedures, of which 5 were interval nephrectomy. Balloon pyelolysis is a simple procedure with good results over a 4-year follow-up period. It is less effective for the treatment of secondary pelviureteric junction obstruction. It has a low morbidity and no mortality, involves a short hospital stay and allows an immediate return to full activity. It is therefore an attractive alternative to open pyeloplasty as first-line treatment for PUJ obstruction.

A comparison of T1 measurements at 1.7 and 3.4 MHz in the diagnosis of prostatic carcinoma.

To compare the specificity of T1 measurement for the diagnosis of prostatic carcinoma in vivo, two groups of patients with clinically enlarged prostate glands have been imaged. One group comprising 25 patients was imaged at 1.7 MHz the other comprising 51 patients at 3.4 MHz. T1 measurements together with the gross anatomical appearances of the prostate gland were observed and compared with the clinical and histologic diagnoses. At 1.7 MHz it was found that the T1 measurement of carcinoma of the prostate and benign hypertrophy of the prostate fell into two distinct ranges with no overlap between the two conditions. Three false-positive diagnoses of carcinoma were made in patients with prostatitis where the T1 values fell in the upper part of the carcinoma range. T1 measurement in the group studied at 3.4 MHz demonstrated no specific value for either condition and diagnosis of malignancy had to be made from the morphologic appearances of the gland. Morphologically benign hypertrophy appeared homogeneous while carcinoma appeared heterogeneous with small areas of increased T1 in the malignant part of the gland.

Nuclear magnetic resonance (NMR) imaging of the prostate.

Nuclear magnetic resonance (NMR) imaging is a safe, non-invasive technique of visualising the prostate gland. The Aberdeen NMR imager has a field strength of 0.08 T and can image in three planes. A correct diagnosis was made in 48 of 51 patients studied with prostatic disease. At this field strength benign and malignant prostatic tissue has the same T1 value. The presence of a metallic hip prosthesis does not interfere with the imaging.

Nuclear magnetic resonance imaging of the prostate.

Nuclear magnetic resonance (NMR) imaging of the prostate has been done in 25 patients, using a prototype machine developed in Aberdeen. It is a non-invasive technique which demonstrated the anatomical extent and pathological nature of prostatic lesions. The NMR images in both benign and malignant prostatic disease on this machine are comparable with first generation CT scans.

Loin pain and haematuria in young women: diagnostic pitfalls.

Cystoscopy, intravenous urography and urine culture frequently fail to reveal the cause of loin pain and haematuria in young women. Two such women are presented in whom renal biopsy was not only unhelpful but also misleading. Subsequent renal arteriography showed arteriovenous fistulae which were considered erroneously to be the cause of the symptoms in both patients; in fact the fistulae were traumatic post-biopsy fistulae rather than congenital malformations. These patients were probably examples of the "loin/pain/haematuria syndrome" which is thought to have a vascular basis and may have predisposed to the formation of fistulae.

Fluid absorption during transurethral prostatectomy.

A study of 39 patients having a transurethral resection (TUR) of prostate for benign prostatic hyperplasia was carried out. Large quantities of mannitol, which was used as the irrigating fluid during the procedure, were found to enter the circulation. A corresponding fall in the serum sodium levels was noted. Those patients with serum mannitol levels greater than 4000 mg/l were noted to be hypotensive and have a bradycardia. These patients were nearly all hypovolaemic and the bradycardia was felt to be inappropriate. The possibility of this being due to a combination of factors including intravascular mannitol is considered.

Current trends in the management of carcinoma of the prostate.

Prostatic carcinoma is a fairly common tumor and its diagnosis should always have a histological basis. Staging of the tumour by the TNM system permits a more rational approach to the choice of therapy--radical prostatectomy, radiotherapy and/or hormonal manipulation. To date there is no hormonal therapy convincingly superior to the use of oestrogen or the undertaking of bilateral orchidectomy. Chemotherapy has so far been disappointing.

An assessment of computerised isotopic renal section scanning.

The basic non-invasive investigation of renal space occupying lesions by excretion pyelography was coupled with ultrasonic scanning. Forty-one patients who have undergone isotopic section scanning as part of their investigative assessment were studied. The conditions investigated included solitary cysts, polycystic kidneys, renal tumours, tumefactive xanthomatous pyelonephritis, renal infarct and non-functioning kidneys. An analysis of the accuracy of isotopic section scanning in these different pathological states was made. Computerised isotopic section renal scanning offers a new non-invasive renal investigative technique.

Diagnostic value of computerised isotopic section renal scanning.

Isotope section renal scanning in the diagnosis of kidney disease has been compared with ultrasonic examination adn specialised radiological techniques. The computerised isotope tomographic section technique developed in Aberdeen has increased the accuracy and differential diagnosis of renal lesions especially cysts and tumours.

Vitamin B12 absorption in patients with ileal conduits.

The absorption of vitamin B12 was assessed using the 58Co-absorption test (Schilling test) in 39 patients in whom ileal loops had been used as urinary diversion after excision of the bladder for transitional cell carcinoma. 29% of the patients were found to absorb less than 12% of the offered dose of labelled vitamin B12 after excluding gastric-mediated malabsorption by the modified Schilling test. Examination of haemoglobin, MCV or vitamin B12 in the peripheral blood gave unreliable indications of the absorptive ability of these patients.