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Acquired multiple bilateral cystic transformation of kidneys has been increasingly noted in patients with long-standing renal failure treated by chronic dialysis. To study the clinical characteristics of this newly described disease and assess the utility of available diagnostic methods, 130 patients with chronic renal failure (100 on dialysis, 30 nondialyzed) were studied with ultrasonography and/or computerized tomography (CT). Among patients on dialysis, 22% had acquired renal cystic disease (ARCD), an additional 30% had one to three solitary cysts, and 48% had no cysts. In nondialyzed patients, 7% had ARCD, 53% had one to three solitary cysts, and 40% had no cysts. Among these 130 chronic renal failure patients (nondialyzed and dialyzed), 21 of 86 males compared to 1 of 44 females had ARCD (P less than 0.001). Duration of dialysis therapy and age were greater in patients with ARCD (49.8 +/- 8 months, 55 +/- 4 years, respectively) compared to those with solitary cysts (28 +/- 6 months, 45 +/- 2 years) or no cysts (15 +/- 3 months, 42 +/- 2 years). The diagnostic accuracy of ultrasound (US) was compared to CT. CT is purportedly 100% accurate in the characterization of renal cysts. We are disappointed at the low level of diagnostic accuracy for both CT and US in the detection of renal cysts in chronic uremia. It appears both a negative CT and ultrasound are necessary to absolutely exclude either ARCD or solitary cyst.
Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. This case report documents a very unusual clinical appearance for this entity: a superior mediastinal mass. Also, the patient underwent multiple imaging studies that demonstrated both common (absence of septations) and unusual (extensive involvement of vertebral body with little involvement of posterior elements) characteristics of ABCs.
Determinants of 5-year survival were evaluated after complete resection of pulmonary metastases from adult soft-tissue sarcomas. Fifty-eight patients had complete resection (median survival 25 months, P = 0.0002), with a 25.8% absolute 5-year survival (15 of 58 patients); six patients had unresectable disease (median survival 6 months) and were excluded from additional analysis. Eleven patients remain disease free, with a median follow-up of 76 months. Significant independent prognostic indicators associated with improved survival (P less than 0.05) included metastasis doubling time of 40 days or greater (median survival 37 months versus 15 months if less than 40 days); unilateral disease on preoperative radiography (33 months versus 15 months if bilateral disease); three or fewer nodules on preoperative computed tomography (40 months versus 14 months if 4 or more nodules); two nodules or fewer resected (40 months versus 17 months if 3 or more nodules resected), and tumor histology (33 months for malignant fibrous histiocytoma versus 17 months for all others). Multivariate analysis identified the number of nodules detected by computed tomography preoperatively as having significant prognostic value.
Pneumothorax was induced in cadavers to determine the effects of patient positioning and imaging modality (conventional screen-film and computed radiography) on radiographic findings. Chest radiography, with cadavers in the supine frontal, erect frontal, and left lateral decubitus positions, was performed at baseline and after injection of incremental quantities of air into the pleural space. Five radiologists independently interpreted each radiograph. The ability of the radiologists to diagnose pneumothorax varied by cadaver position and depended on volume of air. Overall, the left lateral decubitus view was most sensitive (88%) for diagnosis of pneumothorax, followed by the erect (59%) and supine (37%) views. Receiver operating characteristic curves and multiple repeated measures analysis of variance revealed no statistically significant difference between diagnostic proficiency with conventional screen-film radiography and that with computed radiography. The authors conclude that the lateral decubitus view is superior to the erect and supine views for pneumothorax detection and that conventional and computed radiography perform similarly in pneumothorax detection.
We reviewed 124 patients from 1982 to 1988 who had a resected primary non-small cell lung cancer metastatic to mediastinal (N2) lymph nodes and a preoperative assessment of the mediastinum with computed tomography of the chest. Sixty-three patients studied had computed tomographic evidence of mediastinal lymph node enlargement. In these patients the survival at 5 years was only 6.6%, compared with the 5-year survival of 13.5% in 61 patients in whom the mediastinum was normal. Plain chest roentgenography with evidence of mediastinal adenopathy did not predict a poorer outcome. In addition, patients with tumors located in the left upper lobe were found to have an improved survival. These patients had a 5-year survival of 20.8%. Tumor histology, central location of the tumor, extranodal extension, and type of resection did not result in a significant survival difference.
A 55-year-old man developed a pulmonary metastasis to the azygous lobe from a malignant fibrous histiocytoma of the thigh. The azygous lobe was not identified at the initial resection. A simple technique for the identification and mobilization of the azygous lobe is presented. Preoperative identification of this anatomic variant may assist in resection of parenchymal neoplasms.