Several procedures in the interventional radiology for the urogenital system are reviewed herein. Interventional radiology has advanced rapidly in recent years as new technologies have become available. Arterial embolization of uterine fibroids is an example. Pelvic varices are frequently encountered in the general population and can be directly associated with a significant morbidity. The affected venous axes can be easily catheterized in a selective, retrograde manner and then can be occluded through this minimally invasive route, avoiding major surgical complications while giving comparable results. Interventional uroradiologic techniques have had a major impact on the care of the urologic patients by allowing non-operative treatment in many diseases. This article also reviews percutaneous nephrostomy with an emphasis on urologic calculi, interventional therapy for neoplasms and trauma to the urinary tract, treatment of renovascular hypertension, and the management of renal cysts.
Calculi ; Catheters ; Humans ; Hypertension, Renovascular ; Leiomyoma ; Nephrostomy, Percutaneous ; Radiology, Interventional* ; Urinary Tract ; Urogenital System* ; Varicose Veins

Percutaneous drainage of liver abscess is an effective treatment, but the success rate is low for liver abscess that has septa and is multilocular. We experienced one case of successful treatment of multilocular liver abscess using administration of Urokinase into an abscess cavity during the course of percutaneous drainage.
Abscess ; Catheters* ; Drainage* ; Liver Abscess* ; Liver* ; Urokinase-Type Plasminogen Activator*

PURPOSE: To evaluate the difference in each procedure time and complication rates related to percutaneous transhepatic biliary drainage(PTBD) via the right and the left hepatic lobe. MATERIALS AND METHODS: We performed PTBD in 120 patients with biliary obstruction below both main hepatic ducts. Of the 120 catheters, 54 were introduced via a left lobe approach and 66 through the right lobe. All procedures were performed under fluoroscopic guidance by the same operator. For each patient, procedure time was recorded prospectively. PTBD related complications were classified as either early(up to 30 days after procedure) or late(after 30 days), and each complication graded as major, or minor according to its intensity. RESULTS: The difference in the mean procedure time(28.8min versus 36.2rain, left versus right approach group) and that in complication rates (37% versus 58%) were statistically significant(p<0.05). Concerning major complications(bile peritonitis, sepsis, massive hemobilia, liver abscess, pyothorax), the percentages related to left and right lobe approach were 1.8% and 10.6%, and concerning minor complications(catheter obstruction or dislodgement, transient hemobilia, persistent fever or pain), the percentages were 36%and 51%respectively. CONCLUSIONS: PTBD via the left lobe approach was superior with short procedure time and low complication rates than the right approach.
Catheters ; Fever ; Hemobilia ; Hepatic Duct, Common ; Humans ; Liver Abscess ; Peritonitis ; Prospective Studies ; Sepsis

PURPOSE: To evaluate the effectiveness, patency and safty of a self-expandable nitinol stent for palliative treatment of malignant stricture of gastroesophageal junction. MATERIALS AND METHODS: An esophageal stent was inserted in five consecutive patients with malignant stricture of esophagogastric junction. Histologicaily, four cases were adenocarcinoma, and one was squamous cell carcinoma. The location and severity of stricture were evaluated with gastrografin just before stent insertion. In one patient with past subtotal gastrectomy, esophagography revealed fistulous tract at stricture site. RESULTS: No technical failure or procedural complications occurred, and improvement of dysphagia was noted in all patients soon after stent insertion. On follow up esophagograms performed 3 to 7 days after stent insertion, all stents were completely expanded and unchanged in positions. In one patient with fistulous connection at stricture site, esophagogram immediately after the procedure revealed complete occlusion of the fistula. Three patients died within 4, 7 and 8 consecutive months after stent insertion. Two patients are alive maintaining adequate body weight and passing most diet. CONCLUSIONS: Self-expandable nitinol stent with it's good longitudinal flexibility and efficient radial force was effective in the palliative treatment of dysphagia in patient with malignant stricture at esophagogastric junction.
Adenocarcinoma ; Body Weight ; Carcinoma, Squamous Cell ; Constriction, Pathologic* ; Deglutition Disorders* ; Diatrizoate Meglumine ; Diet ; Esophagogastric Junction ; Fistula ; Follow-Up Studies ; Gastrectomy ; Humans ; Palliative Care ; Pliability ; Stents*

PURPOSE: Choroid Plexus papilloma is a rare intracranial neoplasm that is most commonly found in the trigone of the lateral ventricle in children or in the fourth ventricle in adult. Extraventricular extension of choroid plexus papilloma has been rarely reported within the cerebellopontine angle (CPA) cistern. Authors report two cases of choroid plexus papilloma in the posterior fossa seen on magnetic resonance imaging (MRI). MATERIALS AND METHODS: MRI findings of two cases of choroid plexus papilloma in posterior fossa were retrospectively reviewed. RESULTS: In the first case, the tumor was in the fourth ventricle and extended to the left CPA cistern via the foramen of Luschka. In the second case, the tumor presented as an expansile mass of the of fourth ventricle and right lateral recess. Multiple signal voids of low intensity due to prominent feeding vessels and calcifications within the tumors were noted. CONCLUSION: This report demonstrates MR findings of choroid plexus papilloma in the posterior fossa with the brief review of the literatures.
Adult ; Brain Neoplasms ; Cerebellopontine Angle ; Child ; Choroid Plexus* ; Choroid* ; Fourth Ventricle ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging ; Papilloma, Choroid Plexus* ; Retrospective Studies

PURPOSE: To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. MATERIALS AND METHODS:Medical records, anglographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the anglographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). RESULTS: Rebleeding occured in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non-recurred cases showed severe neovascularity. More than three anglographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non-recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non-recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. CONCLUSION: The history of repeated hemoptysis, severe neovascularity, variable anglographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.
Aneurysm ; Arteries ; Diffusion ; Follow-Up Studies ; Hemoptysis* ; Humans ; Recurrence ; Retrospective Studies

Spontaneous infrarenal abdominal aortic dissection (SIAAD) is a rare entity with various clinical presentations. We recently encountered the even rarer condition of a female patient suffering from chronic SIAAD with multiple intimal flaps and prominent lumbar artery collaterals; this all caused stenotic changes of the infrarenal abdominal aorta and produced progressive lower extremity pain and claudication in both her legs. This patient's condition was successfully managed by primary stent placement followed by balloon angioplasty.
Angioplasty, Balloon ; Aorta, Abdominal ; Arteries ; Female ; Humans ; Leg ; Lower Extremity ; Stents*

PURPOSE: To evaluate the therapeutic effect and difficulty of embolization of pseudaneurysm of the splanchnic artery. MATERIALS AND METHODS: Between February 1988 and June 1996, we employed transcatheter embolization to treat a total of eleven patients with splanchnic artery pseudoaneurysm by transcatheter embolization. Eight were males and three were females ; their ages ranged from four to 70 years (mean 44). Three patients had previously been operated on, three had undergone biopsy, and on three, percutaneous transhepatic biliary drainage had been performed ; one had been involved in a traffic accident and one had suffered a gun-shot wound. All patients underwent diagnostic angiography and superselective embolization using a 3F microcatheter. We used Gelfoam with microcoil four times, microcoil twice, Gelfoam once, Gelfoam with ethanol once, a detachable balloon once, and Ivalon once. RESULTS: Arteries in which pseudoaneurysm had occurred were as follows: renal, four, hepatic, three; gastroduodenal, two ; superior mesenteric, one. Nine patients underwent one session of procedure and two underwent two session. Nine patients (82%) were treated successfully and without complication by embolization. Two patients failed to embolize due to vascular spasm and tortuosity in one and a wide aneurysmal neck in the other ; one of these died six days later and the other was operated on. CONCLUSION: Although there are therapeutic difficulties in cases of vascular spasm, tortuosity, or a wide aneurysmal neck, embolization of pseudoaneurysm of the splanchnic artery is a safe and effective life-saving procedure.
Accidents, Traffic ; Aneurysm ; Aneurysm, False* ; Angiography ; Arteries* ; Biopsy ; Drainage ; Ethanol ; Female ; Gelatin Sponge, Absorbable ; Humans ; Male ; Neck ; Spasm ; Wounds and Injuries

A lateral chest radiograph is frequently useful and sometimes decisive in detecting chest pathology. Certainparts, such as the posterior wall of the bronchus intermedius (PWBI) and subcarinal regions, can be evaluated onlyon lateral chest radiograph. The authors present and emphasize the findings of PWBI and subcarinal abnormalities. Abnormal PWBI, more than 3 mm thick, is seen in cases of minor degree of oblique position, pulmonary edema, inflammation, neoplasm and enlarged lymph nodes. It can also be seen in patients with subcarinal mass. The findings of subcarinal mass on lateral view are ill-defined increased opacity, fullness of the inferior hilarregion, doughnut sign, extra-density and thickening of the PWBI. Detection of changes in the PWBI and subcarinalregion may be the only diagnostic evidence of hilar and subcarinal disease and helps in its early detection priorto computed tomography.
Bronchi* ; Humans ; Lymph Nodes ; Pathology ; Radiography, Thoracic* ; Thorax*

PURPOSE: To assess the combined effectiveness of angioinfarction and immunotherapy for improving survival in patients with stage IV renal cell carcinoma. MATERIALS AND METHODS:During the past 3 years, 13 patients of stage IV renal cell carcinoma were treated with angioinfarction and immunotherapy. Angioinfarction was performed on these 13 patients using absolute ethanol and occlusive baloon catheter. After angioinfarction, Interferon alpha was used for immunotherapy. For our analysis, 12 control patients of stage IV renal cell carcinoma without treatment were included in the study. Survival has been calculated according to the Kaplan and Meier method. RESULTS: The 1 year survival rate and median survival time in patients treated with angioinfarction and immunotherapy, were 46% and 13 months and in patients without treatment, 16% and 4 months, respectively. CONCLUSION:The combined treatment of angioinfarction and immunotherapy is of considerable value for improving survival in patients with stage IV renal cell carcinoma
Carcinoma, Renal Cell* ; Catheters ; Ethanol ; Humans ; Immunotherapy* ; Interferon-alpha ; Survival Rate