Acquired cystic disease of the kidney and renal carcinoma in haemodialysis patients: ultrasonographic evaluation

Ultrasonography was performed in 661 dialysis patients and acquired cystic disease of the kidney was found in 156 (125 men and 31 women). A higher incidence of cystic disease was found in males. There was no significant difference between the patients with and those without acquired cystic disease in terms of average age, but the duration of haemodialysis in those with acquired cystic disease was significantly longer. There was an increased incidence of cystic disease in patients with glomerulonephritis and the duration of haemodialysis in these patients was significantly longer. This suggests that the increased incidence of acquired cystic disease of the kidneys in the patients with glomerulonephritis is simply related to the longer duration of treatment. Twelve patients with renal carcinoma were found in this study. The average age at diagnosis of renal carcinoma was not significantly different between the patients with and those without acquired cystic disease, but the duration of dialysis was significantly longer in renal carcinoma patients with acquired cystic disease. The incidence of renal carcinoma in dialysis patients with acquired cystic disease was 3.85% and in those without it was 1.19%. These rates are considerably higher than those found in the general population and indicate that the risk of renal carcinoma is higher in dialysis patients both with and without acquired cystic disease.

Comparison of ultrasonography, computerized tomography and angiography in dialysis patients with renal cell carcinoma

Seventeen dialysis patients with renal cell carcinoma were examined preoperatively by ultrasonography, computerized tomography (CT) and angiography. Ultrasonography, CT and angiography correctly predicted the diagnosis of renal cell carcinoma in 17 (100%) and 12 (71%) of 17, and 11 (69%) of 16 patients, respectively. All renal tumors of more than 3.0 cm in diameter were detected by the three diagnostic procedures. However, ultrasonography, CT and angiography detected renal tumors of less than 3.0 cm in 12 (100%) and 7 (58%) of 12 patients and 6 (55%) of 11 patients, respectively. Seven renal cell carcinomas were associated with acquired cystic disease of the kidney (ACDK). All renal tumors were found by ultrasonography. However, CT predicted the correct diagnosis in 3 (43%) of 7 patients with ACDK and in 9 (90%) of 10 patients without ACDK, and angiography was correct in 3 (50%) of 6 patients with ACDK and 8 (80%) of 10 patients without ACDK. Our results indicate that ultrasonography is an effective procedure to detect renal cell carcinomas in dialysis patients.

[Detection of renal cell carcinoma at health care center]

Abdominal ultrasonography was performed in a total of 19,933 persons at the health care center of our hospital from April 1987 to March 1991. Among them, 16 persons were diagnosed as having renal cell carcinoma and underwent operation. Renal cell carcinoma was detected in one out of 1245 persons (0.08%) by ultrasonography. Of these 16 persons, 15 were males and one was a female and they ranged in age from 38 to 64 years (average age 50.8 years). The tumors were located in the left kidney in 9 and in the right kidney in 7. Regarding the size of the resected tumors, 7 (44%) belonged to T1 and 9 (56%) to T2 by TNM classification of UICC. The minimum size of the tumors was 1.2 x 1.3 cm. Most of the patients had small renal cell carcinoma and all have survived. Abdominal ultrasonography at the health care center is the most effective method of examination for early diagnosis of renal cell carcinoma.

[Study on small renal cell carcinoma diagnosed by ultrasonography]

Sixty-seven patients underwent a resection of renal cell carcinoma in our hospital between July 1984 and Mar. 1989. Out of them 31 patients with small renal cell carcinoma less than 4 cm in diameter were examined. The proportion of small renal cell carcinoma to all renal cell carcinoma was 36% (14 patients) in the first half period (July 1984-July 1987) and 61% (17 patients) in the last half (Aug. 1987-Mar. 1989), i.e. in total more than half of all the carcinomas. The patients diagnosed by ultrasonographic screening were 25 (80%) out of the 31 patients. The incidence of small renal cell carcinoma was 4 (0.06%) out of 6892 patients in our health check-up center and 6 (1.0%) out of 610 hemodialysis patients, and they were found by ultrasonic examination. The carcinoma was protruded from the renal contour in 24 patients (77%) and was inside the renal parenchyma (23%) in 7 patients. The carcinoma in the 24 patients was associated with the deformity of its outline. The patients with a positive IVP were 5 out of 31 patients and the carcinoma in 4 out of the 5 patients was inside the renal parenchyma. Of all patients with protrusion of te renal contour, only one patient was with a positive IVP. The above findings indicate that ultrasonic examination is a useful method for the early diagnosis of small renal cell carcinoma.

Diagnosis of persistent truncus arteriosus by two-dimensional echocardiography: a case study

Two-dimensional echocardiography of a patient revealed overriding of the large aortic trunk which bifurcated above the semilunar valve, suggesting persistent truncus arterious. This diagnosis was confirmed by cardiac catheterization and angiocardiography. Surgery and autopsy also confirmed the accuracy of the two dimensional echocardiographic findings. Two-dimensional echocardiography is thus valuable in diagnosing persistent truncus arteriosus.

Ultrasonic studies on endocardial fibroelastosis

Four patients with endocardial fibroelastosis were studied by two-dimensional and M-mode echocardiography. The two-dimensional echocardiography showed the characteristic echo from the abnormally thickened endocardium of the left ventricle in every case. Of the 4 cases, 2 were still suffering from congestive heart failure at the time of the study and the other 2 had been already free from clinical symptoms. In the former group, the ultrasonic findings revealed an enlargement of the left ventricle (large left ventricular dimension index) and poor movement of the anterior mitral leaflet which was indicated by a decrease in the diastolic descent rate. The latter group presented almost normal findings concerning the above points. The ultrasonic method is thus proved to be very useful for the diagnosis and evaluation of clinical conditions in cases of endocardial fibroelastosis.

Mechanism of production of midsystolic click in a prolapsed mitral valve

In order to examine the production mechanism of the midsystolic click in cases of a midsystolic click and a late systolic murmur, the relationship between the click and the motion of the mitral apparatus was studied by means of ultrasono-cardiotomography and the simultaneous recording of phonocardiograms and ultrasono-cardiograms (UCGs). It was found that the systolic click occurred in exact coincidence with the time at which the hump of the echo of the unusual early systolic anterior motion (early SAM) took its backmost position. This coincidence was found when the click was shifted either by postural changes or inhalation of amyl nitrite. The present ultrasono-cardiotomographic study demonstrated that the echo source of the early SAM could be attributed to the protrusion into the left ventricular outflow tract of the slackened elongated chordae tendineae in systole. The anterior leaflet moved suddenly to the position of maximal prolapse when the slackened chordae tendineae were stretched taut in midsystole. In other words, the midsystolic click occurred when the anterior leaflet prolapsed and the tension exerted on the chordae tendineae was at its maximum.

Ultrasonic evaluation of anatomical abnormalities of heart in congenital and acquired heart diseases

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