Fifteen cases of renal angiomyolipoma not associated with tuberous sclerosis are presented. The clinical and radiological features, the pathology and the management of these rare but well-documented tumors are discussed. They pose problems in diagnosis, and controversy still exists regarding their management. Additional techniques such as ultrasonography and computerized tomography may help in the diagnosis. When conservative surgery is not possible, or when a solid tumor cannot be confidently excluded, nephrectomy should be performed.

Among retroperitoneal injuries in lumbar disc surgery ureteral transection is a rare complication and only 8 cases have been reported so far. They are analysed and a ninth case is added and described. In this case the complication was recognized immediately and successfully treated by end-to-end anastomosis of the ureter with an internal stent. Usually the diagnosis was delayed due to uncharacteristic symptoms (fever, haematuria, abdominal pain and distension, ileus, palpable mass etc.) which led to septic courses and nephrectomy in 3 cases. The anatomical relationship of the lumbar spine and retroperitoneal structures is illustrated by CT scans. Factors contributing to these injuries and ways of recognizing and preventing complications are discussed.

No abstract

The authors' own experiences concerning the prenatal diagnosis and postnatal course in 26 foetuses with anomalies of the urinary tract are reported. The malformations observed can be separated into five groups which can also be distinguished sonographically: Urinary tract malformations of poor prognosis, Unilateral cystic kidneys. Hydronephroses, Urinary tract malformations with ascites, Urinary tract malformations in combination with other anomalies of poor prognosis. Sonographic differentiation of the multicystic kidney (Potter type IIA) from the hydronephrosis is usually possible. The recognition of cystic renal dysplasia in urinary tract obstructions (Potter type IV) and the differentiation of renal hypoplasia from renal agenesis is difficult. The dilatation of the urinary system has to be generally regarded as an unspecific symptom, the cause of which can be finally clarified only in the postnatal period. Prenatal invasive diagnostic procedures were carried out only in two foetuses. A concomitant anhydramnios was always associated with a poor prognosis. In the case of unilateral of bilateral dilatation of the urinary tract with normal or slightly diminished amniotic fluid volume, induction of labour or prenatal intervention for drainage in utero was not indicated. The prognosis was infaust in 15 foetuses. One infant died of an unknown cause. Out of 10 surviving infants, six were successfully operated on, in three the dilatation of the urinary tract resolved spontaneously, and one child with prune belly-syndrome has to be catheterised daily.

Der ungewöhnliche Verlauf einer Patientin mit metastasiertem Nierenzellkarzinom wird dargestellt. Durch einen zerebralen Krampfanfall wegen einer Hirnmetastase des Nierenzellkarzinoms wurde die Patientin erstmalig symptomatisch. Nach operativer Entfernung der Hirnmetastase und der tumortragenden Niere muûte eine weitere Metastase im rechten Lungenflügel exstirpiert werden. Anschlieûend wurde eine Immunbehandlung mit autologer Tumorzellvakzine eingesetzt. Seither ist die Patientin tumorfrei. Da es sich um solitäre operable Metastasen in umschriebenen Organsystemen handelte, wurde eine chirurgische Sanierung angestrebt. Der ausschlieûliche Einsatz einer Immuntherapie mit autologer Tumorzellvakzine erbringt im metastasierten Stadium nur marginale Remissionszahlen. Trotzdem besteht eine Berechtigung zur adjuvanten Tumorzellvakinierung, deren Wert jedoch nur innerhalb prospektiver randomisierter Phase III Studien exakt beurteilbar sein wird.