Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.

1986 ◽  
Vol 4 (4) ◽  
pp. 576-583 ◽  
Author(s):  
T O'Rourke ◽  
C B George ◽  
J Redmond ◽  
H Davidson ◽  
P Cornett ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Metastatic Disease ◽  
Compression Fracture ◽  
Benign Disease ◽  
Plain Radiographs ◽  
Spinal Ct ◽  
Epidural Compression ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.

scholarly journals A tissue-engineered urinary conduit in a porcine urinary diversion model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Arkadiusz Jundziłł ◽  
Piotr Kwieciński ◽  
Daria Balcerczyk ◽  
Tomasz Kloskowski ◽  
Dariusz Grzanka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Urinary Diversion ◽  
Porcine Model ◽  
Histological Evaluation ◽  
Metabolic Complications ◽  
Group 3 ◽  
Group 2 ◽  
The Right ◽  
Group 1

AbstractThe use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant’s remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.

scholarly journals Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

2018 ◽  
Vol 26 (7) ◽  
pp. 552-557 ◽  
Author(s):  
Lieven P Depypere ◽  
Johnny Moons ◽  
Toni E Lerut ◽  
Willy Coosemans ◽  
Hans Van Veer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Metastatic Disease ◽  
Palliative Resection ◽  
Oligometastatic Disease ◽  
Group 3 ◽  
Group 2 ◽  
Curative Esophagectomy ◽  
Group 1 ◽  
Single Organ

Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with potentially resectable esophageal cancer were sheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients, a potentially curative esophagectomy was performed. In 12 patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of metastases; 10 of them had oligometastatic disease (≤4 single-organ metastases). Esophagectomy was not performed in 117 patients (because of disease progression in 50); 14 were also single-organ oligometastatic. Data of 10 single-organ oligometastatic patients who underwent esophageal resection (group 1) were compared those of 10 non-resected but treated counterparts (group 2) and with 228 patients who underwent potentially curative esophagectomy with persistent pathological lymph nodes (group 3). Results Five oligometastatic esophagectomy patients had lung metastases: 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. Two oligometastatic non-resected patients had lung, 5 liver, and 3 brain metastases. Median overall survival was 21.4, 12.1, and 20.2 months in the respective groups (group 1 vs. group 2  p = 0.042; group 2 vs. group 3  p = 0.002; group 1 vs. group 3  p = 0.88). Conclusions Survival is longer in patients undergoing palliative esophagectomy with unexpected single-organ oligometastatic disease and comparable to survival in patients with persistent pathological lymph nodes. Palliative resection in these patients seems to be justified.

scholarly journals The clinical implications of incidental coronary artery calcification in routine, non-triggered high-resolution thoracic computed tomography: a retrospective study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Saluja ◽  
J Sobolewska ◽  
K Khan ◽  
H Contractor ◽  
L.J Mitchell ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Risk Factor ◽  
Coronary Artery ◽  
High Resolution ◽  
Independent Risk Factor ◽  
Incidental Finding ◽  
Agatston Score ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Coronary artery calcium (CAC) is a marker of atherosclerosis and an independent risk factor for cardiac-related mortality. The measurement of this score has traditionally been based on using ECG triggered computed tomography (CT). However, CAC, identified on non-contrast high resolution chest computed tomography (HRCT), should be considered diagnostic for coronary artery disease (CAD). We aimed to evaluate the incidental prevalence and burden of CAC on non-gated HRCT thorax used for patients undergoing lung cancer screening or follow-up for interstitial lung disease. We also assessed how often Radiologists reported CAC as an incidental finding on these scans. Methods Computerised Radiology Information Service (CRIS) was manually searched to determine all HRCT scans performed in our Trust from 01/05/2018 to 01/05/2019. The reports issued by Radiologists and images of selected studies were reviewed. Results 2185 HRCT scans were performed over this period. Patients were divided into three groups of age <50 (Group 1); 50-<60 (Group 2) and 60 (Group 3). 100 scans were randomly selected from each group using a random number generator to give a total of 300 patients. The mean ages of patients in Group 1, 2 and 3 were 48.3±2.3, 54.8±2.4 and 65±3.2 respectively. There was, approximately, the same number of males as females in each group. CAC was noted in 15% of scans in Group 1, 82% of scans in Group 2 and 94% scans in Group 3. CAC was only noted in 1/15 (6.7%) of scan reports in Group 1, 41/82 (50%) in Group 2 and 37/94 (39.4%) in Group 3. Among the 79 patients with radiologist-reported incidental CAC, statin and aspirin prescriptions increased by approximately 7 percentage points each. A diagnosis of CAD was eventually made in 9 (11.4%) patients through functional imaging or coronary angiogram. Two authors independently calculated the Agatston scores of HRCT scans whose reports did not comment on the degree of calcification. We excluded 15/112 (13.4%) scans as they were uninterpretable due to motion artefacts. Of the remaining 97 scans analysed 58/97 (59.8%) had severe CAC with an Agatston score of >400 with the remaining showing moderate calcification (101–400). Cohen κ agreement between the two authors rating was 0.90 (95% confidence interval [CI] 0.87–0.96). Group 2 and 3 had significantly more patients with severe CAC then group 1 (p<0.001). Left anterior descending artery was most commonly affected. Conclusion This study shows that CAC is under reported on non-gated HRCT scans which represents a missed opportunity to implement strategies for primary and secondary prevention. Given that respiratory disease is an independent risk factor for developing cardiac disease, it is incumbent upon the interpreting clinician to report all findings and ensure that critical findings are highlighted. The images of calcified coronary arteries may also potentially have a role in convincing people to make correct lifestyle choices. Funding Acknowledgement Type of funding source: None

Effect of age on the performance of single detector helical computed tomography in suspected pulmonary embolism

2004 ◽  
Vol 91 (02) ◽  
pp. 296-299 ◽  
Author(s):  
Henri Bounameaux ◽  
Arnaud Perrier ◽  
Marc Righini
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Diagnostic Yield ◽  
Helical Ct ◽  
Helical Computed Tomography ◽  
Suspected Pulmonary Embolism ◽  
Predictive Values ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryThe prevalence of pulmonary embolism increases with age, but reduces the diagnostic yield of ventilation-perfusion lung scan age. Helical computed tomography (hCT) is widely used to diagnose pulmonary embolism, and should be less susceptible to the influence of age. We studied the influence of age on the performance of hCT to verify that hypothesis. We analyzed a database of 299 consecutive outpatients suspected of pulmonary embolism, in whom pulmonary embolism was diagnosed according to accepted criteria, and who were all submitted to a helical CT. We divided the patient population into tertiles, corresponding to the following age categories: less than 59 years (group 1), 60 to 75 years (group 2), and over 75 years (group 3). Sensitivity and specificity of hCT were calculated in each age category. Overall sensitivity was 70% (95% CI: 62 to 78) and specificity was 91% (95% CI: 86 to 95). Sensitivity was 81% (95% CI: 64 to 93) in group 1, 63% (95% CI: 46 to 78) in group 2, and 67 % (95% CI: 52 to 80) in group 3.The corresponding values for specificity were 92% (95% CI: 82 to 97) in group 1, 86% (95% CI: 75 to 94) in group 2 and 96% (95% CI: 87 to 100) in group 3. Positive predictive values ranged from 75% to 94% and negative predictive values from 77% to 94%. Our data suggest that age does not have a marked influence on the diagnostic performances of hCT in clinically suspected pulmonary embolism.

Investigation of relation between visceral and subcutaneous abdominal fat volumes and calcified aortic plaques via multislice computed tomography

Vascular ◽  
2014 ◽  
Vol 23 (4) ◽  
pp. 396-402 ◽  
Author(s):  
Duran Efe ◽  
Fatih Aygün ◽  
Türker Acar ◽  
Melda Yildiz ◽  
Kazım Gemici
Keyword(s):  
Computed Tomography ◽  
Visceral Fat ◽  
Multislice Computed Tomography ◽  
Subcutaneous Fat ◽  
Volume Group ◽  
Group 3 ◽  
Group 2 ◽  
Aortic Plaques ◽  
Fat Volume ◽  
Group 1

Objective The present study investigated effect of subcutaneous fat volume and abdominal visceral fat volume on aortic atherosclerosis via multislice computed tomography. Materials and methods The present study comprised 424 subjects who underwent non-contrast-enhanced abdominal CT in our clinic between June 2012 and June 2013. Using dedicated software visceral fat volume was calculated for each individual and then subcutaneous fat volume was calculated by subtracting visceral fat volume from total fat volume. By dividing visceral fat volume/subcutaneous fat volume participants were assigned to three groups according to their mean visceral fat volume/subcutaneous fat volume: Group 1 consisted of subjects with visceral fat volume/subcutaneous fat volume lower than 0.48 (Group 1 < 0.48); Group 2 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.48 and lower than 0.69 (0.48 ≤ Group 2 < 0.69); and Group 3 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.69 (Group 3 ≥ 0.69). Results The mean abdominal aortic calcium scores according to Agatston scoring (au) were 136.8 ± 418.7 au in Group 1, 179.9 ± 463 au in Group 2 and 212.2 ± 486.9 in Group 3, respectively. Conclusions We have demonstrated a significant correlation between visceral fat volume and abdominal aorta atherosclerosis, while there was absence of significant correlation between subcutaneous fat volume and abdominal atherosclerosis.

scholarly journals Buccolingual inclination of molars in untreated children and adults: A cone beam computed tomography study

2018 ◽  
Vol 89 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Brianna Yang ◽  
Chun-Hsi Chung
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cone Beam ◽  
Maxillary Molars ◽  
Computed Tomography Images ◽  
Group 3 ◽  
Left And Right ◽  
Group 2 ◽  
Mandibular First Molar ◽  
Group 1

ABSTRACT Objectives: To evaluate and compare the buccolingual inclinations of maxillary and mandibular first molars in untreated children and adults. Materials and Methods: One hundred and thirty-eight subjects were selected and divided into three groups, as follows: (1) age 6–9 years, N = 46; (2) age 10–19 years, N = 56; and (3) age 25–35 years, N = 36. For each subject, existing cone beam computed tomography images were used, and the long axis for each maxillary and mandibular first molar was determined. The converge angles formed by the long axis of left and right maxillary first molars and by the long axis of left and right mandibular first molars were measured. Results: The maxillary molars exhibited buccal inclination, with the converge angle of 21.1° ± 9.5° in group 1, 17.3° ± 8.6° in group 2, and 9.3° ± 7.3° in group 3. Statistically significant differences were found between groups 1 and 3 and groups 2 and 3, but not between groups 1 and 2. The mandibular molars exhibited lingual inclination, with the converge angle of 34.9° ± 11° for group 1, 26.6° ± 9.2° for group 2, and 26.1° ± 7.7° for group 3. Statistically significant differences were found between groups 1 and 2 and groups 1 and 3, but not between groups 2 and 3. Conclusions: Maxillary first molars exhibited buccal inclination. Adults displayed less inclination than did children. Mandibular first molars exhibited lingual inclination. Adults displayed less inclination than did children. Some degree of curve of Wilson should be maintained at the end of orthodontic treatment to fulfill physiologic needs and stability.

scholarly journals 1050 Normal imaging findings after aortic valve implantation on 18f-fluorodeoxyglucose positron emission tomography with computed tomography and computed tomography angiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A R Wahadat ◽  
W Tanis ◽  
A Scholtens ◽  
M Bekker ◽  
L Graven ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Imaging Findings ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Group 3 ◽  
18F Fdg ◽  
Group 2 ◽  
Group 1

Abstract Purpose Although 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) with computed tomography (CT) and cardiac computed tomography angiography (CTA) are essential tools in diagnosing prosthetic heart valve (PHV) endocarditis, the normal imaging findings in the first year after PHV implantation on 18F-FDG-PET/CT and CTA have not been studied prospectively. We prospectively assessed the perivalvular FDG uptake at different time points after aortic PHV implantation and assessed the normal imaging findings on CTA. Materials and methods Patients who had undergone uncomplicated aortic PHV implantation were included and underwent 18F-FDG PET/CT and CTA at 5(±1) weeks (group 1), 12(±2) weeks (group 2) or 52(±8) weeks (group 3) after implantation. After a preparatory diet to suppress normal myocardial glucose uptake, FDG uptake in the myocardium as well as around the PHV was scored using the Qualification Visual Score for Hypermetabolism (QVSH) as "none" (&lt; mediastinum), "low" (&gt; mediastinum but &lt; liver), "intermediate" (&gt; liver), or "high" (intense uptake) and quantitative analysis was performed with maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio) on standardized European Association of Nuclear Medicine Research Ltd. (EARL) reconstructions by an experienced nuclear medicine physician. CTA was analysed for image quality, artefacts and stranding of the peri-aortic fat by a cardiac radiologist. Results In total 37 patients (group 1: n = 12, group 2: n = 12, group 3: n = 13) (age 66 ± 8 years) were included. Myocardial FDG uptake was intermediate or less in 29/37 scans (78%). QVSH around the PHV was 8/12(67%) low and 4/12(33%) intermediate in group 1, 7/12(58%) low and 5/12(42%) intermediate in group 2 and 8/13(62%) low and 5/13(38%) intermediate in group 3 (p = 0.91). No scan was scored as "none" or "high". EARL SUVmax was 3.48 ± 0.57, 3.50 ± 0.59 and 3.34 ± 0.55 (mean ± SD, p = 0.77) and EARL SUVratio was 2.00 ± 0.29, 1.96 ± 0.41 and 1.71 ± 0.26 (mean ± SD, p = 0.07) for groups 1, 2 and 3, respectively. One patient in group 3 refused to undergo the additional CTA and one CTA in group 3 could not be analysed for image quality and artefacts due to techniqual difficulties. Overall CTA image quality was "good" or "excellent" with an artefact score of "virtually none" or "mild" in most cases (n = 33, 94%). Stranding of peri-aortic fat was seen in 27/35 (77%) of these patients (group 1: n = 11; group 2: n = 9; group 3: n = 7) with no signs of FDG uptake on PET/CT scan. Conclusion Baseline FDG uptake around aortic PHV at 5, 12 and 52 weeks after implantation is similar and mild in the majority of cases with an overall mean SUVmax and SUVratio of 3.44 ± 0.56 and 1.89 ± 0.34 respectively. CTA revealed baseline post-surgical findings in the first year after PHV implantation.

scholarly journals Analysis of The Distribution Characteristics of Thoracolumbar Compression Fractures

2020 ◽  
Author(s):  
Ming-Xue Che ◽  
Ming-Xi Liu ◽  
Shao-Kun Zhang ◽  
Zhen-Shan Lv ◽  
Yuan-Zhe Jin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Osteoporotic Fracture ◽  
Financial Burden ◽  
Compression Fracture ◽  
P Value ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background : Vertebral compression fracture (VCF) is the most common osteoporotic fracture which significantly decreases patient’s quality of life and high risk of subsequent osteoporotic fracture. VCFs also result in substantial financial burden on the public health system. Studying the characteristics of VCFs with analyzing the distributional differences by age and sex is meaningful for us to prevent and treat the VCFs.Methods: We retrospectively reviewed the patients with thoracolumbar VCF from December 2012 to June 2018 in our department. A total of 675 cases met the study inclusion criteria for analysis. We divided the patients into four groups by age with every 10 years from 50 to 89 years old. Morbidity in each sex, the occurrence of single- or multisegment fractures and the distribution of fractures from T7 to L5 was calculated for every group. All the data was tested by SPSS.Results: The highest proportion of male patients was in Group 4 (80-89 years old), and the lowest was in Group 2 (60-69 years old). The highest and lowest proportion of female patients was in Group 2 and Group 4, P value < 0.05.The highest proportion of multisegment fractures was in Group 3 (70-79 years old), and the lowest was in Group 1 (50-59 years old). The highest proportion of single-segment fractures was in Group 1, and the lowest was in Group 3, P > 0.05.Compared with the other vertebral fractures, L4 had P <0.05; others were all >0.05.Conclusions: As affected by individualized stress mechanisms of different vertebras and degree of osteoporosis, thoracolumbar VCFs have different characteristics that could assist physicians in carefully selecting treatment regimens to reduce pain and complications and improve the quality of life of patients.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

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