Eighteen consecutive patients with acute spontaneous perinephric hemorrhage were examined with computed tomography (CT) (n = 18), ultrasonography (US) (n = 15), and angiography (n = 9). Renal cell carcinoma was found in 10 patients; angiomyolipoma, three; and segmental renal infarction, arteriovenous malformation (AVM), hemorrhagic cyst, abscess, and idiopathic hemorrhage, one each. Initial CT examinations demonstrated the extent of hemorrhage in all cases and a distinct mass in 12 (67%), with CT characteristics suggestive of the correct diagnosis in 11. In the other six patients (33%), a discrete mass was not seen at initial CT, and in five cause of hemorrhage was not clear. Two of the five underwent follow-up CT, which correctly demonstrated carcinoma in both. Overall, CT findings suggested the correct diagnosis in 14 patients (78%). US was sensitive for detection of an abnormality but nonspecific as to its nature. Angiography demonstrated unsuspected AVM in one patient, segmental renal infarction seen at CT in one, but only one of five carcinomas suspected at CT. Data from this study suggest that CT is the most valuable examination for patients with spontaneous renal hemorrhage.

Because of the success of this approach, the adoption of an automated biopsy gun technique that includes histologic examination of a core specimen should be considered by all radiologists who perform image-guided biopsies.

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SUMMARY1. Effects of the platelet secretagogues thrombin and Concanavalin A (Con A) on shape change and release have been studied under conditions where external Ca2+ and ADP have been controlled.2. In the absence of detectable aggregation both Con A-and thrombin-induced release of serotonin are markedly dependent upon extracellular calcium.3. Con A, unlike thrombin, does not produce aggregation in calcium-supplemented medium.4. The above property of Con A suggests that, in combination with added creatine phosphate and creatine phosphokinase, this ligand will be of value in the analysis of calcium-dependent release in platelets.

A scoring system has previously been developed to diagnose intrauterine growth retardation (IUGR) based on three parameters: estimated fetal weight, amniotic fluid volume, and maternal blood pressure status. To test the IUGR score prospectively, the authors computed the score in 356 third-trimester fetuses, 39 growth retarded and 317 normal, scanned within 2 weeks prior to delivery. The IUGR score identified three groups, each with a distinct probability of IUGR: A score below 50 virtually excludes IUGR (3% probability), a score above 60 allows confident diagnosis (74% probability), and score of 50-60 is indeterminate (13% probability). The IUGR score performed best in patients with accurate dating by early ultrasound (US), but even among patients lacking accurate dating, the performance of the IUGR score was superior to that previously reported for any single sonographic parameter. The IUGR score can be used in any US facility to diagnose or exclude third-trimester IUGR.

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