2016 FATE OF INDERMINATE/SUSPICIOUS LESIONS FOUND INCIDENTALLY ON CTKUB FOR SUSPECTED RENAL COLIC ? OUTCOMES AFTER A MINIMUM FOLLOW-UP OF 15 MONTHS

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Bhavan Rai ◽  
Robert Fleming ◽  
Samuel McClinton ◽  
Nicholas Cohen ◽  
Bhasker Somani
Keyword(s):  
Renal Colic ◽  
Suspicious Lesions

scholarly journals Incidence of appendicitis and ovarian cyst among female patients presenting with acute abdomen at a tertiary care hospital

2018 ◽  
Vol 6 (12) ◽  
pp. 3838
Author(s):  
E. Chandrasekhara Reddy ◽  
Janaki Vellanki
Keyword(s):  
Acute Abdomen ◽  
Ovarian Cyst ◽  
Renal Colic ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Time Rate ◽  
Delayed Wound Healing ◽  
Female Patients

Background: Physicians working in casualty are often confronted with acute abdomen and get much more bothered as the diagnosis is not easy. This is due to the fact that the etiology of acute abdomen is always much diversified and the classical findings are masked making the diagnosis difficult. Objective was to study incidence of appendicitis and ovarian cyst among female patients presenting with acute abdomen.Methods: A hospital based follow up study was carried out among 64 cases presented with acute abdomen to the casualty from January 2018 to August 2018. All necessary investigations were done to confirm the etiology of acute abdomen. The cases belonged to surgery and gynecology departments where they were operated. The patients were followed from admission in the casualty to the final outcome. The data was analyzed using proportions.Results: During the study period a total of 15413 patients were admitted in the casualty out of them, 64 (0.42%) presented with acute abdomen. Of these 64 cases, majority i.e. 35 (54.7%) were due to acute appendicitis; 13 cases were due to renal colic and eight cases each were due to ectopic pregnancy and ovarian cyst. The most common age group affected was 21-30 years (62.5%) followed by less than 20 years age (21.9%). 25% of the 64 cases had delayed wound healing and no other complications were reported. No death was recorded.Conclusions: Authors achieved excellent results as there were no major complications and no death was recorded. Thus, meticulous diagnosis and prompt treatment can save patient life and at the same time rate of complications can be reduced.

Is MRI suitable for conclusive work-up of suspicious findings in mammography and ultrasound?

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 3-3
Author(s):  
Kevin Strobel ◽  
Simone Schrading ◽  
Christiane K. Kuhl
Keyword(s):  
False Positive ◽  
Breast Mri ◽  
Short Term ◽  
Long Term Follow Up ◽  
Mass Lesions ◽  
Work Up ◽  
Suspicious Lesions ◽  
Made In

3 Background: The current ACR practice guidelines discourage use of MRI for work-up of suspicious findings in mammography (Mx) and ultrasound (US). We investigated whether additional breast MRI assessment of suspicious Mx and U.S. findings could improve PPV and thus possibly help reduce the number of biopsies for false positive findings in Mx or U.S. Methods: Between 06/2010 and 04/2012, a total 2,754 patients underwent DCE breast MRI. Of these, 277 underwent MRI for further work-up of suspicious findings made in Mx (n=173, 57 patients with mass lesions, 33 with asymmetries, 12 with architectural distortions, and 71 with suspicious calcifications) or U.S. (n=104, 74 with masses, 30 with miscellaneous U.S. findings such as suspected intraductal pathology, focal acoustic shadowing or architectural distortions) . All lesions categorized as MR-BIRADS 4 and 5 underwent biopsy, lesions categorized as MR-BIRADS 1 or 2 did not proceed to biopsy, except for selected women with mammographic calcifications suggestive of DCIS. Lesions categorized as MR-BIRADS 3 underwent additional short term follow-up by MRI, US and/or Mx. All women who did not undergo biopsy (MR-BIRADS 1-3) underwent long term follow-up for so far 12-24 months. Results: For suspicious lesions in mammography, MRI increased PPV from 19.3% (11/57) to 92.3% (12/13) for masses, from 3% (1/33) to 33.3% (1/3) for asymmetries, from 8.3% (1/12) to 25% (1/4) for architectural distortions and from 21.1% (15/71) to 62.5% (15/24) for calcifications. For suspicious lesions in ultrasound, MRI increased PPV from 13.5% (10/74) to 71.4% (10/14) for masses and from 3.3% (1/30) to 50% (1/2) for non-mass U.S. findings. In 4/277 patients, MRI showed additional suspicious findings, requiring MR-guided biopsy, one of which was histologically proven malignant. So far, none of the patients who, because of an MR-BIRADS 1-3, did not undergo biopsy has been diagnosed with invasive cancer or DCIS or with progressive conventional imaging findings necessitating secondary biopsy. Conclusions: MRI improves PPV for both suspicious Mx and U.S. findings, especially mass lesions. In experienced hands, careful use of MRI can help avoid biopsies for false positive diagnoses made in Mx and U.S.

scholarly journals 84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Fonseka ◽  
R Ellis ◽  
A Gowda ◽  
L Tuckwood ◽  
A Careless ◽  
...  
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Renal Colic ◽  
Electronic Patient Records ◽  
X Ray ◽  
Improved Outcomes ◽  
Acute Renal Colic ◽  
The Impact ◽  
First Time

Abstract Aim The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold; Method Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed. Results The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients. Conclusions This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.

scholarly journals Application of Skin Electrical Conductance of Acupuncture Meridians for Ureteral Calculus: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Wu-Chou Lin ◽  
Yung-Hsiang Chen ◽  
Jian-Ming Xu ◽  
Der-Cherng Chen ◽  
Wen-Chi Chen ◽  
...  
Keyword(s):  
Renal Colic ◽  
Electrical Conductance ◽  
Diagnostic Methods ◽  
Helical Computed Tomography ◽  
Ureteral Calculus ◽  
Lower Quadrant ◽  
Bladder Meridian ◽  
Acute Renal Colic ◽  
High Level

Renal colic is a common condition seen in the emergency department (ED). Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis.

Emergency Pyelography in Renal Colic

1971 ◽  
Vol 57 (2) ◽  
pp. 75-87
Author(s):  
F. A. F. Mackenzie ◽  
J. R. Kirkpatrick ◽  
R. C. Telfer
Keyword(s):  
Comparative Study ◽  
Great Improvement ◽  
Surgical Approach ◽  
Renal Colic ◽  
Renal Calculus ◽  
Point Of View ◽  
Normal Appearance ◽  
Renal Enlargement

AbstractA comparative study between the results obtained from conventional pyelography and immediate pyelography during renal colic was undertaken during a period of 18 months, at RNFf Malta.Forty-seven patients were examined and there were only four cases with no signs of renal calculus. This is a great improvement on the accuracy obtained by the delayed method. The patients with calculi were examined radiologically until the site of obstruction was determined. In patients who showed the nephrographic effect, the earliest results were obtained in one hour; the majority in two to three hours, and, in the most prolonged examination, a 10 hour follow-up was necessary. The site of the obstruction is important from the point of view of the surgical approach. The interesting feature when obstruction was demonstrated was that approximately 40 per cent of calculi were non-opaque.Estimates were also made of function and the degree of hydronephrosis. Renal enlargement was measured and the return to normal in these indirect signs was followed up in the majority of cases.In one case pyelography repeated in five days, after the passage of a small calculus, showed a return to normal. In several other cases where pyelography was repeated within two to three weeks, a normal appearance was also seen. It is in this group of patients that conventional delayed pyelography would miss the signs of pathology.

scholarly journals Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022649 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Alexis Cournoyer ◽  
Éric Piette ◽  
Judy Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Medication Use ◽  
Pain Medication ◽  
Pain Condition

ObjectivesPrescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.DesignProspective cohort study.SettingTertiary care trauma centre academic hospital.ParticipantsA convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.OutcomesQuantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.ResultsResults for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.ConclusionsPatients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.Trial registration numberNCT02799004; Results.

scholarly journals P074: Improving urology care in the emergency department through implementation of an Acute Care Urology model

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S90
Author(s):  
A. Kirubarajan ◽  
R. Buckley ◽  
S. Khan ◽  
R. Richard ◽  
V. Stefanova ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Outpatient Care ◽  
Renal Colic ◽  
Interdisciplinary Collaboration ◽  
Wait Time ◽  
Acute Care Surgery ◽  
Post Intervention ◽  
Care Surgery

Introduction: Renal colic is one of the most common presentations to the emergency department (ED), and often requires complex interdisciplinary collaboration between emergency physicians and urology surgeons. Previous literature has shown that adoption of interdisciplinary rapid referral clinics can improve both timeliness of care and patient outcomes. However, these Acute Care Surgery models have not yet been commonly adopted for urology care in the ED. Methods: In July 2016, we adopted the intervention of an Acute Care Urology (ACU) model through the creation of a rapid referral clinic dedicated to ED patient referrals, the addition of an ACU surgeon, and enhanced use of daytime OR blocks. We conducted a manual chart review of 579 patients presenting to the ED with a complaint of renal colic. Patient data was collected in two separate time periods to analyze trends before implementation of the ACU model (pre-intervention, September - November 2015), to examine the model's impact (post-intervention, September - November 2016). Secondary methods of evaluation included a survey of 20 ED physicians to capture subjective feedback through Likert scale data. Results: Of the evaluated 579 patients with a complaint of renal colic,194 patients were discharged from ED with an diagnosis of obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p <0.001). The mean time to clinic was 15.76 days (SD = 15.47, range 1-93) pre-intervention versus 4.17 days (SD = 2.33, range = 1-12) post-intervention. Furthermore, the ACU clinic allowed significantly more patients to be referred for outpatient care (p = 0.0004). There was also higher likelihood that patients would successfully obtain an appointment following referral (p = 0.0055). Decreasing trends were shown in mean ED wait time, in addition to time from assessment to procedure. Results of the qualitative survey were overwhelmingly positive. All 20 surveyed ED physicians were more confident that outpatients would be seen in a timely manner (85% strongly agree, 15% agree). Qualitative feedback included the belief that follow-up is more accessible, that ED physicians are less likely to page the on-call urologist, and that they are able to discharge patients sooner. Conclusion: The ACU model for patients with renal colic may be beneficial in reducing ED-to-clinic time, ensuring proper follow-up after ED diagnosis, and improving patient care within the ED.

C-reactive protein to predict the need for surgical intervention in acute renal colic

2013 ◽  
Vol 7 (6) ◽  
pp. 380-383 ◽  
Author(s):  
ST McSorley ◽  
M Drury ◽  
P Majumdar ◽  
A Halsall ◽  
SK Nalagatla
Keyword(s):  
Renal Colic ◽  
Surgical Intervention ◽  
Strong Predictor ◽  
Serum Marker ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
A Value ◽  
Acute Renal Colic ◽  
Emergency Surgical Intervention

Objectives: C-reactive protein (CRP) is a serum marker of systemic inflammation which has been suggested to predict need for emergent surgical intervention in patients with acute renal colic at a value of > 28 mg/l on admission.1 We aimed to determine if this applied to our patients. Patients and methods: We prospectively collected data from all patients admitted with symptomatic urolithiasis, confirmed by CT-KUB, over three months. Fifty-nine patients were included; however, four were excluded because of co-morbidites which could influence CRP, or recent urological surgery, giving N = 55, age 50.0±14.6 years (mean±SD), M:F 40:15. The decision to proceed to intervention was made by each patient’s clinical team and not by the authors; however, there was no blinding to CRP. Results: A total of 24 of 55 patients required intervention on their index admission (22 retrograde ureteric stent, one nephrostomy, one ureteroscopic stone extraction), and 31 were managed conservatively. Those undergoing intervention had higher CRP on admission (mean 16.3 vs 9.4 mg/l, p = 0.06) and higher maximum CRP (mean 94.7 vs 25.7 mg/l, p < 0.001) than those managed conservatively. Nineteen (79%) of those requiring intervention had CRP < 28 mg/l on admission. There were no deaths, no intensive care admissions and all were discharged to outpatient follow-up. Conclusion: Rising CRP during admission is a strong predictor of the need for emergency surgical intervention in patients with acute renal colic; however, CRP at admission is less useful.

scholarly journals Individualized Laparoscopic Surgery for UPJO Patients with Crossing Vessels

2021 ◽  
Author(s):  
Bobin Ning ◽  
Shuqi Du
Keyword(s):  
Laparoscopic Surgery ◽  
Renal Colic ◽  
Ureteropelvic Junction Obstruction ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Good Prognosis ◽  
Comprehensive Understanding ◽  
Crossing Vessels

Abstract Background: To characterize the anatomical subtypes of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CVs) and demonstrate the Individualized operation procedures for these cases.Methods: From March 2015 to July 2019, 51 consecutive adult patients underwent treatment of primary UPJO via a retroperitoneal laparoscopic approach. The clinical data, iconography inspection results, and surgical procedures for each patient were retrospectively reviewed by our team. The diagnosis of etiological CV was confirmed during the operation in 13 patients (25.49%), which included 7 men and 6 women. Results: The mean surgical age was 30±11.66 years. The operating time was approximately 233±62.76 minutes, and there were one open conversions. In the follow-up period (mean, 27.23±15.46 months), all patients had a full recovery in the CV group. However, 3 patients without CV did not completely recover from uronephrosis, as determined on iconography inspection, and there was no improvement in the renal colic symptoms. In the CV group, none of the patients had lithiasis whereas 25% of the patients without CV had lithiasis. Conclusion: CV accounts for approximately 25.49% of the UPJO cases. Based on the anatomical position of the UPJ and CVs, we identified two types of abnormalities, and 84.62% of the CVs were located anterior to the UPJ. The retroperitoneal approach for treating CVs had particular advantages. A comprehensive understanding and interoperative analysis of the anastomosis between the CVs and UPJ is crucial for at least 4 individual treatments. After dismembered pyeloplasty, suspension of the CVs is recommended in approximately 40% of the cases. The follow-up showed good prognosis in the long term.

scholarly journals Renal Safety after More Than a Decade of Deferasirox Use in Patients with Transfusional Hemosiderosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2466-2466 ◽  
Author(s):  
Raffaella Origa ◽  
Antonio Piga ◽  
Immacolata Tartaglione ◽  
Giuseppina Della Corte ◽  
Ali El-Ali ◽  
...  
Keyword(s):  
Renal Function ◽  
Safety Profile ◽  
Research Funding ◽  
Renal Colic ◽  
Normal Limits ◽  
Blood Creatinine ◽  
Over Time ◽  
Renal Safety

Abstract Background: Patients (pts) with transfusion-dependent anemias now have longer life expectancy due to improved quality of care, in particular iron chelation therapy (ICT). Longer life and drug exposure increase the chance of complications, such as changes in renal function, which may be age-, disease- or drug-related. In light of lifelong transfusions and dependence on ICT, it is relevant to understand the long-term ICT safety profile. Published data show some pts receiving ICT experience changes in markers of renal function, mostly within normal limits, non-progressive and reversible with dose reduction and/or interruption, although follow-up was limited to ≤5 years. This retrospective study assessed long-term renal safety of deferasirox in Italian pts with transfusional hemosiderosis who participated in the deferasirox registration studies and continued treatment for up to 10 or more yrs. Methods: Italian pts with β thalassemia, sickle cell disease, MDS or other anemias who participated in deferasirox registration studies and extensions (studies 105, 106, 107, 108 or 109), received ≥1 dose of deferasirox, had ≥1 post-baseline (BL) serum creatinine (SCr) measurement, and had medical records available could be included. BL and worst values were recorded during the prospective studies; values were collected retrospectively in 3-month periods from registration trial end until the latest pt assessment for SCr, urinary protein/creatinine ratio (UPCR) and creatinine clearance (CrCl, if available). Primary endpoint was SCr trend over time. Secondary endpoints included notable renal function values (SCr >33% increase from BL and >ULN at two consecutive measurements ≥7 days apart; CrCl <60 mL/min; UPCR ≥1.0 mg/mg) and evaluation of renal AEs from registration study end to retrospective period end. Results: Of the 366 Italian pts in the registration studies, 282 pts received ≥1 dose of deferasirox in registration studies and were included (Table). In the registration studies (n=282), mean (SD) duration of deferasirox exposure was 3.5 (1.6) yrs and mean daily deferasirox dose was 1032.2 (438.8) mg. In the retrospective period (n=215), mean (SD) duration of deferasirox exposure was 6.1 (2.8) yrs and mean daily deferasirox dose was 1385.6 (500.0) mg. 63.5% of pts received other ICT during the retrospective period either as combination therapy or alone (Table). In the overall population, mean SCr and UPCR values were within normal limits and stable over time during the retrospective period (Figure). In the registration studies, notable SCr values were observed in 12 (4.3%) pts, notable UPCR values in 16 (5.7%) pts and notable CrCl values in 17 (6.0%) pts (CrCl values missing n=91). In the retrospective period, notable SCr values were observed in 15 (5.3%) pts, notable UPCR values in 17 (6.0%) pts (UPCR values missing n=99) and notable CrCl values in 14 (5.0%) pts (missing n=207). In the retrospective period, regardless of ICT received, renal AEs were reported in 86 (30.5%) pts, severe renal AEs in 7 (2.5%) pts. 54% of pts with a renal AE took one concomitant medication associated with potential nephrotoxicity. The most common renal AEs were nephrolithiasis (n=31, 11.0%), renal colic (n=28, 9.9%), increased/abnormal UPCR (n=16, 5.7%), increased blood creatinine (n=12, 4.3%) and proteinuria (n=13, 4.6%). 8 pts (2.8%) had 10 serious renal AEs: nephrolithiasis, renal colic (n=2 each), increased blood creatinine, acute kidney injury, hematuria, hydronephrosis, renal failure, urethral stenosis (n=1 each); at the time of serious AE pts were receiving deferasirox (n=4), deferoxamine or deferiprone (n=3) or no ICT (n=1). Of 86 pts who had renal AEs, 33 (11.7%) were suspected to be deferasirox-related, most commonly increased UPCR (n=14, 5.0%), proteinuria (n=11, 3.9%) and increased blood creatinine (n=8, 2.8%). 5 (1.8%) pts discontinued because of renal AEs: increased blood creatinine, glycosuria (n=2 each), proteinuria (n=1). Conclusions: This is the longest follow-up analysis in pts with transfusion-dependent anemias available today and indicates stable renal function and a lack of any progressive worsening of renal function during long-term deferasirox treatment (3.5 yrs registration studies; 6.1 yrs retrospective period). Results support a favorable long-term risk:benefit renal safety profile for deferasirox in the treatment of transfusional iron overload. Disclosures Origa: Novartis: Honoraria; Apopharma: Honoraria. Piga:Apopharma: Honoraria; Novartis: Research Funding. El-Ali:Novartis: Employment. Han:Novartis: Employment. Castiglioni:Novartis: Employment. Forni:Novartis, Celgene: Research Funding.

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