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Re: Puzzler?? 24 week ob with severe left flank pain From: art fougner, md (evsono@pipeline.com) Wed Aug 27 13:47:10 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bernard Cristalli: "Re: Bernard endometrial ablation details" Previous message: Robert J Woolley: "Re: Puzzler?? 24 week ob with severe left flank pain" In reply to: ATFSOCCER@aol.com: "Re: Puzzler?? 24 week ob with severe left flank pain" At Wed, 27 Aug 1997, ATFSOCCER@aol.com wrote: > >In a message dated 97-08-26 04:07:48 EDT, you write: > ><< I'll bet you find a ureteral stone on CT scan. (But I won't bet the Farm) >>> >Dan, > >Thanks for the input. I agree. Any idea what the incidence of missed stones >is on an IVP. I could not find any numbers but I would guess there would >be a false negative rate of at least 1-3%. > >Pain resolved day before CAT was scheduled. > >Thanks again. > >Andy Hi thought these might be of interest re: dx of ureteral stone. Article Title: Ultrasound diagnosis of ureteral stones: its usefulness with subsequent excretory urography. Article Source: J Urol 1988 Jul;140(1):28-31 Author(s): Saita H; Matsukawa M; Fukushima H; Ohyama C; Nagata Y Abstract: The diagnostic accuracy of ultrasound scanning and excretory urography was compared in 157 patients with ureteral stones. Over-all, the diagnostic accuracy rates were 78.3 per cent for ultrasound scanning and 81.5 per cent for excretory urography. These rates were 83.2 and 85.0 per cent, respectively, in 107 cases of upper ureteral calculi, and 68.0 and 74.0 per cent, respectively, in 50 cases of lower ureteral stones. When the studies were combined the diagnostic accuracy rates increased to 98.1, 94.0 and 96.8 per cent for upper, lower and all stones, respectively. Ultrasound scanning is useful in the diagnosis of ureteral stones, especially in patients with ureteral colic. However, ultrasound combined with subsequent excretory urography is the most reliable method for the diagnosis of ureteral calculi. Bladder filling is a useful diagnostic aid for ultrasound scanning of lower ureteral calculi. Author's Address: Department of Urology, Nakagami Hospital, Okinawa, Japan. Major Subject Heading(s): Ultrasonography; Ureteral Calculi [diagnosis]; Urography Minor Subject Heading(s): Adult; Ureteral Calculi [radiography] Article Title: Ultrasonography for diagnosis of obstructing ureteral calculus. Article Source: Scand J Urol Nephrol 1988;22(4):275-7 Author(s): Kuuliala IK; Niemi LK; Ala-Opas MY Abstract: The reliability of ultrasonography in diagnosing ureteral obstruction caused by calculus was prospectively investigated. In 60 consecutive cases sonograms were compared with excretory urograms. The sonographic diagnosis was correct in 27 (79%) of the 34 cases shown by urography to have ureteral obstruction, and the sonograms showed the causal calculus in 17. The rate of false negative sonographic diagnosis was thus 21%. In two patients with no urographic abnormality, the sonograms indicated ureteral calculus without signs of obstruction. Ultrasonography may be used as an alternative to emergency urography for initial imaging in cases of suspected ureteral obstruction, but urography remains the standard method for evaluating the obstructed urinary tract, due to its greater accuracy and ability to assess renal function. Author's Address: Department of Radiology, Central Hospital of Kanta-Hame, Hameenlinna, Finland. Major Subject Heading(s): Ultrasonography; Ureteral Calculi [diagnosis]; Ureteral Obstruction [diagnosis] Article Title: CT scanning in the diagnosis and management of radiolucent urinary calculi. Article Source: Br J Urol 1988 Nov;62(5):405-8 Author(s): Dean TE; Harrison NW; Bishop NL Abstract: The diagnosis of non-opaque calculi can be difficult. In 4 patients with protracted symptoms, 2 had renal pelvic filling defects, 1 a possible filling defect and 1 complete obstruction of the ureter at L4. Non-opaque calculi were readily diagnosed by CT scanning. Three patients have successfully undergone surgery (2 open, 1 percutaneous) and 1 awaits percutaneous nephrolithotomy. Of two stones available for analysis, one was composed of uric acid and the other calcium and phosphate. We recommend CT scanning as the investigation of choice for unexplained filling defects in the renal pelvis and ureter or when a non-opaque calculus is suspected. Author's Address: Department of Urology, Hove General Hospital. Major Subject Heading(s): Kidney Calculi [radiography]; Tomography, X-Ray Computed; Ureteral Calculi [radiography] Article Title: Ureteroscopic diagnosis and treatment of urinary calculi during pregnancy. Article Source: Urology 1988 Nov;32(5):427-8 Author(s): Rittenberg MH; Bagley DH Abstract: Flexible ureteroscopy has been utilized in two pregnant patients. In one, the procedure was for diagnosis of symptoms simulating ureteral colic, and in the other for the removal of a distal ureteral calculus. The diagnostic procedure was completed with local anesthesia alone, and both procedures were performed without radiation to the mother or fetus. The potentially great benefit must be weighed against the risks of minimal endoscopic intervention in each patient. We advocate the early but judicious use of flexible ureteroscopy in pregnant patients with urinary calculi. Author's Address: Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. Major Subject Heading(s): Endoscopy [methods]; Pregnancy Complications; Ureteral Calculi [therapy] Article Title: Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. Article Source: J Urol 1997 Jun;157(6):2071-3 Author(s): Fielding JR; Steele G; Fox LA; Heller H; Loughlin KR Abstract: PURPOSE: We determined the value of noncontrast enhanced spiral computerized tomography (CT) in the evaluation of suspected renal colic. MATERIALS AND METHODS: Thin section (5 mm.) noncontrast enhanced CT was used to evaluate 100 patients presenting to the emergency room with flank pain. The 55 patients with ureteral obstruction were followed at the urology outpatient clinic and by telephone interview, while 45 without ureteral obstruction were followed by telephone interview and chart review. Sensitivity, specificity, and positive and negative predictive values for CT were determined, with passage, retrieval or identification of a stone on a retrograde study considered the gold standard for diagnosis. RESULTS: A total of 89 patients had adequate clinical followup to assess outcome accurately. Of 55 patients with ureteral obstruction on CT 11 underwent endoscopic stone removal, while 44 were treated conservatively with stone passage documented in 39. Of the 45 patients without ureteral stones identified 38 did not pass calculi and CT provided a definite diagnosis in 14. There was 1 false-negative study. The results yielded 98% sensitivity, 100% specificity, and 100% positive and 97% negative predictive values. CONCLUSIONS: Noncontrast enhanced spiral CT was accurate and reliable in detecting obstructing ureteral calculi in patients with flank pain. Author's Address: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. Major Subject Heading(s): Colic [etiology]; Kidney Diseases [diagnosis]; Tomography, X-Ray Computed; Urinary Calculi [diagnosis] Article Title: Renal colic in pregnancy. Article Source: J Urol 1992 Nov;148(5):1383-7 Author(s): Stothers L; Lee LM Abstract: Renal calculi are an infrequent but significant management problem during pregnancy. We reviewed all cases of renal colic occurring during pregnancy between 1979 and 1990 at Grace Hospital, a tertiary care obstetrical hospital in Vancouver, British Columbia. Of the patients 80 had a discharge diagnosis of renal colic and pregnancy during this 11-year period. Calculi were confirmed in 57 patients. Of the patients 66% were multiparous and 99% of the calculi occurred during either the second or third trimester. The most common symptom was flank pain seen in 89% of the patients, while greater than 95% displayed either microscopic or gross hematuria. Methods of radiographic diagnosis included ultrasonography and limited stage excretory urography. A total of 84% of patients passed stones spontaneously. Indications for urological or obstetrical intervention included persistent pain, sepsis, progressive hydronephrosis, solitary kidney or high grade obstruction. There were 37 procedures done in 23 patients. The most common procedure was placement of a ureteral stent. The complication rate associated with intrapartum intervention and stent passage in the 23 patients was 16%. All patients with a ureteral stent subsequently had spontaneous vaginal delivery without complication. A scheme for managing renal calculi in pregnancy is presented. Author's Address: Department of Surgery, University of British Columbia, Vancouver, Canada. Major Subject Heading(s): Colic; Kidney Diseases; Pregnancy Complications Article Title: An algorithm for diagnosis and therapy of management and complications of urolithiasis during pregnancy. Article Source: Surg Gynecol Obstet 1991 Jan;172(1):49-54 Author(s): Hendricks SK; Ross SO; Krieger JN Abstract: >From 1 January 1986 to 30 June 1989, 15 pregnant women were diagnosed as having urolithiasis. Patients presented in the last two trimesters with an infection of the lower part of the urinary tract (60 per cent), flank and abdominal pain (27 per cent) and hematuria (13 per cent). Ultrasonographic findings confirmed the diagnosis in 47 per cent of the patients. Other roentgenologic procedures were required in the remaining patients. Initially, therapy was conservative in all, and in 67 per cent of patients, no further intervention was necessary. Only 33 per cent required invasive measures; cystoscopic passage of an internal ureteral stent was the initial procedure of choice at our institution. Three of five patients who underwent invasive procedures had surgical intervention for relief of ureteral obstruction. Intensive care management was necessary for one of these three patients who had acute hemorrhage occur during the procedure. These data emphasize the need for the accurate diagnosis of urolithiasis during pregnancy. Ultrasonography was a valuable diagnostic technique, but a limited excretory urogram is safe and appropriate when there is uncertainty. Conservative management (hydration, analgesia and antibiotics as indicated) of obstructive uropathy was successful in the majority of instances. A specific clinical algorithm facilitated the successful management of patients necessitating operative intervention. Optimal management requires clinical suspicion and a precise diagnostic and therapeutic plan. Author's Address: Department of Obstetrics/Gynecology, University of Washington Medical Center, Seattle 98195. Major Subject Heading(s): Algorithms; Clinical Protocols; Decision Trees; Kidney Calculi [surgery]; Pregnancy Complications [surgery] hope these are useful for future reference. -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: Bernard Cristalli: "Re: Bernard endometrial ablation details" Previous message: Robert J Woolley: "Re: Puzzler?? 24 week ob with severe left flank pain" In reply to: ATFSOCCER@aol.com: "Re: Puzzler?? 24 week ob with severe left flank pain"

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