ABSTRACT
OBJECTIVES: To prospectively compare the diagnostic ability of unenhanced spiral computed tomography (NCCT) and intravenous urogram (IVU) in the evaluation of adults with acute flank pain. METHODS: After giving informed consent, 106 adult patients with acute flank pain suspected of having urolithiasis underwent NCCT followed by IVU. Subsequent follow-up was scheduled within 72 hours in the Urology Clinic. Each NCCT was read by a single radiologist who was unaware of clinical history and IVU results. Each IVU was read by a different radiologist who was unaware of clinical history and NCCT results. Sensitivity, specificity, and positive and negative predictive values were determined for NCCT and IVU. RESULTS: The diagnosis of ureterolithiasis was defined as unequivocal evidence of urolithiasis on either NCCT or IVP. Seventy-five of 106 patients evaluated were diagnosed with ureterolithiasis. Clinical follow-up was available in 74 (98%) stone patients and in 31 (100%) of 31 non-stone patients. In 72 of the 75 patients diagnosed with ureteral calculi, the NCCT made the diagnosis. IVU made the diagnosis in 65 of the 75 patients. Of the 31 patients without ureterolithiasis, the NCCT was negative in all cases. IVU was negative in 29 of the 31 cases. Unenhanced spiral CT was 96% sensitive and 100% specific (P <0.001). IVU was 87% sensitive and 94% specific (P <0.001). Compared with IVU, using the log odds ratio and Fisher's exact test, NCCT was significantly better able to predict the presence of urolithiasis (P=0.015). CONCLUSIONS: NCCT accurately diagnoses ureterolithiasis in patients presenting with acute flank pain. NCCT is significantly better than IVU in determining the presence of urolithiasis.
Subject(s)
Pain/etiology , Tomography, X-Ray Computed/methods , Ureteral Calculi/complications , Ureteral Calculi/diagnostic imaging , Urography , Acute Disease , Adult , Aged , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND: The peripherally inserted central catheter (PICC) is increasingly used in protracted intravenous therapy. The device has several advantages for family practice, but its use has been chiefly described in nursing and interventional radiology literature. We investigated the use of the PICC in a family practice teaching hospital. METHODS: Forty PICCs were inserted from 1993 to 1995 in 29 patients. Available records and radiographs were reviewed for indication, nature of placement attempts, indwelling time, PICC role in therapy, and attendant complications. RESULTS: Successful placement was achieved in 95 percent of instances requiring PICC use. Fluoroscopically guided placement, usually without venography, was found to be preferable to unguided bedside placement. In a few cases in which PICCs were placed, no other access was subsequently required to complete therapy. Few clinically serious complications were encountered. Most complications were related to placement at bedside. CONCLUSIONS: Our experience supports the PICC as a minimally invasive, economical alternative for protracted intravenous therapy. Fluoroscopically guided placement was found preferable to unguided bedside placement. Physicians ordering or placing PICCs should understand fully how to assess placement.
Subject(s)
Catheterization, Central Venous/methods , Catheters, Indwelling , Adolescent , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Family Practice/methods , Fluoroscopy/methods , Humans , Injections, Intravenous/instrumentation , Injections, Intravenous/methods , Middle Aged , Parenteral Nutrition/instrumentation , Parenteral Nutrition/methods , Treatment OutcomeABSTRACT
An uncommon case of hepatocellular adenoma is presented. In this case, the tumor was Tc-99m SC avid rather than the typical pattern of no uptake. Liver scintigraphy was able to demonstrate that the tumor originated from the liver correlating with ultrasound and computed tomography. Background information on hepatocellular adenomas, a differential diagnosis, and a logical approach to similar liver lesions is discussed.
Subject(s)
Adenoma, Liver Cell/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Technetium Tc 99m Sulfur Colloid , Adult , Female , Humans , Radionuclide Imaging , Technetium Tc 99m Sulfur Colloid/metabolismABSTRACT
The phenomenon of subclavian steal syndrome has recently been found to have a subset group that has been described as partial or "pre-steal" in physiology. Our case of a Marine Corps pilot with this partial subclavian steal physiology is reviewed, in addition to the maneuvers we performed to temporarily convert him to complete steal physiology. A discussion of the symptomatology and prognosis of this diagnosis is included, with emphasis on military service.
