ABSTRACT
PURPOSE: The aim of this prospective study was to evaluate the relative value of CT and (99m)Tc-DMSA scintigraphy in the diagnosis of acute pyelonephritis (APN) in adult patients suspected of having urinary tract infection. METHOD: The study was conducted in 36 patients presenting with symptoms suggestive of urinary tract infection. Plain B-mode sonography, CT with contrast medium, and (99m)Tc-DMSA scintigraphy of the kidneys were performed in all patients. Both CT and (99m)Tc-DMSA scintigraphy were performed within 72 h after admission. RESULTS: Twelve patients with clinical and biological signs of urinary tract infection had no CT or (99m)Tc-DMSA scintigraphy abnormalities. Among these patients, lower urinary tract infection was found in 10 patients and 2 patients had ureteral obstruction. In the 24 remaining patients, the diagnosis of APN was made. Among these patients, a correlation was found between CT and (99m)Tc-DMSA scintigraphy in 11 cases. In two cases, both examinations were normal, and in nine cases, both were abnormal. In 11 cases of the 13 remaining patients, abnormal CT was found with normal (99m)Tc-DMSA scintigraphy, whereas the 2 last cases had normal CT and abnormal (99m)Tc-DMSA scintigraphy results. In two cases, bilateral lesions found on CT manifested as unilateral abnormalities on (99m)Tc-DMSA scintigraphy images. CONCLUSION: The diagnosis of APN in adult patients is based on clinical presentation and biological findings. Few studies have compared (99m)Tc-DMSA scintigraphy with CT in the detection of parenchymal involvement in APN. We conclude that CT is more accurate than (99m)Tc-DMSA scintigraphy in the detection of APN lesions in adult patients.
Subject(s)
Pyelonephritis/diagnosis , Tomography, X-Ray Computed , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pyelonephritis/diagnostic imaging , Radionuclide Imaging/methods , Radiopharmaceuticals , Technetium Tc 99m Dimercaptosuccinic AcidABSTRACT
Nephrectomy is a debilitating procedure because of the trauma to the abdominal wall. Laparoscopy could be a solution in this matter. Four patients underwent laparoscopic nephrectomy. In 3 patients with renal cancer, the transperitoneal route was used in order to obtain quicker access to the hilus. In the fourth patient with benign disease, a retroperitoneal route was chosen. There was no morbidity or mortality. Mean hospital stay was 5 days. Laparoscopic nephrectomy is safe and effective. Larger series are needed for evaluation of the long-term results in the treatment or renal cancer.
Subject(s)
Carcinoma, Renal Cell/surgery , Hydronephrosis/surgery , Kidney Neoplasms/surgery , Laparoscopy/methods , Nephrectomy/methods , Abdomen , Adult , Blood Loss, Surgical , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Care , Retroperitoneal Space , Time Factors , Treatment OutcomeABSTRACT
The possibility that low-calcium intake in renal stone formers could lead to reduced bone mineral content was investigated in 123 male patients with idiopathic urolithiasis. Radius bone mineral content (BMC) was measured by single photon absorptiometry. Two groups of patients were analyzed: group 1 (n = 63) maintained on a free diet; group 2 (n = 60) maintained on a low-calcium diet (350 mg/day +/- 20 SEM) for 3.9 years +/- 0.6 SEM. The two groups of patients were investigated after a standard reduction of calcium intake for at least 1 week. The urinary excretion of calcium and of hydroxyproline, and the serum alkaline phosphatase activity were higher in both groups than in normal subjects submitted to the same low-calcium diet. Both groups of stone formers showed lowered radius BMC values at 3 cm (distal) and 8 cm (proximal) above the styloid process, but distal BMC was significantly lower in group 2 than in group 1. The results suggest that low-calcium intake could worsen the already decreased BMC of idiopathic renal stone formers.
Subject(s)
Bone Density , Calcium, Dietary/administration & dosage , Kidney Calculi/drug therapy , Adult , Aged , Calcium/deficiency , Calcium, Dietary/metabolism , Cross-Sectional Studies , Humans , Kidney Calculi/etiology , Male , Middle AgedABSTRACT
Repeated measurements of serum calcium and immunoreactive parathyroid hormone were performed in 1433 renal stone formers systematically referred from Accident and Emergency Departments and from Departments of Urology and Nephrology, irrespective of their serum calcium. Primary hyperparathyroidism was found in 23 patients and confirmed in 19/20 patients who underwent neck surgery, including 8 with intermittent hypercalcaemia. Our data suggest that when selection bias is minimised, primary hyperparathyroidism is found in about 2% of renal stone formers in a western country such as Belgium.
Subject(s)
Hyperparathyroidism/complications , Kidney Calculi/complications , Calcium/blood , Female , Humans , Kidney Calculi/blood , Male , Parathyroid Hormone/bloodABSTRACT
Bone mineral content (BMC) was measured with the Norland Cameron apparatus in 120 renal stone formers (RSF) with idiopathic stone disease and in 41 patients with primary hyperparathyroidism. RSF were classified, according to an oral calcium load test, into three groups: no hypercalciuria (HC; 41 cases); absorptive HC (53 cases), and resorptive or renal HC (25 cases). BMC values in RSF as a group were significantly lower than normal (p less than 0.001, Mann-Whitney test) though higher than in hyperparathyroid patients. There was a trend for BMC to decrease from male RSF without HC to patients with renal or resorptive HC. No statistical difference was found between the groups, however, BMC values in absorptive HC were different from normal (p less than 0.001). Why patients with HC are demineralized is unclear since no correlation was found between BMC and basal values of serum phosphate, TRP, calculated TmP/GFR, urinary calcium or hydroxyproline. Nevertheless our results indicate that urolithiasis, and possibly its treatment, is not a benign condition for the skeleton.
