UPJ Obstruction in the Adult Population: Are Crossing Vessels Significant?

Ureteropelvic junction (UPJ) obstruction describes various causes of impaired drainage at the UPJ. Regardless of the cause, the end result is the same: impedance in the normal flow of urine from the renal pelvis into the proximal ureter, resulting in caliectasis and hydronephrosis. This may lead to progressive deterioration of renal function and, thus, often requires intervention to relieve the obstruction and restore the normal flow of urine. Defining the pertinent anatomy, the degree of obstruction, and differential renal function is key to determining whether and when intervention is necessary.

Gunshot wounds: bullet caliber is increasing.

BACKGROUND: The incidence of gunshot wounds has increased over the past two decades. In the past several years at our Level I trauma center in Newark NJ, we perceived that the size of ammunition involved in these wounds has been increasing as well. We sought to document this trend by using autopsy data as well as bullets received by surgical pathology. METHODS: Measurements of bullets stored in surgical pathology were taken from alternate years between 1981 and 1993, then every year through 1997. A total of 745 bullets were studied in this 16-year period. Bullets deformed beyond measurability and shotgun pellets were excluded from the study (approximately 20%). Linear regression of mean bullet caliber over time was performed, and analysis of variance was used to assess statistical significance of apparent differences. In addition, autopsy reports from the regional medical examiner's office were surveyed for description of bullet size. Bullet caliber, in these reports, is described as "small," "medium," or "large." A total of 397 reports were studied from 1981 to 1997. Once again, shotgun wounds (<5%) were excluded. The percentage of large-caliber projectiles was plotted against time, and chi2 for trend was used to determine statistical significance. RESULTS: Results are tabulated as mean +/- standard error bullet caliber (millimeters) over time. Linear regression reveals r = 0.944, p<0.0001. Data obtained from autopsy reports are not tabulated here, but chi2 for trend reveals a statistically significant increase in the proportion of large caliber and decrease in proportion of small-caliber bullets (p<0.001). CONCLUSION: These data unveil an ominous trend toward the use of larger-caliber firearms in accidents, homicides, and suicides.