The diagnostic yield of computed tomography in the management of acute flank pain and the emergency intervention rate for a proven acute ureteric stone.

INTRODUCTION: The diagnostic and management pathways for patients presenting with acute flank pain are complex. Although computed tomography (CT) of the kidneys, ureters and bladder (KUB) is the gold standard investigation for urolithiasis, the multitude of differential diagnoses must also be considered in the context of long-term risk from ionising radiation. This study investigated the integrated role and diagnostic yield of non-contrast CT in cases of acute flank pain. METHODS: A retrospective cohort study was undertaken of 1,442 consecutive patients investigated with CT KUB between March 2013 and February 2015. The primary outcome was diagnostic yield of CT with secondary outcomes being predictors of need for urological intervention. RESULTS: A cause for acute flank pain was identified in 717 patients (50%), there was an incidental finding in 389 patients (27%) and normal imaging was reported in 336 patients (23%). A diagnosis was more commonly made in male than in female patients (70% vs 40%) and with increasing age (46% in patients aged <30 years, 56% in those aged 30-49 years and 63% in those aged ≥50 years). The overall rate for an ipsilateral urinary tract stone was 41%. Factors strongly associated with emergency intervention included stone size >10mm (odds ratio [OR]: 11.7, 95% confidence interval [CI]: 3.3-42.7), stones located at the pelviureteric junction (OR: 7.8, 95% CI: 2.6-22.9), C-reactive protein >50mg/l and ≤100mg/l (OR: 15.2, 95% CI: 5.1-45.3), and estimated glomerular filtration rate ≤30ml/min (OR: 5.8, 95% CI: 1.5-21.8). CONCLUSIONS: This contemporary study identifies age and sex as independent variables affecting the diagnostic yield of CT KUB in cases of acute flank pain, and highlights factors associated with a need for emergency intervention in proven ureteric stones.

Arthroscopy for hip septic arthritis in children.

BACKGROUND: Hip arthroscopy for treatment of septic arthritis in children has previously been reported with excellent short-term results. The purpose of this study was to evaluate the long-term results of hip arthroscopy for hip septic arthritis (HSA) in paediatric patients. HYPOTHESIS: Arthroscopy still is a useful tool in the treatment of HSA, and may be superior to simple hip aspiration. MATERIALS AND METHODS: Twelve patients with a median age of 6 years, with community-acquired infections, were diagnosed as HSA. All of them were treated using arthroscopic drainage. The duration of symptoms at presentation were a median of 3,5 days (2-20). In the younger patients (<8 years), hip joint distension was used instead of hip traction. At final check-up, the Hip Harris Score (HHS) was used and a radiographic study done. RESULTS: Two patients required a repeat arthroscopy. All, except for one patient, achieved excellent clinical results. Two patients presented radiological changes at the last check-up. The poor results were related to late presentation for medical treatment. There was no difference between early and late results. DISCUSSION: Hip arthroscopy for child HSA is a feasible technique even for the youngest patients, moreover the positive clinical results initially obtained are maintained over time. LEVEL OF EVIDENCE: Level IV: retrospective series.

Rebound growth after hemiepiphysiodesis: An animal-based experimental study of incidence and chronology.

Rebound growth after hemiepiphysiodesis may be a normal event, but little is known about its causes, incidence or factors related to its intensity. The aim of this study was to evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal growth plate arrest was maintained for three weeks, and animals were killed at intervals ranging between three days and three weeks after removal of the device. The radiological angulation of the proximal tibia was studied at weekly intervals during and after hemiepiphysiodesis. A histological study of the retrieved proximal physis of the tibia was performed. The mean angulation achieved at three weeks was 34.7° (standard deviation (sd) 3.4), and this remained unchanged for the study period of up to two weeks. By three weeks after removal of the implant the mean angulation had dropped to 28.2° (sd 1.8) (p < 0.001). Histologically, widening of the medial side was noted during the first two weeks. By three weeks this widening had substantially disappeared and the normal columnar structure was virtually re-established. In our rabbit model, rebound was an event of variable incidence and intensity and, when present, did not appear immediately after restoration of growth, but took some time to appear.