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1.
Vet Rec ; 194(10): e4045, 2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38578431

RESUMO

BACKGROUND: The aim of this study was to compare ultrasonographic findings of the ventral midline incision after exploratory laparotomy for colic in horses with and without surgical site infection (SSI). METHODS: Ultrasonographic examination of the surgical wound was performed on postoperative day 5 (D5) and day 10 (D10) to assess the presence of fluid accumulation, suture sinus formation, hyperechogenic spots and fistulous path. Clinical evaluation of the wound was used to classify horses with and without SSI. The accuracy, sensitivity, specificity and positive and negative predictive values of the ultrasonographic findings were then calculated. Multivariable logistic regression analyses were performed with SSI as a dependent variable and age, sex, breed and ultrasonographic findings as independent variables after univariate and collinearity analyses. RESULTS: Twenty-nine of the 84 horses examined had an SSI. Detection of fluid accumulation and hyperechogenic spots increased the odds for SSI at D5 (odds ratio [OR]: 4.99, 95% confidence interval [CI]: 1.53-16.33, p = 0.008; OR: 10.78, 95% CI: 1.75-26.59, p = 0.01, respectively) and D10 (OR: 11.51, 95% CI: 2.39-55.47, p = 0.002; OR: 12.34, 95% CI: 3.45-44.15, p < 0.001, respectively). LIMITATION: Ultrasonographic images were taken only on the longitudinal section. CONCLUSION: Ultrasonographic examination is helpful in evaluating the surgical incision after laparotomy, with the detection of fluid accumulation and hyperechogenic spots surrounding the sutures being strongly related to SSI.


Assuntos
Cólica , Doenças dos Cavalos , Laparotomia , Infecção da Ferida Cirúrgica , Ultrassonografia , Animais , Cavalos , Doenças dos Cavalos/cirurgia , Doenças dos Cavalos/diagnóstico por imagem , Laparotomia/veterinária , Ultrassonografia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Cólica/veterinária , Cólica/cirurgia , Cólica/diagnóstico por imagem , Feminino , Masculino , Sensibilidade e Especificidade
2.
Vet Clin North Am Equine Pract ; 39(2): 197-210, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37169618

RESUMO

Abdominal sonography is currently a routine procedure in the evaluation of colic in the horse. This imaging technique is used in both the assessment of the horse presented in the emergency setting with acute colic and the assessment of the horse presented for chronic or recurrent colic in the nonemergency setting. Sonography for colic evaluation is used by specialists in different disciplines and by general practitioners in the ambulatory and hospital settings. In this review, we will focus on indications and clinical interpretation of findings as well as recent developments in abdominal sonography.


Assuntos
Cólica , Doenças dos Cavalos , Cavalos , Animais , Cólica/diagnóstico por imagem , Cólica/cirurgia , Cólica/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/cirurgia , Hospitais
6.
Vet Clin North Am Equine Pract ; 37(2): 495-513, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34243882

RESUMO

This article provides an overview of initial assessment and management of common emergency presentations in donkeys and mules. The principles are similar to those in horses (and ponies), but clinicians must be aware of differences in recognition of signs of pain/disease, approach to handling, pharmacology of some drugs, and subtle differences in the physiology and local anatomy in donkeys and mules. The epidemiology of common disease presentations will vary between pet/companion or working/farmed donkeys and mules. Regular dental checks, deworming, vaccination, and monitoring of behavior and quality of life are important aspects of preventive care.


Assuntos
Cólica/veterinária , Colite/veterinária , Equidae/fisiologia , Hiperlipidemias/veterinária , Doenças Respiratórias/veterinária , Animais , Cólica/diagnóstico por imagem , Cólica/terapia , Colite/diagnóstico por imagem , Colite/terapia , Emergências/veterinária , Hiperlipidemias/diagnóstico por imagem , Hiperlipidemias/terapia , Doenças Respiratórias/diagnóstico por imagem , Doenças Respiratórias/terapia
7.
Asian J Endosc Surg ; 14(3): 520-528, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33393228

RESUMO

INTRODUCTION: Laparoscopic cholecystectomy is a common surgery with a varying difficulty level. Difficult laparoscopic cholecystectomy may be experienced by many surgeons. If difficult procedures are predicted preoperatively, surgeons may be able to plan the surgical approach and treatment accordingly. Studies have reported using blood and clinical imaging data to predict difficult cholecystectomy. However, to our knowledge, no studies have reported using MRI. The purpose of this study was to evaluate the usefulness of MRI as a predictor of difficult laparoscopic cholecystectomy. METHODS: We retrospectively evaluated 25 patients with cholecystitis or biliary colic who had undergone diffusion-weighted whole-body imaging before laparoscopic cholecystectomy. The apparent diffusion coefficient value of the cystic duct was measured and its relationship with operative time and blood loss was examined to assess the capacity of diffuse-weighted whole-body imaging to predict difficult cholecystectomy. Further, we collected blood data and compared its usefulness as a predictor. RESULTS: The apparent diffusion coefficient value of the cystic duct was significantly lower in patients with difficult laparoscopic cholecystectomy than in those with non-difficult procedures (P = .00007). White blood cell count and serum C-reactive protein level were significantly higher in patients with difficult cholecystectomy than in those with non-difficult procedures (P = .035, .030). In the receiver operating characteristic analysis, the apparent diffusion coefficient value was the best predictor. CONCLUSION: Our results suggest that the apparent diffusion coefficient value of the cystic duct is a predictor of difficult laparoscopic cholecystectomy. In the future, it may be useful to study changes in coefficient values over time to determine optimal surgical timing.


Assuntos
Colecistectomia Laparoscópica , Colecistite , Ducto Cístico/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/diagnóstico por imagem , Doenças Biliares/cirurgia , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Cólica/diagnóstico por imagem , Cólica/cirurgia , Ducto Cístico/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
8.
Eur Radiol ; 31(5): 2983-2993, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33051735

RESUMO

OBJECTIVE: Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU). MATERIALS AND METHODS: A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US. RESULTS: One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%. CONCLUSION: In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold. KEY POINTS: • For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold. • For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.


Assuntos
Cólica , Cólica Renal , Urolitíase , Cólica/diagnóstico por imagem , Cólica/terapia , Humanos , Radiografia Abdominal , Cólica Renal/diagnóstico por imagem , Cólica Renal/terapia , Sensibilidade e Especificidade , Ultrassonografia
9.
Pediatr Res ; 89(5): 1239-1244, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32629458

RESUMO

BACKGROUND: Excessive and inconsolable crying behavior in otherwise healthy infants (a condition called infant colic (IC)) is very distressing to parents, may lead to maternal depression, and in extreme cases, may result in shaken baby syndrome. Despite the high prevalence of this condition (20% of healthy infants), the underlying neural mechanisms of IC are still unknown. METHODS: By employing the latest magnetic resonance imaging (MRI) techniques in newborns, we prospectively investigated whether newborns' early brain responses to a sensory stimulus (smell) is associated with a subsequent crying behavior. RESULTS: In our sample population of 21 healthy breastfed newborns, those who developed IC at 6 weeks exhibited brain activation and functional connectivity in primary and secondary olfactory brain areas that were distinct from those in babies that did not develop IC. Different activation in brain regions known to be involved in sensory integration was also observed in colicky babies. These responses measured shortly after birth were highly correlated with the mean crying time at 6 weeks of age. CONCLUSIONS: Our results offer novel insights into IC pathophysiology by demonstrating that, shortly after birth, the central nervous system of babies developing IC has already greater reactivity to sensory stimuli than that of their noncolicky peers. IMPACT: Shortly after birth, the central nervous system of colicky infants has a greater sensitivity to olfactory stimuli than that of their noncolicky peers. This early sensitivity explains as much as 48% of their subsequent crying behavior at 6 weeks of life. Brain activation patterns to olfactory stimuli in colicky infants include not only primary olfactory areas but also brain regions involved in pain processing, emotional valence attribution, and self-regulation. This study links earlier findings in fields as diverse as gastroenterology and behavioral psychology and has the potential of helping healthcare professionals to define strategies to advise families.


Assuntos
Cólica/diagnóstico por imagem , Cólica/fisiopatologia , Choro , Encéfalo/fisiologia , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Imageamento por Ressonância Magnética , Masculino , Mães , Pais , Prevalência , Estudos Prospectivos , Inquéritos e Questionários
10.
J Hepatobiliary Pancreat Sci ; 27(11): 839-850, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32351049

RESUMO

BACKGROUND/PURPOSE: The aim of the present study was to investigate the relationship between hepatobiliary scintigraphy findings and histopathological results in patients with recurrent biliary colic. METHODS: We retrospectively enrolled 107 patients who underwent hepatobiliary scintigraphy for recurrent biliary colic and subsequent cholecystectomy. According to the hepatobiliary scintigraphy findings, patients were categorized into a nonvisualization of gallbladder activity (nonvisualized GB) group, low gallbladder ejection fraction (GBEF) group, and normal GBEF group. Differences in histopathologic factors between the three groups were evaluated and multivariate logistic regression analyses were performed to identify histopathological predictors for hepatobiliary scintigraphy findings. RESULTS: The nonvisualized group had a higher frequency of patients with empyema and severe infiltration by neutrophils, lymphoplasma cells, and eosinophils. The low GBEF group had a higher muscle-to-total wall thickness ratio and muscle-to-fibrosis thickness ratio of the gallbladder wall than those in the normal GBEF group. On multivariate logistic regression analyses, severe degrees of lymphoplasma cell infiltration and eosinophil infiltration were independent predictors for nonvisualization of gallbladder activity, and a higher muscle-to-fibrosis thickness ratio was an independent predictor for low GBEF. CONCLUSIONS: In patients with recurrent biliary colic, nonvisualization of gallbladder activity on hepatobiliary scintigraphy was related to the degree of inflammation in the gallbladder, while low GBEF was related to muscular hypertrophy of the gallbladder.


Assuntos
Cólica , Doenças da Vesícula Biliar , Cólica/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Humanos , Cintilografia , Estudos Retrospectivos
11.
Am Fam Physician ; 101(5): 275-285, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32109031

RESUMO

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Abscesso/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Apendicite/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico por imagem , Competência Clínica , Cólica/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Perfuração Intestinal/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Derrame Pericárdico/diagnóstico por imagem , Gravidez , Cuidado Pré-Natal , Síndrome do Desconforto Respiratório , Descolamento Retiniano/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico por imagem , Volume Sistólico , Ultrassonografia de Intervenção , Trombose Venosa/diagnóstico por imagem
12.
Vet Rec ; 186(15): 491, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31542725

RESUMO

BACKGROUND: Ultrasonographic visualisation of the mesenteric vasculature of the large colon (LC) from the right side of the abdomen in cases of displacement and volvulus has been described. However, the LC can move freely within the abdomen and its mesentery can potentially contact both sides of the abdominal wall. METHODS: Thirty-four horses presented with LC-related colic that had visible LC mesenteric vasculature visible on abdominal ultrasound were included. A control group was made including horses with confirmed small intestinal-related colic. The objective of this study was to evaluate the visibility of LC mesenteric vasculature with transabdominal ultrasonography in horses with LC-related colic and to determine its diagnostic value. RESULTS: The LC mesenteric vasculature was identified on the right side of the abdomen in 16/34 horses with right dorsal displacement of the LC (RDDLC), 180° LC volvulus (LCV), 540° LCV or LC impaction. On the left side of the abdomen, LC mesenteric vessels were identified in 17/34 horses with left dorsal displacement of the LC (LDDLC), 180° LCV or RDDLC. Vessels were visualised on both sides in one horse with a 180° LCV. Presence of LC mesenteric vasculature in the dorsal aspect on the left side of the abdomen was significantly associated with LDDLC. CONCLUSION: LC mesenteric vasculature can be visualised on transabdominal ultrasound from either side of the abdomen in horses with different forms of LC-related colic.


Assuntos
Cólica/veterinária , Doenças do Colo/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Artérias Mesentéricas/diagnóstico por imagem , Animais , Estudos de Casos e Controles , Cólica/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Feminino , Cavalos , Masculino , Ultrassonografia/veterinária
13.
Pan Afr Med J ; 30: 68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30344852

RESUMO

Excessive or persistent crying is a common presentation to the pediatric emergency department, and often poses a diagnostic dilemma to emergency physicians. There are several reasons for excessive or persistent crying in children, ranging from benign causes like hunger, to life-threatening causes such as intussusception. The objective of this work is to specify the place of abdominal ultrasound in the diagnosis and management of incessant cries in the infant. A cross sectional investigation for 3 months about cases of infants admitted for excessive or persistent crying to the paediatric emergency medical department of the Rabat Children's Hospital. Thirty-nine cases of excessive crying. The average age of our patients was 5.7 months with a male predominance. The incessant cries constituted the main reason for consultation in all our patients. The abdominal ultrasound performed in all the patients and revealed six cases of "Intestinal intussusception, eight cases of colic with distention gas, one case of uretero-hydronephrosis, one case with lymphadenitis mesenteric whereas it was normal in twenty-three cases. Children presenting with excess or persistent crying with no clear historical and physical examination clues, pose a diagnostic challenge to emergency physicians. This survey illustrates that despite the fact that abdominal ultrasound was normal in 58% of the cases, it made possible to make an early diagnosis of 15% of acute intestinal intussusception and it has become the gold standard in management of excessive crying in infants.


Assuntos
Abdome/diagnóstico por imagem , Choro/fisiologia , Ultrassonografia/métodos , Cólica/diagnóstico por imagem , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Lactente , Intussuscepção/diagnóstico por imagem , Masculino
14.
Emerg Radiol ; 25(6): 621-626, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29946802

RESUMO

PURPOSE: Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC. METHODS: We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016. Patients who had both CT KUB and CTU were then compared to determine if CT KUB had missed a UTUC and if the diagnoses were concordant by the two tests. A radiologist independent from the reporting radiologists reviewed images as well as their reports. According to the Health Research Authority, England regulations, we did not obtain an ethical review on a voluntary basis for this retrospective study. RESULTS: Four hundred eighty-five patients [228 (47.01%) male and 257 (52.99%) female] had a CT KUB scan over the 34-month period. Their mean age was 74 (SD 6.97) [males 73 (SD 6.42), females 75 (SD 7.42)] years. One hundred eighty-seven scans were normal. Ureteric calculi (167), renal calculi (58) and renal cysts (28) were most frequent diagnoses. The diagnosis was uncertain in 33 patients (6.8%) [16 (48.49%) males and 17 (51.51%) females]. The mean age of this group of patients was 74 (SD 6.64) [males 73 (SD4.43), females 74 (SD7.64)] years. These patients had a CTU for clarity. CTU identified one UTUC not identified by CT KUB (0.2%), corroborated the diagnosis of a ureteric tumour in one patient and excluded UTUC in two others. CTU diagnosed two new bladder tumours and an endometrial tumour. Diagnoses were concordant between CT KUB and CTU in 17 of 33 patients (51.5%). CONCLUSIONS: CT KUB scans for patients 65 years and over presenting with ureteric colic is justified. Only a small proportion of patients will subsequently require the higher radiation dose CTU as the probability of missing UTUC is low.


Assuntos
Cólica/diagnóstico por imagem , Serviço Hospitalar de Emergência , Tomografia Computadorizada por Raios X/métodos , Doenças Ureterais/diagnóstico por imagem , Urografia/métodos , Doença Aguda , Idoso , Cólica/etiologia , Feminino , Hematúria , Humanos , Masculino , Doenças Ureterais/complicações
15.
J Am Vet Med Assoc ; 253(1): 108-116, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29911939

RESUMO

OBJECTIVE To describe clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography. DESIGN: Retrospective case series. ANIMALS 25 horses. PROCEDURES Medical records of horses that underwent transabdominal ultrasonography between 2003 and 2010 were reviewed. Horses were included if the wall of the large intestine was ≥ 9 mm thick in any of 6 abdominal zones. RESULTS Median age was 13 years (range, 3 to 28 years). Horses were initially examined because of colic, diarrhea, inappetence, weight loss, lethargy, fever, or hematuria. Severe large intestinal thickening (range, 9 to 46.6 mm; mean ± SD, 18.8 ± 6.8 mm) was the primary ultrasonographic finding in all horses. Thickened large intestine was more likely to be detected in ventral versus upper (ie, combined paralumbar and intercostal) abdominal zones and in right versus left zones. Eleven horses survived and had resolution of clinical signs, including the l horse treated surgically for colon torsion. An additional horse survived but continued to have intermittent colic. Ten horses were euthanized or died, including 3 horses with neoplasia and 3 with colitis. Three horses were lost to follow-up, including 1 horse with a cecal mass and 1 with hepatosplenic lymphoma. Severity of thickening and number of zones affected were not significantly different between survivors and nonsurvivors. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in horses undergoing transabdominal ultrasonography, large intestinal wall thickness ≥ 9 mm may be detected in patients with a variety of conditions. Ultrasonographic examination of all abdominal zones was helpful to determine the extent of thickening and identify additional findings that helped prioritize differential diagnoses.


Assuntos
Cólica/veterinária , Doenças do Colo/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Intestino Grosso/diagnóstico por imagem , Animais , Cólica/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Feminino , Cavalos , Masculino , Valor Preditivo dos Testes , Registros/veterinária , Estudos Retrospectivos , Ultrassonografia/veterinária
16.
Yonsei Med J ; 59(3): 389-396, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29611401

RESUMO

PURPOSE: To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department. MATERIALS AND METHODS: We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups. RESULTS: The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p<0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found. CONCLUSION: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.


Assuntos
Cólica/diagnóstico por imagem , Doses de Radiação , Ureter/diagnóstico por imagem , Cálculos Ureterais/diagnóstico por imagem , Urolitíase/diagnóstico por imagem , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
17.
Eur J Emerg Med ; 25(6): 429-433, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28704268

RESUMO

BACKGROUND: Computed tomography of the kidneys, ureters and bladder is the recommended imaging modality for suspected urolithiasis. Early scanning is advised in guidelines, but there is limited published evidence to support this recommendation. PATIENTS AND METHODS: In a retrospective study, we reviewed patients managed according to a local guideline. Patients without high-risk features were either imaged during their initial visit (if in the daytime) or discharged for outpatient scans. Complications, unplanned returns, final diagnosis, and intervention rates were compared between groups. RESULTS: Fifty-four patients were scanned during their initial visit and 151 were scanned as an outpatient at a median interval of 10 days. Unplanned return rates were lower in those scanned as outpatients (7.3 vs. 24.1%), with no significant difference in complications (2.0 vs. 3.7%; none leading to permanent harm). Those scanned as outpatients were less likely to have a stone proven by imaging (39.7 vs. 64.8%), but did not have a significantly higher rate of proven alternative diagnosis (9.3 vs. 13.0%). CONCLUSION: There is no evidence in this cohort that discharging patients for outpatient imaging is associated with poorer outcomes, provided that an appropriate clinical risk assessment is carried out.


Assuntos
Assistência Ambulatorial/métodos , Cólica/diagnóstico por imagem , Cálculos Ureterais/diagnóstico por imagem , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Cólica/terapia , Intervalos de Confiança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Alta do Paciente , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Reino Unido , Cálculos Ureterais/terapia , Adulto Jovem
18.
Vet Surg ; 46(6): 860-867, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28626911

RESUMO

OBJECTIVE: To determine the influence of radiographic quantification of sand accumulation on the medical versus surgical management of large colon sand accumulations. To compare short- and long-term outcomes and complications associated with medical and surgical management of these horses. STUDY DESIGN: Retrospective. SAMPLE POPULATION: A total of 153 horses. METHODS: Medical records and abdominal radiographs of horses presented for colic between 2004 and 2014 were reviewed. Severity of sand accumulation was quantified by tracing and measuring a region of interest with a commercial software program. Breed, weight, amount of sand, presence of diarrhea at presentation, treatment, and the development of complications were recorded. RESULTS: Records from 153 horses were reviewed. The mean cross-sectional area of sand accumulation was 692.9 cm2 (median = 658.7 cm2 , 84.6-1780.7 cm2 ). Increased accumulation of gas on radiographs and abnormal transrectal examination findings were associated with an increased likelihood of surgery. The most common complication was the development of diarrhea (20.3%) with only 4 (2.6%) horses positive for Salmonella spp. Horses had a favorable prognosis, with 94.8% of horses treated medically and 94.7% of those treated surgically surviving to discharge. CONCLUSION: Increased accumulation of gas on radiographs and transrectal palpation of impaction or intestinal gas distension increase the likelihood of surgery. Both medical and surgical treatments carry a good prognosis. CLINICAL RELEVANCE: The sheer quantity of sand is not a factor when determining surgical intervention. Attention should be paid to the presence of increased gas accumulation on rectal or radiographic examination.


Assuntos
Cólica/veterinária , Doenças dos Cavalos/terapia , Enteropatias/veterinária , Dióxido de Silício/efeitos adversos , Animais , Cólica/diagnóstico por imagem , Cólica/cirurgia , Cólica/terapia , Colo/cirurgia , Feminino , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/cirurgia , Cavalos , Enteropatias/diagnóstico por imagem , Enteropatias/cirurgia , Enteropatias/terapia , Masculino , Radiografia/veterinária , Estudos Retrospectivos
19.
Eur J Gastroenterol Hepatol ; 29(9): 1017-1021, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28520575

RESUMO

BACKGROUND: Patients with gallstone disease can present with elevated liver function tests (LFTs). It is often challenging to differentiate those with a common bile duct (CBD) stone from those without a CBD stone on the basis of the LFTs levels. In this study, we aim to evaluate the predictors of a CBD stones among patients presenting with symptomatic gallbladder disease and elevated LFTs. PATIENTS AND METHODS: We retrospectively examined all patients who had undergone a cholecystectomy between January 2010 and December 2015. Patients with symptomatic cholelithiasis and increased LFTs were included. Patient characteristics, imaging findings, lab findings, endoscopic interventions, and operative report were recorded and evaluated. The diagnosis of CBD stones was made on the basis of ERCP and IOC findings. RESULTS: We included 354 patients in the final analysis. Of these, 113 (32%) had confirmed choledocholithiasis. The prevalence of CBD stones among biliary colic, acute cholecystitis, and pancreatitis patients was 47, 25, and 26%, respectively. γ-Glutamyl transferase and direct bilirubin had the highest sensitivities for CBD stones among these patients (83 vs. 79%). In the setting of biliary colic, total bilirubin was highly predictive of CBD stones with a positive predictive value of 85%. In the setting of acute cholecystitis, elevated LFTs were even less significant in predicting stones, with a positive predictive value of less than 40% for most. CONCLUSION: Although γ-glutamyl transferase and bilirubin levels showed a relatively higher sensitivity for CBDS compared with the other LFTs, these were not reliable enough because of high false-positive as well as false-negative values, especially in patients presenting with acute cholecystitis.


Assuntos
Colecistite Aguda/patologia , Coledocolitíase/patologia , Cólica/patologia , Ducto Colédoco/patologia , Adulto , Idoso , Bilirrubina/sangue , Biomarcadores/sangue , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Colecistite Aguda/sangue , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Coledocolitíase/sangue , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Cólica/sangue , Cólica/diagnóstico por imagem , Cólica/cirurgia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , gama-Glutamiltransferase/sangue
20.
Vet Radiol Ultrasound ; 57(6): E63-E66, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27144594

RESUMO

A 2-year-old Holstein cow presented with a history of colic signs of 3 days' duration that had not responded to routine medical therapy. Physical examination findings were consistent with tachycardia and colic. Ultrasonographic examination of the abomasum revealed a thin hyperechoic line producing a cone shadow. Radiography of the cranial abdomen revealed two radiopaque objects within the abomasum. Right paracostal laparotomy and abomasotomy permitted palpation and manual removal of two metallic foreign bodies and a small quantity of gravel. The animal recovered well after surgery and no signs of colic were observed. Her appetite and rumination were also improved.


Assuntos
Bovinos/lesões , Corpos Estranhos/veterinária , Abomaso/diagnóstico por imagem , Abomaso/patologia , Abomaso/cirurgia , Animais , Bovinos/cirurgia , Cólica/diagnóstico por imagem , Cólica/etiologia , Cólica/cirurgia , Cólica/veterinária , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Laparotomia/veterinária
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