[Not all low back pain is renal colic]. / No todo dolor lumbar es un cólico nefrítico.

Low back pain is one of the most frequent reasons for consultation in primary care. Sometimes it is not easy to make a good differential diagnosis, because the number of pathologies that can express themselves with such symptoms is very wide and a complementary test or referral to the reference hospital is not always indicated. The following is a clinical case of a 59-year-old female patient with a history of dyslipidemia treated with ezetimibe, who consulted again for breakthrough low back pain, which was finally diagnosed as a penetrating ulcer of the abdominal aorta, treated endovascularly by the vascular surgery service. The clinical case aims to provide an overview of the acute treatment of aortic syndrome, showing the differences compared to the management of other common pathologies in primary care with the same clinical expression.

Study on Acute Renal Colic and Comparison of Diclofenac and Ketorolac in Pain Management in University Hospital, Kavre, Nepal.

Background Acute renal colic is the most frequent clinical presentations of renal stone and a common cause of patient visits to emergency departments worldwide. The prevalence of the renal stone disease has increased steadily over the past decades. Objective To describe the prevalence, epidemiological features and clinical management of renal colic patients at emergency department in Kathmandu University Hospital, Kavre, Nepal. Method Two hundred and thirty-six patients with acute renal colic presented in emergency department during a six-months period were included in the study. Using a standard predesigned proforma, demographic characteristics, presenting symptoms, practice of pain management and outcome were investigated. Renal colic attacks in patients were defined according to International Classification of Diseases, Tenth Revision, and Clinical Modification-10. Result Prevalence of renal colic was 2.61%. Mean age of the patients was 33.9±13.7 years. More than half of participants were male (54%). Majority of the patients (47.9%) were from Kavrepalanchowk district. The most common presenting symptom of the patients was flank pain on affected side (79.2%). In almost 43% of patients, diclofenac sodium was administered as a first line analgesic. There was no significant difference between diclofenac and ketolorac with respect to the need of second line analgesic (Chi-square value: 0.19, p value = 0.664). Conclusion Prevalence of renal colic was 2.61% at Dhulikhel hospital. More male pateints were affected and the most common presenting symptom was flank pain on the affected. Diclofenac and ketorolac are equally effective for the pain management of renal colic patients.

The Determination and Clinical Significance of Prostaglandin E2 in Blood and Urine of Patients with Renal Colic.

BACKGROUND: This study explores the role of prostaglandin E2 (PGE2) in the etiology of urolithiasis in acute renal colic by analyzing the PGE2 levels in blood and urine throughout the clinical course of renal colic. METHODS: From June 2015 to November 2017, a total of 60 patients with acute renal colic were enrolled in the study. Blood and urine samples were taken before and after administration of drug to inhibit prostaglandin synthesis; further blood and urine samples were obtained from the patients 2 weeks after their recovery. The concentration of PGE2 in blood and urine samples was determined by using a Human Prostaglandin E2 ELISA Kit. RESULTS: The mean concentration of PGE2 was 420 ± 50.3 ng/L in blood and 600 ± 70.1 ng/L in urine when the patients had renal colic. After drug therapy, these concentrations fell to 300 ± 40.4 ng/L in blood and 500 ± 54.5 ng/L in urine. After 2 weeks the PGE2 concentration was 220 ± 47.5 ng/L and 300 ± 50.2 ng/L in blood and urine, respectively. Compared with PGE2 levels after medication, these concentrations were significantly higher during acute renal colic (p < 0.05). CONCLUSIONS: The synthesis and release of PGE2 increase at the onset of renal colic, suggesting that PGE2 plays an important role in acute renal colic. Administration of a prostaglandin synthesis inhibitor is a reliable way to treat renal colic.

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic.

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

The Effect of Lavender Oil in Patients with Renal Colic: A Prospective Controlled Study Using Objective and Subjective Outcome Measurements.

OBJECTIVE: To assess the usability of lavender oil as an adjuvant in the medical treatment of pain due to renal stones. METHODS: One hundred patients age 19-64 years diagnosed with renal colic were included in the study. Group 1 (n=50) received standard medical therapy (diclofenac sodium, 75 mg intramuscularly); group 2 (n=50) received aromatherapy (lavender oil) in addition to the standard medical treatment. In both groups, the severity of the pain was graded between 0 (no pain) and 10 (severe pain) by using the visual analogue scale (VAS). RESULTS: The VAS values at the beginning and at 10 and 30 minutes in group 1 were 7.70±1.61, 5.02±2.20, and 2.89±1.96, respectively; in group 2, the values were 7.83±2.02, 4.42±2.46, and 2.20±1.74, respectively. The VAS values for the male patients in group 1 at the beginning and at 10 and 30 minutes were 7.61±1.47, 4.80±2.00, and 2.67±1.74; in the female patients, the values were 7.81±1.80, 5.40±2.41, and 3.72±1.94. For the male patients in group 2, the VAS values at the beginning and at 10 and 30 minutes were 8.25±2.01, 4.93±2.72, and 2.96±1.90, respectively; for the female patients, the values were 7.52±1.94, 4.15±1.95, and 1.21±0.91, respectively. Results are presented as mean±SD. Although there was no significant difference between the VAS values at the beginning and at 10 minutes in both groups, the VAS values at 30 minutes in the group receiving aromatherapy plus conventional treatment were statistically significantly low. CONCLUSION: These findings suggest that the use of aromatherapy, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods will help decrease pain, particularly in female patients.

Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm.

AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck. METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery. RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo. CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department.

BACKGROUND: Despite the fact that numerous medications have been introduced to treat renal colic, none has been proven to relieve the pain rapidly and thoroughly. In this study, we aimed at comparing the effects of intravenous lidocaine versus intravenous morphine in patients suffering from renal colic. METHODS: In a prospective randomized double-blind clinical trial performed in the emergency department of Imam Reza educational hospital of Tabriz, Iran, we studied 240 patients, 18-65 years old, who were referred due to renal colic. Patients were divided into two groups. In group I (120 people) single-dose intravenous lidocaine (1.5 mg/kg) was administered and in group II (120 people) single-dose intravenous morphine (0.1 mg/kg) was administered slowly. Visual Analogue Pain Scale (VAS) was recorded while admission, 5, 10, 15 and 30 minutes after injection. Statistical data and results were studied using descriptive statistics as percentage and Mean ± SD. To compare the response to treatment, Mann-Whitney U-test was used in two groups. Consequently, the data were analyzed using the SPSS16 software. RESULTS: Pain score measured in two groups five minutes after the injection of lidocaine and morphine were 65 % and 53 % respectively (95% CI 0.60 - 0.69, CI 0.48 - 0.57, p = 0.0002).108 (90 %) patients (95 % CI 0.84 - 0.95) from group I and 84 (70%) patients (95 % CI 0.62 - 0.78) from group II responded appropriately at the end of the complete treatment. The difference was statistically significant (p = 0.0001). CONCLUSIONS: Changing the smooth muscle tone and reducing the transmission of afferent sensory pathways, lidocaine causes a significant reduction in pain. TRIAL REGISTRATION: Clinical Trials IRCT138901042496N3.

Regional short-term climate variations influence on the number of visits for renal colic in a large urban Emergency Department: results of a 7-year survey.

The pathogenesis of renal stones is an intricate process and varies widely depending on the composition of stones. There is also a marked geographic variability, strongly attributable to the mean annual temperature (MAT) and, to a lesser extent, on the seasons. Previous investigations report peaks in Emergency Department (ED) visits for renal colic during the summer. The aim of the present investigation is to assess the influence of day-by-day climate changes on the number of visits due to renal colic in our ED (city of Parma, located in the Po river valley, with a temperate continental climate). A total of 8,168 colic episodes were retrieved from our database during a period of 2,557 days (from 1 January 2002 to 31 December 2008). Over the same period 557,990 patients were admitted to our ED, renal colic visits representing 1.46% of the total. The linear regression analysis fitting the mean number of colic visits per day and the mean daily temperature displays a very high and significant correlation (R = 0.88, p < 0.0001). A multiple linear regression analysis between the mean temperature of each of the 30 days preceding the colic episode also shows strong correlations, being the strongest on the 5th-7th days (R = 0.80, p < 0.0001 on the 6th day before the colic episode), and a weaker but highly significant correlation on days 14 (R = 0.77, p < 0.0001) and 20 (R = 0.70, p < 0.0001) before the colic episode. Taken together, these findings suggest a kind of "acceleration" process of stone formation caused by the hot climate and, perhaps, by dietary variations during the summer. This process might trigger a sudden growth of the stone and, finally, the resulting clinical episode.

[Epidermoid cyst of the kidney : a rare cause of recurrent renal colic]. / Epidermoidzyste der Niere : Eine seltene Ursache für rezidivierende Nierenkoliken.

In contrast to epidermoid cysts of the dermis, epidermoid cysts of the kidneys are rare. We report on a female patient with recurrent renal colic caused by an epidermoid cyst of her right kidney. A malignant tumor was suspected by computed tomography but was ruled out through ureterorenoscopic biopsy. The epidermoid cyst was removed by a partial nephrectomy.

Clinical management of Nutcracker's syndrome during pregnancy.

BACKGROUND: The Nutcracker syndrome (mesoaortic compression of the left renal vein) is a rare condition which causes macroscopic hematuria and colic pain. METHODS: We have carried out a search in Medline database of the current trends in the management of this rare syndrome during pregnancy. RESULTS: We found four reports on diagnosis of the syndrome during pregnancy but there is no published articles concerning the management of pregnancy after diagnosis of a Nutcracker syndrome treated with a vascular stent. A case of Nutcracker's syndrome during pregnancy is reported as well as a review of the clinical findings and management of the syndrome. CONCLUSION: The pregnancy of patients with Nutcracker syndrome, undergone vascular stent placement, should be considered high risk gestation and should be managed with low molecular weight heparin and serial renal vein flow Doppler studies.

Evaluation of suspected renal colic patients with unenhanced low-dose multi-detector computed tomography.

OBJECTIVES: To determine the proportion of correctly diagnosed ureteric calculi and alternate diagnoses using unenhanced low dose multidetector CT KUB. DESIGN: Descriptive - prospective study. SETTING: Aga Khan University Hospital, Nairobi between November 2006 and October 2007. SUBJECTS: One hundred and four patients underwent low dose multi-detector computed tomography (MDCT) KUB. RESULTS: Ninety (47 males and 43 females with age range of 17 - 79 years, mean 40 years) were included in the statistical analysis while 14 were excluded. Eighteen out of ninety (20%) were classified as definitely having ureteric calculi on the composite reference. Among the 18,17 were correctly identified on unenhanced low dose MDCT, giving a proportion of (17/18) 94.4%, Pearson Correlation of 0.898 and Fishers exact test significance < 0.001. 29/90 (32%) had alternative diagnosis and 42/90 (47%) had no abnormality detected on unenhanced low dose MDCT. CONCLUSION: This study shows that, unenhanced low dose MDCT KUB can be effectively used for evaluation of suspected renal colic patients as demonstrated by the statistically significant correctly detected ureteric calculi.