RESUMEN
The potential for variability among observers interpreting diagnostic tests is well known but has not been well established for radiological imaging of urolithiasis. We measured the inter-observer and intra-observer variability in the reporting of plain abdominal films and tomograms from patients who had undergone extracorporeal shock wave lithotripsy (ESWL). Unlabeled copies of the plain abdominal films and tomograms for 58 patients were individually submitted to 3 different radiologists. Selected films from 25 patients were resubmitted to the same radiologists. We found differences among radiologists reporting plain abdominal films alone 52% of the time and even by the same radiologist rereading the films 24% of the time. Tomograms alone decreased the uncertainty but differences still occurred among radiologists 24% of the time and with themselves 16% of the time. When plain abdominal films and tomograms were read together there were differences among radiologists 28% of the time and with themselves 7% of the time but these were usually minor. We concluded from this study that the plain abdominal film alone was frequently difficult to interpret, resulting in uncertainty about the presence or absence of residual stone fragments. Tomograms alone or a plain abdominal film plus tomograms is superior to a plain abdominal film alone. Finally, radiological assessment with all modalities probably overestimates stone-free rates after ESWL even without consideration of the potential for reporting variability among observers.
Asunto(s)
Cálculos Renales/diagnóstico por imagen , Litotricia , Humanos , Cálculos Renales/terapia , Variaciones Dependientes del Observador , Tomografía Computarizada por Rayos XRESUMEN
A panorama of signs and symptoms from the primary and associated disease processes complicates the clinical picture of chronic adult renal vein thrombosis (RVT). This has made the diagnosis of RVT very challenging. In addition, this entity is often overlooked in differential diagnosis due to the patient's often multiple other problems. Detecting this condition may lead to restoration of renal function compromised by renal vein obstruction and thus be of critical benefit in patients who often have compromise of renal function. Two unusual presentations of chronic RVT are discussed and provide a basis for review of the salient features of aetiology, diagnosis and disease management, providing what is hoped to be useful suggestions in diagnosis and management of this condition.
Asunto(s)
Venas Renales , Trombosis , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Trombosis/diagnóstico , Trombosis/diagnóstico por imagenRESUMEN
We herein describe a new technique for the assessment of the clinically significant obstructed renal unit. The diuretic ultrasound utilizes the noninvasive, high resolution ultrasound unit in combination with diuresis induction with furosemide to assess renal collecting system obstruction.
Asunto(s)
Furosemida , Hidronefrosis/diagnóstico , Ultrasonografía , Obstrucción Ureteral/diagnóstico , HumanosRESUMEN
The authors report a case of right ureteropelvic junction obstruction in an otherwise healthy 31-year-old man. Because of previous surgical manipulation of the right testicle, the diagnosis was obscured, delaying therapeutic intervention. Renal pain often refers to the testicle and groin, and testicular pain to the flank. Therefore evaluation of organs in the primary referral distribution must be considered in cases of obscure intractable pain in this area.
Asunto(s)
Enfermedades Renales/fisiopatología , Dolor/etiología , Testículo , Obstrucción Ureteral/fisiopatología , Adulto , Humanos , Enfermedades Renales/diagnóstico , Pelvis Renal , Masculino , Dolor/fisiopatología , Obstrucción Ureteral/diagnósticoRESUMEN
The role of percutaneous transluminal angioplasty in treating advanced peripheral vascular disease is unknown. The authors therefore reviewed the experience of Sunnybrook Medical Centre in Toronto with 85 consecutive patients who had rest pain, ulceration, pregangrene or gangrene as a result of peripheral vascular disease and who underwent percutaneous transluminal angioplasty. Seventy-four percent were smokers and 91% were at increased risk due to one or more of the following: coronary or cerebral ischemic disease, diabetes mellitus, obesity and hypertension. Thirty-six patients underwent dilatation of iliac lesions, 46 of superficial femoral or popliteal and 3 of more distal lesions. In nine patients angioplasty was repeated on the same lesion. In 16 patients, the procedure was technically unsatisfactory. The morbidity and 30-day mortality were 5% and 2%, respectively. When the procedure was technically satisfactory, surgery was avoided and the limb was salvaged at 1, 2 and 5 years in 69%, 62% and 54% of cases, respectively (life-table analysis). The authors conclude that percutaneous transluminal angioplasty is acceptable treatment for patients with advanced peripheral vascular disease, because the morbidity and mortality are low and the long-term results are good.
Asunto(s)
Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Pierna/irrigación sanguínea , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/mortalidad , Arteriopatías Oclusivas/complicaciones , Femenino , Arteria Femoral , Estudios de Seguimiento , Humanos , Arteria Ilíaca , Masculino , Persona de Mediana Edad , Arteria Poplítea , RiesgoRESUMEN
Angiography plays a vital role in the investigation of the patient suffering from multiple trauma. The commonest injuries have been rupture of the thoracic aorta, renal lacerations, arterial bleeding associated with fractures and soft-tissue injuries to the pelvis, and occlusions of the arteries supplying the limbs. Transcatheter arterial embolization may be the definitive therapeutic procedure in pelvic bleeding.