Bladder outflow obstruction caused by prostatic calculi.
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Biomedical subjects
Publications and source records attributed to R Calleja.
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OBJECTIVE: To determine the safety of the conservative management of ureteric calculi of > 4 mm in diameter, using mercapto-acetyltriglycine (MAG3) radioisotope renography to monitor renal parenchymal function. PATIENTS AND METHODS: Patients with symptomatic unilateral ureteric calculi were recruited prospectively. After confirming the position of the stone using contrast urography, a MAG3 radioisotope renogram was taken within 48 h of admission and again 1 month after the patients became stone-free. The indications for intervention were ipsilateral loss of function (>/= 5% loss), infection, pain or any combination of these factors. The recovery of function was determined by follow-up renography. RESULTS: In all, 54 patients were recruited; 18 were initially allocated to conservative treatment although four later required intervention for pain. The remainder required early intervention for pain (eight), diminished function only (15) or diminished function with infection (13). Of the 54 patients, 28% had 'silent' loss of renal function at presentation. No calculi of > 7 mm diameter passed without intervention. The mode of initial management was determined according to individual clinical need. The upper tracts of all patients were relieved of obstruction and all patients were rendered stone-free. Intervention for reduced function only (at </= 7 days) gave a significantly better (P = 0.03) recovery of function than those undergoing later intervention. The combination of reduced function and infection were unrelated to outcome after intervention. CONCLUSIONS: The conservative management of stones of 5-7 mm diameter is safe, providing that radioisotope renography is used to identify those renal units requiring intervention. This approach allows timely intervention to maximize the recovery of renal function.
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The appearance of digital radiographs were markedly influenced by post-processing. To optimise images of the hand, radiographs of 7 patients with arthritis were modified by various filters. 6 observers evaluated the presence or absence of erosive changes during an ROC study and the advantages of low filtration were demonstrated. Further images were prepared of anatomical preparations in which para-articular defects had been made and of a hand phantom covered in perforated plexiglass. Limited filtration and low enhancement factors again provided the best results. Dose reduction of 50% resulted in a significant deterioration in the ability to recognise erosions and artificial lesions.
By means of the Pettersson scoring system, the degree of severity of haemophilic arthropathy in 128 knee, elbow and ankle joints was estimated by 5 radiologists. Their scores varied on average by approximately 3 points. Minimal and maximal joint involvement were scored consistently; exclusion of haemophilic arthropathy was possible with the highest degree of certainty. With regard to changes of a moderate degree agreement was seldom reached. With precisely defined characteristics, a high degree of consistency between observers was evident. Interobserver variation in the scoring was more marked in the ankle joint than in the other joints. Scoring was more consistent with the more experienced observers.