Detection of urinary bladder mass in CT urography with SPAN

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134872/1/mp2503.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134872/2/mp2503_am.pd

Ultrasonography Alone is Not Enough To Exclude Vesicoureteral Reflux in All Small Children After a Urinary Tract Infection

As knowledge on vesicoureteral reflux (VUR) and the limited effectiveness of its treatment has increased, several guidelines have been updated, and no longer recommend extensive routine imaging of all children with urinary tract infection (UTI). We determined the possible consequences of following the most widely used guidelines for imaging children with UTI, in a retrospective cohort of children treated for UTI in Turku University Hospital in the years 2000-2009. Using the same cohort, we identified factors associated with abnormal imaging and UTI recurrence after a first febrile UTI. We also performed a meta-analysis aiming to determine the value of ultrasonography in identifying patients with VUR after UTI. We found that following the guidelines issued by the National Institute for Health and Care Excellence may lead to missing a substantial number of patients with significant urological anomalies, whereas following the guidelines issued by the American Academy of Pediatrics may lead to fewer patients being missed. Both strategies may lead to avoiding a significant number of unnecessary imaging studies. We identified several factors associated with abnormal imaging and UTI recurrence, and determined a risk score system for predicting the risk for VUR and high-grade VUR. This system had high sensitivity in detecting high-grade VUR in our population. In a meta-analysis of 14 studies, we found that ultrasonography is not sufficiently accurate in predicting the presence or absence of VUR. The optimal imaging strategy for imaging children with UTI is controversial, and depends ultimately on the significance of VUR and the effectiveness of its treatment.Ultraäänitutkimus yksin ei riitä poissulkemaan vesikoureteraalista refluksia kaikilla pienillä lapsilla virtsatieinfektion jälkeen Viime vuosikymmenien aikana tieto vesikoureteraalisen refluksista (VUR) ja sen hoidon rajallisesta vaikuttavuudesta on lisääntynyt. Tämän myötä useita suosituksia on päivitetty, eikä kaikkien virtsatieinfektion (VTI) sairastaneiden lasten rutiinikuvantamista enää suositella. Me selvitimme, mitä mahdollisia seurauksia suosituimpien suositusten noudattamisella olisi ollut potilaskohortissa lapsia, joita hoidettiin Turun yliopistollisessa keskussairaalassa VTI:n vuoksi vuosien 2000-2009 aikana. Samaa potilaskohorttia käyttäen selvitimme tekijöitä, jotka ovat yhteydessä poikkeaviin kuvantamistuloksiin sekä infektion uusiutuvuuteen ensimmäisen kuumeisen VTI:n jälkeen. Suoritimme myös meta-analyysin, jonka tarkoitus oli selvittää, miten hyvin ultraäänitutkimus ennustaa VURia VTI:n jälkeen. Totesimme, että National Insitute of Health and Care Excellencen suositusten noudattaminen voi johtaa siihen, että huomattava määrä potilaita, joilla on merkittäviä, hoitotoimenpiteitä vaativia urologisia poikkeavuuksia, jäävät löytymättä, kun taas American Academy of Pediatricsin suositusten noudattaminen voi johtaa selvästi pienemmän määrän potilaita löytymättä jäämiseen. Molemmat kuvantamisstrategiat voivat johtaa turhien tutkimuksien selvään vähenemiseen. Tunnistimme useita tekijöitä, joilla on yhteys poikkeaviin kuvantamistuloksiin sekä VTI:iden uusiutuvuuteen, ja muodostimme riskipisteytysjärjestelmän VURin ja korkea-asteisen VURin riskin ennustamiseksi. Riskipisteytysjärjestelmällä oli korkea sensitiivisyys korkea-asteisen VURin tunnistamiselle. Meta-analyysissä, jossa käsiteltiin 14 tutkimusta, totesimme, ettei ultraäänitutkimus ole riittävän tarkka ennustamaan VURia tai sen puuttumista. Optimaalinen kuvantamisstrategia lapsilla VTI:n jälkeen on ristiriitainen aihe, joka riippuu olennaisesti VURin merkityksestä sekä sen hoidon vaikuttavuudesta.Siirretty Doriast

VOIDING DYSFUNCTION AND DETRUSOR INSTABILITY AFTER THE COLPOSUSPENSION OPERATION FOR GENUINE STRESS INCONTINENCE

Colposuspension is an effective treatment for genuine stress incontinence. Continence is restored by positioning the bladder neck in a fixed and elevated retro-pubic position. Despite a high success rate of up to 90%, post-operative complications occur which may have an adverse effect on quality of life. Voiding difficulties develop in 0-43% of patients and detrusor instability in 2- 25%. This considerable variability is due to differences in definition, the timing of assessment, patient selection, and probably also in surgical technique. The natural history of these complications is not clearly known due to the lack of prospective follow-up studies. There is also general uncertainty with regards to their causes. While retrospective studies have attempted to identify pre-operative risk factors, there are no prospective studies which attempt to correlate the anatomical and functional changes caused by surgery with the development of voiding dysfunction and detrusor instability. This study has investigated prospectively 77 women undergoing the operation of colposuspension in relation to the incidence, natural history and causes of post-operative voiding dysfunction and detrusor instability. The complications were identified and followed-up objectively by means of serial urodynamic studies. Patients were also assessed clinically and using quality of life measures. The development of complications were correlated to a number of anatomical and functional changes caused by surgery. Anatomical changes were identified mainly by imaging the bladder neck with Magnetic Resonance Imaging (MRI). Functional changes were identified using urodynamic studies. Voiding dysfunction after colposuspension was common, with 69% of women requiring a catheter for more than seven days, and 28% for longer than 14 days. Improvement occurred gradually in most cases, with only 7. 7% and 2.5% of them needing catheterization at three months and one year respectively. De novo detrusor instability occurred in 21% of women at three months follow-up, and was symptomatic in 66% of these cases. Objective and subjective resolution was seen in 50% of these at one year follow-up. Quality of life after colposuspension improved in most cases despite the development of these complications, probably due to the resolution of their incontinence. Voiding dysfunction and detrusor instability after colposuspension were found to be multifactorial, due to patient related factors (age and detrusor contractility for voiding dysfunction, and age and a past history of bladder neck surgery for detrusor instability), and to operative factors (amount of bladder neck elevation and urethral compression). These findings might lead to the development of preventative measures

Imaging of tumours of the urinary tract in children, with particular reference to Wilms' tumour

The investigation of an abdominal mass in a child is a common problem in the radiology department of the Red Cross Children's Hospital. The majority of these masses involve the urinary tract. The commonest neoplasm is a Wilms' tumour of the kidney. Against a pathological and clinical background, the investigation of Wilms' tumour by diagnostic imaging is presented. The imaging modalities currently utilised are the intravenous urogram (IVU), ultrasound (US), computed tomography (CT) and magnetic resonance (MR). Using the material available in the last decade, the principles, techniques and imaging characteristics of these modalities are investigated and compared. These results are reflected against those reported in the medical literature. This literature is not yet extensive as the current technology has only been available for the last six to seven years. The IVU has in the past been the main imaging modality and we still use it extensively. Its strengths and weaknesses are discussed. In the last five years US has taken its place as the primary method of diagnostic imaging. We have found that with our increasing experience that this is justified. The use of US and IVU in a practiced hand is a powerful diagnostic combination. CT as a primary investigation is not readily available at our institution. We have used it for comparative purposes in about 20% of our recent cases. CT has not added greatly to our initial diagnostic impression. However, it has been most useful for follow up of metastasis and for assessing the normality of the lungs before ceasing chemotherapy. Our experience with MRI is limited and confined to unusual presentations in the last year. Other modalities such as arteriography and nuclear medicine have special indications which are to be discussed. The remaining tumours of the upper urinary tracts are all rare, but are reported and the literature researched. In the lower urinary tract the main pelvic lesion is a rhabdomyosarcoma. The comparative advantages of the IVU, US, CT and MRI are also noted. In the pelvis, US has also become the primary imaging modality, and is replacing contrast medium cystography. However, examples of the latter are included as it still has a place, particularly in the less sophisticated institutes. CT and MRI, when available, have imaging advantages in the pelvis and are becoming the methods of choice for follow up. The main objective of this document has been to investigate the available imaging techniques, but, against this overall theme, the clinical care of the child is most important. With this in mind the treatment protocols that are used at our hospital are noted in the appendices to the thesis

UWOMJ Volume 26, No 1, January 1956

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1039/thumbnail.jp

Abdominal Ultrasonography in Domestic Species

This study was designed to evaluate the use of abdominal ultrasonography in small animals and horses presented at Glasgow University Veterinary School for investigation of abdominal disease and to assess the application of ultrasonography in ovine, canine and feline pregnancy. Initially, the normal ultrasonographic appearance of the liver and spleen were determined by examination of four dogs, six horses and two cats. The appearance of these organs was found to be consistent within and across the species. The most suitable anatomical sites from which these structures could be imaged in these species and the most appropriate equipment were also determined in this study. Twenty-seven dogs and three cats were selected for hepatic ultrasonography and the clinical, radiographic and laboratory indications for the procedure were considered. In twelve out of the thirteen cases of confirmed hepatic disease ultrasonographic abnormalities were detected and these were subsequently compared with the findings at postmortem examination or exploratory laparotomy in the majority of the cases. Twenty dogs and one horse were selected for splenic ultrasonography and in four of these abnormalities were detected. The indications and final diagnoses were reviewed to evaluate the merits and limitations of this procedure. An experiment was designed to determine the accuracy of ultrasonographic estimation of ovine foetal number and to compare the results of inexperienced and experienced operators at various stages of gestation. The optimum efficiency was obtained by ultrasonographic examination at, or around, day 60 of gestation and considerable improvement was observed during the training period of the inexperienced operator. The efficiency of ultrasonographic determination of pregnancy and estimation of foetal numbers in bitches and queens was evaluated by examination of thirty-six bitches and four cats referred to this hospital. Sensitivity of pregnancy diagnosis was 100% but the sensitivity of estimation of foetal number was found to vary with the stage of gestation and the litter size. The most sensitive estimations were obtained in medium sized litters (four to eight foetuses) at days 37 to 43 of gestation. Two methods of estimation of ovine foetal age were developed which were based on ultrasonographic measurement of biparietal and transthoracic diameters, but the estimated age range obtained with these methods was wide. Nine dogs were selected for prostatic ultrasonography. In all of these cases there were clinical signs referrable to the prostate and prostatic disease was subsequently confirmed. Ultrasonographic abnormalities were detected in all of these cases

Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo

Cholesterosis of the gall-bladder: a clinical and experimental study

The occurrence of cholesterol deposits in the wall of the gall- bladder has appeared to the writer to be of more than passing interest, for the following reasons:- (i) Although cholesterol is of widespread distribution and may be laid down in many sites throughout the body in large collections, yet little is known either of its real function in regard to the general body economy or of the conditions which control its deposition, Such deposits consequently attract interest in inverse proportion to our knowledge of their causation. (2) The biliary tract is known to bear very particular relationship to cholesterol, for, with the exception of the milk during lactation, the bile forms by far the most important vehicle for its excretion, and it therefore becomes a very attractive hypothesis that the gall- bladder, as a specialised part of the biliary tract, bears some close relationship to this excretory process and that this relationship renders it particularly subject to the deposition of cholesterol.Part II. of this thesis is devoted to a consideration of these and other aspects of the disease, and to a description of experimental work which.has been carried out in relation to them, Firstly, Cholesterosis of the Gall-bladder will be considered in its relation to similar deposits of cholesterol in other organs. Secondly, an excursion will be made into the realms of Comparative Pathology, to describe a similar. change which it has been the writer's good fortune to observe in the gall-bladder of a cat.Thirdly, the possible causes of Cholesterosis in the human being will be considered, and the experimental production of the disease in animals under controlled conditions will be described. And lastly, experimental work will be recorded which goes to indicate the relation of Cholesterosis to the function of the gall-bladder and biliary tract.Whatever may be the pathogenesis of Cholesterosis of the Gall-bladder, a feature of very practical interest is its relation to the formation of gall-stones. It is well recognised that Cholesterol forms the chief constituent of the great majority of gall-stones, and it will be shown later that those stones which consist almost entirely of Cholesterol seem particularly apt to be associated with Cholesterosis of the Gall-bladder. The relationship between these two conditions therefore invites examination.In Part III, the present-day views as to the formation of gall-stones are considered, and in this connection several cases from the series here reported are described, which indicate the relationship existing between the origin of stones and cholesterol deposition in the gall-bladder wall