Ultra-low-dose CTKUB: the new standard of follow-up of ureteric calculi not visible on plain radiograph?

PURPOSE: With sensitivities over 95%, non-contrast computer tomography of kidney, ureter and bladder (CTKUB) is the investigation of choice in renal colic to diagnose or exclude ureteric calculi. CTKUB delivers an average effective radiation dose of 5.4 millisievert (mSv) and is used to follow-up calculi not visible on plain X-ray, whereas plain radiography has a radiation exposure of 0.7 mSv and is used to follow-up radio-opaque calculi. We assessed the effectiveness of using ultra-low-dose CTKUB (ULDCTKUB) for the follow-up of ureteric calculi not visible on plain radiograph of the kidneys, ureter and bladder (KUB), as an emerging option to reduce radiation exposure compared to standard dose CTKUB. METHODS: Between 2013 and 2016 we retrospectively analysed 86 patients who underwent ULDCTKUB for CTKUB-confirmed ureteric calculi that were not visible on plain radiography. Patients were identified from our Radiology Management System with additional information from electronic patient records. RESULTS: 98% of ULDCTKUBs were of diagnostic quality; two patients required further cross-sectional imaging. 67% of patients had passed their calculi after the initial diagnostic CTKUB. In the remaining 33% who had persistent calculi on ULDCTKUB, 20% required surgical intervention and 13% required no intervention. The mean ULDCTKUB effective radiation dose was six times lower than conventional CTKUB (0.8 vs 5.4 mSv). 67% of patients had a radiation dose equivalent to X-ray KUB (< 1 mSv). CONCLUSION: ULDCTKUB is a reliable and safe follow-up investigation of ureteric calculi and has absorbed radiation doses similar to plain radiography and lower than annual background radiation. We advocate ULDCTKUB as the primary imaging modality in the follow-up of ureteric calculi not visible on plain radiograph.

Glucose-lowering effect of fenugreek in non-insulin dependent diabetics.

The effect of fenugreek on postprandial glucose and insulin levels following the meal tolerance test (MTT) was studied in non-insulin dependent diabetics (NIDDM). The addition of powdered fenugreek seed (15 g) soaked in water significantly reduced the subsequent postprandial glucose levels. The plasma insulin also tended to be lower in NIDDM given fenugreek but without a statistical difference. Fenugreek had no effect on lipid levels 3 h following the MTT. Fenugreek may have a potential benefit in the treatment of NIDDM.

Age at first conscious ejaculation: a milestone in male puberty.

The age of occurrence of the first conscious ejaculation was registered in 263 boys belonging to two categories: (1) 128 boys (70 normal controls, 22 boys with unilateral cryptorchidism with normal puberty, and 36 boys with delayed puberty) who had been under regular follow-up throughout puberty. All underwent a complete physical examination at intervals of 3 to 6 months, and in most a wrist X-ray was made within three months of the first ejaculation. (2) A group of 135 boys examined and questioned at their school served as additional controls. Eighty of these reported ejaculations. Despite a wide range in the chronological age at occurrence of the first conscious ejaculation, the mean bone age in all groups, including that with delayed puberty, was 13 1/2 +/- 1/2 years (SD), with a range between 12 1/2-15 1/2 years. There was no correlation between the age at first ejaculation and testicular volume, pubic hair or penis length. It is proposed that the age at the first conscious ejaculation be used as an index of maturation in male puberty.

The distribution of the biliary-anionic polypeptide fraction between cholesterol carriers in bile and its effect on nucleation.

The small (7 kD) biliary phospholipid and calcium binding polypeptide (anionic polypeptide fraction/calcium binding protein) has been found in higher concentrations in the bile of patients with pigment stones than in controls. In different model systems it was variously found to promote or retard cholesteral crystalization. In the present study we investigated its distribution between cholesterol carriers in bile and its effect on cholesterol crystalization in native and model biles. On gel chromatography anionic polypeptide fraction/calcium binding protein was found predominantly in three areas: in the vesicular fraction, in the non-vesicular lipid fraction and in another fraction unassociated with biliary lipids. It was much more concentrated in the vesicular than in the non-vesicular fraction, the mean anionic polypeptide fraction/phospholipid molar ratio being 219 +/- 181 vs. 30.4 +/- 16, respectively. Anionic polypeptide fraction/calcium binding protein was added at three dose levels, 0.14, 0.28, 0.42 mg/ml (representing approximately 18%-55% of the physiologic biliary concentration), to 19 human and five model biles. This did not produce any significant changes in the nucleation time. The addition of anionic polypeptide fraction/calcium binding protein at a dose level of 0.42 mg/ml to 13 different human biles did not induce changes in the distribution of cholesterol among its carriers. The present experiments do not support a role for anionic polypeptide fraction/calcium binding protein in the process of cholesterol nucleation in bile. Qualitative changes in the protein molecule, as demonstrated in other human secretions, cannot be excluded.

Octogenarian subjects have low postprandial levels of chylomicron remnants: a possible explanation for protection against atherosclerosis.

Postprandial lipoprotein metabolism may play an important role in the development of atherosclerosis. It is widely believed that in healthy octogenarians, the atherogenic process occurs very slowly. In the present study, postprandial lipoprotein metabolism was examined in 14 octogenarian subjects (mean age, 84 +/- 4.2 years) and 19 younger controls (mean age, 50 +/- 4.8 years) using the vitamin A-fat loading test, in which intestinally derived lipoproteins are specifically labeled with retinyl palmitate (RP). Results indicated that mean peak chylomicron remnant RP levels and the areas below the chylomicron remnant RP curve were significantly lower in the octogenarian group than in the controls (625 +/- 329 vs 1321 +/- 688 micrograms/L and 3740 +/- 1078 vs 6162 +/- 1063 micrograms/L.h, respectively; p < .0001). No differences were found between the two groups in chylomicron RP levels or in lipolytic activity. The study suggests that octogenarians do not exhibit the decrease in chylomicron lipolysis that usually accompanies aging. In addition, these subjects have significantly lower levels of chylomicron remnants in the circulation. Since accumulation of these particles has been implicated in the development of atherogenesis, our findings may indicate a major mechanism of atherosclerosis prevention in healthy octogenarians.

Vitamin A loading--an indicator of post-prandial lipoprotein clearance in healthy and hypertriglyceridemic subjects.

To study post-prandial lipoprotein metabolism in normolipidemic and hypertriglyceridemic subjects, a vitamin A fat loading test was used. This method specifically labels dietary fat particles with retinyl palmitate (RP). Following RP concentrations, metabolic behavior of chylomicrons and chylomicron remnants were studied. In normal subjects, post-prandial lipoproteins were present for more than 10 h. Total RP increased rapidly between 1 and 4 h, peaked at 6 h and declined rapidly between 6 and 10 h. The chylomicron and chylomicron remnant fractions behaved differently, showing precursor product relationship. The hypertriglyceridemic patients demonstrated a very severe defect in chylomicron clearance. This fraction was 2.8-fold higher than in normal subjects, which was 7,260 vs. 2,600 micrograms/l, respectively. The large magnitude and long duration of post-prandial lipemia in normal and hypertriglyceridemic patients support the hypothesis that these atherogenic particles may play a role in the development of coronary heart disease.

Successful treatment of secondary hyperparathyroidism in hemodialysis patients with oral pulse 1-alpha-hydroxy-cholecalciferol therapy.

We have used high-dose oral pulse therapy with 1 alpha-hydroxycholecalciferol (1 alpha-OH-D3) to treat 40 hemodialysis patients suffering form secondary hyperparathyroidism. Forty patients with intact parathyroid hormone (PTH) levels of > 150 pg/ml were treated with 4 micrograms oral 1 alpha-OH-D3 twice weekly for 1 year. The mean PTH level was 515 +/- 50 pg/ml prior to treatment, which fell to 191 +/- 42 pg/ml after 6 months of treatment (p < 0.00001), and to 164 +/- 39 pg/ml after 12 months of treatment. Patients with very high PTH levels (> 800 pg/ml) suppressed less well than patients with lower levels (150-300 pg/ml). The therapeutic end point of PTH < 100 pg/ml was achieved in 23 patients (58%). The main side effect of the treatment was hypercalcemia, but this was symptomatic in only 3 patients, all above the age of 70 years. In summary, oral high-dose pulse therapy with 1 alpha-OH-D3 was highly effective in suppressing PTH levels in hyperparathyroid hemodialysis patients, and side effects were relatively few.