Implications of urine F2-isoprostane metabolite concentration in horses with colic and its potential use as a predictor for surgical intervention.

REASONS FOR PERFORMING STUDY: F2-isoprostanes have been used extensively to quantify lipid peroxidation in association with risk factors in various diseases. Horses with colic may have intestinal ischaemia and/or inflammation characterised by oxidative stress and increased production of isoprostanes. OBJECTIVES: To gather preliminary data regarding the feasibility of using urine F2-isoprostanes and isoprostane metabolites as early screening tools for the presence of gastrointestinal disease requiring surgical intervention in horses and ultimately develop a stall-side test capable of identifying these horses as early as possible for timely referral. METHODS: Concentrations of urine isoprostane and isoprostane metabolite were determined by mass spectroscopy and normalised to urine creatinine (Cr) concentrations in urine samples from 42 healthy control horses and 43 horses with gastrointestinal pain or colic. RESULTS: Horses with colic were treated medically (n = 21) or surgically (n = 22). Mean ± s.d. concentrations of urine isoprostane and isoprostane metabolite were significantly higher in horses with colic (2.94 ± 1.69 and 0.31 ± 0.22 ng/mg Cr, respectively), compared to control horses (1.89 ± 1.39 and 0.22 ± 0.08 ng/mg Cr, respectively). Mean urine isoprostane metabolite concentrations were significantly higher in horses undergoing surgery (0.38 ± 0.28 ng/mg Cr) compared to controls and medical colics (0.26 ± 0.11 ng/mg Cr). Nonsurvivors had significantly higher mean urine isoprostane metabolite concentrations (0.47 ± 0.39 ng/mg Cr) than control or surviving colic horses (0.29 ± 0.24 ng/mg Cr). CONCLUSIONS: Measurement of urine isoprostane metabolite concentration may be a useful prognostic indicator in equine colic. POTENTIAL RELEVANCE: Urine isoprostane metabolites may aid in early recognition of surgical colic. Isoprostanes are a potential therapeutic target to prevent further systemic and gastrointestinal tissue injury in horses with colic.

[Chromatographic mass spectrometric assessment of the course of different forms of urolithiasis].

The study has been undertaken to improve the methods for diagnosing urolithiasis, which comprehensively evaluate the severity of a pathological process and the results of treatment in patients with nephrolithiasis. The paper gives the data of investigating the processes of chromatographic mass spectrometric urinalysis in 82 patients aged 15 to 81 years urgently admitted to the units of urology of Moscow City Clinical Hospital Seven for a renal colic attack. The levels of lithogenic substances were measured in patients with different types of metabolic disturbances. There was evidence that the chromatographic mass spectrometric parameters of the level of lithogenic substances and hydrolytic enzymes might be used as diagnostic criteria for the progression of urolithiasis, the prediction of the severity of a pathological process, and the development of preventive methods against lithogenesis in patients with a renal colic attack.

'Watered down' renal colic: using tap water mixed with blood to simulate macroscopic haematuria.

Renal colic is a frequent presentation to the emergency department. Although most cases are genuine, up to 0.6% of cases are factitious, representing attempts to procure parenteral narcotic medication or rarely, to attain unnecessary investigation or invasive treatment. Urethral catherization has been recommended to procure an untampered urine sample, but is viewed as invasive. Calculi analysis has no relevance to acute management. We report a case of factitious renal colic which was definitively proven to be so using sample biochemistry to confirm a tap water sample contaminated with blood. This is diagnostically useful if tap water or normal saline is used to produce an alleged urine sample.

Emergency ultrasound and urinalysis in the evaluation of flank pain.

OBJECTIVES: To determine the sensitivity and specificity of limited emergency ultrasonography of the kidney in diagnosing renal colic. METHODS: This was a prospective observational trial from December 2001 to December 2003 at a suburban emergency department. Patients who presented with flank pain suspicious for renal colic were enrolled. Exclusion criteria included fever, trauma, known current kidney stone, unstable vital signs, and inability to provide consent. All patients underwent sequential emergency ultrasonography and computed tomography of the kidneys and bladder. Data were analyzed using chi-square analysis. The primary outcome was the sensitivity and specificity of ultrasonography. Results were also stratified for presence of hematuria. RESULTS: Fifty-eight of the 104 patients enrolled in the study were diagnosed with renal colic. The overall sensitivity and specificity of bedside ultrasonography for the detection of hydronephrosis were 86.8 (95% confidence interval [CI] = 78.8 to 92.3) and 82.4 (95% CI = 74.1 to 88.1), respectively. In patients with hematuria, hydronephrosis by emergency ultrasonography demonstrated a sensitivity and specificity of 87.8 (95% CI = 80.3 to 92.5) and 84.8 (95% CI = 73.7 to 91.9), respectively. In 55 of the cases, the initial computed tomograph was read by a resident and later re-read by an attending physician. Using the reading of the attending physician as the criterion standard resulted in a sensitivity and specificity of 83.3 (95% CI = 73.2 to 88.0) and 92.0 (95% CI = 79.9 to 97.6), respectively. CONCLUSIONS: Emergency ultrasonography of the kidneys shows very good sensitivity and specificity for diagnosing renal colic in patients with flank pain and hematuria.

Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results.

OBJECTIVES: To determine the utility of hematuria testing in a large series of patients with suspected renal colic using unenhanced helical computed tomography (CT) as the reference standard. METHODS: A retrospective review of the CT reports of all patients who underwent unenhanced helical CT for suspected renal colic at one institution during a 3.5-year period and who also underwent a formal microscopic urinalysis within 24 hours of the CT study was conducted. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of any blood on the urinalysis for renal colic were calculated. RESULTS: Urolithiasis was present in 587 (62%) of the 950 patients, and 363 patients had negative examinations for renal colic, including 69 with significant alternative diagnoses in the latter group. Of the urinalyses, 492 were true-positive, 174 were true-negative, 189 were false-positive, and 95 were false-negative, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 48%, 72%, and 65%, respectively. Forty-six percent of the urinalysis results were negative for blood in the subset of patients with significant alternative diagnoses. CONCLUSIONS: The sensitivity of hematuria on microscopic urinalysis for renal colic using unenhanced CT as the reference standard was 84%, and the specificity and negative predictive value was low. The presence or absence of blood on urinalysis cannot be used to reliably determine which patients actually have ureteral stones.

Isolated renoureteric aspergilloma due to Aspergillus flavus: case report and review of the literature.

In this paper we describe a case in which acute renal colic was associated with elimination of multiple hyphal masses of Aspergillus flavus. Also, we reviewed the literature on similar cases and we found a similar pattern characterized by a marked male predominance, association with at least one underlying medical condition that predisposes to fungal infection, the presence of local symptoms resembling acute ureteral colic, and the absence of systemic manifestations. Moreover, our data suggest that Aspergillus balls must be suspected when a diabetic and intravenous drug user presents with acute renal colic and that non-obstructive renal aspergillosis may be initially treated with itraconazole.

[Crystalluria]. / Kristalluriia.

The paper considers a clinical role of crystalluria and its relation to urolithiasis. Examination of 185274 cases of symptomless crystalluria in the citizens of Kharkov and Kharkov region revealed oxalic-calcic urinary crystals in 12.2%, urate crystals in 3.6% and phosphate crystals in 1.2% of the examinees. Oxalic-calcic crystalluria in urgent urinary conditions occurs significantly more frequently (25.8%). Crystalluria was studied in 372 nephrolithiasis patients. Urinary crystals were found in 44.0%. The type of the crystals corresponded to chemical composition of the urinary concrements. Oxalic-calcic nephrolithiasis was detected in a younger group of patients (aged 37.3 +/- 1.3). It is suggested to consider crystalluria as microurolithiasis indicating predisposition to lithogenesis in the urinary tract and as a preclinical manifestation of urolithiasis.

[Acute lead poisoning]. / Akute Bleivergiftung.

A 36-year-old woman had for two months experienced progressively more marked diffuse abdominal pain, at times colicky, as well as nausea, vomiting and severe constipation. In addition, paraesthesias and motor weakness developed in the thighs. This was accompanied by a normochromic, normocytic anaemia with a haemoglobin concentration of 9.6 g/l. A short time later her mother and daughter also fell ill with similar symptoms. After symptomatic treatment had failed, secondary coproporphyria due to lead poisoning was found. The poisoning had resulted from criminal contamination of food, especially of cocoa powder, with lead acetate. Raised lead concentrations in serum were found in two other members of the family. In all the patients treatment was undertaken with sodium calcium edetate (20 mg/kg body-weight) in several three-day cycles, achieving a gradual fall in serum lead concentration. When the level had fallen to below 4 mumol/l the symptoms disappeared. Below 3 mumol/l porphyria was no longer demonstrable and the anaemia regressed. It is pointed out that, as lead poisoning may be fatal, it should be considered in the differential diagnosis of acute abdominal colic of unclear cause.

Prophylaxis of uric acid stones with alternate day doses of alkaline potassium salts.

Uric acid stone formation ordinarily is prevented by increases in the urinary pH after meals. This postprandial alkaline tide is lost in patients who make such calculi. Single dose, alternate day administration of an alkaline potassium salt will increase urinary pH and simulate this normal physiological mechanism. An important part of the regimen is patient self-monitoring to verify that the urinary pH increases to greater than 6.8, 1 1/2 to 2 hours after the medication is taken. In contrast to multiple dose daily regimens, this mode of base administration is tolerated better and easier to follow. In 17 patients, 7 with the recurrent gravel/colic syndrome and 10 with prior stones, this regimen abolished calculus formation during an average followup of 2 1/2 years. However, further studies are needed before this regimen can be recommended as standard therapy for uric acid stone prophylaxis.

Renal disease presenting as severe unremitting colic.

We made a retrospective study of 1770 infants with colic. Of these infants 206 were classified as having severe colic. Six of the infants with severe colic failed to respond to intensive behaviour management and were found to have urinary infection. Later investigation revealed that all six had significant renal disease. We recommend that all infants with colic who do not respond rapidly to conventional management be investigated for urinary tract infections.

[Renal colic: behavior of urinary parameters in the assessment of lithogenic risk]. / Colica renale: comportamento dei parametri urinari di valutazione del rischio litogeno.

In patients with renal colic we studied lithogenic urinary risk factors before and after the stone passage. We showed abnormalities in water, electrolytes and other substances excretion due to retention and metabolic disorders. The effects more pronounced is on urinary sodium, calcium, magnesium and ammonium. Citrate behaviour suggests a transient intracellular acidosis.