[Nephritic colic management in an emergency room of a referral hospital]. / Manejo del cólico renal en urgencias de un hospital de tercer nivel.

BACKGROUND: To evaluate the diagnostic and therapeutic management of patients with nephritic colic in a referral hospital, their monitoring and the incidence of alternative diagnoses. METHODS: This is a retrospective review of 182 randomly selected patients who presented a clinical diagnosis compatible with nephritic colic in a referral hospital. In these cases initial treatment, monitoring and alternative diagnoses have been evaluated. RESULTS: Fifty-five point four percent of the patients were male, the mean age was 47.7 years and 40% of the cases were in spring. Urinalysis was carried out in every patient (62.7% dipstick and 72% urinary sediment); they were pathological in over 70%. In 26.4% of cases renal function deteriorated, always transiently. Abdominal radiography (81.9%) was the most frequently diagnostic test performed, followed by ultrasound (25.8%). Treatment included a serum therapy in 31.3%; metamizol (61%) was the most commonly used analgesic followed by ketorolac (44.5%). More than one non-steroidal anti-inflammatory was used by 46.2%. Hospital admission was required by 24 patients, and 5 of them needed emergency surgery. Twenty-four point one percent of patients had relapses during the next six months. Forty-one point six percent were referred to urology discharge on from the emergency room. Eighteen point one percent of patients had alternative diagnoses; acute pyelonephritis was the most frequent of these (55%). CONCLUSIONS: In our work we found a significant variation in the diagnostic and therapeutic management of these patients. The use of clinical guidelines could help us to unify the management of patients with nephritic colic, both in the emergency room and on discharge. Due to the high prevalence of alternative diagnoses, we have to systematically exclude more serious diseases.

Manejo del cólico renal en urgencias de un hospital de tercer nivel / Nephritic colic management in an emergency room of a referral hospital

Fundamento. El objetivo del presente trabajo es conocerlas características epidemiológicas, el manejo diagnóstico yterapéutico, su seguimiento y la incidencia de diagnósticosalternativos en una muestra de pacientes diagnosticados decólico renal en el Servicio de Urgencias de un Hospital detercer nivel.Material y métodos. Estudio descriptivo retrospectivo de182 pacientes seleccionados aleatoriamente que consultanpor clínica compatible con cólico renal en un hospital detercer nivel, valorando su manejo inicial, seguimiento al altay diagnósticos alternativos.Resultados. El 55,4% fueron varones, la edad media fue de47,7 años y el 40% de los casos se produjeron en primavera.En todos los pacientes se realizó analítica urinaria (62,7%tira reactiva y 72% sedimento) apareciendo alteraciones enmás del 70%. La función renal se deterioró en el 26,4 % delos casos, siempre de forma transitoria. La prueba de imagenrealizada con más frecuencia fue la radiografía de abdomen(81,9%) seguida de la ecografía (25,8%). El tratamiento incluyófluidoterapia en el 31,3% y el analgésico más usado fue elmetamizol (61%) seguido del ketorolaco (44,5%). El 46,2% delos pacientes necesitó más de un analgésico. Un total de 24pacientes precisaron ingreso hospitalario y 5 de ellos cirugíaurgente. El 24,1% presentó recaídas en los seis meses posteriores.El 41,6% fue remitido al Servicio de Urología al alta. El18,1% presentaron diagnósticos alternativos, siendo la pielonefritisaguda el más frecuente de ellos (55%).Conclusiones. Hemos detectado una importante variaciónen el manejo diagnóstico y terapéutico de estos pacientes.El uso de guías clínicas debe permitirnos unificar el manejodel paciente con cólico renal tanto en urgencias como posteriormente.El alto porcentaje de diagnósticos alternativosnos obliga a descartar sistemáticamente patologías másgraves(AU)

Background. To evaluate the diagnostic and therapeuticmanagement of patients with nephritic colic in a referralhospital, their monitoring and the incidence of alternativediagnoses.Methods. This is a retrospective review of 182 randomly selectedpatients who presented a clinical diagnosis compatiblewith nephritic colic in a referral hospital. In these casesinitial treatment, monitoring and alternative diagnoses havebeen evaluated.Results. Fifty-five point four percent of the patients weremale, the mean age was 47.7 years and 40% of the cases werein spring. Urinalysis was carried out in every patient (62.7%dipstick and 72% urinary sediment); they were pathologicalin over 70%. In 26.4% of cases renal function deteriorated,always transiently. Abdominal radiography (81.9%) was themost frequently diagnostic test performed, followed by ultrasound(25.8%). Treatment included a serum therapy in 31.3%;metamizol (61%) was the most commonly used analgesic followedby ketorolac (44.5%). More than one non-steroidal anti-inflammatory was used by 46.2%. Hospital admission wasrequired by 24 patients, and 5 of them needed emergencysurgery. Twenty-four point one percent of patients had relapsesduring the next six months. Forty-one point six percentwere referred to urology discharge on from the emergencyroom. Eighteen point one percent of patients had alternativediagnoses; acute pyelonephritis was the most frequent ofthese (55%).Conclusions. In our work we found a significant variationin the diagnostic and therapeutic management of these patients.The use of clinical guidelines could help us to unifythe management of patients with nephritic colic, both in theemergency room and on discharge. Due to the high prevalenceof alternative diagnoses, we have to systematicallyexclude more serious diseases(AU)

Endocrine and lymphoproliferative response changes produced by social stress in mice.

Daily dyadic resident-intruder encounters and uninterrupted cohabitation in pairs were used to assess the impact of different durations (5 and 15 days) of dominance and subordination experiences on splenic lymphoproliferative responses in male OF1 strain mice. HPA axis activity was assessed by measuring serum corticosterone levels, whereas splenic norepinephrine (NE) content provided a sympathetic activity index. Corticosterone levels in subordinate subjects were generally higher than in their control or dominant counterparts in both treatment paradigms. Corticosterone levels in dominant subjects were lower than in their control counterparts in both. Increasing the duration of treatments generally decreased such titers, especially so in subordinate subjects. No differences were detected in splenic NE content. Animals subjected to social interaction generally showed greater proliferation than their control counterparts. This effect was more pronounced in subordinates than dominants and after longer- rather than short-duration treatments. There was no inverse relation between proliferative responses and the subject's corticosterone levels. While corticosterone may have a general immunomodulating effect, other mediators apparently account for the effects produced by these social stress paradigms on splenic proliferative response.

Effects of chronic mild stress (CMS) and imipramine administration, on spleen mononuclear cell proliferative response, serum corticosterone level and brain norepinephrine content in male mice.

There is increasing evidence that stress and emotional reactions produce changes in various immune processes. These changes may be due to alterations of the stress responses endocrine and for autonomic mediating mechanisms. In order to study such effects, the impact of chronic mild stress (CMS) application, and of subsequent imipramine administration were studied on the spleen mononuclear cell proliferative response period. OFI strain male mice were subjected to 4 or 7 weeks of CMS. The effects of these treatments on serum corticosterone levels and hypothalamic and hippocampal norepinephrine (NE) contents were also assessed. Subjects submitted to CMS had a higher spleen mononuclear cell proliferative response after either treatment duration. Imipramine treatment diminished this response enhancement in CMS exposed animals, but did not alter the proliferative responses of control subjects. Serum corticosterone levels, as well as hypothalamic and hippocampal nonrepinephrine contents did not significantly vary between groups. Taken together, these results suggest that CMSs effects on immune reactivity are not related to serum glucocorticoids or NE changes in these locations associated with the hypothalamic-pituitary- adrenocortical (HPA) axis.