[Cerebral venous thrombosis and SARS-CoV-2 infection]. / Trombosis venosa cerebral e infección por SARS-CoV-2.

TITLE: Trombosis venosa cerebral e infección por SARS-CoV-2.

Trombosis venosa cerebral e infección por SARS-CoV-2 / Cerebral venous thrombosis and SARS-CoV-2 infection

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Sustainability of a Curriculum-based Intervention on Dietary Behaviours and Physical Activity among Primary School Children in Trinidad and Tobago.

OBJECTIVES: Childhood obesity and poor lifestyle practices are emerging as major public health challenges in the Caribbean. Given the fact that a significant part of childhood is spent at school, curriculum-based interventions aimed at improving good dietary and physical activity patterns may provide a useful vehicle for mass inculcation of long-term healthy lifestyle practices. In this study, we evaluated the long-term impact of a brief curriculum based intervention on dietary behaviour, physical activity and knowledge level of primary schoolchildren. METHODS: The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed-up for 18 months. Participants in the IVG group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis. RESULTS: In multivariate regression equations controlling for age, gender, body mass index (BMI) and baseline values, intervention was associated with lower intake of fried foods and sodas (p < 0.05) and higher knowledge scores (p < 0.01) 18 months later but not significantly associated with improved physical activity or lower BMI. CONCLUSIONS: In this study, participants in the intervention group reported significantly lower intakes of fried foods and sodas and higher knowledge scores than participants in the control group some 18 months post-intervention independent of age, gender, BMI, ethnicity and the intakes at baseline.

Sustainability of a curriculum-based intervention on dietary behaviours and physical activity among primary school children in Trinidad and Tobago / Sostenibilidad de una intervención basada en el currículo sobre las conductas dietéticas y la actividad física entre los niños de escuela primaria en Trinidad y Tobago

OBJECTIVES: Childhood obesity and poor lifestyle practices are emerging as major public health challenges in the Caribbean. Given the fact that a significant part of childhood is spent at school, curriculum-based interventions aimed at improving good dietary and physical activity patterns may provide a useful vehicle for mass inculcation of long-term healthy lifestyle practices. In this study, we evaluated the long-term impact of a brief curriculum based intervention on dietary behaviour, physical activity and knowledge level of primary schoolchildren. METHODS: The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed-up for 18 months. Participants in the IVG group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis. RESULTS: In multivariate regression equations controlling for age, gender, body mass index (BMI) and baseline values, intervention was associated with lower intake of fried foods and sodas (p < 0.05) and higher knowledge scores (p < 0.01) 18 months later but not significantly associated with improved physical activity or lower BMI. CONCLUSIONS: In this study, participants in the intervention group reported significantly lower intakes of fried foods and sodas and higher knowledge scores than participants in the control group some 18 months post-intervention independent of age, gender, BMI, ethnicity and the intakes at baseline.

OBJETIVOS: La obesidad infantil y las prácticas de estilo de vida pobre se presentan cada vez más como importantes retos para la salud pública en el Caribe. Dado el hecho de que una parte significativa de la infancia transcurre en la escuela, las intervenciones basadas en el currículo dirigidas a mejorar los patrones de actividad física y dietética, pueden proporcionar una vía útil para inculcar masivamente prácticas de estilo de vida saludable a largo plazo. En este estudio, evaluamos el impacto a largo plazo de una intervención basada en un currículo breve de la conducta dietética, la actividad física, y el nivel de conocimientos de los escolares de la escuela primaria. MÉTODOS: El estudio consistió en una intervención de la actividad física y educación sobre la nutrición de base escolar, controlada y randomizada. Cien estudiantes fueron individualmente asignados de forma aleatoria a grupos de intervención (GIV) y grupos de no intervención (GNIV), con un seguimiento de 18 meses. Los participantes en el grupo GIV fueron expuestos a un programa consistente en seis módulos de una hora, seguidos de actividades escolares orientadas a fomentar comportamientos saludables. Los chilestudiantes en el grupo de no intervención no recibieron ningún módulo y estaban sujetos a la información disponible en la escuela de forma regular. The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed up for eighteen months. Participants in the (IVG) group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis. RESULTADOS: En las ecuaciones de regresión multivariante de edad, género, índice de masa corporal (IMC) y valores de referencia, la intervención estuvo asociada con una menor ingesta de alimentos fritos y refrescos (p < 0.05), y una mayor puntuación en cuanto a conocimientos (p < 0.01) 18 meses más tarde, pero no significativamente asociada con una mejor actividad física o un IMC más bajo. CONCLUSIONES: En este estudio, los participantes en el grupo de intervención reportaron ingestas de alimentos fritos y refrescos significativamente menores, y puntuaciones de conocimiento más altas que las de los participantes en el grupo control, unos 18 meses tras la intervención, independientemente de la edad, el género, el IMC, la etnia, y las ingestas, en relación con los valores iniciales del estudio.

Body image perception and the risk of unhealthy behaviours among University students / La percepción de la Imagen corporal y el riesgo de conductas malsanas entre los estudiantes Universitarios

BACKGROUND: In this study, we sought to determine whether dissatisfaction with one's body was associated with unhealthy behaviours among University students. SUBJECTIS AND MEHOTDS: A cross-section of 383 male and female students recruited from the general University population completed a questionnaire consisting of socio-demographic items, Eating Attitudes Test (EATS-26), Body Shape Questionnaire (BSQ-16), Body Silhouette Chart, Rosenberg Self-Esteem Scale (RSE) and the Centre for Epidemiologic Studies depression scale (CES-D). RESULTS: Overall, 4.2% of participants reported to have been diagnosed with an eating problem. Females had significantly higher EATS-26, BSQ-16 and RSE scores than males. They were significantly more likely than males to choose silhouettes that were underweight to represent their current or desired body sizes and to engage in dieting behaviours. Additionally, persons who reported being diagnosed with an eating disorder were significantly more likely than those not diagnosed to report binging, bulimic and other eating-related behaviours (p < 0.01). For both males and females, perceived body image was significantly and positively associated with BSQ-16, EATS-26, and CES-D and inversely associated with RSE scores. Females of African-descent were significantly more likely than those of East Indian descent and other ethnic groups to report higher weights and to select larger silhouettes to represent their current body figure. CONCLUSIONS: Among participants, body dissatisfaction was associated with increased risk for depression, lower self-esteem, disordered eating and other weight related behaviours.

ANTECEDENTES: En este estudio, buscamos determinar si la insatisfacción con el propio cuerpo se hallaba asociada con conductas malsanas entre los estudiantes universitarios. SUJETOS Y MÉTODOS: Una sección transversal de 383 estudiantes - hembras y varones - reclutados de la población universitaria general, respondieron un cuestionario sobre información socio-demográfica, el Test de Actitudes hacia la Comida (EATS-26), el Cuestionario sobre la Forma Corporal (BSQ-16), la Gráfica de Silueta Corporal, la Escala de Autoestima de Rosenberg (RSE), y la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). RESULTADOS: En general, 4.2% de los participantes reportó que se le habían diagnosticado algún problema de hábito de ingestión. Las mujeres tenían puntuaciones de EATS-26, BSQ-16 y RSE significativamente más altas que los hombres. Asimismo presentaban una tendencia significativamente mayor que los hombres, a escoger figuras corporales de bajo peso, a la hora de representar las dimensiones corporales que tenían o deseaban, o establecer comportamientos dietéticos. Además, las personas que reportaron haber sido diagnosticadas con algún trastorno alimentario, presentaron una tendencia significativamente mayor que las no diagnosticadas de ese modo, a reportar hiperfagia, bulimia y otros comportamientos relacionados con la ingestión (p < 0.01). Tanto para los hombres como para las mujeres, la percepción de la imagen corporal estuvo significativamente y positivamente asociada con las puntuaciones de BSQ-16, EATS-26, y CES-D e inversamente asociada con las puntuaciones del RSE. Las mujeres de ascendencia africana presentaron una tendencia significativamente más alta que las de ascendencia indoriental y otras razas, a reportar pesos más altos y a elegir siluetas más grandes a la hora de presentar su figura corporal actual. CONCLUSIONES: Entre los participantes, la insatisfacción corporal estuvo asociada con el aumento del riesgo de depresión, baja autoestima, trastornos alimentarios y otras conductas relaciones con el peso.

Body image perception and the risk of unhealthy behaviours among university students.

BACKGROUND: In this study, we sought to determine whether dissatisfaction with one's body was associated with unhealthy behaviours among University students. SUBJECTS AND METHODS: A cross-section of 383 male and female students recruited from the general University population completed a questionnaire consisting of socio-demographic items, Eating Attitudes Test (EATS-26), Body Shape Questionnaire (BSQ-16), Body Silhouette Chart, Rosenberg Self-Esteem Scale (RSE) and the Centre for Epidemiologic Studies depression scale (CES-D). RESULTS: Overall, 4.2% of participants reported to have been diagnosed with an eating problem. Females had significantly higher EATS-26, BSQ-1 6 and RSE scores than males. They were significantly more likely than males to choose silhouettes that were underweight to represent their current or desired body sizes and to engage in dieting behaviours. Additionally, persons who reported being diagnosed with an eating disorder were significantly more likely than those not diagnosed to report binging, bulimic and other eating-related behaviours (p < 0.01). For both males and females, perceived body image was significantly and positively associated with BSQ-16, EATS-26, and CES-D and inversely associated with RSE scores. Females of African-descent were significantly more likely than those of East Indian descent and other ethnic groups to report higher weights and to select larger silhouettes to represent their current body figure. CONCLUSIONS: Among participants, body dissatisfaction was associated with increased risk for depression, lower self-esteem, disordered eating and other weight related behaviours.

The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines / Estatus nutricional de personas con VIH/SIDA atendidas en clínicas en San Vicente y las Granadinas

OBJECTIVE: The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA). METHODS: A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file. RESULTS: HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/µL. CONCLUSION: The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

OBJETIVOS: El propósito de este estudio fue evaluar es estatus nutricional y las prácticas dietéticas de personas que viven con VIH/SIDA (PVVS). MÉTODOS: Se usó un diseño de control de casos. Los casos consistían en 36 PVVS. Los controles consistían en 37 personas en el mismo rango de edad de la población general. Los participantes llenaron un cuestionario contentivo de aspectos socio-demográficos, dietéticos, y cuestiones relacionadas con la historia de la salud. Además, se les determinó el peso, y se les tomó las medidas de la altura, la circunferencia del brazo medio superior, y el pliegue cutáneo del tríceps, usando procedimientos estándar: Los datos bioquímicos y clínicos para los casos, fueron extraídos de sus historias clínicas. RESULTADOS: Las personas VIH positivas tuvieron un promedio de peso, IMC, circunferencias del brazo medio superior, área muscular del brazo, y área adiposa del brazo, significativamente más bajo que las personas en el grupo control. También mostraron una menor tendencia a usar multivitaminas, suplementos dietéticos, frutas y vegetales, que las personas en el grupo control. Los coeficientes de correlación entre el área muscular del brazo corregida (AMBC), y el IMC y el peso tuvieron un rango de 0.67 a 0.74 en los casos y de 0.41 a 0.68 en el grupo control, respectivamente. El pesquisaje para el conteo de células CD4 agotadas usando límites de AMBC específicos del género, indicativos del agotamiento de las reservas musculares del brazo, arrojó un 48% de sensibilidad y un 100% de especificad en la identificación de PVVS con conteos de CD4 < 200 células/µL. CONCLUSIÓN: Los hallazgos sugieren que las PVVS enfrentan un riesgo mayor debido a un consumo pobre de frutas y vegetales, y a una masa corporal magra menguada. Además, la AMBC junto con las otras medidas clínicas, podría ser útil a la hora de identificar PVVS que pudieran esta respondiendo adecuadamente al tratamiento.

The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines.

OBJECTIVES: The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA). METHODS: A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file. RESULTS: HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/microL. CONCLUSION: The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

Segmental disorders of the nephron: histopathological and imaging perspective.

Recent advances in molecular genetics and immunocytochemistry have clarified the cell of origin in many renal disorders. Several renal disorders are thought to involve specific segments of the nephron. Renin-secreting tumours arise from juxtaglomerular cells. Clear cell and papillary renal cell carcinoma (RCC) recapitulate the epithelium of the proximal tubules. Oncocytoma and chromophobe RCC differentiate towards Type A and Type B intercalated cells of the cortical collecting duct, respectively. Medullary collecting ducts are the target sites for the development of autosomal recessive polycystic kidney disease, collecting duct carcinoma and medullary carcinoma. Renal papillae are susceptible to unique changes such as necrosis or papillitis. The purpose of our article is threefold: to illustrate the imaging findings of renal disorders that show segmental involvement of the nephron, to describe proximal and distal nephron disorders and to correlate imaging findings of some entities with histopathological features.

Hounsfield unit density in the determination of urinary stone composition.

OBJECTIVES: Noncontrast computed tomography (NCCT) has emerged as the diagnostic study of choice in the evaluation of acute flank pain. Recent in vitro studies have suggested that NCCT can be used to predict the composition of urinary stones on the basis of differences in radiodensity (measured in Hounsfield units, HUs). We sought to determine whether the analysis of in vivo urinary stones seen on NCCT could predict their composition. METHODS: Between March 1997 and August 1999, 100 pure stones from patients seen at the Wilford Hall Medical Center in San Antonio, Texas were submitted for analysis. All had been visualized by NCCT before stone passage or retrieval. A General Electric High-Speed Advantage CT scanner evaluated most of these patients by a "flank pain protocol" (ie, helical technique with breath-holding at 120 kV, 200 mA with 5 mm collimation). Each scan was interpreted by one of two staff radiologists who measured the HUs for each stone. A statistical comparison was made between the stone composition and radiodensity. To allow for subsequently observed increases in radiodensity with increasing stone size regardless of composition, the HU value was divided by each stone's largest transverse diameter in millimeters to give the HU density. A statistical comparison was then made between stone composition and HU density. RESULTS: No significant difference was noted between the HU values of calcium oxalate and calcium phosphate stones, and thus they were analyzed collectively as "calcium stones." When the HU values of calcium (n = 87), uric acid (n = 7), struvite (n = 4), and cystine (n = 2) stones were compared, the overlap of ranges precluded accurate identification, and the mean HU values were not significantly different from one another. There was less overlap noted when comparing the HU densities of the stones studied, and no noncalcium stone had an HU density greater than 76 HU/mm. Using one-way analysis of variance, significant differences were noted between the mean HU density of calcium (105 +/- 43) and uric acid (50 +/- 24) stones (P = 0.006). A trend toward significance was found between the mean HU density of the calcium and struvite stones (53 +/- 28, P = 0.073). No significant differences were found among the other stones. CONCLUSIONS: HU density compared with the HU value alone better characterized differences in radiodensities among urinary stones; calcium stones can be distinguished from uric acid stones on the basis of this value. However, neither the HU density nor the mean HU value was able to identify urinary stones in vivo.

Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model.

OBJECTIVES: To evaluate the laparoscopic and percutaneous delivery of impedance-based radiofrequency ablation (RFA) of the kidney by studying the acute and chronic clinical, radiographic, and histopathologic effects in the porcine model. METHODS: Eight kidneys from 4 pigs underwent laparoscopic RFA. Six kidneys from 3 additional pigs received computed tomography (CT)-guided, percutaneous RFA. CT scans were performed immediately after RFA and before harvest at 2 hours, 24 hours, 3 weeks, and 13 weeks. The gross, radiographic, and histopathologic changes were recorded for each period. RESULTS: Grossly, the RFA lesions were sharply demarcated, measuring 3 to 5 cm. Two major complications (14%) occurred (one urinoma, one psoas muscle injury) in 14 ablations. No deaths or significant blood loss occurred as a result of RFA. Radiographically, the immediate CT scanning demonstrated small perinephric hematomas and wedge-shaped defects. Delayed CT showed nonenhancing defects up to 5 cm. Color-flow and power Doppler were unable to distinguish significant tissue changes during RFA. The histopathologic evaluation revealed marked inflammation surrounding the necrotic regions in the early lesions; chronic lesions were characterized by dense fibrosis. The tissue temperatures ranged from 62 degrees to 118 degrees C in the area of ablation. CONCLUSIONS: RFA is readily delivered laparoscopically or percutaneously with minimal morbidity. Impedance-based application of radiofrequency energy allows monitoring and control of ablation. Using a multi-antenna probe, areas of tissue up to 5 cm can be completely destroyed. The RFA lesion can be monitored as a nonenhancing cortical defect on CT.

Appendiceal CT in pediatric patients: relationship of visualization to amount of peritoneal fat.

OBJECTIVE: This study was performed to determine the rate of visualization of the normal pediatric appendix on CT and to evaluate the relationship of the appendix to parameters such as amount of intraperitoneal fat, use of contrast material, patient age, and slice thickness. MATERIALS AND METHODS: Three board-certified radiologists retrospectively reviewed 248 successive pediatric abdominal and pelvic CT examinations performed from 1995 to 1999. Each radiologist independently assessed the degree of intraperitoneal fat (minimal, moderate, or marked compared with a standard slice), appendiceal visualization (definite, unsure, not seen), cecal and terminal ileal opacification, and the outer diameter of visualized appendixes. The age and sex of the patient, collimation thickness (3-10 mm), and use of enteric or IV contrast material was also recorded. RESULTS: A normal appendix was identified in 120 (48.4%) of 248 examinations. The only individual variable with statistically significant correlation was the degree of intraperitoneal fat. This was determined using the Pearson chi-square test, the likelihood ratio, and logistic regression. The appendix was seen in 68.8% (n = 93) of patients with moderate or marked intraperitoneal fat versus 36.1% (n = 155) with minimal fat (p<0.001). A trend toward decreased visualization in children younger than 10 years old with minimal peritoneal fat was identified and confirmed with a 95% confidence limit. The outer diameter of the visualized appendix varied from 3 to 10 mm, with a mean value of 6 mm. CONCLUSION: Increased peritoneal fat significantly increases the rate of identification of the normal appendix in pediatric patients. Although less fat is generally seen in younger patients, there is significant overlap of appendix visualization among age groups.

Pearls and pitfalls in the diagnosis of ureterolithiasis with unenhanced helical CT.

Several signs to assist interpretation of unenhanced helical computed tomographic (CT) scans obtained for suspected ureterolithiasis have been described. Because signs such as perinephric stranding are not always readily apparent, a methodical approach to interpretation of CT studies is important in determining the presence or absence of ureterolithiasis. Evaluation of the poles of the kidneys is helpful in detecting subtle stranding of the perinephric fat. Inspection of the intrarenal collecting system within the poles of the kidneys is helpful in identifying subtle collecting system dilatation and can help prevent mistaking an extrarenal pelvis for hydronephrosis. Careful inspection of the ureter throughout its course is the most reliable method of distinguishing between ureteral stones and phleboliths. However, when the ureter cannot be followed antegrade, the pelvic portion can often be identified in a retrograde fashion. When secondary signs of obstruction are present but no stone is present, differential diagnostic considerations include a recently passed stone, pyelonephritis, urinary tract obstruction unrelated to stone disease, and protease inhibitor deposition disease.

Eating habits of children with autism.

Autism is a developmental disorder characterized by severe deficits in social interaction and communication, as well as by stereotyped and repetitive behaviors. Children with autism frequently have significant eating difficulties with highly restricted range of food choices. Eating habits and patterns are often unusual and have an impact on family life. The purpose of this article was to review pertinent information regarding this complex developmental disorder and describe a recent study based on a parent survey of feeding patterns in children with autism to give a new perspective for both parents and professionals.

Reexamining the value of hematuria testing in patients with acute flank pain.

PURPOSE: Hematuria testing is routinely performed in patients with acute flank pain to screen for ureterolithiasis and to help determine the need for excretory urography. Unenhanced helical computerized tomography (CT) has recently been shown to be superior to excretory urography in diagnosing ureteral obstruction and can evaluate many other causes of flank pain. Given the speed, accuracy and safety of CT the value of hematuria testing for acute flank pain should be reexamined. MATERIALS AND METHODS: We reviewed the medical records of 267 consecutive patients with acute flank pain referred for unenhanced helical CT. Microscopic and dipstick urinalysis data were obtained in 195 patients. Using helical CT as the gold standard, we calculated the sensitivity, specificity, predictive value and accuracy of hematuria for diagnosing ureterolithiasis. RESULTS: Of the patients with ureterolithiasis 33% had 5 or less, 19% had 1 or less and 11% had no red blood cells (RBCs) per high power field. Of the patients without ureterolithiasis 24% had greater than 5 and 51% had greater than 1 RBC per high power field. Of the patients with ureterolithiasis 14% had a negative dipstick test and 1 RBC or less per high power field. There were 25 patients without ureterolithiasis who had CT abnormalities unrelated to the urinary tract, of whom 8 had greater than 1 RBC per high power field. CONCLUSIONS: Absence of hematuria in the setting of acute flank pain cannot exclude a diagnosis of ureterolithiasis and should not obviate other diagnostic testing. Even when strongly positive on microscopy, hematuria has insufficient positive predictive value for diagnosing ureterolithiasis and may be misleading as other serious conditions resulting in acute flank pain may yield a positive test.

Acute flank pain: a modern approach to diagnosis and management.

Acute flank pain is a common and complex clinical problem. In addition to flank pain caused by ureterolithiasis, other urinary and extraurinary abnormalities can result in a similar clinical picture. Unenhanced CT can rapidly, accurately, and safely determine the presence or absence of ureteral obstruction. When obstruction is caused by ureterolithiasis, CT allows precise determination of stone size and location. These are the two most important factors used for patient management. In addition to direct stone visualization, there are many secondary CT signs of ureteral obstruction that are direct manifestations of the underlying pathophysiology. On the other hand, when obstruction is absent, CT can diagnose or exclude most other abnormalities that result in flank pain. As a result of its many advantages, unenhanced helical CT should become the dominant imaging modality for evaluation of all patients with acute flank pain in whom a clinical diagnosis is uncertain.