Distal ureteral calculi: US follow-up.

PURPOSE: To assess accuracy of ultrasonographic (US) follow-up of distal ureteral calculi by using computed tomography (CT) and conventional radiography (kidneys, ureters, and bladder) as reference standards. MATERIALS AND METHODS: The study was approved by the Regional Ethics Committee, and written informed consent was obtained. One hundred fifty-eight patients with CT-diagnosed symptomatic ureteral calculi, for whom follow-up imaging was ordered, were enrolled from February 2006 to December 2008. Six were excluded, having not met study entry criteria, with 121 men (mean age, 49 years; range, 20-91 years) and 31 women (mean age, 44 years; range, 34-77 years) completing the protocol with adequate reference standard imaging. Targeted transabdominal US occurred coincidently with follow-up CT (n = 92) or radiography (n = 60), with US evaluation prospectively compared considering sensitivity and specificity. Statistical analysis was performed with a χ(2) test, t test, or paired t test, as appropriate. RESULTS: Results of nine US examinations were nondiagnostic because of inadequate ureteral visualization, and among these, two cases showed residual distal calculi. Of the remaining 143 patients, 33 had residual distal calculi, all visualized with US. There was a single false-positive study, giving sensitivity, including nondiagnostic US examinations, of 94.3% (95% confidence interval [CI]: 80.8%, 99.3%) and specificity of 99.1% (95% CI: 95.3%, 100%). All calculi appeared hyperechoic with posterior acoustic shadowing. Additional diagnostic features included presence of a hypoechoic rim and Doppler twinkle artifact. Mean stone length was 7.2 mm ± 2.6 (standard deviation) (range, 4-18 mm). Mean ureteral length visualized was 36.4 mm (range, 12-77 mm), with calculi positioned at a mean of 13.1 mm ± 11.2 (range, 0-40 mm) from the ureterovesical junction (UVJ). Nondiagnostic results were more likely with bladder volume of 110 mL or less (eight [16%] of 50 vs one [1%] of 102, P = .0009). CONCLUSION: Ureteral calculi within 35 mm of the UVJ can be accurately followed-up by using transabdominal US, which substantially reduces patient radiation burden.

Malnutrition and anaemia among Somali refugee children in long term camps

In a long term Somali refugee camp where nutritional and general health status of children is now considered satisfactory and stable, a randomized community based survey of 300 children under five years was under taken. Results indicate that the prevalence of protein-energy malnutrition is rising again: 17.3 percent of children are <80 percent median weight/height and 1.7 per cent are <70 percent median weight/height. In addition, there is a high prevalecence of anaemia: 50.5 percent have a haemoglobin level <9g percent and 10.8 percent <6g percent. This cannot be explained by chronic malaria as the spleen rate is only 2 percent. Stool examination of 161 children show 29.8 per cent to have evidence of Giardia Lamblia infection, but this is not statistically correlated with either anaemia or with protein-energy malnutrition. Other potentially pathogenic parasites are uncommon and no hookworm is seen. Examination of blood films of anaemic children shows hypochromia as a striking feature. It is concluded that nutritional deficiencies are a likely major factor in the aetiology of the anaemia. Both protein-energy malnutrition and anaemia seem related to the weaning period (AU)