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Irish Journal of Medical Science Jun 2024Ureteric colic is a common emergency urological presentation [1]. When operative intervention is required, retrograde ureteroscopy is the most common approach. There are...
BACKGROUND
Ureteric colic is a common emergency urological presentation [1]. When operative intervention is required, retrograde ureteroscopy is the most common approach. There are multiple treatment strategies including primary ureteroscopy (URS), staged ureteroscopy, and deferred ureteroscopy following ureteric stent placement. The approach is based on a number of clinical and stone factors. This study assesses the factors which predict stone clearance at the initial procedure.
AIMS
All patients diagnosed with an obstructing ureteric stone who were managed operatively in a consecutive 12-month period were included. Patients were evaluated for stone clearance following a single or multiple procedures. A number of factors including stone size, location, gender, age and pre-operative laboratory results were evaluated for association with stone clearance at index procedure. Multivariate logistic regression analyses were performed to produce odds ratios (OR) with confidence interval (CI) at 95% and significance values P < 0.05.
RESULTS
One hundred and seventy patients were included in the final analysis. Stone clearance following the index procedure was achieved in 57% (n = 100) of patients. Predictors of successful stone clearance at index procedure were stone size < 6 mm, male gender and distal stone location (p < 0.05). Proximal stone location, stone size > 10 mm and elevated c-reactive protein (CRP) were associated respectively with multiple procedures to achieve stone clearance (p < 0.05).
CONCLUSIONS
Acute ureteric stones can be managed with a number of treatment strategies. This study identifies factors which predict stone clearance at index procedure. These results will help urologists accurately counsel patients when undertaking operative management for ureteric colic.
PubMed: 38940857
DOI: 10.1007/s11845-024-03703-8 -
Urology Case Reports Jul 2024Peritoneal dialysis (PD) catheter migration is a common complication of PD which usually results in obstruction of dialysate outflow. We report the first known case in...
Peritoneal dialysis (PD) catheter migration is a common complication of PD which usually results in obstruction of dialysate outflow. We report the first known case in the literature of a 62-year-old male with end-stage renal disease on PD who presented with acute renal colic secondary to the PD catheter overlying right mid-ureter causing hydronephrosis with spontaneous resolution of pain and hydronephrosis two days later. The patient was discharged home with a functioning dialysis catheter and complete resolution of both symptoms and radiographic findings of hydronephrosis. While management of migrated PD catheters usually require surgical intervention, our case resolved without intervention.
PubMed: 38939450
DOI: 10.1016/j.eucr.2024.102746 -
Diagnostics (Basel, Switzerland) Jun 2024This paper introduces a novel one-dimensional convolutional neural network that utilizes clinical data to accurately detect choledocholithiasis, where gallstones...
This paper introduces a novel one-dimensional convolutional neural network that utilizes clinical data to accurately detect choledocholithiasis, where gallstones obstruct the common bile duct. Swift and precise detection of this condition is critical to preventing severe complications, such as biliary colic, jaundice, and pancreatitis. This cutting-edge model was rigorously compared with other machine learning methods commonly used in similar problems, such as logistic regression, linear discriminant analysis, and a state-of-the-art random forest, using a dataset derived from endoscopic retrograde cholangiopancreatography scans performed at Olive View-University of California, Los Angeles Medical Center. The one-dimensional convolutional neural network model demonstrated exceptional performance, achieving 90.77% accuracy and 92.86% specificity, with an area under the curve of 0.9270. While the paper acknowledges potential areas for improvement, it emphasizes the effectiveness of the one-dimensional convolutional neural network architecture. The results suggest that this one-dimensional convolutional neural network approach could serve as a plausible alternative to endoscopic retrograde cholangiopancreatography, considering its disadvantages, such as the need for specialized equipment and skilled personnel and the risk of postoperative complications. The potential of the one-dimensional convolutional neural network model to significantly advance the clinical diagnosis of this gallstone-related condition is notable, offering a less invasive, potentially safer, and more accessible alternative.
PubMed: 38928692
DOI: 10.3390/diagnostics14121278 -
Equine Veterinary Journal Jun 2024The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary...
BACKGROUND
The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner.
OBJECTIVES
To explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic.
STUDY DESIGN
Qualitative study using a phenomenological approach.
METHODS
Individual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help-seeking behaviour, and challenges. Thematic analysis was performed on collected data.
RESULTS
Four over-arching themes were identified; 'head', 'heart', 'practicalities' and 'impact'. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance ('head'). Both vets and owners described how the horse-human relationship ('heart') often led to conflict during decision-making. The vet-client relationship was influential on decision-making for both owners and vets; involving other people in decision-making was described both positively and negatively by participants ('heart'). 'Practicalities', such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a 'rollercoaster' of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long-term changes in behaviour ('impact'), and a lack of support to manage these feelings.
MAIN LIMITATIONS
Small sample size.
CONCLUSIONS
This study describes stakeholder decision-making during critical cases of equine colic. Factors that commonly influenced decisions included an owner's previous knowledge and beliefs, social pressures, logistics and the relationship between the owner and vet. The study highlighted long-term impacts on the owner, including their management and decisions for subsequent horses. These factors should be considered in shared decision-making.
PubMed: 38924162
DOI: 10.1111/evj.14124 -
Veterinary World May 2024Colic is the primary problem affecting equestrian care worldwide. The primary cause of colic is digestive diseases; however, they can also affect organs from different...
BACKGROUND AND AIM
Colic is the primary problem affecting equestrian care worldwide. The primary cause of colic is digestive diseases; however, they can also affect organs from different systems in the abdominal region. In addition to a prior history of the disease and its treatment, risk factors may be assessed to determine the etiology of the disease in horses without or with a history of colic. This study aimed to present a summary of the incidence, risk factors, and medical procedures for colic in horses.
MATERIALS AND METHODS
Based on owner reports, 223 horses in Tuban, Indonesia, suspected of having colic were investigated. During the investigation of clinical parameters, investigators went door-to-door with interested horse owners to gather information about potential risk factors related to equine colic. Information on horses diagnosed with colic was obtained from the medical records of treatment. A Chi-square test was used to investigate the potential association between the risk factors, medical protocol, and the outcome of colic in horses.
RESULTS
Of the 187 cases, spasmodic colic was the most common (48.13%), but 17 (9.09%) had no definitive diagnosis. Poor body condition scores (χ = 58.73; p < 0.001), wheat bran feeding (χ = 26.79; p < 0.001), concentrate (χ = 10.66; p < 0.01), less access to water (χ = 128.24; p < 0.001), recurrence of colic (χ = 85.64; p < 0.001), no deworming program (χ = 54.76; p < 0.001), the presence of gastrointestinal parasites (χ = 56.79; p < 0.001), stressed physical activity (χ = 28.53; p < 0.001), and summer season (χ = 7.83; p < 0.01) were the risk factors for colic. We further reported that 185 (98.93%) patients who received the following medical interventions recovered: injection of non-steroidal anti-inflammatory drugs was necessary, Vitamin B complex (χ = 39.98; p < 0.001), fluid therapy (χ = 92.99; p < 0.001), and gastric intubation (χ = 4.09; p < 0.05).
CONCLUSION
The importance of colic was demonstrated in 187 (83.86%) of the 223 horses investigated in Tuban, Indonesia, documented. In this study, recommendations for medical procedures when colic risk factors have been determined are presented.
PubMed: 38911082
DOI: 10.14202/vetworld.2024.963-972 -
Cureus May 2024A 41-year-old woman presented with acute, severe left-sided abdominal pain and vomiting at 37 weeks' gestation. Her symptoms were attributed to renal colic, and she was...
A 41-year-old woman presented with acute, severe left-sided abdominal pain and vomiting at 37 weeks' gestation. Her symptoms were attributed to renal colic, and she was admitted for supportive treatment. During her admission, she went into spontaneous labour. Due to other obstetric indications, the team proceeded with delivery by emergency caesarean section. Intra-operatively, a necrotic left fallopian tube and ovary were identified, and a diagnosis of adnexal torsion (AT) was recognised. There was no return of tissue perfusion on de-torsion, and a left salpingo-oopherectomy was performed. AT in pregnancy is unusual, with only a minority of cases occurring in the third trimester. This is a challenging diagnosis to establish and requires a high index of suspicion. Ultrasound and magnetic resonance imaging can be helpful in establishing a diagnosis but should not delay definitive treatment. Prompt surgical intervention is paramount to prevent irreversible damage to ovarian tissue.
PubMed: 38910722
DOI: 10.7759/cureus.60836 -
Journal of Ethnopharmacology Jun 2024H. pectinata (L.) Poit, popularly known as "sambacaitá" or "canudinho", is a plant endemic to north-eastern Brazil. Its aerial parts, leaves and flowers have... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
H. pectinata (L.) Poit, popularly known as "sambacaitá" or "canudinho", is a plant endemic to north-eastern Brazil. Its aerial parts, leaves and flowers have traditionally been used to treat gastrointestinal disorders, rhinopharyngitis, nasal congestion, bacterial and fungal infections, fever, colic, inflammation, and pain.
AIM OF THE STUDY
The aim of this review was to provide information on the botanical characteristics, ethnomedicinal uses, phytochemistry and biological-pharmacological activities of H. pectinata.
MATERIALS AND METHODS
This systematic review followed the Cochrane Handbook Collaboration and the PRISMA guidelines. The review question was what are the biological-pharmacological activities of H. pectinata presented in non-clinical studies. The search for articles was conducted in the Medline (via PubMed), Embase, Web of Science, Scopus, Virtual Health Library, SciELO, Google Scholar and the Brazilian Digital Library of Theses and Dissertations databases. Two reviewers independently selected the studies that met the inclusion criteria, extracted the data, and assessed the risk of bias of the included studies.
RESULTS
39 articles were included in this review, of which 19 reported in vitro experiments, 16 in vivo studies and 4 in vivo and in vitro experiments. H. pectinata is a plant widely used in folk medicine in north-eastern Brazil for the treatment of various ailments, such as respiratory diseases, gastrointestinal disorders, bacterial and fungal infections, and general inflammation. Supporting its popular use, several in vitro and in vivo pharmacological investigations of the essential oil and extract of H. pectinata have demonstrated their anti-inflammatory, antinociceptive, antioxidant, antidepressant, anticancer, hepatoregenerative, healing, and antimicrobial activities. H. pectinata has been reported to contain 75 bioactive constituents, comprising 9 flavonoids, 54 terpenes, and 12 other compounds.
CONCLUSION
H. pectinata is a plant commonly used in traditional medicine. Phytochemically, it contains several bioactive constituents, including terpenes and flavonoids, and has been shown to have antinociceptive, anti-inflammatory, antimicrobial and antitumour activity, as well as hepatorregenerative and healing effects, and low toxicity.
PubMed: 38909822
DOI: 10.1016/j.jep.2024.118478 -
American Family Physician Jun 2024In the United States, 10% to 15% of adults are affected by gallstones, and cholesterol gallstones are the most prevalent subtype. Risk factors for developing gallstone... (Review)
Review
In the United States, 10% to 15% of adults are affected by gallstones, and cholesterol gallstones are the most prevalent subtype. Risk factors for developing gallstone disease include female sex; older age; certain medications; and having type 2 diabetes mellitus, nonalcoholic fatty liver disease, obesity, rapid weight loss, or hemolytic anemia. Nearly 80% of gallstones are found incidentally and remain asymptomatic. When symptomatic, gallstone disease usually presents as sudden onset right upper quadrant or epigastric abdominal pain. Common complications of gallstones include cholecystitis, choledocholithiasis, gallstone pancreatitis, and ascending cholangitis. The Murphy sign is a specific physical examination finding for acute cholecystitis. Ultrasonography is the initial imaging choice for detecting gallstones and acute cholecystitis. A hepatobiliary iminodiacetic acid (HIDA) scan can be used to evaluate for cholecystitis in patients with negative or equivocal ultrasound findings. Magnetic resonance cholangiopancreatography (MRCP) is an accurate, noninvasive diagnostic test to identify choledocholithiasis, certain malignancies, and biliary obstruction. Nonsteroidal anti-inflammatory drugs are safe and effective in treating pain from acute cholecystitis and biliary colic. Laparoscopic cholecystectomy is the treatment of choice for most patients with biliary colic or acute cholecystitis. Ursodeoxycholic acid and chenodeoxycholic acid should not routinely be used to treat gallstone disease, but they can be used as a nonsurgical alternative for certain patients. Postcholecystectomy syndrome is a potential postoperative complication that presents with abdominal pain, bloating, and diarrhea. (Am Fam Physician. 2024;109(6):518-524.
Topics: Humans; Gallstones; Risk Factors; Female; Ultrasonography; Cholecystectomy, Laparoscopic; Male
PubMed: 38905549
DOI: No ID Found -
Journal of Surgical Case Reports Jun 2024Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated...
Pneumo-peritoneum, pneumo-retroperitoneum and subcutaneous emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy-an uncommon complication case report.
Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated risks. A 45-year-old female with biliary colic and multiple gallbladder calculi was diagnosed with choledocholithiasis based on imaging showing CBD dilation and gallstones. ERCP was planned for stone removal. Sphincterotomy was performed, but stone retrieval attempts failed, leading to severe pneumo-peritoneum and respiratory compromise. Immediate CBD stenting was done, avoiding surgical intervention. The patient recovered uneventfully, later undergoing laparoscopic cholecystectomy with CBD exploration and stone removal. ERCP-related perforations, rare but severe, involve retroperitoneal air collection. Clinical signs include abdominal discomfort, and imaging confirms diagnosis. Management varies by type, with some requiring surgical repair. Conservative management sufficed in this case, with successful patient recovery. ERCP-related complications like pneumo-peritoneum require prompt diagnosis and conservative management if no perforation is evident.
PubMed: 38903772
DOI: 10.1093/jscr/rjae415 -
Frontiers in Immunology 2024
Topics: Humans; Myeloid-Derived Suppressor Cells; Immunotherapy; Animals; Neoplasms
PubMed: 38903510
DOI: 10.3389/fimmu.2024.1411391