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Robert C. Smith - One of the best experts on this subject based on the ideXlab platform.

  • REEXAMINING THE VALUE OF HEMATURIA TESTING IN PATIENTS WITH ACUTE Flank Pain
    The Journal of Urology, 1999
    Co-Authors: Peter Bove, Neal C. Dalrymple, Arthur T. Rosenfield, David L. Kaplan, M Verga, Kevin M. Anderson, Robert C. Smith
    Abstract:

    AbstractPurpose: 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...

  • Acute Flank Pain: a modern approach to diagnosis and management.
    Seminars in ultrasound CT and MR, 1999
    Co-Authors: Robert C. Smith, Neal C. Dalrymple, Jonathan Levine, Matthew A. Barish, Arthur T. Rosenfield
    Abstract:

    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.

  • the value of unenhanced helical computerized tomography in the management of acute Flank Pain
    The Journal of Urology, 1998
    Co-Authors: Neal C. Dalrymple, Peter Bove, M Verga, A T Rosenfield, Kevin R Anderson, Anne M Covey, Robert C. Smith
    Abstract:

    AbstractPurpose: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute Flank Pain and suspected ureteral obstruction.Materials and Methods: During a 25-month interval 417 patients with acute Flank Pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.Results: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone...

  • Noncontrast helical CT in the evaluation of acute Flank Pain
    Abdominal imaging, 1998
    Co-Authors: Robert C. Smith, Neal C. Dalrymple, J. D. Neitlich
    Abstract:

    When a patient presents with acute Flank Pain, ureteral obstruction secondary to stone disease is a primary consideration in the differential diagnosis. However, there are many diseases unrelated to ureteral obstruction that can result in Flank Pain (e.g., appendicitis, diverticulitis, pancreatitis, torsion of a mass, cholecystitis, bowel obstruction, intussusception, hemorrhage into a mass, aortic dissection, ruptured aortic aneurysm, etc.). In addition, there are conditions that arise outside of the urinary tract which can themselves result in ureteral obstruction. An ideal test for evaluating patients with acute Flank Pain would provide the following information:

  • Diagnosis of acute Flank Pain: value of unenhanced helical CT.
    AJR. American journal of roentgenology, 1996
    Co-Authors: Robert C. Smith, M Verga, Shirley Mccarthy, Arthur T. Rosenfield
    Abstract:

    The purpose of our study was to determine the value of unenhanced CT in the diagnosis of acute Flank Pain. We determined the accuracy of unenhanced Ct for stone detection as well as the detection of abnormalities unrelated to stone disease.During an 18-month interval, 292 patients with acute Flank Pain were imaged with unenhanced CT. Confirmation of the CT diagnosis was obtained for 210 patients: One hundred patients were proved to have ureteral stones based on other imaging studies (58 patients), lithotripsy (seven patients), ureteroscopic stone extraction (five patients), and stone recovery (30 patients). One hundred ten patients were proved not to have ureteral stones based on other imaging studies (24 patients), failure to recover a stone (56 patients), or a confirmed diagnosis unrelated to stone disease (30 patients). This latter group of 30 patients included diagnoses of adnexal masses (eight patients), appendicitis (five patients), diverticulitis (four patients), and common bile duct stones (three ...

Rolf Harzmann - One of the best experts on this subject based on the ideXlab platform.

  • low dose unenhanced helical computerized tomography for the evaluation of acute Flank Pain
    The Journal of Urology, 2002
    Co-Authors: Michael Hamm, Friedhelm Wawroschek, Dorothea Weckermann, E. Knöpfle, Susanne Wartenberg, Rolf Harzmann
    Abstract:

    Purpose: Unenhanced helical computerized tomography (CT) has proved to be an excellent diagnostic tool for evaluating acute Flank Pain with reported 95% to 100% sensitivity, 92% to 100% specificity, 96% to 100% positive and 91% to 100% negative predictive values. The diagnostic value of a new low dose protocol was prospectively studied and compared with the results of conventional unenhanced helical CT in a previous series with an effective dose equivalent (HE) of 3.1 to 4.3 mSv. and in current literature with an estimated HE of 4.3 to 4.7 mSv.Materials and Methods: In 109 patients 18 to 86 years old with acute Flank Pain we performed low dose unenhanced helical CT in addition to abdominal ultrasound and urinalysis with new CT parameters (120 kV. 70 mA., 5 mm. collimation, pitch 2 and incremental reconstruction each 5 mm.) that led to a more than 50% decrease in radiation exposure to 1.50 mSv. in females and 0.98 mSv. in males. Ureteral calculi were confirmed or excluded by retrograde ureteropyelography i...

  • Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain
    European urology, 2001
    Co-Authors: Michael Hamm, Friedhelm Wawroschek, Dorothea Weckermann, E. Knöpfle, Thomas Häckel, Hannes Häuser, Gunnar Krawczak, Rolf Harzmann
    Abstract:

    Objective: The diagnostic value of unenhanced helical computed tomography (CT) for the evaluation of acute Flank Pain is investigated in a prospective study. Patients and M

M Verga - One of the best experts on this subject based on the ideXlab platform.

  • REEXAMINING THE VALUE OF HEMATURIA TESTING IN PATIENTS WITH ACUTE Flank Pain
    The Journal of Urology, 1999
    Co-Authors: Peter Bove, Neal C. Dalrymple, Arthur T. Rosenfield, David L. Kaplan, M Verga, Kevin M. Anderson, Robert C. Smith
    Abstract:

    AbstractPurpose: 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...

  • Reexamining the value of hematuria testing in patients with acute Flank Pain.
    The Journal of urology, 1999
    Co-Authors: Peter Bove, M Verga, D Kaplan, N Dalrymple, A T Rosenfield, K Anderson, R C Smith
    Abstract:

    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. 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. 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. 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.

  • the value of unenhanced helical computerized tomography in the management of acute Flank Pain
    The Journal of Urology, 1998
    Co-Authors: Neal C. Dalrymple, Peter Bove, M Verga, A T Rosenfield, Kevin R Anderson, Anne M Covey, Robert C. Smith
    Abstract:

    AbstractPurpose: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute Flank Pain and suspected ureteral obstruction.Materials and Methods: During a 25-month interval 417 patients with acute Flank Pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.Results: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone...

  • Diagnosis of acute Flank Pain: value of unenhanced helical CT.
    AJR. American journal of roentgenology, 1996
    Co-Authors: Robert C. Smith, M Verga, Shirley Mccarthy, Arthur T. Rosenfield
    Abstract:

    The purpose of our study was to determine the value of unenhanced CT in the diagnosis of acute Flank Pain. We determined the accuracy of unenhanced Ct for stone detection as well as the detection of abnormalities unrelated to stone disease.During an 18-month interval, 292 patients with acute Flank Pain were imaged with unenhanced CT. Confirmation of the CT diagnosis was obtained for 210 patients: One hundred patients were proved to have ureteral stones based on other imaging studies (58 patients), lithotripsy (seven patients), ureteroscopic stone extraction (five patients), and stone recovery (30 patients). One hundred ten patients were proved not to have ureteral stones based on other imaging studies (24 patients), failure to recover a stone (56 patients), or a confirmed diagnosis unrelated to stone disease (30 patients). This latter group of 30 patients included diagnoses of adnexal masses (eight patients), appendicitis (five patients), diverticulitis (four patients), and common bile duct stones (three ...

  • acute Flank Pain comparison of non contrast enhanced ct and intravenous urography
    Radiology, 1995
    Co-Authors: Robert C. Smith, M Verga, A T Rosenfield, K A Choe, K R Essenmacher, M G Glickman, Robert C Lange
    Abstract:

    PURPOSE: To compare non-contrast-enhanced computed tomography (CT) and intravenous urography (IVU) in the evaluation of patients who present with acute Flank Pain and in whom ureteric obstruction is suspected. MATERIALS AND METHODS: The findings at non-contrast-enhanced CT and IVU in 20 patients with acute Flank Pain were compared for the presence or absence of ureteric obstruction and delineation of ureteric stones. RESULTS: Twelve of the 20 patients had non-contrast-enhanced CT and IVU findings consistent with ureteric obstruction. Of these 12 patients, five had a ureteric stone that was demonstrated on both non-contrast-enhanced CT scans and IVU radiographs, six had a stone that was depicted on non-contrast-enhanced CT scans only, and in one patient a stone could not be delineated definitively on either non-contrast-enhanced CT scans or IVU radiographs. Eight patients had findings at non-contrast-enhanced CT and IVU consistent with the absence of obstruction. CONCLUSION: Non-contrast-enhanced CT is mor...

Michael Hamm - One of the best experts on this subject based on the ideXlab platform.

  • low dose unenhanced helical computerized tomography for the evaluation of acute Flank Pain
    The Journal of Urology, 2002
    Co-Authors: Michael Hamm, Friedhelm Wawroschek, Dorothea Weckermann, E. Knöpfle, Susanne Wartenberg, Rolf Harzmann
    Abstract:

    Purpose: Unenhanced helical computerized tomography (CT) has proved to be an excellent diagnostic tool for evaluating acute Flank Pain with reported 95% to 100% sensitivity, 92% to 100% specificity, 96% to 100% positive and 91% to 100% negative predictive values. The diagnostic value of a new low dose protocol was prospectively studied and compared with the results of conventional unenhanced helical CT in a previous series with an effective dose equivalent (HE) of 3.1 to 4.3 mSv. and in current literature with an estimated HE of 4.3 to 4.7 mSv.Materials and Methods: In 109 patients 18 to 86 years old with acute Flank Pain we performed low dose unenhanced helical CT in addition to abdominal ultrasound and urinalysis with new CT parameters (120 kV. 70 mA., 5 mm. collimation, pitch 2 and incremental reconstruction each 5 mm.) that led to a more than 50% decrease in radiation exposure to 1.50 mSv. in females and 0.98 mSv. in males. Ureteral calculi were confirmed or excluded by retrograde ureteropyelography i...

  • Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain
    European urology, 2001
    Co-Authors: Michael Hamm, Friedhelm Wawroschek, Dorothea Weckermann, E. Knöpfle, Thomas Häckel, Hannes Häuser, Gunnar Krawczak, Rolf Harzmann
    Abstract:

    Objective: The diagnostic value of unenhanced helical computed tomography (CT) for the evaluation of acute Flank Pain is investigated in a prospective study. Patients and M

Peter Bove - One of the best experts on this subject based on the ideXlab platform.

  • REEXAMINING THE VALUE OF HEMATURIA TESTING IN PATIENTS WITH ACUTE Flank Pain
    The Journal of Urology, 1999
    Co-Authors: Peter Bove, Neal C. Dalrymple, Arthur T. Rosenfield, David L. Kaplan, M Verga, Kevin M. Anderson, Robert C. Smith
    Abstract:

    AbstractPurpose: 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...

  • Reexamining the value of hematuria testing in patients with acute Flank Pain.
    The Journal of urology, 1999
    Co-Authors: Peter Bove, M Verga, D Kaplan, N Dalrymple, A T Rosenfield, K Anderson, R C Smith
    Abstract:

    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. 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. 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. 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.

  • the value of unenhanced helical computerized tomography in the management of acute Flank Pain
    The Journal of Urology, 1998
    Co-Authors: Neal C. Dalrymple, Peter Bove, M Verga, A T Rosenfield, Kevin R Anderson, Anne M Covey, Robert C. Smith
    Abstract:

    AbstractPurpose: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute Flank Pain and suspected ureteral obstruction.Materials and Methods: During a 25-month interval 417 patients with acute Flank Pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.Results: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone...