KEYWORDSRenal colic; Hydronephrosis; Renal color Doppler ultrasound; Renal resistive index.Abstract Introduction: The objective of this study was to determine whether the renal resistive index (RI) can predict hydronephrosis in patients with renal colic (RC) and whether or not its performance is time-dependent. Materials and methods: The study population was composed of 54 patients admitted for unilateral RC. At the time of the first observation (time point I, tpI), each patient underwent routine examinations, abdominal ultrasonography, and renal color Doppler ultrasound (CDUS) with measurement of the RI. The two imaging studies were repeated 6,12,18,24,36, and 48 h later (tpII, tpIII, tpIV, tpV, tpVI, tpVII). In addition, each patient underwent noncontrast urinary tract CT 48e60 h after admission. A mean renal RI of >0.70 (mRIþ) for the symptomatic kidney was considered indicative of obstruction. Patients were retrospectively divided into two groups: those who developed dilatation (group A) and those who did not (group B). Results: A mRIþ on CDUS predicted the onset of hydronephrosis with 100% sensitivity, 84% specificity, 92.6% accuracy, PPV and NPV of 87.9% and 100%, and diagnostic efficiency of 84%. In group A, mRIþ were always observed before onset of hydronephrosis in a timedependent manner. In group B, mRIþ were observed occasionally in 4/25 patients (16%) and all were recorded at tpII. In these cases, the RI had returned to normal by tpIII. Conclusions: In our RC patients, renal RI obtained with CDUS predicted the onset of acute dilatation with higher sensitivity, specificity, accuracy, and diagnostic efficiency than ultrasonography, and it can be used routinely in the emergency department to supplement ultrasound findings. Sommario Introduzione: Obiettivo di questo studio è stato verificare se l'Indice di Resistenza Renale (IR) possa essere considerato un parametro predittivo dell'insorgenza dell'idronefrosi (IN) in caso di colica renale (CR) monolaterale e se esso è tempo correlato. Materiali e metodi: Lo studio ha incluso 54 pazienti ricoverati per CR monolaterale. Al momento della prima osservazione (time point I) tutti i pazienti sono stati sottoposti a esami routinari, a Ecografia addome e a Eco color Doppler renale (ECD) bilaterale con misurazione dell'IR. Dopo 6 (tpII), 12 (tpIII), 18 (tpIV), 24 (tpV), 36 (tpVI) e 48 (tpVII) ore è stata ripetuta l'ecografia dell'apparato urinario e l'ECD con la misurazione bilaterale dell'IR. A 48e60 ore dal ricovero inoltre tutti i pazienti sono stati sottoposti a TC dell'apparato urinario senza mezzo di contrasto. Un valore medio di IR maggiore di 0,70 (mRIþ) a livello del rene sintomatico è stato considerato come suggestivo di ostruzione. I pazienti, in relazione allo sviluppo di IN, sono stati suddivisi a posteriori in gruppo A (dilatazione presente) e B (dilatazione assente). Risultati: L'ECD con il rilevamento dei valori mRIþ ha mostrato un significativo valore diagnostico relativamente all'insorgenza dell'IN con una sensibilità del 100%, specificità 84%, ...
Introduction Seroma is one of the most common complications after laparoscopic ventral hernia repair (LVHR), even if the incidence brought in literature is varying because definition and criterions of evaluation employed in the different studies are not always the same. This study proposes a classification for seroma after LVHR based on ultrasound findings, useful for an assessment of this complication. Materials and methods On 93 patients submitted to LVHR an ultrasound of the abdominal wall after 3, 7, 15, 21 and 28 days and subsequently at a distance of 3 and 6 months was performed postoperatively. At each control site, sonomorphology characteristics and size of seroma (if present) were noted. Results At the end of the study using ultrasound findings obtained, a classification scheme for seroma articulated into three groups based on the parameters detected (site, sonomorphology character and volume) was developed, each of which is subdivided into five different classes to which a precise score is assigned. From the sum of the scores assigned, a value (between 3 and 15) that represents a prognostic index (PI) is obtained. A low PI is typical of small asymptomatic seroma that resolves spontaneously in a short time and without the need for invasive therapies; a high PI is typical of more or less symptomatic voluminous seroma that tends to persist for long periods and which often requires an interventional therapeutic approach. Conclusions This proposed classification helps to perform a precise nosological assessment of seroma after LVHR, allowing the surgeon to predict the clinical and temporal evolution of this complication and to plan appropriate therapy from time to time. Furthermore this classification can represent a tool to assess the uniqueness of seroma formation in relation to surgical technique used, to the type of material employed and to the method of mesh fixing.Keywords Ventral hernia Á Laparoscopic repair Á Seroma Á Ultrasound classification Sommario Introduzione Il sieroma è una delle complicanze più comuni dopo la riparazione laparoscopica delle ernie ventrali (RLEV), anche se l'incidenza riportata in letteratura è alquanto variabile perché la definizione e i criteri di valutazione impiegati nei diversi studi non sono sempre gli stessi. Proponiamo una classificazione dei sieromi dopo RLEV basata sui rilievi ecografici, che consenta un inquadramento condivisibile di questa complicanza. Materiali e Metodi Su 93 pazienti sottoposti a RLEV è stata eseguita un'ecografia della parete addominale dopo 3, 7, 15 21 e 28 giorni e successivamente a distanza di 3 e 6 mesi dall'intervento. Ad ogni controllo sono state annotate sede, caratteri ecosemiologici e dimensioni del sieroma (se presente). Risultati Alla fine dello studio grazie a tutti i rilievi ecografici ottenuti è stata elaborato uno schema classificativo dei sieromi basato su 3 parametri (sede, caratteri ecosemiologici e volume), ciascuno dei quali suddiviso in 5 diverse classi a cui viene attribuito un preciso punteggio. Dalla somma dei p...
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