The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.

Influenza vaccination prevented influenza cases and hospitalizations and was associated with a better prognosis in inpatients with influenza. The combined effect of these 2 mechanisms would explain the high effectiveness of the vaccine in preventing severe cases due to influenza.

In Wistar rats experimentally infected with Fasciola hepatica, the association between time of infection, number of flukes, rat weight, and serum lipid levels and the risk of developing pigment stones in the main bile duct was examined using data obtained at 100, 200, 300, 400, and 500 days postinfection. Gallstone presence increased with infection time. The relative risk of gallstone disease increased when the number of flukes per rat and rat weight increased. The presence of gallstones was associated with serum high-density lipoproteins and triglyceride levels. In a multivariate analysis, the association between gallstones and rat weight disappeared after adjustment for serum lipids. The absence of an effect of rat weight independent from serum lipids suggests that serum lipids are more closely linked to gallstone pathogenesis than is overweight. The presence of gallstones was strongly associated with the number of flukes located in the bile duct. A high risk of developing gallstones may be expected in human subjects inhabiting areas where F. hepatica is highly endemic and where high egg outputs detected in humans suggest that liver fluke burdens may also be very high.

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