was significant intra-individual variation of FC within CD patients, this could impact on the interpretation of single values in isolation. A prospective study to evaluate the degree of variability of FC in three consecutive days stool samples in CD patients in clinical remission was performed. Methods 143 patients with CD in remission (CDAI <150, no escalation of medical therapy within 3 months) who were attending for routine follow-up were identified and enrolled. Patients were excluded if they were taking NSAIDs or developed any change in symptoms over the 3-day collection period. After informed consent, patients were asked to provide stool samples from three consecutive days for analysis. FC was analysed using the Buhlman FC ELISA as per the manufacturer 's instructions. Results Of the 143 patients recruited 34 did not return any samples, 6 returned less than the required number of stool samples, 2 withdrew consent and 2 developed clinical evidence of a flare of disease during the collection period and were excluded from analysis. Therefore 98 complete sets of three stool samples were obtained and analysed. The intraclass correlation coefficient of the 3 FC values, log-transformed, was 0.842 with corresponding 95% CI 0.788 to 0.886 showing that consistency between the three log-transformed FC measurements is high. The reliability of a "normal" FC result of <50 and of <100 was assessed using the k statistic for agreement between the three measurements. For a FC result of <50 k was 0.648 (95% CI 0.508 to 0.770) and for a FC result of <100, k was 0.603 (95% CI 0.483 to 0.712) demonstrating that there is moderately good and similar levels of agreement across the 3 samples for both measures. The reliability of the cut-off of 50 is slightly better than the cut-off of 100. Conclusion The consistency of three faecal calprotectin samples over three consecutive days is high and the CI is narrow suggesting that in a larger population consistency would also be high. This indicates that there is little intra-individual variability of the test and a one off sample can indeed provide reliable information for use in clinical practice. Higher intrapatient variability of high FC values suggests that the log-transformed values are more reliable.
included abnormally elevated renal parameters, signs of a concomitant infectious process (fever, leukocytosis, or a positive urine dipstick), pain poorly responding to analgesia, radiolucent stones, or stones smaller than 4-mm or larger than 15-mm in size. 72 patients had been randomly assigned to undergo ESWL directly without pre-stenting (Group A), while 52 patients were assigned for pre-stenting (Group B), with their data and outcomes prospectively collected. Mean patient BMI in both groups was 26.1 and 26.7 kg/m2 (p ¼ 0.49), mean skin-to-stone distance was 11 and 10.1 cm (p ¼ 0.03), mean stone size was 7.3 and 7.8 mm (p ¼ 0.114), and mean stone density was 902 and 1078 Hounsfield units (p ¼ 0.005) respectively.RESULTS: 72 patients had undergone emergency ESWL directly without pre-stenting (Group A), while 52 patients had undergone pre-stenting before emergency ESWL (Group B). All 124 patients had their first session of ESWL done within 48 hours of their initial presentation. 8 patients were lost to follow up in Group A, while one patient was lost to follow up in Group B. Four patients' stones had migrated to the kidney with stenting and were excluded from the study. Stone clearance in both groups was 61% and 44% (p ¼ 0.068) after one session, 91% vs 59% (p ¼ <0.001) by the second session, and 95% and 73% (p ¼ 0.001) by the third and last session. No patients in Group A crossed over to Group B or required stenting at any point.CONCLUSIONS: Emergency ESWL for upper ureteric calculi offers excellent stone clearance outcomes for properly selected patients with an acute presentation of renal colic that has subsided. Proceeding directly for ESWL without pre-stenting was associated with significantly enhanced stone clearance while sparing the patient multiple invasive interventions and their potential morbidity.
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