BackgroundTo determine accuracy of ultrasound (US) kidney, ureter and bladder (KUB) compared to un-enhanced helical CT (UHCT) in patients with renal failure in the diagnosis of stone and obstruction.MethodsThis is a case controlled study conducted in the period from June 2000 to July 2003 at a university hospital. All patients had both US and UHCT scan. Patients with serum creatinine ≥ 1.8 mg/dl were included in the study. Only direct visualization of stone was considered as confirmatory. In both the studies, UHCT and US, presence of stone and obstruction were noted. The relevant biochemicals, radiological and clinical records of all the patients were analyzed. Data was analyzed using commercially available software.ResultsDuring the period of study 864 patients had UHCT for evaluation of the urinary tract in patients presenting with flank pain. Out of these 34 patients had both UHCT and US done within a span of one day and had serum creatinine of ≥1.8 mg/dl. Mean age was 48 ±15.8 years and 59% of patients were males. UHCT identified renal stones in 21 (62%), whereas 17 of these were identified on US, with a sensitivity of 81%. Of the four patients with renal stones missed on US, three were identified on plain x-ray; the mean size of stones missed was 6.3 mm. Of the 22 (65%) patients with ureteric stone on UHCT, US could only identify 10; a further 7 were identified on x-ray KUB, giving a sensitivity of 45% (US alone) and 77% (US with x-ray KUB).ConclusionsUS is sensitive and specific for renal stones, 81% and 100% and for hydronephrosis, 93% and 100%, respectively. Its sensitivity to pick ureteric stone (46%) and to identify hydroureter (50%) is low. Addition of x-ray KUB abdomen increases the sensitivity for ureteric stones to 77%.
Lactate dehydrogenase (LD; EC 1•1•1•27) is a tetramer made up of two subunits, M (type 5) and H (type I). Various combinations of M and H subunits produce five LD isoenzymes (LD-l to LD_5).l,2 Analysis of LD isoenzymes in biological fluids is important in the diagnosis of various diseases, such as myocardial infarction, haemolysis, muscular dystrophy, hepatic disease and malignancy.' 3 Normal urine, cerebrospinal fluid (CSF), plasma and amniotic fluid have negligible amounts of LD-4 and 5 (LD-M), while levels of these isoenzymes have been shown to be increased significantly in various pathological conditions.I' In our previous report, describing the detection of LD isoenzymes by gel filtration," we showed that albumin in the samples inhibits the binding of LD-M to dextran blue (DB) and we were unable to detect LD-M in samples containing albumin. We now report a modified version that detects LD-M in these samples.The basic principle of this method was described previously." It has been shown that human serum albumin inhibits binding of LD-M with DB,4,5 Albumin was removed from the samples by affinity chromatography using adenosine monophosphate (AMP)-Sepharose gel. Total LD was then eluted from the gel by reduced nicotinamide adenine dinucleotide (NADH) and mixed with DB. The LD-M-DBcomplex was separated from other LD isoenzymes by gel filtration, as previously described."
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