Study Type – Prognosis (cohort) Level of Evidence 4 What’s known on the subject? and What does the study add? Several small series studies have looked at the natural history of asymptomatic renal stones. The number of subjects in these studies ranged from 24 to 300 and duration of follow‐up ranged from 19.4 to 52.3 months. The reported incidences of spontaneous passage, progression and intervention were 3 to 15%, 33 to 77% and 7 to 26%. This study reports on the natural history of asymptomatic stones with an average size of 5.7 mm which were smaller in size than those reviewed in other series. The findings were that the incidence of spontaneous passage was higher than in other series at 20% and that the incidence of intervention was low at 7.1%. This study found that stones that were less than 5 mm in diameter were significantly more likely to pass spontaneously than stones that were larger and there were no other significant differences in the outcomes when stratified according to the initial size and location of stones. OBJECTIVE • To evaluate the long‐term outcomes of patients undergoing observation of asymptomatic renal calculi. PATIENTS AND METHODS • This is a retrospective review of 50 patients with 85 stones undergoing observation with annual imaging from January 2005 to December 2009. • The incidences of spontaneous stone passage, stone progression and intervention were evaluated and assessed for statistical difference according to initial size and location of stone. • Percutaneous nephrolithotomy, shock wave lithotripsy and ureteroscopy were performed when patients developed complications from the stones. RESULTS • Patients were followed up for a mean of 46 months. Sixteen percent had bilateral stones and 38% had multiple stones. • The average stone size was 5.7 mm and 31%, 26% and 43% of the stones were located in the upper, middle and lower pole respectively. • Overall incidences of spontaneous passage, progression and intervention were 20%, 45.9% and 7.1% respectively. • Stones measuring 5 mm or less were significantly more likely to pass (P= 0.006). • There was no significant difference in the incidence of passage according to the initial location of the stone (P= 0.092). There was no significant difference in intervention or progression according to the initial size (P= 0.477 and 0.282 respectively) or location of stone (P= 0.068 and 0.787 respectively). CONCLUSIONS • Patients with asymptomatic renal stones may be managed conservatively in view of low risk of intervention (7.1%). • Annual imaging should be performed as half of these stones will progress in size.

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The preferred measures of serum testosterone in older men are cBT and cFT. Visceral adiposity and SHBG, rather than testosterone, appeared to be the link between androgen deficiency and poorer metabolic status. QOL scores correlate poorly with androgen concentrations.

Epidural emphysema secondary to traumatic pneumomediastinum is benign and self-limiting. However, the life-threatening causes should be considered and ruled out.

A patient with perforated appendicitis developed progressive vasodilatory shock which was complicated by perioperative acute myocardial infarction. Cardiovascular support included dopamine infusion, and later, intra-aortic balloon counterpulsation balloon pump and noradrenaline and dobutamine infusion. Vasopressin was introduced as a final attempt to reverse the refractory shock and was associated with recovery. The experience with this case suggests that vasopressin may be a valuable adjunct to the treatment of catecholamine-resistant vasodilatory shock.