Minutes of the ESPR Workgroup Session on Urinary Tract Infection
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Percutaneous Nephrostomy and Sclerotherapy with 96% Ethanol for the Treatment of Simple Renal Cysts: Pilot Study Mustafa Kadıhasanoğlu1, Mete Kilciler2, Özcan Atahan3
İstanbul Med J 2016; 17: 20-3 Original Article DOI: 10.5152/imj.2016.20981 Percutaneous Nephrostomy and Sclerotherapy with 96% Ethanol for the Treatment of Simple Renal Cysts: Pilot Study Mustafa Kadıhasanoğlu1, Mete Kilciler2, Özcan Atahan3 Introduction: The objectives of this study was to evaluate the safety and efficacy of aspiration with percutaneous nephrostomy tube and sclerotherapy with 96% ethanol for simple renal cyst. Methods: Between 2011-2014, 34 patients with symptomatic renal cysts were included in the study. Mean age was 52.3±4.6 years (range, 39-72 years). The Abstract patients had only flank pain. Procedure was performed with ultrasound guidance and under fluoroscopic control. After puncture with 18 G angiography needle, guide-wire was advanced to the collecting system. An 14Fr nephrostomy catheter was then advanced over the guide wire. After taking cystography 96% ethyl alcohol was injected into the cyst and drained amount 10%. We continued daily to inject same amount of alcohol postoperatively until the drainage was less than 50 mL. 6th months and yearly follow-up were performed with ultrasound.. Results: Percutaneous access was achieved in all patients. Cysts were unilateral, single and with a mean diameter 9.1±3.2 cm (range, 7-16 cm). Median drained volume was 212 mL (200-1600 mL) and median the injected ethanol volume was 54 mL (20- 160 mL). Radiological improvement at the end of the 6th month was amount 94.1% and 91.1% at the end of the 1st year while 83.3% of patients had symptomatic decline. There was no major complication after the procedure. -
ICD-10 Coding Clinic Corner: Accountability Act of 1996 (HIPAA) Is 413.65(A)(2): Diabetes and Osteomyelitis
Issue No. 6 Volume No. 2 September 2015 New and Revised Place of Service TABLE of CONTENTS Codes for OutpatientNote Hospital from Tony New and Revised Place of Joette P. Derricks, MPA, CMPE, CHC, CPC, CSSGB Service Codes for Outpatient Joh Vice President of Regulatory Affairs & Research Hospital ..................................... 1 MiraMed Global Services ERCP with Exchange of a Common Bile Duct Stent .......... 3 Any health insurer subject to the policy. Contractor editing shall Laparoscopic Procedure: An uniform electronic claim transaction treat POS 19 and POS 22 in the Education .................................. 5 and code set standards under the same way. The definition of a Health Insurance Portability and “campus” is found in Title 42 CFR ICD-10 Coding Clinic Corner: Accountability Act of 1996 (HIPAA) is 413.65(a)(2): Diabetes and Osteomyelitis ..... 7 required to make changes to the Campus means the physical Place of Service (POS) code from the Stars of MiraMed ...................... 8 area immediately adjacent to POS code set maintained by the the provider’s main buildings, Are You a Good Auditor? ......... 9 Centers for Medicare and Medicaid other areas and structures that Services (CMS) effective January 1, Coding Case Scenario ............. 11 are not strictly contiguous to 2016. the main buildings but are The POS code set provides setting located within 250 yards of the If you have an article information necessary to main buildings, and any other appropriately pay Medicare and areas determined on an or idea to share for The Medicaid claims. Other payers may individual case basis, by the Code , please submit to: or may not use the POS codes in the CMS regional office, to be part Dr. -
Nuclear Medicine for Medical Students and Junior Doctors
NUCLEAR MEDICINE FOR MEDICAL STUDENTS AND JUNIOR DOCTORS Dr JOHN W FRANK M.Sc, FRCP, FRCR, FBIR PAST PRESIDENT, BRITISH NUCLEAR MEDICINE SOCIETY DEPARTMENT OF NUCLEAR MEDICINE, 1ST MEDICAL FACULTY, CHARLES UNIVERSITY, PRAGUE 2009 [1] ACKNOWLEDGEMENTS I would very much like to thank Prof Martin Šámal, Head of Department, for proposing this project, and the following colleagues for generously providing images and illustrations. Dr Sally Barrington, Dept of Nuclear Medicine, St Thomas’s Hospital, London Professor Otakar Bělohlávek, PET Centre, Na Homolce Hospital, Prague Dr Gary Cook, Dept of Nuclear Medicine, Royal Marsden Hospital, London Professor Greg Daniel, formerly at Dept of Veterinary Medicine, University of Tennessee, currently at Virginia Polytechnic Institute and State University (Virginia Tech), Past President, American College of Veterinary Radiology Dr Andrew Hilson, Dept of Nuclear Medicine, Royal Free Hospital, London, Past President, British Nuclear Medicine Society Dr Iva Kantorová, PET Centre, Na Homolce Hospital, Prague Dr Paul Kemp, Dept of Nuclear Medicine, Southampton University Hospital Dr Jozef Kubinyi, Institute of Nuclear Medicine, 1st Medical Faculty, Charles University Dr Tom Nunan, Dept of Nuclear Medicine, St Thomas’s Hospital, London Dr Kathelijne Peremans, Dept of Veterinary Medicine, University of Ghent Dr Teresa Szyszko, Dept of Nuclear Medicine, St Thomas’s Hospital, London Ms Wendy Wallis, Dept of Nuclear Medicine, Charing Cross Hospital, London Copyright notice The complete text and illustrations are copyright to the author, and this will be strictly enforced. Students, both undergraduate and postgraduate, may print one copy only for personal use. Any quotations from the text must be fully acknowledged. It is forbidden to incorporate any of the illustrations or diagrams into any other work, whether printed, electronic or for oral presentation. -
Nuclear Pharmacy Quick Sample
12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 1 CHAPTER 1 Radioisotopes Distribution for Not 1 12614-01_CH01-rev3.qxd 10/25/1110:56AMPage2 2 N TABLE 1-1 Radiopharmaceuticals Used in Nuclear Medicine UCLEAR Chemical Form and Typical Dosage P Distribution a b HARMACY Radionuclide Dosage Form Use (Adult ) Route Carbon C 11 Carbon monoxide Cardiac: Blood volume measurement 60–100 mCi Inhalation Carbon C 11 Flumazenil injection Brain: Benzodiazepine receptor imaging 20–30 mCi IV Q UICK Carbon C 11 Methionine injection Neoplastic disease evaluation in brain 10–20 mCi IV R Carbon C 11 forRaclopride injection Brain: Dopamine D2 receptor imaging 10–15 mCi IV EFERENCE Carbon C 11 Sodium acetate injection Cardiac: Marker of oxidative metabolism 12–40 mCi IV Carbon C 14 Urea Diagnosis of Helicobacter pylori infection 1 µCi PO Chromium Cr 51 Sodium chromate injection Labeling red blood cells (RBCs) for mea- 10–80 µCi IV suring RBC volume, survival, and splenic sequestration Cobalt Co 57 Cyanocobalamin capsules Diagnosis of pernicious anemia and 0.5 µCi PO Not defects of intestinal absorption Fluorine F 18 Fludeoxyglucose injection Glucose utilization in brain, cardiac, and 10–15 mCi IV neoplastic disease Fluorine F 18 Fluorodopa injection Dopamine neuronal decarboxylase activity 4–6 mCi IV in brain Fluorine F 18 Sodium fluoride injection Bone imaging 10 mCi IV Gallium Ga 67 Gallium citrate injection Hodgkin’s disease, lymphoma 8–10 mCi IV Acute inflammatory lesions 5 mCi IV Indium In 111 Capromab pendetide Metastatic imaging in patients with biopsy- -
Percutaneous Nephrostomy
Page 1 of 6 Percutaneous Nephrostomy (PCN) Tube Related Infections Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. Local microbiology and susceptibility/resistance patterns should be taken into consideration when selecting antibiotics. CLINICAL EVALUATION PRESENTATION Patient presentation suspicious for PCN infection: ● Lower UTI: dysuria, frequency, urgency and/or suprapubic pain ● Upper UTI: fever/chills, leukocytosis and/or CVA tenderness (with or without lower UTI symptoms) ● PCN exit site infection: local signs for erythema, ● Renal ultrasound or CT abdomen and pelvis with contrast warmth, tenderness and/or purulence ● Consider Infectious Diseases (ID) consult ● See Sepsis Management - Adult algorithm Yes Labs: Does ● CBC with differential, patient exhibit at BUN, creatinine least two modified ● Blood cultures SIRS criteria2 and ● Urine analysis and urine 1 hemodynamic ● Start empiric IV antibiotics (refer to Page 2) culture from urethral 3 instability ? ● Consider CT abdomen and pelvis with and PCN sites No contrast to rule out hydronephrosis, Fever, chills, Yes pyelonephritis and renal -
Percutaneous Nephrostomy
SEMINARS IN INTERVENTIONAL RADIOLOGY VOLUME 17, NUMBER 4 2000 Percutaneous Nephrostomy Michael M. Maher, M.D., Timothy Fotheringham, M.D., and Michael J. Lee, M.D. ABSTRACT Percutaneous nephrostomy (PCN) is now established as a safe and effective early treatment for patients with urinary tract obstruction. In experienced hands, PCN is usually successful and is associated with low complication rates. This article discusses all aspects of PCN, including the indications and contraindications to PCN, patient preparation, the techniques employed for gaining access to the urinary tract, and placement of the PCN tube. In addition, we discuss the complications of PCN and possible ways of avoiding them, as well as the care of patients following PCN. Keywords: Percutaneous nephrostomy, renal failure, pyonephrosis Urinary tract obstruction invariably requires eral anesthesia is avoided and surrounding organs treatment, and indications for immediate or urgent can be imaged and avoided during PCN. In expert intervention include clinical and laboratory signs of hands, PCN is associated with a major complication underlying sepsis and clinical or radiological signs rate of 4 to 5%4 and a minor complication rate of of pyonephrosis. Urgent intervention is also manda- approximately 15%.1 PCN is usually faster, less ex- tory for the treatment of life-threatening biochemi- pensive, and less likely to be associated with compli- cal abnormalities associated with the rapid onset of cations than is surgery.5 In the current era, PCN renal failure. also allows access to the urinary tract for more In the past decade, image-guided PCN has re- definitive treatment of underlying pathologies such placed the conventional surgical approach for the as percutaneous nephrolithotomy (PCNL) for temporary drainage of urinary tract obstruction. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Outcome of Percutaneous Nephrostomy in Children with Ureteropelvic Junction Obstruction Mohammad Mahfuzur Rahman Chowdhury1, Rifat Zaman2, Md
OUTCOME OF PERCUTANEOUS NEPHROSTOMY IN CHILDREN WITH URETEROPELVIC JUNCTION OBSTRUCTION MOHAMMAD MAHFUZUR RAHMAN CHOWDHURY1, RIFAT ZAMAN2, MD. AMANUR RASUL1, AKM SHAHADAT HOSSAIN1, SHAFIQUL ALAM CHOWDHURY1, MD. MIZANUR RAHMAN1 1Department of Urology, Dhaka Medical College & Hospital, Dhaka, 2Department of Pediatrics, Dhaka Medical College Hospital, Dhaka. Abstract: Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. -
Uroradiology Tutorial for Medical Students Lesson 3: Cystography & Urethrography – Part 1
Uroradiology Tutorial For Medical Students Lesson 3: Cystography & Urethrography – Part 1 American Urological Association Introduction • Conventional radiography of the urinary tract includes several diagnostic studies: – Cystogram – Retrograde urethrogram – Voiding cystourethrogram • All of these studies answer questions that are essential to urologic patient management Voiding Cystourethrogram (VCUG) • The voiding cystourethrogram is a dynamic test used to define the anatomy and, in part, the function of the lower urinary tract. It is performed by placing a catheter through the urethra into the bladder, filling the bladder with contrast material and then taking x-rays while the patient voids. You can imagine how popular it is among children. Scout Film • Several films are taken when performing a VCUG. The first image is a KUB called the scout film. On this film one can evaluate the bones of the spine and pelvis (injury or congenital anomaly such as spina bifida) and the soft tissues (calcifications, foreign bodies, etc.). • Normal scout image • What gender? Scout Film • Patients with urologic problems (urine infection or incontinence) may have a spinal abnormality that results in abnormal innervation of the bladder. Such anomalies are commonly associated with anomalies of the vertebral column. Let’s look at some spines. • Here is a spine from a normal KUB or scout film. Notice that the posterior processes of all the vertebrae are intact. You can see the posterior process behind and below each vertebral body. • Here is another scout film. Notice that the posterior processes are absent below L-4. This patient has lower lumbar spina bifida. Read This Scout Film • The bones are normal • What about soft tissues (bowel, etc.)? • This child has significant constipation. -
FDA-Approved Radiopharmaceuticals
Medication Management FDA-approved radiopharmaceuticals This is a current list of all FDA-approved radiopharmaceuticals. USP <825> requires the use of conventionally manufactured drug products (e.g., NDA, ANDA) for Immediate Use. Nuclear medicine practitioners that receive radiopharmaceuticals that originate from sources other than the manufacturers listed in these tables may be using unapproved copies. Radiopharmaceutical Manufacturer Trade names Approved indications in adults (Pediatric use as noted) 1 Carbon-11 choline Various - Indicated for PET imaging of patients with suspected prostate cancer recurrence based upon elevated blood prostate specific antigen (PSA) levels following initial therapy and non-informative bone scintigraphy, computerized tomography (CT) or magnetic resonance imaging (MRI) to help identify potential sites of prostate cancer recurrence for subsequent histologic confirmation 2 Carbon-14 urea Halyard Health PYtest Detection of gastric urease as an aid in the diagnosis of H.pylori infection in the stomach 3 Copper-64 dotatate Curium Detectnet™ Indicated for use with positron emission tomography (PET) for localization of somatostatin receptor positive neuroendocrine tumors (NETs) in adult patients 4 Fluorine-18 florbetaben Life Molecular Neuraceq™ Indicated for Positron Emission Tomography (PET) imaging of the brain to Imaging estimate β amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease (AD) or other causes of cognitive decline 5 Fluorine-18 -
Percutaneous Nephrostomy and Antegrade Pyelography
Marmara Medical Journal Volume 3 No 4 October 1990 PERCUTANEOUS NEPHROSTOMY AND ANTEGRADE PYELOGRAPHY MAkinci, MD.** / A.Kadioglu, M.D.* * * * / I.Nane, M.D.* * * / COzsoy. M.D.* / A.R.Ersay MD.* * * * * Professor, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey. ** Associate Professor, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey *** Specialist, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey **** Research Assistant, Department o f Urology, Istanbul Medical Faculty, University o f Istanbul, Istanbul, Turkey SUMMARY Between October 1986 and January 1989, 66 per cases in our clinic. The ages o f the patients varied cutaneous nephrostomy (PCN) were performed in 47 from 4 to 43 years and 9 patients were in the pediatric patients in our clinic. Nine cases were children and group The indications for PCN in our series are shown the remainder were adults. Seven of nine children had in table I. bilateral vesico-ureteric reflux and the other two cases had idiopathic megaureter 19 of our adult patients had Basic haematologic parameters were obtained in all bladder tumor, nine patients had cervix ca. three cases patients before the procedure. W e used antibiotic pro had carcinoma of the prostate, two cases had tuber phylaxis routinely in our patients. Ultrasonic scann culosis pyenephrose, two patients had stone-way, ing was used to localise renal pelvis, the appropriate three cases had lymphoma and another two cases caliyx for nephrostomy tract and to measure the tumor of the ureter. Local anesthesia was used in all distance from skin to renal pelvis and caliyx. -
Radionuclide Cystography 138
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice guidelines and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice guidelines and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review, requiring the approval of the Commission on Quality and Safety as well as the ACR Board of Chancellors, the ACR Council Steering Committee, and the ACR Council. The practice guidelines and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline and technical standard by those entities not providing these services is not authorized. Revised 2010 (Res. 25)* ACR–SPR–SNM PRACTICE GUIDELINE FOR THE PERFORMANCE OF ADULT AND PEDIATRIC RADIONUCLIDE CYSTOGRAPHY PREAMBLE These guidelines are an educational tool designed to assist Therefore, it should be recognized that adherence to these practitioners in providing appropriate radiologic care for guidelines will not assure an accurate diagnosis or a patients.