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Urolithiasis is a condition which is commonly encountered in practice, however retrograde migration of a calculus within the ureter has only recently been documented with few cases reported in the literature. We present the case of a 47-year-old woman presenting with symptomatic urolithiasis confirmed by CT who recovered from her symptoms only for it to be discovered that the calculus had undergone retrograde migration into the renal calyx on a follow up CT examination. We theorise that retrograde urolithiasis migration may be an innate safety mechanism that evolved to prevent complications and/or death from urolithiasis impaction by attempting to return a migrated lithiasis to the renal calyx. [ABSTRACT FROM AUTHOR]

Subsequent to a human rabies death in Sumter County, South Carolina, we assessed the frequency of exposures to bats in homes and citizens' rabies knowledge. A self-administered survey was mailed to 6033 randomly selected Sumter County addresses. The survey inquired about household exposures to bats and respondents' rabies knowledge. Surveys were returned by mail for descriptive analysis. Of 597 respondents, 3.5% (21/597) reported having bats living in (2.8% or 17/597) or entering their homes (2.5% or 15/597) during 2010-2012. Respondents generally understood that mammals transmit rabies virus through bites, but were less aware of the severity of rabies illness and modern post-exposure vaccine administration. Respondents were unsure about how to exclude bats from homes and ranked highly both healthcare and non-healthcare entities as preferred resources for obtaining assistance with bat-related concerns. We found potential for human exposures to bats in Sumter County households and gaps in citizen knowledge of rabies and bat exclusion. Public health officials should engage non-healthcare partners in assistance disseminating rabies educational materials and for providing appropriate referral for persons potentially exposed to bats. [ABSTRACT FROM AUTHOR]

Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long-distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re-introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel- and trade-associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of a two-third re- duction of the scanned length (i.e. 10 cm) on diagnosis of both pulmonary embolism (PE) and alternative diseases. Methods: 247 consecutive patients suspected of acute PE had a CT pulmonary angiography (CTPA) of the thorax (standard length, L). Based on this acquisition, a second set of images was created to obtain a scan length of 10cm caudally to the aortic arch (I). Images were anonymized, randomized and interpreted by two independent readers. The quality of enhancement, the presence of PE and the possible alternative and/or complementary diagnoses were recorded. A McNemar exact test investigated differ- ences in discrepancies between readers and between scan lengths. Results: 57 (23%) patients had an acute PE. Among I sets, PE was missed by both readers in one (1.8%) patient, because the unique clot was localized in a subsegmental artery out of the 10-cm range. There were discrepancies between L and I sets in 9 (3.6%) and 11(4.5%) patients, by Readers 1 and 2 (p = 0.820), respectively. Discrepancies between the readers of L sets and those between both sets were not different regardless of the reader (p> 0.99). There were discrepancies between both sets for alternative and/or complementary diagnoses in 43 (17.2%) patients. Conclusion: Although its performance in diagnosing PE is maintained, CTPA should not be restricted to a range of 10cm centred over the pulmonary hilum, because alternative and/or complementary diagnoses could be missed. Advances in knowledge: (1) A 10-cm CTPA acquisition reduces the radiation dose by two-thirds as compared with a standard one, but does not impair the accuracy for the diagnosis of PE. (2) Significant alternative diagnoses are missed in 17.2% of patients when reducing the acquisition height to 10 cm. [ABSTRACT FROM AUTHOR]

Objective: To compare diagnostic performances of two reduced z-axis coverages to full coverage of the abdomen and pelvis for the diagnosis of acute appendicitis and alternative diseases at unenhanced CT. Methods: This study included 152 adults suspected of appendicitis who were enrolled in two ethical committeeapproved previous prospective trials. Based on scans covering the entire abdomen and pelvis (set L), two additional sets of images were generated, each with reduced z-axis coverages: (1) from the top of the iliac crests to the pubis (set S) and (2) from the diaphragmatic crus to the pubis (set M). Two readers independently coded the visualisation of the appendix, measured its diameter and proposed a diagnosis (appendicitis or alternative). Final diagnosis was based on surgical findings or clinical follow-up. Fisher exact and McNemar tests and logistic regression were used. Results: 46 patients had a definite diagnosis of appendicitis and 53 of alternative diseases. The frequency of appendix visualisation was lower for set S than set L for both readers (89% and 84% vs 95% and 91% by Readers A and B, respectively; p=0.021 and 0.022). The probability of giving a correct diagnosis was lower for set S (68%) than set L (78%; odds ratio, 0.611; p=0.008) for both readers, without significant difference between sets Land M (77%, p=0.771); z-axis coverage being reduced by 25% for set M. Conclusion: Coverage from diaphragmatic crus to pubis, but not focused on pelvis only, can be recommended in adults suspected of appendicitis. Advances in knowledge: In suspected appendicitis, CT-coverage can be reduced from diaphragmatic crus to pubis. [ABSTRACT FROM AUTHOR]