Thiazide Prophylaxis of Urolithiasis

ABSTRACT Fifty recurrent stone formers were included in a double-blind randomized study (median 3 years) performed in a Norwegian general practice to compare twice daily administration of 25 mg hydrochlorothiazide versus placebo. The number of patients with new stones was significantly higher in the placebo group than in the thiazide group (p=0.05, one-tailed test). If a new stone was formed, thiazide, but not placebo, had the effect of prolonging the stone-free interval (p≤0.01). The probability of not forming a new stone during the treatment period was 45% for the placebo group and 75% for the thiazide group. The thiazide effect seemed to be independent of urinary calcium, but was less beneficial in patients with hyperuricosuria. The placebo group also showed a substantial decrease in the expected number of new stones (p≤0.01), emphasizing the importance of an adequate control group.     

Referrals for Radiological Examination of the Large Bowel. Pre-radiological Examinations, Tests and Referral Letters

The aims of the present study were to assess the frequency ofexaminations or tests before referral for a barium enema, toidentify predictors for the use of such examinations or testsand to evaluate the quality of the referral letters. 1852 patientscompleted a questionnaire on symptoms and examinations or testsperformed before referral. Symptoms, examination procedures,laboratory data and reason for referral were registered in 1781referral letters and were compared with the information givenby the patients. Serum haemoglobin was measured in 76%, per-rectalexamination in 45%, faecal occult blood tests in 37% and proctosigmoidoscopyin only 16% of the patients. High age was a significant predictorfor all examinations, and patients with rectal bleeding andrectal pain were more often examined rectally, although thiswas omitted in several patients with such symptoms. All evaluatedinformation was reported significantly more frequently by thepatients than by the doctors in the referral letters. The verylow figures for rectal examinations and the lack of completenessand adequacy of the information in the referral letters underlinethe need for efforts to change doctors' behaviour when investigatingand referring patients with possible colorectal disease.