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Renal trauma

Hannah A Blair, James E Frampton
Methoxyflurane (Penthrox(®)) is a halogenated ether first used clinically as a volatile inhalational anaesthetic. It has been used as an analgesic in Australia and New Zealand for the past 30 years. In the UK and Europe, methoxyflurane has been approved for the emergency relief of moderate to severe trauma pain in conscious adult patients. Methoxyflurane is self-administered using a hand-held inhaler. This article reviews the pharmacological properties of methoxyflurane and its clinical efficacy and tolerability in these patients...
October 13, 2016: Clinical Drug Investigation
Yasumasa Kawano, Shinichi Morimoto, Yoshito Izutani, Kentaro Muranishi, Hironari Kaneyama, Kota Hoshino, Takeshi Nishida, Hiroyasu Ishikura
BACKGROUND: Augmented renal clearance (ARC) of circulating solutes and drugs has been recently often reported in intensive care unit (ICU) patients. However, only few studies on ARC have been reported in Japan. The aims of this pilot study were to determine the prevalence and risk factors for ARC in Japanese ICU patients with normal serum creatinine levels and to evaluate the association between ARC and estimated glomerular filtration rate (eGFR) calculated using the Japanese equation...
2016: Journal of Intensive Care
Ahmad S Alobaidi, Ammar Al-Hassani, Ayman El-Menyar, Husham Abdelrahman, Mazin Tuma, Hassan Al-Thani, Mohammed A Aldosari
BACKGROUND: Femur fracture (FF) is a common injury, and intramedullary nailing (IMN) is the standard surgical fixation. However, the time of intervention remains controversial. We aimed to describe the reamed IMN (rIMN) timing and hospital outcomes in trauma patients presenting with FF. MATERIALS AND METHODS: A retrospective analysis was conducted for all patients admitted with FF and they underwent fixation at level 1 trauma unit between January 2010 and January 2012...
July 2016: International Journal of Critical Illness and Injury Science
Naranpurev Mendsaikhan, Tsolmon Begzjav, Ganbold Lundeg, Martin W Dünser
CONTEXT: The epidemiology and outcome of critical illness in Mongolia remain undefined. AIM: The aim of this study was to evaluate the epidemiology and outcome of critical illness in Mongolia. SETTINGS AND DESIGN: This is a multicenter, prospective, observational cohort study including 19 Mongolian centers. MATERIALS AND METHODS: Demographic, clinical, and outcome data of patients >15 years admitted to the Intensive Care Units (ICUs) were collected during a 6-month period...
July 2016: International Journal of Critical Illness and Injury Science
Piotr Buda, Ryszard Grenda, Anna Wieteska-Klimczak, Piotr Gietka, Lidia Skobejko-Włodarska, Karina Felberg, Janusz Książyk
Eosinophilic cystitis (EC) is a rare inflammatory disorder of the urinary tract characterized by infiltration of bladder with eosinophils. The cause remains unclear, immunological mechanisms have been implicated in pathogenesis. Potential etiological factors include: tumors, allergy, parasitic infections, trauma. The disease may have a variable course, from a mild self-limiting, through common symptoms like: dysuria, hematuria, abdominal pain, tumor, to severe renal failure, with eosinophilic infiltration of the other organs and systemic complications...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Menno V Huisman, John Fanikos
As expected with all antithrombotic agents, there is a risk of bleeding complications in patients receiving direct oral anticoagulants (DOACs) because of the DOAC itself, acute trauma, invasive procedures, or underlying comorbidities. For many bleeding events, a prudent course of action will be to withdraw the DOAC, then "wait and support" the patient, with the expectation that the bleeding event should resolve with time. Likewise, DOAC therapy may be interrupted ahead of a planned procedure, the stopping time being dependent on the agent involved and the patient's renal function...
September 28, 2016: American Journal of Emergency Medicine
Ardalan Akbari, Manraj K S Heran, Kourosh Afshar
This case report explores the efficacy of simultaneous use of endourological and radiological methods to assess and manage high-grade renal trauma. A male rugby player was diagnosed with Grade 4 blunt renal trauma. A segment of the patient's kidney was isolated from the main renal pelvis with intact perfusion. This resulted in urinary extravasation. Ureteral stenting and angioembolization were used to treat the patient's severe symptoms. Angioembolization ablated functional tissue that was causing a persistent urinary leak...
September 2016: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Karla M Greco, Bianca M Conti, Cynthia J Bucci, Samuel M Galvagno
STUDY OBJECTIVE: To determine risk factors associated with reintubations in adult patients with soft tissue infections. DESIGN: A retrospective case-control design. SETTING: Operating room and postoperative recovery area. PATIENTS: There were 39 patients who presented for surgical intervention of their soft tissue infection and 222 controls having general surgery who were matched for age, sex, and body mass index. All patients were older than the age of 18 years and mostly American Society of Anesthesiologists physical status of III to IV and presented to our level 1 trauma center...
November 2016: Journal of Clinical Anesthesia
X B Wu, G T Zhang, F Zhang, W D Gan, G X Liu, X G Li, S W Zhang, H Q Guo
Objective: To explore the safety and clinical efficacy of partial nephrectomy for solitary kidney tumor. Methods: Twenty patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were retrospectively analyzed. There were 15 male and 5 female patients with mean age of 63 years.Patients were divided into open partial nephrectomy(OPN) group and laparoscopic partial nephrectomy(LPN) group, the two groups were followed up.Demographic and clinical characteristics were analyzed using student t-test for continuous variables, and the χ(2) test for categorical variables...
October 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Tatenda Calvin Nzenza, Derek Barry Hennessey, Tim Dunshea, Nathan Lawrentschuk
Upper urinary tract rupture in the absence of trauma is typically related to ureteric calculi causing obstructive nephropathy. Spontaneous extravasation of contrast during CT intravenous pyelography (CT IVP) is infrequently reported. Two cases, who underwent CT IVP to further investigate positive urine cytology and microscopic haematuria, respectively, are described here. In both cases, there was spontaneous extravasation of contrast seen in the postcontrast scans in the absence of ureteric calculi or hydronephrosis which is very unusual...
2016: BMJ Case Reports
M S Reich, A J Dolenc, T A Moore, H A Vallier
BACKGROUND: Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. METHODS: Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied...
September 26, 2016: Journal of Orthopaedic Surgery and Research
Emily Earl-Royal, Elinore J Kaufman, Jesse Y Hsu, Douglas J Wiebe, Patrick M Reilly, Daniel N Holena
BACKGROUND: Failure to rescue (FTR: the conditional probability of death after complication) has been studied in trauma cohorts, but the impact of age and preexisting conditions (PECs) on risk of FTR is not well known. We assessed the relationship between age and PECs on the risk of experiencing serious adverse events (SAEs) subsequent FTR in trauma patients with the hypothesis that increased comorbidity burden and age would be associated with increased FTR. MATERIALS AND METHODS: We performed a retrospective cohort analysis at an urban level 1 trauma center in Pennsylvania...
October 2016: Journal of Surgical Research
Marc Maegele, Oliver Grottke, Herbert Schöchl, Oliver A Sakowitz, Michael Spannagl, Jürgen Koscielny
BACKGROUND: Direct (non-vitamin-K-dependent) oral anticoagulants (DOAC) are given as an alternative to vitamin K antagonists (VKA) to prevent stroke and embolic disease in patients with atrial fibrillation that is not due to pathology of the heart valves. Fatal hemorrhage is rarer when DOACs are given (nonvalvular atrial fibrillation: odds ratio [OR] 0.68; 95% confidence interval [95% CI: 0.48; 0.96], and venous thromboembolism: OR 0.54; [0.22; 1.32]). 48% of emergency trauma patients need an emergency operation or early surgery...
September 5, 2016: Deutsches Ärzteblatt International
Ramez R Hanna, Nicholas Kolanko, Carlos Torres
History A 70-year-old woman presented to a peripheral hospital with signs and symptoms of acute chronic obstructive pulmonary disease (COPD) exacerbation. The patient also reported acute on chronic onset of thoracolumbar back pain over a period of 24 hours. She denied any history of recent trauma or intravenous drug use. She did not have any long-term indwelling catheters. The patient's medical history was also complicated by stage 4 renal failure from long-standing type II diabetes, hypertension, iron deficiency anemia, aortic stenosis, and prior bariatric surgery...
October 2016: Radiology
Arulselvi Subramanian, Venencia Albert, Biplab Mishra, Shilpi Sanoria, Ravindra Mohan Pandey
BACKGROUND: The literature suggests an association of pancreatic enzymes with systemic inflammation resulting in secondary organ injury and dysfunction following trauma. Elevation in serum enzymes may not always be predictive of pancreatic disease, and can reflect extra pancreatic production. OBJECTIVES: This study was conducted to evaluate the rise in serum pancreatic enzyme levels with the incidence of organ failure following trauma. PATIENTS AND METHODS: A retrospective review was performed on critically injured patients from December 2009 to March 2010...
May 2016: Trauma Monthly
Natalie Pozzi, Sarah Koblick, Patricia Leung, Leon Boudourakis
INTRODUCTION: There has been a recent trend toward nonoperative management of solid organ injuries with arteriography and embolization as alternatives to surgical exploration. We examine the use of arterial embolization in the management of a post-subtotal nephrectomy urinoma in a patient with severe renal injury secondary to blunt trauma. METHODS: This case report has been reported in line with the CARE criteria [13]. PRESENTATION OF CASE: A 35-year-old female patient presented with a persistent urinoma after an incomplete nephrectomy for blunt renal trauma...
2016: International Journal of Surgery Case Reports
Guofeng Xu, Lei He, Xiaoliang Fang, Dapeng Jiang, Longhu Jin, Houwei Lin, Maosheng Xu, Yeming Wu, Hongquan Geng
We report two successful treatment cases of renal artery occlusion (RAO) related to multiple trauma. A 4-year-old boy was diagnosed with right RAO and liver laceration after a traffic accident. Surgical thrombectomy and revascularization were performed, but lacerated liver not sutured. Lacerated liver was surgical repaired 6 days postoperation because of delayed bleeding. 13% of the patient's right kidney function was conserved. Another 7-year-old boy was compressed by an agitator. Renal scintigraphy showed that the right kidney was nonfunctional...
September 7, 2016: Urology
Vasileios Rafailidis, Annamaria Deganello, Tom Watson, Paul S Sidhu, Maria E Sellars
Contrast-enhanced Ultrasound (CEUS) represents a complementary technique to grey-scale and colour Doppler ultrasonography (US) which allows for real-time visualization and characterization of tissue perfusion. Its inherent advantages in the child makes US an ideal imaging modality; repeatability and good tolerance along with the avoidance of computed tomography (CT), a source of ionizing radiation, renders US imaging desirable. Although currently paediatric CEUS is principally used in an "off-label" manner, US contrast agents have received regulatory approval for assessment of paediatric focal liver lesions in the United States of America...
September 9, 2016: British Journal of Radiology
Bellal Joseph, Herb Phelan, Ahmed Hassan, Tahereh Orouji Jokar, Terence O'Keeffe, Asad Azim, Lynn Gries, Narong Kulvatunyou, Rifat Latifi, Peter Rhee
INTRODUCTION: Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS: We performed a prospective cohort study of all elderly (age ≥ 65 yrs.) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission...
September 16, 2016: Journal of Trauma and Acute Care Surgery
Ayşe Başak Uçan, Zehra Günyüz Temir, Arzu Şencan, Aytaç Karkıner, Hüseyin Evciler
BACKGROUND: Conservative management procedures are implemented in cases of low-grade pediatric blunt renal trauma, but procedures for grade 4 injuries are not clearly defined. The present objective was to discuss treatment procedures in patients who presented with or developed urinoma during follow-up. METHODS: Treatment procedures implemented in 8 patients (female:male ratio=1:7; average age: 6) with grade 4 renal trauma who presented to the clinic between 2003 and 2012 were retrospectively analyzed...
July 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
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