scholarly journals On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region

2021 ◽  
Author(s):  
Christian Deininger ◽  
Thomas Freude ◽  
Florian Wichlas ◽  
Lukas Konstantin Kriechbaumer ◽  
Sebastian Hubertus Markus Deininger ◽  
...  
Keyword(s):  
Operative Management ◽  
Primary Treatment ◽  
Renal Trauma ◽  
Primary Therapy ◽  
Concomitant Injuries ◽  
Winter Sports ◽  
Kidney Trauma ◽  
Number Of Patients ◽  
Grade 3 ◽  
Non Operative Management

Abstract Purpose The aim of this study was to analyze the injury patterns and clinical course of a winter sport dominated by blunt renal trauma collective. Methods Blunt renal trauma cases (N = 106) treated in a Level 1 Trauma Center in Austria were analyzed. Results We encountered 12.3% grade 1, 10.4% grade 2, 32.1% grade 3, 38.7% grade 4 and 6.6% grade 5 renal traumata classified according to the American Association for the Surgery of Trauma (AAST). The mechanisms of injury (MOI) did not have an influence on the frequency of HG trauma (i.e., grade 4 and 5). No concomitant injuries (CIs) were found in 57.9% of patients. The number of patients without CIs was significantly higher in the sports associated trauma group compared to other MOIs (p < 0.01). In 94.3% the primary treatment was a non-operative management (NOM) including 56.6% conservative, 34.0% endourological, and 3.8% interventional therapies. A follow-up computed tomography (FU-CT) was performed in 81.1%, 3.3 days after trauma. After FU-CT, the primary therapy was changed in 11.4% of cases (grade ≥ 3). Comparing the Hb loss between the patients with grade 3 and 4 kidney trauma with and without revision surgery, we find a significantly increased Hb loss within the first 96 h after the trauma in the group with a needed change of therapy (p < 0.0001). The overall rate of nephrectomy (primary or secondary) was 9.4%. Independent predictors of nephrectomy were HG trauma (p < 0.01), age (p < 0.05), and sex (p < 0.05). The probability of nephrectomy was lower with (winter) sports-associated trauma (p < 0.1). Conclusions Sports-associated blunt renal trauma is more likely to occur isolated, and has a lower risk of severe outcomes, compared to other trauma mechanisms. NOM can successfully be performed in over 90% of all trauma grades.

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

scholarly journals Non-Operative Management for Renal and Splenic Trauma – A Case Report

2020 ◽  
Vol 13 (62) (2) ◽  
pp. 43-52
Author(s):  
Alexandru Georgian Lăculiceanu ◽  
Denis Anamaria Mereț ◽  
Ruxandra Rotaru ◽  
Mircea Daniel Hogea ◽  
Ioan Scârneciu
Keyword(s):  
Injury Severity ◽  
Left Kidney ◽  
Operative Management ◽  
Renal Trauma ◽  
Iliopsoas Muscle ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Grade Ii ◽  
Non Operative Management

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma  is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

Clarithromycin, lenalidomide and dexamethasone combination therapy as primary treatment of multiple myeloma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7545-7545 ◽  
Author(s):  
R. Niesvizky ◽  
D. S. Jayabalan ◽  
J. R. Furst ◽  
H. J. Cho ◽  
R. N. Pearse ◽  
...  
Keyword(s):  
Low Dose ◽  
Objective Response ◽  
Symptomatic Treatment ◽  
Primary Treatment ◽  
Primary Therapy ◽  
Stage Design ◽  
Low Dose Aspirin ◽  
Treatment Naïve ◽  
Grade 3 ◽  
Intent To Treat

7545 Background: Lenalidomide (Revlamid [R]) is the leading clinical compound in a new group of drugs called IMiDs. Our group demonstrated that clarithromycin (Biaxin [Bi]) augments tumor mass reduction and improves responses in patients (pts) receiving low-dose thalidomide and/or dexamethasone (D). We report the results of the combination of Bi plus R plus D (BiRD) in newly diagnosed MM. Methods: A phase II trial designed to accrue 50 pts. A 2-stage design rejects a CR rate of < 10% (alt >30%). Between Nov. 2004 and Jan. 2006, 46 pts have been accrued of which 40 pts are eligible for evaluation. R is given po at 25 mg daily on days 1–21 of a 28-day cycle. D is given po at 40 mg once weekly. Bi is given po at 500 mg bid. Pts receive low dose aspirin (ASA)(81mg) qd as thrombosis (TE) prophylaxis. Responses are defined according to modified EBMTR criteria. Analysis is by intent-to-treat. Patient Selection: Median age: 62.5 years (36–80), Male/Female 25/15, Hgb: 10.6 g/dL (7.2–15.1), Plt 234 k/uL (51–526), β2m: 3 mg/L (0.8–12.8), CRP: 0.6 mg/dL (0.12–14.2), creat: 1.1 mg/dL (0.6–3.1), albumin 3.5 g/dL (2.3–4.9). SD stage IIIa: 48%, stage IIIb: 10% and IIa: 42%. ISS stage I: 50%, stage II: 25% and stage III: 25%. Cytogenetics and FISH: trisomy 11 (10 pts), tetrasomy 11 (3 pts), del13q14 (14 pts), t (4,14) (1pt), t (11,14) (3 pts). Results: Of the 40 evaluable pts, 38 (95%) have achieved an objective response (>PR) within 3–4 months of Rx with the remaining pts continuing to respond. Seventeen pts (43%) had a >90% reduction of the initial paraprotein. Nearly one third of pts have achieved either a CR (10/40) or a nCR (2/40-continuing on Rx). CR has been confirmed in all pts by normalization of free light chain levels and ratio. The remaining 26 pts (65%) achieved a PR. Of those pts who achieved a PR, 5/26 pts (19%) had >90% reduction in the initial paraprotein. Nineteen pts have experienced grade ≥3 adverse events. Heme toxicities: anemia (11%), neutropenia (9%) and thrombocytopenia (9%). Non-heme toxicities (NHT) include TE in 7 patients (15%) 2 of them fatal. Four of the TE events were while off ASA. Other NHT include myopathy (6%), GI (4%), and mood (4%). Conclusions: BiRD therapy is a safe and highly effective primary therapy for symptomatic, treatment-naïve MM. [Table: see text]

E-scooter accidents: A rising cause of kidney injury

2021 ◽  
pp. 039156032110376
Author(s):  
Alberto Bianchi ◽  
Sebastian Gallina ◽  
Francesco Cianflone ◽  
Alessandro Tafuri ◽  
Maria Angela Cerruto ◽  
...  
Keyword(s):  
Fluid Layer ◽  
Kidney Injury ◽  
Operative Management ◽  
High Grade ◽  
Abdominal Ct ◽  
Perirenal Hematoma ◽  
First Case ◽  
Kidney Trauma ◽  
Kidney Involvement ◽  
Non Operative Management

Introduction: E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma. Case reports: The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn’t show anemization nor impaired renal function. The patient was discharged after 10 days. Discussion: Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective. Conclusion: E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

scholarly journals Increased hospital treatment volume of splenic injury predicts higher rates of successful non-operative management and reduces hospital length of stay: a Swiss Trauma Registry analysis

2021 ◽  
Author(s):  
Joël L. Lavanchy ◽  
◽  
Luciane Delafontaine ◽  
Tobias Haltmeier ◽  
Piotr Bednarski ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Splenic Injury ◽  
Trauma Registry ◽  
High Volume ◽  
Operative Management ◽  
Hospital Treatment ◽  
Number Of Patients ◽  
Treatment Volume ◽  
The Mean ◽  
Non Operative Management

Abstract Purpose First time analysis of the epidemiology, management and outcomes of patients with splenic injuries in Switzerland. This study aims to assess the effect of hospital treatment volume on successful non-operative management (NOM) in splenic injuries. Methods A multicentric registry-based study including all patients with splenic injuries entered into the Swiss Trauma Registry from 2015 to 2018 was conducted. Patients were stratified according to the hospitals treatment volume of splenic injuries. Primary outcome was the rate of successful NOM. Results During the 4-year study period, 652 patients with splenic injury were included in the study. Median age of the study population was 42 (IQR 27–59) years, and median ISS was 26 (20–34). The overall rate of successful NOM was 86.5%. Median HLOS was 13 (8–21) days. In-hospital mortality was 7.2% (n = 47). The mean number of patients with splenic injuries per center and year was 14. Five out of 12 Level I trauma centers treating more patients than the mean (≥ 15/year) were defined as high-volume centers. Multivariable analysis adjusting for differences in baseline and injury characteristics revealed treatment in a high-volume center as an independent predictor for successful NOM (OR 2.15, 95% CI 1.28–3.60, p = 0.004) and shorter HLOS (RC − 2.39, 95% CI − 4.91/− 0.48, p = 0.017), however, not for reduced in-hospital mortality (OR 0.92, 95% CI 0.39–2.18, p = 0.845). Conclusion Higher hospital treatment volume was associated with a higher rate of NOM and shorter HLOS, but not lower mortality. These results constitute the basis for further quality improvement in the care of splenic injury patients within the trauma system in Switzerland.

scholarly journals Renal Shell injuries with Retaining renal shell fragments due to improvised explosive devices. Acute conservative approach and long term follow-up

2021 ◽  
Author(s):  
Murat Zor ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Sercan Yilmaz ◽  
Sinan Akay ◽  
...  
Keyword(s):  
Renal Injury ◽  
Medical Records ◽  
Operative Management ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Grade 3 ◽  
One Year ◽  
Non Operative Management ◽  
Shell Fragments

Abstract Introduction: Among penetrating injuries, renal shrapnel injuries consist of a rarity of renal gunshot injuries. Due to the paucity of cases reported in the literature, there is no consensus regarding the management of renal shrapnel injuries and retaining renal shell fragments. In this study we aimed to report our non-operative management experience of renal shrapnel injuries who had also retaining renal shell fragments.Material and Methods: We retrospectively evaluated the medical records of renal shrapnel injuries that had also retaining renal shell fragments. All hemodynamically stable patients managed non-operatively and included to the study. The medical records of age, renal injury grade according to AAST, presenting pulse, systolic blood pressure, transfusion requirement, complications and need for adjuvant procedures, non-operative management success and mortality was reviewed. Complication rates due to retaining renal shell fragments were assessed by interviewing via telephone at the end of the first year of injury. The patients asked for plumbism symptoms and any surgical intervention for these foreign bodies.Results: A total of 8 patients with retaining renal shell fragments due to renal shrapnel injuries were included to the study. Mean patient age was 27,8 years. Mean follow-up period was 38.7±15.1 months. All patients were male. AAST renal injury scores were grade 1 one, grade 2 two, grade 3 four, grade 4 one patient. All patients were successfully managed non-operatively and discharged on the 7th day without any complication. No symptoms of plumbism and surgery necessity secondary to retaining renal shell fragments were seen in at least one year follow-up.Conclusion: Our study demonstrates that non-operative management of renal shrapnel injuries with retaining renal shell fragments lead low complication rates and high chance of renal preservation. However, we must keep in mind that this kind of management is safe in experienced trauma centers that have experienced staff.

339 Factors predicting the outcome of non-operative management of high grade blunt renal trauma

2015 ◽  
Vol 14 (2) ◽  
pp. e339
Author(s):  
A.M. Maarouf ◽  
A-F. Ahmed ◽  
E. Shalaby ◽  
Y. Badran ◽  
E.A. Salem ◽  
...  
Keyword(s):  
Operative Management ◽  
Renal Trauma ◽  
High Grade ◽  
Non Operative Management

VTD (Velcade, Thalidomide, Dexamethasone) as Primary Therapy for Newly-Diagnosed Multiple Myeloma.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 210-210 ◽  
Author(s):  
Luhua M. Wang ◽  
Donna M. Weber ◽  
Kay B. Delasalle ◽  
Raymond Alexanian
Keyword(s):  
Multiple Myeloma ◽  
Side Effects ◽  
Autologous Blood ◽  
Rapid Onset ◽  
Initial Therapy ◽  
Primary Treatment ◽  
Primary Therapy ◽  
Newly Diagnosed ◽  
Myeloma Protein ◽  
Grade 3

Abstract The combination of thalidomide and dexamethasone (TD) has induced disease remission in 69% of 132 newly diagnosed patients with multiple myeloma (MM) treated at our center, with preventable and/or manageable side effects, and represents our primary treatment of choice. By adding bortezomib (Velcade), the 3-drug combination (VTD) has induced remission in 55% of patients with myeloma resistant to standard therapies, twice the frequency observed with bortezomib alone (Zangari, Barlogie et al, 2003). From 6/03 to 6/04, we combined bortezomib with thalidomide (100–200 mg each evening) and dexamethasone (20 mg/m2 on days 1–4, 9–12, 17–20) with therapeutic anticoagulation for 25 previously untreated patients with MM. Bortezomib was given at a dose of 1.0 (n=2), 1.3 (n=11), 1.5 (n=7), 1.7 (n=4) or 1.9 (n=1) mg/m2 IV on days 1, 4, 8 and 11, every 4 weeks to patients for 2–3 cycles of VTD. Median age was 63 (39–81), median B2M 5.1 mg/L (1.7–19), Hgb <10.5 g/dl in 60%, corrected serum calcium >11.5 mg/dl in 17%, and high tumor mass in 32% of patients. Grade 3 or 4 toxicities included non-neutropenic infection (2), orthostatic hypotension (1), DVT (1), neutropenia (1), thrombocytopenia (1); grade 3 or 4 neuropathy was not seen. Median nadir of ANC was 2360/ul and of platelets 135,000/ul with no correlation between bortezomib dose and myelosuppression. An initial dose of bortezomib of 1.5 mg/m2 IV x 4 was safe unless age > 70 and/or drugs for hypertension were taken concurrently. Responses were confirmed (>75% reduction serum myeloma protein and/or >95% reduction Bence Jones protein) in 19 patients (76%) and when defined by less stringent Blade criteria in 21 patients (84%); median time to remission was 0.6 mo (range 0.3–1.8) by either criteria in comparison with 1.1 mo (range 0.3–8.1) after TD (p<.01). Disease resistance was recognized by one month in 5 of 6 patients rated as unresponsive. Autologous blood stem cells were collected easily with G-CSF alone in 12 patients who were intensified a median 3.6 months after initial therapy; all 4 patients with primary resistant disease who received such therapy achieved partial remission. The frequency of CR to VTD could not be assessed because of early intensification. All patients are alive after median follow-up of 6 months (range 2–14). VTD induced a slightly higher frequency of PR, and significantly more rapid onset of remission, than those observed in similar patients treated previously with TD. No more than 2 courses of therapy were necessary before intensification or maintenance, so that the potential side effects and cost of more therapy were avoided. Results appeared superior to those observed with any prior program for previously untreated patients with MM at our center.

Sign in / Sign up

Export Citation Format

Share Document