scholarly journals TO017CLINICAL CHARACTERISTICS AND INDEPENDENT PREDICTORS OF CHECK POINT INHIBITORS-ASSOCIATED AKI: WHAT DO WE KNOW?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mónica Bolufer ◽  
Clara Garcia Carro ◽  
Roxana Bury ◽  
Eva Muñoz ◽  
Enriqueta Felip ◽  
...  
Keyword(s):  
Kidney Function ◽  
Kidney Biopsy ◽  
Checkpoint Inhibitors ◽  
Obstructive Uropathy ◽  
Demographic Data ◽  
Complete Recovery ◽  
Older Age ◽  
Solid Organ ◽  
Common Diagnosis ◽  
Baseline Creatinine

Abstract Background and Aims Checkpoint inhibitors (CPI) are used to treat solid organ malignancies. CPI–associated acute renal injury (AKI) is an adverse effect of these therapies and its incidence is 13-29%. Clinical data on this complication is scarce. The aim of our study is to define clinical characteristics and risk factors of CPI-associated AKI. Method Clinical and demographic data of all patients receiving immunotherapy between March 2018 and May 2019 at our center were evaluated. Patients were divided into two groups depending on the development of AKI during the study period. AKI was defined according to AKIN classification. We compared clinical and demographic characteristics between these two groups and patients who developed mild AKI and severe AKI. Results During the study period, 821 patients received CPIs. Mean age 62.03±12.06 years and 486(59.2%) men. Malignancies were lung in 249 (30.3%), urogenital tract in 168 (20.5%), melanoma in 89 (10.8%) and others in 315 patients (38.4%). 446(54.3%) patients received anti-PD1, 230(28%) anti-PDL1, 13 (1.6%) anti-CTLA4, 36 (4.4%) received other drug and 96(11.7%) were treated with both anti-CTLA4 and anti-PD1 or anti.PDL1. Baseline creatinine was 0.85±0.30 mg/dL and 188 (22.9%) patients presented creatinine>1 mg/dL before starting CPI. 125 patients (15.2%) developed AKI during the study period, 85(68%) men and mean age 65.1±10.7 years. Baseline creatinine of these patients 0.97±0.45 mg/dL and 44 (35.2%) presented basal creatinine>1mg/dL. Mean creatinine at the diagnosis of AKI 2.27±1.34 mg/dL and two patients required haemodialysis. Leukocyturia was present in 21 patients(16.8%) and haematuria in 12 (9.6%). 5 patients presented AKI secondary to obstructive uropathy. Mean time from CPI initiation to AKI was 5.6±5.8 months. Of those 125 patients, 23 (18.4%) were referred to Nephrology and 9 (7.2%) underwent kidney biopsy. 1 patient presented endocapillar proliferative non-CPI related glomerulonephritis and 8 (6.4%) acute tubule-interstitial nephritis (ATIN). 23 (18.4%) patients were treated with corticosteroids. Mean creatinine at 6 months after AKI was 1.04±0.34 mg/dL (data from 45 patients) and 40 patients (data from 45 patients) showed complete recovery of kidney function at 6 months. Patients who developed a severe AKI stage 2 or 3 were more frequently women (41.8% vs 24.3%, p=0.03), had lower basal creatinine (0.86±0.25 vs 1.06±0.54 mg/dL, p=0.0130), showed and increased latency from CPI initiation to AKI (6.9±6 vs 4.5±5.5 months, p=0.0267) and presented worse recovery of kidney function at 6 months than patients with AKI stage 1(creatinine 6 months 1.18±0.40 mg/dL, p=0.0398 and complete recovery of kidney function at 6 months 70.5% vs 93.3%, p=0.0353). There was no association between the severity of AKI and type of CPI and type of malignance. When comparing patients who developed AKI with patients whit patient who did not, patients with AKI were older (65.1±10.7 vs 62.03±12.06 years old, p=0.0017), more frequently men (68% vs 57.9%), p=0.0296) and presented higher baseline creatinine (0.97±0.45 vs 0.85±0.30 mg/dL, p<0.0001), as well as more frequently a baseline creatinine > 1 mg/dL (35.2% vs 20.7%, p=0.0004). Type of CPI and type of malignance were not associated with the presence of AKI. Older age (OR 1.020, CI 95% 1.002-1.038) and baseline creatinine (OR 3.293, CI 95% 1.678-6.461) were identified as independent predictors of AKI development in our CPI treated patients Conclusion CPI-associated AKI incidence in our centre is 15.2%. Of them, 44% developed severe AKI. Only 18.4% were referred to a nephrologist and kidney biopsy performed in 7.2%. ATIN was the most common diagnosis. 18.4% received corticosteroids. Older age and higher baseline creatinine were identified as independent predictors for AKI development in patients with cancer CPI-treated. Patients developing a severe AKI showed worse kidney function at 6 months.

scholarly journals P0306ACUTE KIDNEY INJURY AFTER CHECKPOINT INHIBITOR TREATMENT: FACING THE FUTURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Clara Garcã­a Carro ◽  
Mónica Bolufer ◽  
Diana Oleas ◽  
María A Azancot ◽  
Irene Agraz ◽  
...  
Keyword(s):  
Kidney Biopsy ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Acute Interstitial Nephritis ◽  
University Hospital ◽  
Induction Treatment ◽  
Renal Lesion ◽  
Solid Organ

Abstract Background and Aims Checkpoint inhibitors (CPI) are used to treat solid organ metastatic malignancies. They act on by triggering a vigorous immune response against tumoral cells, preventing their proliferation. CPIs reinvigorate antitumor immune responses by interrupting co-inhibitory signaling pathways and promote immune-mediated elimination of tumor cells.This is not a selective response, deriving in immune related adverse events (irAEs). The kidney can potentially be damaged with an incidence of 13-29%. The most frequent type of toxicity is acute interstitial nephritis (AIN). Method We evaluated all the patients with solid organ metastatic malignancies treated with immunotherapy that developed acute renal injury (AKI) and underwent to kidney biopsy from March 2018 to November 2019 at Vall d’Hebron University Hospital. Results 11 patients with solid organ metastatic malignancies treated with immunotherapy developed AKI and underwent to kidney biopsy during the study period. The most frequent malignancy was lung cancer - in 6 patients-, followed by 3 patients with melanoma. 8 patients (72%) had already received previous oncological therapy, and for the remaining 3 patients (27%), CPI was the first line therapy. 8 patients (72%) were treated with anti-PD1 (programmed cell death protein 1), 4 patients (36 %) received anti PDL-1 (programmed death-ligand 1) 1 of these patients in combination with an anti CTLA-4 (cytotoxic T-lymphocyte antigen 4) and another patient received both anti PD1 and anti PDL-1. The time between the start of CPI and the onset of the AKI ranged between 2-11 months. The most frequent urine findings were subnephrotic range proteinuria with a mean protein/creatinine (mg/g creatinine) 503.6 ± 190.5 and leukocyturia in 9 of 11 patients. Mean creatinine (mg/dl) at diagnosis was 3.4 ± 1.3. 10 out of the 11 patients were diagnosed of AIN after performing a kidney biopsy. The remaining patient presented chronic changes (IFTA and glomerulosclerosis) in the biopsy, performed after receiving steroids for a month. 3 patients who presented AIN received pulses of methylprednisolone 250-500mg as induction treatment and 7 patients received prednisone 1mg/kg/day. Mean prednisone accumulated dose (mg) during the first month of treatment was 1387.5 ± 540. 9 patients experienced complete recovery of kidney function and two patients progressed to CKD. Conclusion We reported 11 patients who presented AKI associated to CPI treatment and underwent to kidney biopsy in the last 20 months at our center. 10 out of 11 presented biopsy confirmed CPI related AIN. In our experience, CPI related AIN is the most frequent renal lesion associated to the novel immunotherapy treatments. This entity seems to have good renal prognosis as long as steroid treatment is early started.

scholarly journals Acute interstitial nephritis associated with immune checkpoint inhibitors: a single-centre experience

2020 ◽  
Author(s):  
Diana Oleas ◽  
Mónica Bolufer ◽  
Irene Agraz ◽  
Enriqueta Felip ◽  
Eva Muñoz ◽  
...  
Keyword(s):  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
University Hospital ◽  
Solid Organ ◽  
First Line Therapy ◽  
Proliferation And Metastasis

Abstract Background Checkpoint inhibitors (CPIs) are used to treat solid organ metastatic malignancies. They act by triggering a vigorous immune response against tumoural cells, preventing their proliferation and metastasis. However, this is not a selective response and can cause immune-related adverse events (irAEs). The kidney can potentially be damaged, with an incidence of irAEs of 1–4%. The most frequent type of toxicity described is acute interstitial nephritis (AIN). Methods We conducted a study of patients with solid organ metastatic malignancies treated with immunotherapy who developed acute renal injury and underwent kidney biopsy in the last 14 months at the Vall d’Hebron University Hospital. Results In all, 826 solid organ malignancies were treated with immunotherapy in our centre, 125 of them (15.1%) developed acute kidney injury (AKI), 23 (18.4% of AKI) visited the nephrology department and 8 underwent kidney biopsy. The most frequent malignancy was lung cancer, in five patients (62%), followed by two patients (25%) with melanoma and one patient (12%) with pancreatic cancer. Four patients (50%) had already received previous oncological therapy, and for the remaining four patients (50%), CPI was the first-line therapy. Five patients (62%) were treated with anti-programmed cell death protein 1, three patients (37%) received anti-programmed death ligand 1 and two (25%) patients were treated in combination with anti-cytotoxic T-lymphocyte antigen 4. The time between the start of CPI and the onset of the AKI ranged from 2 to 11 months. The most frequent urine findings were subnephrotic-range proteinuria, with a mean protein:creatinine ratio of 544 mg/g (standard deviation 147) and eosinophiluria. All patients were biopsied after being diagnosed with AIN. Three patients (37%) received treatment with pulses of methylprednisolone 250–500 mg/day and five patients (62%) received prednisone 1 mg/kg/day. Seven patients (87%) experienced recovery of kidney function and one patient (12%) progressed to chronic kidney disease. Conclusions We report on eight patients with CPI-related AIN diagnosed in the last 14 months at our centre. The novel immunotherapy treatment of metastatic solid organ malignancies carries a higher risk of irAEs. The kidney is one of the most commonly affected organs, frequently presenting as an AIN and exhibiting a favourable response to steroid treatment.

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

scholarly journals Risk of infection associated with targeted therapies for solid organ and hematological malignancies

2021 ◽  
Vol 8 ◽  
pp. 204993612198954
Author(s):  
Isabel Ruiz-Camps ◽  
Juan Aguilar-Company
Keyword(s):  
Hematological Malignancies ◽  
Opportunistic Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Checkpoint Inhibitors ◽  
Janus Kinase ◽  
Prolonged Treatment ◽  
Solid Organ ◽  
Risk Of Infection ◽  
Increased Risk

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.

scholarly journals 550 ARTACUS: An open-label, multicenter, phase 1b/2 study of RP1 in solid organ transplant recipients with advanced cutaneous malignancies

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A580-A580
Author(s):  
Jason Luke ◽  
Michael Migden ◽  
Wanxing Chai-Ho ◽  
Diana Bolotin ◽  
Trisha Wise-Draper ◽  
...  
Keyword(s):  
Immune Checkpoint ◽  
Allograft Rejection ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Locally Advanced ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Open Label ◽  
Multicenter Phase

BackgroundSolid organ transplantation (SOT) has emerged as an important lifesaving procedure for patients with a wide range of end-organ diseases characterized by dysfunction or specific organ function failure. SOT rejection is a major complication requiring patients (pts) to undergo lifelong immunosuppression to prevent allograft rejection.1Skin cancers (SCs) including cutaneous squamous cell carcinoma (CSCC) are common post transplant malignancies.2 SC in SOT pts is generally managed with surgical resection, radiation therapy and chemotherapy or targeted therapy. Use of immune checkpoint inhibitors in SOT recipients has improved outcomes but are associated with the high risk of allograft rejection.3–5 Thus, there is a high unmet need for a safe and effective treatment that also protects pts from allograft rejection. RP1 is an oncolytic virus (HSV-1) that expresses a fusogenic glycoprotein (GALV-GP R-) and granulocyte macrophage colony stimulating factor (GM-CSF). In preclinical studies, RP1 induced immunogenic tumor cell death and provided potent systemic anti-tumor activity6 and clinical data in combination with nivolumab has demonstrated a high rate of deep and durable response in patients with advanced SCs.7 The objective of this study is to assess the safety and efficacy of single agent RP1 in kidney and liver transplant recipients with SCs, with focus on CSCC. After determining the safety and tolerability in the initial cohort with kidney and liver transplants the study may also enroll heart and lung transplant recipients.MethodsThis study will enroll up to 65 evaluable allograft transplantation pts with locally advanced or metastatic SCs. Key inclusion criteria are pts with confirmed recurrent, locally advanced or metastatic CSCC and up to 10 pts with non-CSCC SC, stable allograft function and ECOG performance status of ≤1. Pts with prior systemic anti-cancer treatment are allowed. Key exclusion criteria are prior treatment with an oncolytic therapy, active herpetic infections or prior complications of HSV-1 infection and a history of organ graft rejection within 12 months. Pts will receive an initial dose of 1 x 10^6 plaque-forming units (PFU) of RP1. Two weeks later they will receive 1 x 10^7 PFU of RP1 and continue every two weeks until pre-specified study endpoints are met. RP1 will be administered by intra-tumoral injection including through imaging guidance as clinically appropriate. The primary objective of the trial is to assess efficacy determined by ORR and safety of single agent RP1. Additional secondary endpoints include DOR, CR, DCR, PFS and OS.Trial RegistrationNCT04349436ReferencesFrohn C, Fricke L, Puchta JC, Kirchner H. The effect of HLA-C matching on acute renal transplant rejection. Nephrol Dial Transplant 2001;16(2):355–60.Madeleine MM, Patel NS, Plasmeijer EI, Engels EA, Bouwes Bavinck JN, Toland AE, Green AC; the Keratinocyte Carcinoma Consortium (KeraCon) Immunosuppression Working Group. Epidemiology of keratinocyte carcinomas after organ transplantation. Br J Dermatol 2017;177(5):1208–1216.Spain L, Higgins R, Gopalakrishnan K, Turajlic S, Gore M, Larkin J. Acute renal allograft rejection after immune checkpoint inhibitor therapy for metastatic melanoma. Ann Oncol 2016;27(6):1135–1137.Herz S, Höfer T, Papapanagiotou M, Leyh JC, Meyenburg S, Schadendorf D, Ugurel S, Roesch A, Livingstone E, Schilling B, Franklin C. Checkpoint inhibitors in chronic kidney failure and an organ transplant recipient. Eur J Cancer 2016;67:66-72.Kittai AS, Oldham H, Cetnar J, Taylor M. Immune checkpoint inhibitors in organ transplant ptss. J Immunother 2017;40(7):277–281.Thomas S, Kuncheria L, Roulstone V, Kyula JN, Mansfield D, Bommareddy PK, Smith H, Kaufman HL, Harrington KJ, Coffin RS. Development of a new fusion-enhanced oncolytic immunotherapy platform based on herpes simplex virus type 1. J Immunother Cancer 2019 10;7(1):214.Middleton M, Aroldi F, Sacco J, Milhem M, Curti B, Vanderwalde A, Baum S, Samson A, Pavlick A, Chesney J, Niu J, Rhodes T, Bowles T, Conry R, Olsson-Brown A, Earl-Laux D, Kaufman H, Bommareddy P, Deterding A, Samakoglu S, Coffin R, Harrington K. 422 An open-label, multicenter, phase 1/2 clinical trial of RP1, an enhanced potency oncolytic HSV, combined with nivolumab: updated results from the skin cancer cohorts. J Immunother Cancer 2020;8(3): doi: 10.1136/jitc-2020-SITC2020.0422Ethics ApprovalThe study was approved by institutional review board or the local ethics committee at each participating site. Informed consent was obtained from patients before participating in the trial.

scholarly journals Evaluation of Procalcitonin (PCT) As a Marker of Infection in Early Post Living Donated Liver Transplant Period.

2021 ◽  
Author(s):  
Eman Ibrahim El-Desoki Mahmoud ◽  
Mohammad A. Algendy ◽  
Adel M. Al-Ansary ◽  
Maissa K. Noaman
Keyword(s):  
Liver Transplantation ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Demographic Data ◽  
Positive Culture ◽  
Infectious Complications ◽  
Total Leukocyte Count ◽  
Solid Organ ◽  
Single Center ◽  
Cutoff Value

Abstract Background: Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy. Despite its increased use, data in patients with solid organ transplants are limited. The study aim is to assess the frequency of rising procalcitonin associated with infectious complications in immunosuppressed living donated liver transplantation.Methods: A single center, retrospective observational study. Preoperative patients' demographic data, operative, anesthetic data and postoperative clinical course are analyzed till discharge from intensive care unit.Results: Sixty patients were classified according to the culture results' into a positive culture group & a negative one, then following up sepsis variables in each group. Total leukocyte count (TLC) and procalcitonin (PCT) were high in the positive culture group in the first 4 and 5 days respectively and was statistically significant (P-value < 0.05).PCT at a cutoff value ≥ 9ng/ml had higher specificity, especially on day three postoperative (90.7%). The TLC cutoff value of ≥ 17.3/mm3on day one; had the specificity of > 90%. Conclusions: following up PCT level on day one with TLC is essential and will help to detect sepsis and guide early antimicrobial initiation post liver transplantation.Trial registration: NHTMRI, NCT03389360. Registered 7 February, 2018,https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007O6F&selectaction=Edit&uid=U0003W0U&ts=2&cx=fwyacz

scholarly journals Synchronous Esophageal and Renal Malignancies with Unexpected Site of Metastasis: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Sharhanin Bahrudin
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Obstructive Uropathy ◽  
Left Kidney ◽  
Gastroesophageal Junction ◽  
Wall Thickening ◽  
Solid Organ ◽  
Synchronous Malignancies

Introduction: Esophageal cancer is the fifth most common cancer in Asia. Synchronous malignancies with an esophageal malignancies is not uncommon however synchronous esophageal malignancy and renal cell carcinoma is rare. Case Report: A 70 years old non smoker man with comorbid of hypertension and diabetes mellitus presented with multiple episode of hemoptysis and pleuritic chest pain within one day duration. He also complaint of worsening dysphagia to solid food for 1 month duration with constitutional symptoms. Otherwise he does not have any other symptoms. Clinically he was pale and cachexic, otherwise all systemic examination was unremarkable. His blood investigation reveal low hemoglobin level of 9.9g/L with normal coagulation and renal profile. He underwent Oesophagoduodenoscopy which showed a tumor narrowing the lumen of the lower esophagus. Biopsy of the tumor revealed esophageal adenocarcinoma. CT thorax, abdomen and pelvis showed smooth circumferential wall thickening of the distal part of the esophagus near the gastroesophageal junction. Incidentally, there were heterogenous enhancing lobulated mass seen at the lower pole of left kidney with no obstructive uropathy features. Otherwise, others solid organ were normal. A left renal mass biopsy performed revealed renal cell carcinoma. An oncologist opinion was gathered for initiation of palliative chemotherapy however he developed symptomatic malignant pleural effusion which need a drainage. HRCT Thorax revealed multiple bilateral intrapulmonary nodule. He also complaint of a new right upper eyelid mass that increasing in size with contact bleeding however does not affect his visual. An assessment from an ophthalmologist and CT orbital performed consistent with features of a metastasis. Conclusion: Synchronous malignancies with an esophageal malignancies is not uncommon. Most common site reported is head and neck followed by lung malignancies. However synchronous esophageal malignancies and renal cell carcinoma is rare. Esophageal malignancies often have distant metastasis to the liver, lung and bone however rare to the eyelid.

scholarly journals Management of pancreatic trauma in adult patients at tertiary care institute of Gujarat, India

2020 ◽  
Vol 6 (5) ◽  
pp. 310-315
Author(s):  
Dr. Krunal Chandana ◽  
◽  
Dr. Priyank Patel ◽  
Keyword(s):  
Road Traffic ◽  
Demographic Data ◽  
Tertiary Care ◽  
Pancreatic Injury ◽  
Solid Organ ◽  
Pancreatic Trauma ◽  
Tertiary Center ◽  
Fall From Height ◽  
Study Population ◽  
Grade Ii

Background and Aim: Pancreatic trauma is rare compared to other solid organ injuries of theabdomen. These injuries are difficult to diagnose and pose a problem in treatment strategy. Thisretrospective study aims to report our tertiary center experience in the management of pancreatictrauma. Material and Methods: The present study is one and half year observational study of 30patients who underwent pancreatic trauma management in the Department of Surgery, tertiary careinstitute of Gujarat. Demographic data and baseline characteristics were recorded, including age,sex, medical co-morbidities, mechanism of pancreatic trauma, length of the hospital stay, andassociated extrapancreatic injuries. All patients underwent a CT scan for the diagnosis of pancreaticinjury. Grading of pancreatic trauma was carried out according to the American Association forsurgery for Trauma (AAST). Results: Road traffic accident (RTA) (n=20) was the leading cause ofpancreatic trauma in the study population followed by fall from height (n=7) and assault (n=3). Themajority of the study population had Grade III pancreatic injury (n=12) followed by Grade IV (n=8),Grade II (n=7), and Grade I (n=3) injuries. No patients had Grade V injury. Isolated pancreatictrauma was seen in 13 patients. Associated liver and spleen injury was seen in 15 patients. Renaltrauma was seen in 2 patients. The extra-abdominal injury was seen to be associated withpancreatic injury in 7 patients. Conclusion: Pancreatic trauma can be managed conservativelyirrespective of the grade of injury supported by radiological percutaneous drainage and pancreaticduct stenting in selective cases.

scholarly journals Orthopedic injuries due to parachute jumping in soldiers and the effect of trauma scoring systems in determining injury level:  A prospective observational study

2020 ◽  
Author(s):  
Taner Sahin ◽  
Sabri Batin
Keyword(s):  
Injury Severity ◽  
Demographic Data ◽  
Military Training ◽  
Scoring Systems ◽  
The Body ◽  
Treatment Methods ◽  
Severity Of Injury ◽  
Common Diagnosis ◽  
Trauma Scoring ◽  
Orthopedic Injuries

Abstract Background During parachute jumping in soldiers, minör or life-threatining majör injuries may be occur in various parts of the body. Various trauma scoring systems have been developed to determine the severity of these injuries. The aim of this study is to determine orthopedic injuries and other injuries due to parachute jumping for military training who admitted to ED and the severity of their injuries using by anatomical and physiological trauma scores (AIS and ISS), to examine applied treatment methods, their hospitalization conditions and the length of hospital stay prospectively over a 44-month period between January 2016 and August 2019. Methods 200 military personnel were included in the study, between the ages of 18-52, who were injured as a result of daytime static parachute jumping for military training. Demographic data such as age, gender, ISS trauma region classification, anatomical injury sites, AIS and ISS scores, diagnosis, treatment methods applied, hospitalization status and duration of hospitalization were examined prospectively in a total of 185 patients. Results Among 184 individuals included in the study, 184 were male and 1 was female. The most common injured body site were 33.5% foot. and the most common diagnosis was 64.3% soft tissue trauma. Considering the treatment methods applied, 51.4% was determined as medication cold application, 42.7% as splint plaster, and 5.9% as surgery. The mean ISS of the patients was 5.16 ± 3.92. The hospitalization rate of patients with a critical AIS score was significantly higher than those with a severe AIS score (p <0.001). Conclusions The use of trauma scoring systems in determining the severity of injury to patients who come to ED due to parachute injury may facilitate treatment selection. Key words: Parachuting injuries, Abbreviated Injury Scale ve Injury Severity Score

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