Renal trauma

The kidney is the most commonly injured genitourinary organ, and renal involvement has been reported in 1–5% of all trauma cases. Two mechanisms of renal injury are described, namely blunt (direct blow to the kidney, rapid acceleration/deceleration or a combination) and penetrating (from stab or gunshot wounds), with blunt injuries being most common in the UK. It is important to keep an index of suspicion for renal trauma as given by the mechanism of the injury or in poly-trauma. Accurate assessment and resuscitation are vital in the initial management. Imaging with computed tomography is critical to the accurate grading of the injury and helps guide subsequent treatment. The approach to management of renal injuries has changed over time. During the past two decades, advances in cross-sectional imaging coupled with minimally invasive intervention strategies (like angiography, embolisation and ureteric stenting) for managing traumatic renal injuries have allowed increased renal preservation by reducing the need for major surgical intervention. Nowadays, the vast majority of blunt injuries (up to 95%) are managed conservatively with accumulated experience suggesting this is safe. However, there is still a role for open surgical exploration in patients with haemodynamic instability or those who fail initial conservative/minimally invasive management.

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Radiological Assessment of Postoperative Paraspinal Muscle Changes After Lumbar Interbody Fusion With or Without Minimally Invasive Techniques

Global Spine Journal ◽

10.1177/2192568221994794 ◽

2021 ◽

pp. 219256822199479

Author(s):

Keigo Kameyama ◽

Tetsuro Ohba ◽

Tomoka Endo ◽

Marina Katsu ◽

Fujita Koji ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Cross Sectional Area ◽

Paraspinal Muscle ◽

Lumbar Interbody Fusion ◽

Sectional Area ◽

Paraspinal Muscles ◽

Cross Sectional ◽

Muscle Density ◽

Muscle Changes

Study Design: Retrospective cohort study. Background: Percutaneous pedicle screws (PPS) have the advantage of being able to better preserve the paraspinal muscles when compared with a traditional open approach. However, the nature of changes in postoperative paraspinal muscle after damage by lumbar fusion surgery has remained largely unknown. It is clinically important to clarify and compare changes in paraspinal muscles after the various surgeries. Objective: (1) To determine postoperative changes of muscle density and cross-sectional area using computed tomography (CT), and (2) to compare paraspinal muscle changes after posterior lumbar interbody fusion (PLIF) with traditional open approaches and minimally invasive lateral lumbar interbody fusions (LLIF) with PPS. Methods: We included data from 39 consecutive female patients who underwent open PLIF and 23 consecutive patients who underwent single-staged treatment with LLIF followed by posterior PPS fixation at a single level (L4-5). All patients underwent preoperative, 6 months postoperative, and 1-year postoperative CT imaging. Measurements of the cross-sectional area (CSA) and muscle densities of paraspinal muscles were obtained using regions of interest defined by manual tracing. Results: We did not find any decrease of CSA in any paraspinal muscles. We did find a decrease of muscle density in the multifidus at 1 year after surgery in patients in the PILF group, but not in those in LLIF/PPS group. Conclusions: One year after surgery, a significant postoperative decrease of muscle density of the multifidi was observed only in patients who underwent open PLIF, but not in those who underwent LLIF/PPS.

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Serum immunoglobulin free light chains and their association with clinical phenotypes, serology and activity in patients with IgG4-related disease

Scientific Reports ◽

10.1038/s41598-021-81321-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eduardo Martín-Nares ◽

Vanessa Saavedra-González ◽

Reynerio Fagundo-Sierra ◽

Blanca Estela Santinelli-Núñez ◽

Teresa Romero-Maceda ◽

...

Keyword(s):

Renal Involvement ◽

Serum Levels ◽

Serum Immunoglobulin ◽

Light Chains ◽

Free Light Chains ◽

Cross Sectional ◽

Clinical Phenotypes ◽

Related Disease ◽

Igg4 Related Disease ◽

Head Neck

AbstractThe clinical utility of serum immunoglobulin free light chains (sFLC) in IgG4-related disease (IgG4-RD) is unknown. Herein we evaluated their association with clinical phenotypes, serology and activity in patients with IgG4-RD. Cross-sectional study that included 45 patients with IgG4-RD, and as controls 25 with Sjögren’s syndrome (SS) and 15 with sarcoidosis. IgG4-RD patients were classified in clinical phenotypes: pancreato-hepato-biliary, retroperitoneum/aorta, head/neck-limited and Mikulicz/systemic; as well as proliferative vs. fibrotic phenotypes. We assessed the IgG4-RD Responder Index (IgG4-RD RI) at recruitment and measured IgG1, IgG4, κ and λ sFLC serum levels by turbidometry. sFLC levels were similar among IgG4-RD, SS and sarcoidosis groups. Regarding the IgG4-RD patients, the mean age was 49 years, 24 (53.3%) were men and 55.5% had activity. Eight (17.7%) belonged to pancreato-hepato-biliary, 6 (13.3%) to retroperitoneum/aorta, 14 (31.1%) to head/neck-limited, 16 (35.5%) to Mikulicz/systemic phenotypes, whereas 36 (80%) to proliferative and 9 (20%) to fibrotic phenotypes. High κ sFLC, λ sFLC and κ/λ ratio were present in 29 (64.4%), 13 (28.9%) and 13 (28.9%) of IgG4-RD patients, respectively. There were no differences in sFLC among IgG4-RD phenotypes. κ sFLC and κ/λ ratio correlated positively with the number of involved organs and IgG4-RD RI. Patients with renal involvement had higher κ sFLC and λ sFLC. The AUC for κ sFLC and λ sFLC, for renal involvement was 0.78 and 0.72, respectively. Active IgG4-RD had higher levels of κ sFLC and more frequently a high κ/λ ratio. The AUC for κ sFLC and κ/λ ratio for predicting active IgG4-RD was 0.67 and 0.70, respectively. sFLC correlated positively with IgG1 and IgG4 levels. sFLC may be useful as a biomarker of disease activity as well as multiorgan and renal involvement. In particular, a high κ/λ ratio may identify patients with active disease.

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Alterations of serum levels of plasminogen, TNF-α, and IDO in granulomatosis with polyangiitis patients

Vascular ◽

10.1177/1708538120986305 ◽

2021 ◽

pp. 170853812098630

Author(s):

Dobroslav Kyurkchiev ◽

Tsvetelina Yoneva ◽

Adelina Yordanova ◽

Ekaterina Kurteva ◽

Georgi Vasilev ◽

...

Keyword(s):

Granulomatosis With Polyangiitis ◽

Renal Involvement ◽

Clinical Manifestations ◽

Area Under The Curve ◽

Serum Levels ◽

Necrosis Factor Alpha ◽

Cross Sectional ◽

Spearman's Rho ◽

Tnf Α ◽

Spearman’S Rho

Background Granulomatosis with polyangiitis (GPA) is a representative of vasculitides associated with anti-neutrophil cytoplasmic autoantibodies. “Classical” antibodies directed against proteinase 3 are involved in the pathogenesis and are part of the GPA diagnosis at the same time. Along with them, however, antibodies against Lysosomal-Associated Membrane Protein-2 (LAMP-2) and antibodies directed against plasminogen have been described in GPA. Objectives and methodology: We performed a cross-sectional study enrolling 34 patients diagnosed with GPA. Our study was aimed at looking for correlations between serum levels of LAMP-2 and plasminogen and the clinical manifestations of the GPA. Furthermore, we examined serum levels of tumor necrosis factor-alpha (TNF-α) and its associated indoleamine-pyrrole 2,3-dioxygenase (IDO), as well as we looked for a correlation between these cytokines and the clinical manifestations of GPA. Results The results showed that in GPA, serum plasminogen levels were negatively associated with renal involvement (receiver operating characteristic (ROC) area under the curve (AUC) of 0.78) (95% CI 0.53–0.91), p = 0.035, and the extent of proteinuria, Spearman’s Rho = –0.4, p = 0.015. Increased levels of TNF-α and IDO correlated with disease activity, Spearman’s Rho =0.62, p = 0.001 and Spearman’s Rho = 0.4, p = 0.022, respectively, whereas only TNF-α was increased in severe forms of GPA with lung involvement (ROC AUC of 0.8) (95% CI 0.66–0.94), p = 0.005. Conclusions In this study, we demonstrate the alteration of soluble factors, which play an important role in the pathogenesis of GPA and their relationship with the clinical manifestations of the disease. Our main results confirm the associations of increased secretory TNF-α and some clinical manifestations, and we describe for the first time decreased serum plasminogen levels and their association with renal involvement.

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Teaching Minimally Invasive Interventions in Paediatric Dentistry: A Cross-Sectional Survey of Dental Schools in Iran

BMC Oral Health ◽

10.1186/s12903-021-01735-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

S. Moradi ◽

S. Sabbagh ◽

L. Timms ◽

V. Ravaghi

Keyword(s):

Dental Caries ◽

Minimally Invasive ◽

Public Health Problem ◽

Paediatric Dentistry ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Fissure Sealant ◽

Resin Infiltration ◽

Dental Schools ◽

Hall Technique

Abstract Background Dental caries is a significant public health problem in Iran. Teaching minimally invasive interventions in paediatric dentistry may facilitate the provision of treatment for untreated dental caries in children. We evaluated the teaching of such interventions in both undergraduate dental curriculum and Paediatric Dentistry Specialty Training Programme (PDSTP) in Iran. Methods This was a cross-sectional questionnaire-based survey. Participants in this study were the directors of 40 undergraduate programmes and 15 PDSTPs in all Iranian dental schools (response rate = 100%). Descriptive statistics were reported. Results The most commonly taught methods were preventive fissure sealant and preventive resin restoration (PRR), which were taught ‘both didactically and clinically’ in all undergraduate dental programmes. The least commonly taught methods were silver diamine fluoride (SDF), the Hall technique and resin infiltration, which were taught ‘both didactically and clinically’ in less than 5% of dental schools. The same three methods were the least commonly approaches taught in PDSTP, further, they were less often perceived to be ‘essential’. Conclusions There was a notable variation in the teaching of the management of dental caries in Iran’s dental education. Some minimally invasive approaches including SDF, the Hall technique and resin infiltration are not being commonly taught in Iranian dental schools despite the evidence base for these techniques.

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A Clinical Analysis of the Medicolegal Cases Presented at Khawaja Muhammad Safdar Medical College, Sialkot

10.53350/pjmhs2115102820 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2820-2822

Author(s):

Usman Shahid Butt ◽

Kanwal Zahra ◽

Maryam Shahid

Keyword(s):

Alcohol Intake ◽

Road Traffic ◽

Winter Season ◽

Clinical Analysis ◽

Blunt Injury ◽

Cross Sectional ◽

Medical College ◽

Gunshot Injuries ◽

Acid Intake ◽

Blunt Injuries

Objective: To determine the clinical pattern of the medicolegal cases presented at Khawaja Muhammad Safdar Medical College, Sialkot Material and Methods: It was a retrospective Hospital based cross-sectional study, which was conducted at medicolegal clinic of government Khawaja Muhammad Safdar Medical College, Sialkot. All the cases those, who were presented at emergency department (medicolegal clinic) with history of industrial injuries, Road traffic accidents, burns, Assault, Falls and Poisoning and others with either of age and gender were included. This analysis was of one year from January 2020 to December 2020. All the data was recorded via self-made study proforma and analyzed by using SPSS version 20. Results: A total of 1079 medicolegal incidents were analysed. Out of all blunt injury, sharp weapon injury, poisoning, acid intake and road traffic incidences were found to be commonest as 27.20%, 20.60%, 15.60%, 12.40% and 10.20% respectively. Blunt injuries, sharp weapon injuries, gunshot injuries and alcohol intake incidences were significantly higher among males and poisoning and acid intake incidences were significantly high among females (p-<0.05). Blunt injuries, sharp weapon injuries, alcohol and poisoning events were seen significantly high almost during winter season from January to march (p-0.001). Conclusion: In the study conclusion, blunt injury, sharp weapon injury, poisoning, acid intake and road traffic incidences were observed to be the commonest medicolegal incidences. These events mostly observed during January to March duration. However blunt injuries, sharp weapon injuries, gunshot injuries and alcohol intake incidences were mostly observed among males, while poisoning and acid intake incidences among females. Keywords: Medicolegal events, gender, season

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Effectiveness of Long-Term Treatment of Multiple Myeloma in Regular Care: Comparison of a Longitudinal and a Cross-Sectional Analysis Approach

Oncology Research and Treatment ◽

10.1159/000519419 ◽

2021 ◽

pp. 1-8

Author(s):

Tilman Steinmetz ◽

Angela Ernst ◽

Martin Hellmich ◽

Melanie Heinz ◽

Uwe Totzke

Keyword(s):

Multiple Myeloma ◽

Treatment Guidelines ◽

Term Treatment ◽

Subsequent Treatment ◽

New Drugs ◽

Event Analysis ◽

Cross Sectional ◽

Regular Care ◽

Long Term Treatment ◽

Cross Sectional Studies

Introduction: New drugs for multiple myeloma have considerably increased the options for consecutive treatment lines in regular care. Official treatment guidelines still discuss several regimens per line, and therefore, current practice is of topical interest. Large cross-sectional studies revealed a greater than linear loss of patients reaching consecutive treatment lines of ever decreasing effectiveness. Methods: In a longitudinal approach, we analyzed data of all 145 multiple myeloma patients treated in our outpatient clinic in Germany between January 1, 2012, and December 31, 2019, using a time-to-event analysis with death as competitive risk. Results: The estimated incidences of reaching the 2nd, 3rd, 4th, and 5th lines of therapy were 88, 66, 44, and 30%, respectively. Median times to subsequent treatment lines were 34, 18, 14, 13, and 15 months, respectively. Discussion: Percentages of patients reaching later therapy lines were considerably greater than predicted by cross-sectional studies and median times after the 1st line did not suggest a further decrease in effectiveness, while use of new drug regimens was similar to that reported in cross-sectional studies. Conclusion: Effectiveness of later therapy lines appears to be underestimated by cross-sectional analyses, and the conveyed focus on 1st-line treatment for multiple myeloma needs to be scrutinized.

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A comparative study on clinical and serological characteristics between patients with rhupus and those with systemic lupus erythematosus and rheumatoid arthritis

Lupus ◽

10.1177/0961203320938456 ◽

2020 ◽

Vol 29 (10) ◽

pp. 1216-1226

Author(s):

Beatriz Frade-Sosa ◽

Javier Narváez ◽

Tarek Carlos Salman-Monte ◽

Raul Castellanos-Moreira ◽

Vera Ortiz-Santamaria ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Disease Duration ◽

Renal Involvement ◽

Clinical Manifestations ◽

Classification Criteria ◽

Systemic Lupus ◽

Cross Sectional

Background The concomitant presence of two autoimmune diseases – systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) – in the same patient is known as rhupus. We evaluated a group of patients with rhupus to clarify further their clinical, serological and immunogenic features in a multi-centre cohort. In addition, the study aimed to explore the utility of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in our group of patients with rhupus. Methods This was a cross-sectional study. We included rhupus patients from 11 different rheumatology departments, and compared them to SLE and RA patients at a ratio of 2:1. All information was recorded following a pre-established protocol. Results A total of 200 patients were included: 40 rhupus patients and 80 each of SLE and RA patients as controls. Disease duration was similar among SLE and rhupus groups (around 13 years), but the RA group had a significantly lower disease duration. Main clinical manifestations were articular (94.2%), cutaneous (77.5%) and haematological (72.5%). Rhupus patients had articular manifestations similar to those expected in RA. Only 10% of rhupus patients had renal involvement compared with 25% of those with SLE ( p < 0.05), while interstitial lung disease was more common in patients affected by RA. The 2019 EULAR/ACR SLE criteria were met in 92.5% of the rhupus patients and in 96.3% of the SLE cohort ( p > 0.05). Excluding the joint domain, there were no differences between the numbers of patients who met the classification criteria. Conclusion Rhupus patients follow a particular clinical course, with full expression of both SLE and RA in terms of organ involvement, except for a lower prevalence of kidney affection. The new 2019 EULAR/ACR SLE criteria are not useful for differentiating SLE and rhupus patients. A new way of classifying autoimmune diseases is needed to identify overlapping clusters.

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Profile of renal trauma victims treated at a university hospital in Curitiba

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016005008 ◽

2016 ◽

Vol 43 (5) ◽

pp. 341-347 ◽

Cited By ~ 1

Author(s):

CESAR AUGUSTO BROSKA JÚNIOR ◽

ANDRÉ DE CASTRO LINHARES ◽

ANDRÉ MONTES LUZ ◽

CARLOS ROBERTO NAUFEL JÚNIOR ◽

MARIANA SANTOS DE-OLIVEIRA ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Group ◽

Conservative Treatment ◽

Early Morning ◽

Kidney Damage ◽

University Hospital ◽

Renal Trauma ◽

Cross Sectional ◽

Kidney Trauma ◽

Motorcycle Accidents

ABSTRACT Objective: to study the profile of victims of kidney trauma who underwent surgical and medical treatment in a hospital in Curitiba. Methods: we conducted a retrospective, analytical, quantitative, cross-sectional study of patients with renal trauma admitted to the Evangelical Hospital of Curitiba between February 2011 and January 2014. Results: participated in the study 38 patients, four women and 34, men with a mean age of 28.4 years. Most injuries (60.5%) was due to closed mechanisms, especially motorcycle accidents. Injuries were treated conservatively in most cases. Patients who required surgical treatment had severe kidney damage or some other associated lesion, usually intra-abdominal. Hospital stay was lower in the conservative treatment group (10.8 days) compared with the surgical treatment one (18.8 days); mortality was also lower in the conservative treatment group (8.3%) compared with the surgical (14.3%). There were no deaths associated to kidney damage itself. Conclusion: patients with renal trauma in this study were young men, victims of motorcycle accidents, taking place during the night and early morning. Most injuries were treated conservatively.

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Minimally Invasive Surgery at Paropakar Maternity and Women’s Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v12i2.19943 ◽

2018 ◽

Vol 12 (2) ◽

pp. 16-20

Author(s):

Gehanath Baral ◽

Rijuta Joshi

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Hospital Stay ◽

Histopathological Examination ◽

Mucinous Cystadenoma ◽

Cystic Teratoma ◽

Laparoscopic Hysterectomy ◽

Serous Cystadenoma ◽

Cross Sectional ◽

Benign Condition

Aims: The purpose of this study is to review the reintroduced minimally invasive surgical practice in the hospital after a couple of decades long gap. Methods: It is a two years (2015 to 2017) retrospective cross-sectional study carried out in Paropakar Maternity and Women’s Hospital. The patients with pre-operative diagnosis of benign condition underwent laparoscopic surgery; hysteroscopy was diagnostic and operative both. Data were collected by demographics, indication of surgery, nature of surgery, complications, hospital stay and histo-pathological reports. Data were entered in the SPSS and MS-excel. Results were presented as tables and graphs.Results: Sixty five and 39 women underwent laparoscopic surgery and hysteroscopy respectively. None of them had major complications and hospital stay was1-3 days in majority. The most common age group was 31-35 years. Preoperative diagnoses of them were adnexal tumor in 47 women, fibroid uterus in six, AUB in two, ectopic pregnancies in four, PCOD in two and one women each with primary sub-fertility and POP Q II with elongated cervix. Laparoscopic cystectomy was performed on 25 women for the adnexal masses while 13 women underwent laparoscopic oophorectomy for the ovarian masses. Total laparoscopic hysterectomy was the second commonest surgery (n=12). On histopathological examination of the ovarian tissues, mature cystic teratoma was the commonest finding (n=18) followed by the endometriotic cysts (n=9), benign serous cystadenoma (n=7) and mucinous cystadenoma (n=4). Conclusions: Laparoscopy and hysteroscopy procedures have become the alternative in surgical modality at this hospital.

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