World journal of surgery
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World journal of surgery · Dec 2001
Current experience with computed tomographic cystography and blunt trauma.
We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. ⋯ For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.
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Of our last 2483 renal trauma patients, 113 had grade IV injuries. In most the mechanism was a penetrating injury (60%: 30% gunshot, 30% stab wounds). Associated injuries were common (80%) and hospital stays prolonged, averaging 16 days. ⋯ Delayed complications after hospital discharge were not seen, although follow-up was rare in this inner-city trauma population. Among the 21% of patients in whom postoperative nucleotide renal function scans were available, function was generally good (average 36%). Only patients who underwent concomitant vascular repair had poor function (below 20%).
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World journal of surgery · Dec 2001
ReviewRadiographic evaluation of suspected bladder rupture following blunt trauma: critical review.
Indications for urgent radiographic evaluation of suspected bladder injuries are poorly defined. Review of the existing literature reveals that traumatic bladder rupture is strongly correlated with the combination of pelvic fracture and gross hematuria. Nearly all patients with hematuria or pelvic fracture alone do not have bladder rupture. ⋯ Intoxicated or unresponsive patients should warrant a higher index of suspicion for bladder injury among clinicians treating patients with pelvic trauma. Similarly, patients having neurologic or preexisting urologic co-morbidities may not manifest typical symptoms of bladder rupture. The above clinical indicators should be considered when clinicians determine the appropriateness of urgent cystography to detect bladder rupture.
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World journal of surgery · Dec 2001
Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria.
As a result of the rapid increase in medical costs, the efficacy of diagnostic imaging is under examination, and efforts have been made to identify patients who may safely be spared radiographic imaging. We reviewed the records of children who presented to our institution with suspected blunt renal injuries to determine if radiographic evaluation is necessary in children with microscopic hematuria and blunt renal trauma. We retrospectively reviewed the medical records of 1200 children (ages less than 18 years) who sustained blunt abdominal trauma and who presented to our level I pediatric trauma center between 1995 and 1997. ⋯ The degree of hematuria did not correlate with the grade of renal injury. Pediatric patients with blunt trauma, microscopic hematuria, and no associated injuries do not require radiologic evaluation, as significant renal injuries are unlikely. However, children who present with associated injuries and microscopic hematuria after blunt trauma may have significant renal injuries and should undergo radiologic evaluation.
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World journal of surgery · Dec 2001
Determinants of early and late outcome after surgery for type A aortic dissection.
The aim of this study was to identify the most important variables associated with early and late mortality in patients operated on for type A aortic dissection over a 15-year period. From January 1984 to March 1999, 110 patients underwent surgery for type A aortic dissection. The 88.1% of patients had an acute type A dissection (AD) and 11.8% had a chronic dissection (CD). ⋯ Preoperative renal impairment both affects early and late outcome. Early postoperative course affects late outcome in hospital survivors. The presence of the intimal tear in the aortic arch has a negative impact on late survival.