High grade renal trauma due to blunt injury in children: do all require intervention? / Trauma renal de alto grau devido a lesão contusa em crianças: será que todas necessitam intervenção?

ABSTRACT Introduction: The aim of this study was to analyze the presentation and management of major grade renal trauma in children. Method: A retrospective study was performed including data collected from the patients who were admitted in Pediatric surgery with major grade renal injury (grade 3 and more) from January 2015 to August 2018. Demography, clinical parameters, management, duration of hospital stay and final outcome were noted. Results: Out of 13 children (9 males and 4 females), with age range 2-12 years (mean of 8 years), reported self-fall was the commonest mode of injury followed by road traffic accident. The majority (10/13, 75%) had a right renal injury. Eight children had a grade IV injury, one had a grade V injury, and four children had grade III injury. Duration of hospital stay varied from 3 to 28 (mean of 11.7) days. Three children required blood transfusion. One child required image guided aspiration twice and two required pigtail insertion for perinephric collection. All the 13 children improved without readmission or need for any other surgical intervention. Conclusion: Children with major grade renal trauma due to blunt injury can be successfully managed without surgical intervention and minimal intervention may only be needed in select situations.

RESUMO Introdução: O objetivo deste estudo foi analisar a apresentação e tratamento de grande trauma renal em crianças. Método: Foi realizado um estudo retrospectivo incluindo dados coletados dos pacientes que foram internados na cirurgia pediátrica com lesão renal de grau importante (grau 3 ou mais) de janeiro de 2015 a agosto de 2018. Coletamos dados a respeito de demografia, parâmetros clínicos, manejo, tempo de internação e resultado final. Resultados: Das 13 crianças (9 homens e 4 mulheres) com faixa etária de 2-12 anos (média de 8 anos), a queda auto-relatada foi o modo de lesão mais comum seguido de acidente de trânsito. A maioria (10/13, 75%) apresentou lesão renal direita. Oito crianças tiveram uma lesão grau IV, uma apresentou uma lesão grau V e quatro crianças apresentaram lesão grau III. A duração da internação hospitalar variou de 3 a 28 (média de 11,7) dias. Três crianças necessitaram de transfusão de sangue. Uma criança necessitou de aspiração guiada por imagem duas vezes e duas inserções de dreno pigtail exigidas para coleções perinefréticas. Todas as 13 crianças melhoraram sem re-internação ou necessidade de qualquer outra intervenção cirúrgica. Conclusão: Crianças com trauma renal de alto grau devido a lesão contusa podem ser manejadas com sucesso sem intervenção cirúrgica, e intervenção mínima pode ser necessária apenas em situações selecionadas.

Composition Analysis of Remaining Metal Particles on Ferrochrome Kitchen Knife / 法医学杂志

OBJECTIVE@#To establish a feasible evaluation index and method to identify composition of remaining metal particles on ferrochrome kitchen knife.@*METHODS@#The small samples of remaining metal particles were rubbed from the knives using filter paper. The composition of remaining metal particles was detected by scanning electron microscopy and energy dispersive X-ray spectrometer (SEM-EDX) and GSR particle analysis function, using mathematical methods to calculate the ratio (relative amount) of Fe and Cr in remaining metal particles.@*RESULTS@#The ratio (relative amount) of Fe and Cr of remaining metal particles had significant differences among most ferrochrome kitchen knives (P < 0.05).@*CONCLUSION@#Using GSR particle analysis function to quantitatively detect the ratio (relative amount) of Fe and Cr of remaining metal particles on ferrochrome kitchen knife, which can establish the feasible evaluation method to estimate such injury tool.

Inspection of left metal particles on skin impacted by the steel hammers / 法医学杂志

OBJECTIVE@#To establish a new method to estimate injury-tool by analyzing the components of left metal particles from hammers impact on pig skin and filter paper using scanning electron microscope and energy dispersive X-ray spectrometer (SEM-EDX).@*METHODS@#The pig skin and filter paper were stricken by two steel hammers. The left metal particles were examined by SEM-EDX and the results were statistically analyzed by SPSS 13.0.@*RESULTS@#The characteristics of left particles showed stable by several impacts using one steel hammer. The left particles showed no statistical difference for impact on pig skin and filter paper. The left particles displayed a statistical difference using two hammer with different components.@*CONCLUSION@#SEM-EDX can be used to detect the left metal particles from the steel hammer and can provide a method for estimating injury-tool.

Analysis on the characters of injuries in body surface and deduction of injury-causing instruments in 146 cases / 法医学杂志

OBJECTIVE@#To study the deduction of injury-causing instruments and its value as judicial evidence.@*METHODS@#To collect 146 cases involved in injury-causing instruments deduction, which accepted by Judicial Appraisal Center of Wannan Medical College during the period from 1998 to 2007, then to deduce the instrument by analyzing the characters of injuries in body surface. The accuracy of those deductions was evaluated by comparing the deduced instruments with the actual instruments.@*RESULTS@#The deduction from sharp injuries was more accurate than that from blunt injuries.@*CONCLUSION@#Sometimes the result of deduction about injury-causing instruments are uncertain, it may be accepted as judicial evidence when supported by other evidences.

Severe haematoma of the vulva--a report of two cases and a clinical review.

Haematoma of the vulva may occur following blunt trauma due to its highly vascular structure. We present two cases of haematoma of the vulva caused by domestic violence, following a kick on the perineum and falling astride on the perineum. Evacuation of the haematoma and repair of lacerated tissues were successfully performed.

Analysis on the injury by lock-against-theft / 法医学杂志

Nowdays, it is common seen that criminals tend to use the lock-against-theft for motorcycle to harm others as a tool. In order to find out the chief characters of this kind of injury, 28 cases in which victims were hurt by lock-against-theft for motorcycle were analyzed. In each case, the victims carefully questioned to confirm the damage procedure. Furthermore, the wound configuration was observed and the forming mechanism was deduced to provide morphological evidences for the judgement in this kind of case.

Analysis of cranio-cerebral injury based on 200 autopsy cases / 法医学杂志

Two hundred autopsy cases that died from cranio-cerebral injury were analyzed on the damage characteristics caused by different instruments. The injury mechanism was then classified according to beating direction, sequence, as well as baring spot of injury, which is seek to serve for the estimation of wounding instruments and determination of the character of case.

Hepatic injury / Trauma hepático

Hepatic trauma occurs in approximately 5 percent of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.

O trauma hepático corresponde a aproximadamente 5 por cento das admissões das salas de urgência. A localização anatômica do fígado e o seu tamanho o tornam mais susceptível ao trauma contuso e freqüentemente às lesões penetrantes. A associação Americana para a Cirurgia do Trauma estabeleceu uma classificação detalhada, o que possibilita comparações uniformes do trauma hepático. O diagnóstico destas lesões pode ser muitas vezes fácil, contudo a utilização de modalidades diagnósticas como o lavado peritoneal, a ultrassonografia e a tomografia computadorizada, permite o diagnóstico mais rápido e acurado. O tratamento conservador não operatório do trauma hepático contuso em pacientes com estabilidade hemodinâmica tornou-se padrão na maioria dos centros de trauma. Poucas lesões penetrantes do abdome permitem o tratamento conservador. As exceções podem ser justamente aquelas localizadas no quadrante superior direito do abdome que atinjam apenas o fígado. O tratamento cirúrgico de pequenas lesões hepáticas geralmente necessita de nenhum reparo ou podem ser tratadas com cauterização ou pequenas suturas. As lesões mais graves, a despeito dos avanços tecnológicos, constituem ainda um desafio aos cirurgiões. Muitos procedimentos podem ser realizados como: simples suturas, ressecções associadas a desbridamentos ou mesmo em lesões ainda mais graves, o empacotamento. Este constitui o controle do dano, o qual pode permitir a recuperação do paciente com diminuição da mortalidade precoce após o trauma.

Management of hepatic trauma

A review of 32 consecutive patients with liver trauma admitted in two surgical units of Mayo Hospital, Lahore in the year 1994 is presented. Majority of patients were young [mean age 26.5 years] male [90.6%]. Penetrating injuries [81%] were far more common than blunt trauma. Firearm injury was later confirmed at laparotomy except in two stable patients where diagnosis was confirmed on ultrasonography. These patients were managed conservatively. Right lobe [59.4%] was primarily involved in trauma. According to Moore's classification of liver trauma, twenty two patients had Grade-1 and II injuries 9 had Grade III and IV and one had Grade V injury. Eighty percent of patients had associated injuries to other organs. Hepatorrhaphy [64.3%] was the commonest amongst the procedures carried out, others were Hepatoomentorrhaphy, [10.7%] resectional debridement with selective ligation of the vessels [14.3%] perihepatic packing [7.1%] and hepatic lobar resection [3.6%]. Morbidity in this series was 59.5% and mortality 12.5%

Blunt injuries of the diaphragm

Over a 9-year period, 15 patients [12 males and 3 females] with blunt traumatic rupture of the diaphragm were managed in Banha University Hospital. Their age ranged from 18-49 years. Automobile accident was the main traumatic mechanism in 12 patients. 3 patients presented with diaphragmatic hernia due to missed detection of diaphragmatic rupture a month to 2 years following the accident. The other 12 patients presented with acute diaphragmatic ruptures which could be diagnosed on emergency laparotomy [4 patients], within 24 hours [6 patients] and after 48-72 hours [2 patients]. Left and right diaphragmatic ruptures were encountered in 12 and 3 patients respectively. Transabdominal repair was the procedure of choice in the acutely injured patients due to the presence of associated abdominal injuries in all of them, with extension to right and left thoracotomy in 4 patients. Thoracic approach was used in the repair of missed cases. Diaphragmatic tears were repaired by interrupted mattress silk sutures [12 cases], or double breasting [3 cases] when enough tissues were available. Mortality rate was 20% which was not related to diaphragmatic injuries but reflecting the severity of associated traumatic injuries. Awareness of the possibility of traumatic diaphragmatic ruptures with major blunt trauma to abdominothoracic region and the presense of strongly suspicious clinical and radiological evidence of diaphragmatic rupture remain the best way of making early diagnosis and hence successful management of the condition

Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature

Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of Säo Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature