Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients.

OBJECTIVE: To review the records of patients with suspected urinary tract trauma to determine whether eliminating imaging studies would have missed any significant injuries. PATIENTS AND METHODS: The records of 1103 consecutive patients who underwent radiographic evaluation of the urinary tract because of suspected renal trauma were evaluated retrospectively. A comprehensive review was made of the group of patients who were normotensive and had only microscopic haematuria. RESULTS: Abnormal intravenous pyelograms (IVP) were found in 10% of patients with normotension and microscopic haematuria. In patients with injuries due to penetrating trauma, five of 16 with an abnormal IVP required operative intervention, while in patients with injuries due to blunt trauma, only one of 60 had a significant renal injury. None of the 605 patients with a blunt injury, microscopic haematuria, no history of hypotension, and no significant associated injuries required operative intervention solely for the renal injury. CONCLUSION: Radiographic evaluation of the urinary tract is recommended for all patients with penetrating trauma and any degree of haematuria, but only for patients with blunt trauma if associated with gross haematuria, microscopic haematuria and hypotension, or microscopic haematuria and significant associated injuries.

alpha-Chloralose alters autonomic reflex function of the lower urinary tract.

The effects of alpha-chloralose on the micturition reflex were evaluated using an efficiently voiding decerebrate cat model. At laparotomy cannulas were introduced into the urethra and/or bladder for measurement of urethral perfusion pressure and/or bladder pressure during bladder filling and voiding. After establishment of efficient voiding in the anesthetic-free decerebrate cat, chloralose, 50 mg/kg iv, was administered. Parameters assessed before and after anesthetic included bladder pressure at peak of contraction (voiding pressure), intravesical pressure at onset of bladder contraction (threshold pressure), contraction amplitude, duration of bladder contraction, bladder volume at onset of bladder contraction (volume threshold), and residual bladder volume after voiding (postvoid residual). In addition to these parameters, preparations with intact bladder-urethra and with divided bladder-urethra were used to assess effects of chloralose on voiding efficiency and coordination between bladder and urethra, respectively. Chloralose significantly reduced voiding pressure, contraction amplitude, and voiding efficiency. Neither vehicle for the chloralose nor sympathetic denervation of the lower urinary tract affected these reductions. Chloralose had no effect on direct contraction of the bladder and urethra produced by intra-arterial acetylcholine (25-100 micrograms). Chloralose converted the synergic bladder and urethral responses during voiding to dyssynergic responses. Neuromuscular blockade with gallamine, 10 mg/kg iv, improved voiding efficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative decision-making in renal trauma surgery.

Surgery for renal trauma requires three intraoperative decisions: Should the kidney be explored? Is pedicle control necessary? What procedure should be performed? In 85 explorations for penetrating (66) and blunt (19) trauma, we found that penetrating injuries, active hemorrhage, or major tissue destruction are reasons for mandatory renal exploration. This resulted in 26 nephrectomies, 9 partial nephrectomies, and 4 major renorrhaphies. Forty-six patients underwent minor renorrhaphy or needless exploration without complications. Formal pedicle control was carried out 33 times (39%), but it was never necessary to control parenchymal hemorrhage. Unless a wound overlies the great vessels, perirenal hematomas can be safely entered laterally without prior pedicle control using manual pedicle or parenchymal control if needed.

Blood flow to acutely ischaemic myocardium during pericardial tamponade: dominant influence of aortic blood pressure.

The effect of increased pericardial pressure on blood flow to acutely ischaemic and normal myocardium was investigated and the mechanisms responsible for this effect evaluated in eight open chest anaesthetised dogs. After coronary artery occlusion regional myocardial blood flows were estimated from the tissue content of radioactive microspheres administered systemically during control conditions, mild tamponade (pericardial pressure 8.4(1.0) mmHg), severe tamponade (pericardial pressure 13.3(1.4) mmHg), and severe tamponade (pericardial pressure 13.5(1.6) mmHg) with aortic blood pressure held constant by blood volume expansion. Mild tamponade decreased aortic blood flow by 20% and aortic pressure by 90%. Right and left atrial blood pressures were moderately increased. Blood flow to ischaemic and normal myocardium was not significantly altered. Severe tamponade decreased aortic blood flow by 50% and aortic pressure by 35%. Heart rate increased by 18%, and right and left atrial pressures were appreciably increased. Blood flow to ischaemic and normal myocardium decreased in proportion to the decrease in aortic pressure, but the transmural distribution of flow in ischaemic myocardium was not altered. During severe tamponade with constant aortic pressure, right and left atrial blood pressures were further increased, but blood flow to ischaemic and normal myocardium was similar to that observed under pre-tamponade control conditions. These results show that blood flow to acutely ischaemic myocardium during tamponade is determined primarily by aortic pressure.