[Urinary tract trauma: anatomo-lesional, etiological and clinical considerations]. / Consideratii anatomo-lezionale, etiologice si clinice in traumatismele aparatului urinar.

UNLABELLED: Urinary tract injuries are rare lesions and account for about 3%, of all injuries and 10% of abdominal trauma injuries. The aim of this study is to review retrospectively a series of patients with urinary tract injuries treated in a general surgery clinic. MATERIAL AND METHODS: A series of 41 consecutive patients with urinary tract trauma who hospitalized in Surgery Clinic of "St. John" Hospital of Iasi during a 7 years period (January 2002 - December 2008). The main analyzed variable was age, mechanism of injury, anatomical site of injury, associated injuries, and methods of treatment, morbidity and mortality. RESULTS: Urinary tract injuries accounted for 3.2% of all abdominal trauma injuries. Adults males were more affected with 90.2% of cases. Traffic road accident and falls represented over 50% of cases. Renal trauma were present in 73.7% of cases, and associated lesions were present in all cases. Conservative treatment was applied for 24 patients (58.5%), nephrectomy (total or partial) was performed in 9 cases, suture of the urethra 1 case, suture of the urinary bladder 5 cases and cystostomy in 3 cases. Conservative treatment failed in 24 cases (58.5%), urinary complications were present in 8 patients (19.5%) and one patient died due to associated lesions. CONCLUSIONS: Urinary tract injuries are rarely encountered in trauma settings, to a high index of suspicion is necessary to establish the diagnosis. Renal trauma is the most fervently lesions and conservative treatment represent feasible solution for these.

[Traumatic rupture of the diaphragm: diagnostic considerations, prognostic factors, outcomes]. / Traumatismele diafragmului: consideratii diagnostice, factori prognostici, rezultate.

UNLABELLED: Diaphragmatic rupture remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. AIM: To analyze our experience with the management of these injuries, diagnosis problems, and to identify predictors of outcomes. MATERIAL AND METHOD: Sixty-one patients were treated for diaphragmatic rupture in our hospital, between January 1992 and August 2003. RESULTS: Blunt trauma accounted for 15 injuries (24.6%) and penetrating trauma for the rest of 46 injuries (75.4%). The preoperative diagnostic was established for 17 patients (27.8%), 7 blunt and 10 penetrating. Twenty-nine patients (47.5%) presented with hemorrhagic shock upon admission and 48 patients (78.6%) had associated injury with an average Injury Severity Score of 24 (range 6-75). All cases but 4 were operated on the first 12 hours upon admission. Two right penetrating lesions were treated conservatively and two cases presented after 11 and 23 years respectively from the trauma episode. Intraoperatively, 15 right lesions (24.6%), 45 left (73.7%) and one bilateral (1.6%) were identified. There were 9 deaths (14.7%) and 14 patients (22.9%) developed complications. CONCLUSIONS: Hemorrhagic shock upon admission, Injury Severity Score, mechanism of the injury and age strongly influenced the outcome (p < 0.05). In emergency trauma settings the diagnostic for diaphragmatic lesions is mainly established by laparotomy. A high index of suspicion and a thorough examination of both diaphragms during laparotomy is mandatory in order to avoid missing traumatic diaphragmatic injuries.

Abdominal wall actinomycosis associated with prolonged use of an intrauterine device: a case report and review of the literature.

The relationship between pelvic actinomycosis and the presence of an intrauterine device is well known. Abdominal wall actinomycosis with no involvement of pelvic organs in the presence of an intrauterine device is extremely rare. We report a case of a 32-year-old woman with a long-standing intrauterine device who developed abdominal wall actinomycosis. The diagnosis was established late by histopathological examination after an initial surgical procedure during which the abscess was evacuated and all the necrotic tissue was excised. Postoperatively, the patient developed two intra-abdominal abscesses, which were treated by surgical drainage. The combination of long-term high-dose antibiotic therapy with surgery led to successful management of the condition. We highlight the difficulty in diagnosis, necessity for an early postoperative diagnosis, and the importance of high-dose intravenous antibiotic therapy to prevent recurrence. Abdominal wall actinomycosis should be considered in intrauterine device users who present with abdominal abscesses of unknown origin.

[Cystic lymphangioma of the adrenal gland]. / Limfangiom chistic al glandei suprarenale.

Cystic lymphangioma of the adrenal gland is a rare tumor, which is often sub-clinical. Preoperative diagnosis is difficult. We present a case of a 47 year-old female in whom an incidental left cystic mass of 12 cm by 10 cm with no features of malignancy was discovered by ultrasound scan. A further computed tomography scan confirmed the ultrasound findings. Biochemical screening ruled out a secreting adrenal tumor. Because of the size of the cyst, the lesion was resected and the diagnosis of benign adrenal cystic lymphangioma was histologically confirmed. Computed tomography is the reference examination for delineating the topography and extent of the lesion, especially when it is large. Although imaging can characterize the cystic nature of a lesion, it sometimes fails to establish a specific diagnosis, so surgery or fine needle aspiration should be done for a definitive diagnosis. The characteristic features of cystic adrenal lymphangioma are discussed together with a review of the recent literature.

[Treatment of hepatic trauma by hepatotomy with selective vasculo-biliary control. Technical aspects and outcomes]. / Tratamentul traumatismelor hepatice prin hepatotomie cu ligatura/sutura vasculo-biliara selectiva. Aspecte tehnice si rezultate.

Severe hemorrhage from liver parenchyma in hepatic trauma remains a formidable challenge even for the most experienced trauma surgeons. One therapeutic option when dealing with such hemorrhage is hepatotomy with selective vasculo-biliary control. The aim of this study was to evaluate the outcomes of hepatotomy with selective vasculo-biliary control for hepatic trauma. We used this technique in 27 patients with deep hepatic lacerations secondary to trauma. There were 19 penetrating and 8 blunt injuries. The lesions were graded as grade III--19 lesions, grade IV--6 lesions and grade V--2 lesions. The Pringle maneuver was applied in all cases (mean time 26 min). Hepatotomy was performed in all cases using a finger fracture technique; the average for this part of the procedure was 11.2 min. The resulting defect was treated by insertion of a viable omental pack in 11 patients and by hepatorrhaphy in 10 cases. There were 4 post-operative complications (14.8%) directed related to hepatic trauma--2 hemorrhages, one hepatic abscess and one biliary fistula. We recorded two deaths (7.4%), one by exsanguination and one by multiple organ failure. The low rates of morbidity and mortality, the wide range of application (grade III to V, penetrating and blunt) and the speed of execution suggest that hepatotomy with selective vasculo-biliary control is a safe and efficient technique for controlling hemorrhage from deep lacerations.