MANAGEMENT OF RENAL TRAUMA - ASSIUT EXPERIENCE

Objective To conform a rational approach for diagnosis and treatment of renal injuries with either conservative or interventional treatment. Patients and Methods The study included 36 male and 6 female patients (total 42) with renal trauma. The patients' age ranged from 6 to 65 years. Thirty-one patients (73.8%) presented with blunt renal trauma, while eleven patients (26.2%) presented with penetrating renal trauma. Haematuria was the commonest presenting symptom accounting for 98%. All patients were thoroughly evaluated clinically and by abdo-minal ultrasonography, while excretory urography and abdominal computerized tomography were required in some patients only. Results Conservative treatment was successful in 10 patients with minor blunt trauma, while immediate exploration was done for 26 patients and late exploration was required in 6 patients. Conclusion For renal salvage, the traumatized kidney is to be explored in all cases of penetrating and major blunt renal trauma. Prise en Charge des Traumatismes du Rein: Expérience dAssiut Objectif Déterminer une approche rationnelle dans le diagnostic et le traitement conservateur ou interventionnel dans les traumatismes du rein. Patients et Méthodes Il sagit dune série de 42 patients dont 36 hommes et 6 femmes présentant un traumatisme rénal. Lâge des patients variait de 6 à 65 ans. Trente et un (73,8%) avaient un traumatisme fermé, tandis que 11 patients (26,2%) avaient un traumatisme ouvert. Le maître symptôme était lhématurie qui a été retrouvée dans 98% des cas. Tous les patients on été évalués par examen clinique, une échographie abdominale, une urographie intraveineuse. Une tomodensitométrie abdominale na été requise que chez certains patients. Résultats Un traitement conservateur a donné un bon résultat dans 10 cas, une exploration immédiate a été faite dans 26 cas et une exploration différée etait nécessaire dans 6 cas. Conclusion Pour préserver le rein, lexploration rénale est de rigueur devant tout traumatisme ouvert du rein et devant tout traumatisme fermé grave. African Journal of Urology Vol.8(1) 2002: 32-3

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda