A review of ureteral injuries after external trauma

<p>Abstract</p> <p>Introduction</p> <p>Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management.</p> <p>Literature review</p> <p>Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%.</p> <p>Conclusion</p> <p>The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.</p

Does Thoracic Irrigation at the Time of Chest Tube Placement Decrease the Incidence of a Retained Hemothorax?

Retained hemothorax following thoracic trauma remains a difficult problem to manage. Multiple studies have demonstrated the association between retained hemothorax and negative patient outcomes. A significant body of literature exists regarding specific treatment strategies and the optimal time period for intervention. Fewer studies have assessed the impact of specific variables and strategies during the initial tube thoracostomy and their relation to subsequent development of retained hemothorax. Analysis of factors such as chest tube size, expertise of practitioner, and chest tube position has not yielded significant actionable data to change practice patterns or decrease the incidence of retained hemothorax. A technique that has gained interest in recent years involves irrigating the thoracic cavity with normal saline at the time of initial tube thoracostomy for traumatic hemothorax. This procedure is utilized by many trauma surgeons but has only been studied in a few small series to date. This chapter addresses the data on this preventative measure and attempts to determine if this practice can be recommended based on currently available evidence

Nonoperative management of pediatric burn injuries

There are an estimated 1.2 million burn injuries per year in the United States, one third of which occur in children. Most of these injuries will be treated nonoperatively, frequently in an outpatient setting. This article aims to provide the practitioner with a understanding of the pathophysiology of burn injuries, a guide to the initial assessment of the patient, and management recommendations for nonoperative treatment of the burned pediatric patient

Acute generalized pustular psoriasis, von Zumbusch type, treated in the burn unit. A review of clinical features and new therapeutics

Generalized pustular psoriasis (GPP) is an immune-mediated dermatologic condition that is characterized by a widespread eruption of sterile, subcorneal pustules. Cases of GPP may present to the burn intensive care unit (ICU), and they may be confused with toxic epidermal necrolysis (TEN) due to the generalized erythema and desquamation. GPP often benefits from admission to an ICU for management of fluid and electrolyte imbalances and for complications such as pneumonitis, renal dysfunction and sepsis. We present the case of a 42 year-old man who was transferred to the burn unit for presumed TEN where he was diagnosed with GPP and successfully treated with intravenous cyclosporine and supportive care. Our objective is to increase awareness of this condition in the critical care community, discuss clinical and laboratory findings, and to review the treatment guidelines published by the National Psoriasis Foundation in August 2012. We also discuss the latest reports utilizing biological response modifying drugs

Critical care and monitoring of the pediatric burn patient

Burn injuries continue to be a significant cause of pediatric morbidity in the United States, with approximately 20,000 admissions per year to centers specializing in the treatment of burn injuries. In this article, we aim to provide the practitioner with a guideline to the unique challenges, advances and current expectations, and treatment in this patient population

An unusual cause of septicemia and death in a burn patient: discussion and review

Sepsis remains a common source of morbidity and mortality for seriously burned patients. Sources of sepsis are varied, although some are dramatically more common than others. Rarely, the burn surgeon may be confronted with an infectious source that remains unelucidated until postmortem examination. This case report describes the hospital course and subsequent death of a severely burned patient with sepsis, the source of which was only discovered on postmortem examination by our county medical examiner