Traumatic Kidney Injury: A 6-Year Retrospective Study in Childhood and Adolescence

Background

Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center.

Methods

A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded.

Results

Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the females with a ratio of 10:1. Most cases occurred during the adolescent (12-18) years (81.82%). Left-side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%.

Conclusion

Non-operative management is safe and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

Cancer Incidence and Mortality in a Tertiary Hospital in Indonesia: An 18-Year Data Review

Background

Every population, regardless of wealth or social development, faces the major health issue of cancer. Cancer incidence and mortality differ by region and period. Thus, this study aimed to determine the characteristics, incidence, and mortality of various cancers at Dr. Wahidin Sudirohusodo Hospital, a referral center hospital in Makassar, Indonesia.

Methods

This study employed a descriptive research design using secondary data recorded at Dr. Wahidin Sudirohusodo Hospital in Makassar, Indonesia, between January 2002 and December 2019.

Results

We classified the 7824 cancer patients in our study into solid and non-solid cancer groups. The incidence of solid cancer (79.3%) was higher than that of non-solid cancer (20.7%), causing 1063 deaths, or 61.7%, of all cancer-related deaths. There were 6083 (77.7%) cases of cancer survival. The cancers with the highest incidence were breast cancer (1008 cases [12.9%]), leukemia (683 cases [8.7%]), and cervical cancer (631 cases [8.1%]). Breast, cervical, and ovarian cancers were the most frequent cancers in female patients. Leukemia was the most frequent cancer in male patients, followed by colorectal and liver cancers.

Conclusions

A region-based statistical record of cancer incidence and mortality is vital and useful to prioritizing cancer treatment at a given time.

The Effect of Minocycline on MMP-9 Levels in Traumatic Brain Injury: An Experimental Study in Wistar Rats

Introduction The matrix metalloproteinase-9 (MMP-9) inhibition is an important target in the treatment of traumatic brain injury. Recent studies have shown that Minocycline may have MMP-9 inhibition activity. This study aims to determine the effect of minocycline in inhibiting MMP-9 in cases of head injury which has not been studied much.   Methods This research was conducted using a laboratory experimental method on rats with a post-test control group design. The research was conducted at the Animal Laboratory, Faculty of Medicine, Hasanuddin University for a period of 2 weeks. The research population was rats with traumatic brain injury and rats without traumatic brain injury as controls. The sample size for each group was determined with Federer's formula, the minimum number of samples for each group was 9 experimental animals (a total of 27 mice in this study). Group 1 are control group, group 2(TBI) are rats with a traumatic brain injury, and group 3 are rats with a traumatic brain injury who was given minocycline.   Results The mean value of MMP-9 in group 2 (TBI) was 0.610116 ng/ml compared to the control mean value of 0.519300 ng/ml. The mean value of MMP-9 in group 3 (TBI+M) was 0.552674 ng/ml. From the ANOVA test, there was a significant relationship with a p-value = 0.001 There was a statistically significant relationship between the administration of minocycline and the decrease in MMP-9 levels in traumatic brain injury in Wistar rats.   Conclusion The level of MMP-9 in Wistar rats with traumatic brain injury who were given minocycline was shown to be significantly lower than that of those without minocycline treatment. This result showed that minocycline has the potential to inhibit the increase of MMP-9 levels in traumatic brain injury.

Recurrent cholangitis after choledochoduodenostomy: A case report

Introduction

Recurrent cholangitis is a long-term consequence of choledochoduodenostomy (CDD) that requires urgent treatment. The frequency of recurrent cholangitis ranges between 2.5 and 15.7%. This case demonstrated the importance of rapid and precise diagnosis through screening and therapeutic modalities in recurrent cholangitis.

Presentation of case

A male patient presented with a history of recurring right upper abdominal discomfort during the previous 3 years. The pain had been intermittent but had become more intense during the prior month. The patient was diagnosed with recurrent cholangitis following CDD. The therapeutic plan was closure of the CDD, which was identified as the cause of the recurrent cholangitis, and biliary drainage by modified Roux-en-Y choledochojejunostomy.

Discussion

Recurrent cholangitis was diagnosed based on clinical manifestations, including recurring right upper abdomen discomfort, jaundice, and fever accompanied with consistent laboratory and imaging findings. Drainage of bile into the distal common bile duct (CBD) is reduced in the side-to-side CDD arrangement. Consequently, the distal CBD becomes a reservoir with inadequate drainage, predisposing this so-called ‘sump’ to debris accumulation and cholangitis. The surgery was considered successful in preventing the recurrent cholangitis.

Conclusion

The recurrent cholangitis was occurred due to inadequate biliary drainage. The choledochojejunostomy procedure with modified Roux-en-Y might prevent the recurrent cholangitis by improving biliary drainage to the enteric.

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Recurrent cholangitis in side-to-side CDD may be induced by infection.

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Recurrent cholangitis manifests with symptoms such as abdominal pain, jaundice, and fever.

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The principal treatment is to enhance the biliary drainage of the CBD to the anastomosis

Penile Ischemia as a Complication of Epinephrine Use in Penile Nerve Block: Truth or Myth?

The administration of a local anesthetic agent with epinephrine is controversial in penile surgery because of necrosis risk resulting from prolonged vasoconstriction of terminal vessels. We reported a case of an 8-year-old boy suffering from ischemia in the glans of the penis and epidermolysis of the penile skin after circumcision with penile nerve block using anesthetic agents containing epinephrine. The addition of epinephrine to the anesthetic agent (lidocaine) in penile nerve block before circumcision remains controversial. It remains controversial because multiple factors can cause skin necrosis after the circumcision. The adverse effect of epinephrine use in circumcision remains unproven because of a lack of scientific evidence. The administration of epinephrine in penile surgery is the decision of the physician.

Partial penile amputation due to Klingsor syndrome: A case report with a successful macroscopic reconstruction

INTRODUCTION

Traumatic penile amputation is a highly uncommon surgical emergency that requires immediate intervention. Most reported cases involve genital self-mutilation induced by underlying psychiatric disorder, especially schizophrenia. The self-mutilation of external genitals in psychiatric patients, also known as Klingsor syndrome, is a rare form of urotrauma.

PRESENTATION OF CASE

We present a case of partial penile amputation in a 46-year-old male with Klingsor syndrome admitted to the hospital 3 days after the incident. Urological examination revealed a subtotal cut of the penis, including the distal part of the mons pubis, dorsal and lateral parts of the penile skin, corpus cavernosum, and corpus spongiosum, as well as a partial bulbous urethra rupture. The penis remained suspended by only a thin ventral part of the penile skin. After macroscopic surgical replantation, the patient recovered well and could urinate without any symptoms of urethral stricture. The entire penis remained viable with minimal scarring at the surgical site, and penile erection could be achieved and maintained.

CONCLUSION

The case demonstrates a rare instance of the successful proximal penile shaft amputation via macrosurgical techniques by an experienced urologic surgeon.