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1.
Tunis Med ; 95(5): 331-335, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-29509213

RESUMO

PURPOSE: The authors evaluated the usefulness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to peroperative findings. METHODS: A retrospective review was performed on 107 patients (mean age=29,2±5.8 years) with a testis blunt trauma treated between January 2005 and August 2015. All patients underwent surgical scrotal exploration. Preoperative US was performed in all cases. Testis trauma was classified according to the AAST organ injury scale, preoperatively based on physical examination and scrotal US and then compared to peroperative definitif grading scale. RESULTS: Of the included patients, 14 were found to have abnormal testis contours on US, 25 had a rupture of the tunica albuginea, with a sensitivity of 70,8% and a specificity of 71,2%. Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. CONCLUSIONS: Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.


Assuntos
Guias de Prática Clínica como Assunto , Escroto/lesões , Sociedades Médicas/normas , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/classificação , Ferimentos não Penetrantes/diagnóstico , Adulto , Humanos , Masculino , Orquiectomia/métodos , Exame Físico , Guias de Prática Clínica como Assunto/normas , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/cirurgia , Escroto/patologia , Escroto/cirurgia , Sensibilidade e Especificidade , Testículo/lesões , Testículo/patologia , Testículo/cirurgia , Estados Unidos , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
5.
Tunis Med ; 94(3): 198-202, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27575503

RESUMO

OBJECTIVE: Pre-existing renal lesions (PERL) may interfere with the patho-physiology of trauma, alter the radiographic imaging and influence the therapeutic approach. The aims of this study were to record the PERL found incidentally during blunt renal trauma, to specify the place for effective conservative management and to determin the estimated partial permanent disability (PPD). PATIENTS AND METHODS: The medical records of 14 patients with PERL and blunt renal trauma were reviewed. In each patient, pre-existing renal abnormalities, clinical symptoms, CT scan study findings, associated injuries, therapeutic approach, the accountability criteria and the estimated PPD were recorded. RESULTS: There were 11 men and 3 women with a mean age of 35,6 years (range 19-66 years). Renal trauma was due to a traffic accident in 8 patients. Renal damage appeared to be disproportionate to the severity of the trauma (minor trauma). They had a lower rate of associated trauma to other abdominal organs (four patients only). Urinary stones were present in 5 patients, pelvi-ureteric junction obstruction in 3, horseshoe kidny in 3, ectopic kidney in 2 and upper urinary tract carcinoma in one case. Early nephrectomy was required in three cases for hemodynamic instability. Ureteral stenting was indicated in 3 cases. Six patients were operated later because of their underlying renal pathology. A conservative treatment was possible only in 7 of cases. The PPD related to renal trauma varide from 0 to 13% in all cases. CONCLUSION: PERL may complicate a negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome. The imaging findings are crucial but may be confusing. The therapeutic approach is, to a large extent, dependent on the type of PERL and the severity of damage, and is often conservative in the hemo-dynamically stable patient. Accountability link may be difficult to establish and the PPD depends on the PERL and the renal injuries severity. FUNDING: We have no involvement with funding in this case. Ethical approval: Not required Conflicts of interest: None.


Assuntos
Achados Incidentais , Nefropatias/diagnóstico , Rim/lesões , Ferimentos não Penetrantes/complicações , Adulto , Idoso , Feminino , Humanos , Rim/anormalidades , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Tunis Med ; 94(12): 844, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28994883

RESUMO

INTRODUCTION: Data concerning the efficacy of intravesical Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder are limited. OBJECTIVES: We analyzed long-term outcomes of instillation therapy with BCG to treat bladder CIS, evaluated its effectiveness and safety and searched for prognostic factors that could predict disease recurrence and progression. METHODS: Between March 1994 and December 2010, 47 patients (male: 40; female: 7) with median age of 59,5 years (range 40-76 years), diagnosed with bladder CIS underwent weekly BCG instillations (75 mg of Pasteur strain) for six weeks followed by 6 monthly instillations. Patients were collected from four different institututions.Proven bladder CIS diagnosis was made through random biopsy (n=19), macroscopic lesion (n=28) and urinary cytology (n=6).Primary, concomitant, and secondary CIS was found in 13 (27,6%), 28 (59,6%) and 6 (12,7%), patients, respectively. RESULTS: The median follow up period was 67.5 months (range 60-116 months).The recurence rates were 15,4%, 35,7% and 50% respectively in group I,II and III at 5 years follow-up. The overall complete response rate was 68%.The five-year progression-free survival rate was 87.2%.Several factors, such as age (<60 or >60 years), gender, previous transurethral resection and type of CIS, were examined by multivariate analysis to predict recurrence and progression. None of them was an independent prognostic factor.Bladder irritation symptoms were the main BCG adverse effects. There were no severe adverse effects requiring discontinuation of drug administration.Radical cystectomy was performed in 5 patients. Extravesical involvement was identified in only one patient. During follow-up period, none died of bladder cancer. CONCLUSION: Therapy with BCG is remarkably effective and safe for primary CIS and concomittent CIS, which might be a prognostic factor. We didn't find any significant risk factor. Recurrence and disease progression including extravesical involvement should be carefully monitored over the long-term after BCG therapy.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Vacina BCG/administração & dosagem , Carcinoma in Situ/terapia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adulto , Idoso , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
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