Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation.

Background: We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius. Methods: This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18 months. Results: The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07). Conclusion: Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.

Simultaneous separation and degradation of methylene blue by a thin film nanocomposite membrane containing TiO2/MWCNTs nanophotocatalyst.

ABSTRACTAn innovative photocatalytic thin film nanocomposite (TFN) membrane was prepared and used for the simultaneous separation/degradation of methylene blue (MB) under UV irradiation. For this purpose, we used the sol-gel method to prepare the TiO2/MWCNTs nanophotocatalyst and added to the 1,3-phenylenediamine (MPD) solution during interfacial polymerization (IP) of 1,3,5-benzenetricarbonyl chloride (TMC) and 1,3-phenylenediamine monomers on the polysulfone (PSF) support. Using scanning electron microscopy (SEM) analysis and studying the cross-sectional images of membrane samples, it was revealed that the polyamide (PA) thin layer was well fabricated over the support membrane. The attendance of the TiO2/MWCNTs nanophotocatalyst in the PA thin layer of TFN samples was also proved using EDX (energy-dispersive X-ray) analysis. According to the results of the contact angle (CA), it is clear that the hydrophilicity of membrane samples first increased and then decreased by enhancing the TiO2/MWCNTs nanophotocatalyst content in the PA thin layer. In comparison with the pristine thin film composite (TFC) membrane, TFN samples showed higher water flux and MB removal when they were exposed to UV light. Finally, it turned out that the TFN membrane comprising 0.2 wt. % TiO2/MWCNTs nanophotocatalyst (TFN 0.2) had the foremost efficiency among TFNs with the water flux of 13 L/m2·hr and dye separation/degradation of almost 100% under UV irradiation.

Fouling Prevention in Polymeric Membranes by Radiation Induced Graft Copolymerization.

The application of membrane processes in various fields has now undergone accelerated developments, despite the presence of some hurdles impacting the process efficiency. Fouling is arguably the main hindrance for a wider implementation of polymeric membranes, particularly in pressure-driven membrane processes, causing higher costs of energy, operation, and maintenance. Radiation induced graft copolymerization (RIGC) is a powerful versatile technique for covalently imparting selected chemical functionalities to membranes' surfaces, providing a potential solution to fouling problems. This article aims to systematically review the progress in modifications of polymeric membranes by RIGC of polar monomers onto membranes using various low- and high-energy radiation sources (UV, plasma, γ-rays, and electron beam) for fouling prevention. The feasibility of the modification method with respect to physico-chemical and antifouling properties of the membrane is discussed. Furthermore, the major challenges to the modified membranes in terms of sustainability are outlined and the future research directions are also highlighted. It is expected that this review would attract the attention of membrane developers, users, researchers, and scientists to appreciate the merits of using RIGC for modifying polymeric membranes to mitigate the fouling issue, increase membrane lifespan, and enhance the membrane system efficiency.

Impacts of Multilayer Hybrid Coating on PSF Hollow Fiber Membrane for Enhanced Gas Separation.

One of the most critical issues encountered by polymeric membranes for the gas separation process is the trade-off effect between gas permeability and selectivity. The aim of this work is to develop a simple yet effective coating technique to modify the surface properties of commonly used polysulfone (PSF) hollow fiber membranes to address the trade-off effect for CO2/CH4 and O2/N2 separation. In this study, multilayer coated PSF hollow fibers were fabricated by incorporating a graphene oxide (GO) nanosheet into the selective coating layer made of polyether block amide (Pebax). In order to prevent the penetration of Pebax coating solution into the membrane substrate, a gutter layer of polydimethylsiloxane (PDMS) was formed between the substrate and Pebax layer. The impacts of GO loadings (0.0-1.0 wt%) on the Pebax layer properties and the membrane performances were then investigated. XPS data clearly showed the existence of GO in the membrane selective layer, and the higher the amount of GO incorporated the greater the sp2 hybridization state of carbon detected. In terms of coating layer morphology, increasing the GO amount only affected the membrane surface roughness without altering the entire coating layer thickness. Our findings indicated that the addition of 0.8 wt% GO into the Pebax coating layer could produce the best performing multilayer coated membrane, showing 56.1% and 20.9% enhancements in the CO2/CH4 and O2/N2 gas pair selectivities, respectively, in comparison to the membrane without GO incorporation. The improvement is due to the increased tortuous path in the selective layer, which created a higher resistance to the larger gas molecules (CH4 and N2) compared to the smaller gas molecules (CO2 and O2). The best performing membrane also demonstrated a lower degree of plasticization and a very stable performance over the entire 50-h operation, recording CO2/CH4 and O2/N2 gas pair selectivities of 52.57 (CO2 permeance: 28.08 GPU) and 8.05 (O2 permeance: 5.32 GPU), respectively.

[Clinical significance of chronologic immature platelet fraction analysis in TAFRO syndrome].

TAFRO syndrome is characterized by thrombocytopenia with unknown etiology. The assessment of immature platelet fraction (IPF) is useful for differential diagnoses that include thrombocytopenia. However, the significance of IPF in cases of TAFRO syndrome remains to be reported. We present a case of TAFRO syndrome wherein the patient demonstrated a marked increase in IPF without thrombocytopenia, which offers vital information concerning TAFRO diagnosis and the serial measurements of IPF during treatment. A 65-year-old man presenting with fever was admitted to our hospital. He exhibited mild splenomegaly and lymphadenopathy, as well as rapidly worsening renal failure and fluid retention. These indications prompted the initiation of corticosteroid therapy. A normal platelet count and aberrantly high IPF implied abnormal thrombopoiesis, and subsequent bone-marrow findings suggested TAFRO syndrome. The platelet counts started to decrease following the corticosteroid therapy, but the treatment refractoriness prompted the urgent administration of rituximab. Thereafter, the platelet count nadir remained for approximately one month, whereas the decreasing IPF trend preceded platelet recovery. In the present case, a high pre-treatment IPF was demonstrated before the emergence of thrombocytopenia, and a decreasing trend of IPF was observed before platelet recovery during treatment. Therefore, serial IPF measurements could be useful for the early diagnosis and prognostication of TAFRO syndrome.

Thin Film Composite and/or Thin Film Nanocomposite Hollow Fiber Membrane for Water Treatment, Pervaporation, and Gas/Vapor Separation.

Thin film composite (TFC) polymeric hollow fiber (HF) membranes are widely used in industrial gas/vapor separations and water treatment. There are many advantages of TFC HF membranes, such as low energy requirements, simplicity of operation, and high specificity. In the present article, a review is made on the progress that has been achieved during the past 15 years in the preparation of the HF substrate and the preparation/modification of the thin selective layer. The review also includes their applications in water treatment, dehydration of alcohols via pervaporation, and gas/vapor separation.

Familial Carney complex with biatrial cardiac myxoma.

We report a case of Carney complex (CNC) with biatrial cardiac myxoma. The patient had left and right atrial myxomas which were resected in a surgery. She showed bilateral adrenal tumors and multiple mammary tumors. She had pigmentation on her lower lip. Previously, her daughter was also diagnosed with CNC with cardiac myxoma. Both of them showed mutations in the PRKAR1A gene. .

Montrichardia linifera (Araceae) biological potential, phytochemical prospection and polyphenol content / Montrichardia linifera is commonly known in Brazil as "aninga." In November 2008 and August 2009, we collected plant samples and extracted leaves and stems using hexane or dichloromethane and methanol to evaluate its biological and chemical potential, phytochemical profile and polyphenol content. Differences in the chemical composition of the collections were evident. In the first collection, the apolar extracts were the richest in metabolite composition while the polar extracts were the richest in the second collection. In general, extracts from Aug/2009 had higher antioxidant and cytotoxic activities than extracts from Nov/2008 and the stem and leaf extracts from the Aug/2009 collection showed the highest polyphenol content. As an insecticide against Sitophilus zeamais, the hexane extract of the leaves (Aug/2009) presented concentration-dependent insecticidal activity. Only the methanolic extract of stems and leaves (Aug/2009) presented a small inhibition halo (9 and 7 mm, respectively) against Aeromonas hydrophila when evaluating its antibacterial potential. The study demonstrates that, collection period is an important factor to consider in phytochemical and biological activity studies of M. linifera. / Potencial biológico, prospección fitoquímica y contenido de polifenoles de Montrichardia linifera (Araceae) / Potencial biológico, prospecção fitoquímica e teor de polifenóis de Montrichardia linifera (Araceae)

Montrichardia linifera es comúnmente conocida en Brasil como "aninga". Fue colectada dos veces (Nov/2008 y Ago/2009), y sus hojas y tallos fueron extraídos con hexano o diclorometano y metanol. El potencial biológico y químico, perfil fitoquímico y contenido de polifenoles de sus extractos fueron evaluados. Fueron encontradas diferencias en la composición química: de la primera colecta, los extractos apolares fueron más ricos, mientras que de la segunda colecta, los polares fueron los más ricos. Extractos de Ago/2009 mostraron, en general, actividades antioxidante y citotóxica mayores que los de Nov/2008. Los extractos de los tallos y hojas de Ago/2009 mostraron un mayor contenido de polifenoles. Cuanto al ensayo insecticida sobre Sitophilus zeamais, el extracto hexánico de las hojas (Ago/2009) presentó actividad insecticida concentración-dependiente. Cuando evaluado el potencial antibacteriano, apenas los extractos metanólicos de los tallos y hojas (Ago/2009) presentaron un halo de inhibición pequeño (9 y 7 mm, respectivamente) contra Aeromonas hydrophila. Este estudio muestra que el período de la colecta es un factor importante a ser considerado cuando los objetivos son estudios fitoquímicos y de actividades biológicas de M. linifera.

Montrichardia linifera é comumente conhecida no Brasil como "aninga". Foi coletada duas vezes (Nov/2008 e Ago/2009), e suas folhas e caules foram extraídos com hexano ou diclorometano e metanol. O potencial biológico e químico, perfil fitoquímico e teor de polifenóis de seus extratos foram avaliados. Foram encontradas diferenças na composição química: da primeira coleta, os extratos apolares forem mais ricos, enquanto que da segunda coleta, os polares foram os mais ricos. Extratos de Ago/2009 mostraram, em geral, atividades antioxidante e citotóxica maiores que os de Nov/2008. Os extratos dos caules e das folhas de Ago/2009 mostraram um maior teor de polifenois. Quanto ao ensaio inseticida sobre Sitophilus zçamais, o extrato hexânico das folhas (Ago/2009) apresentou atividade inseticida dependente da concentração. Quando avaliado o potencial antibacteriano, apenas os extratos metanólicos dos caules e folhas (Ago/2009) apresentaram um halo de inhibição pequeno (9 e 7 mm, respectivamente) contra Aeromonas hydrophila. Este estudo mostra que o período da coleta é um fator importante a ser considerado quando os objetivos são estudos fitoquímicos e de atividades biológicas de M. linifera.

Production and characterization of surface-active compounds from Gordonia amicalis

Two methods were used to make crude preparations of surface-active compounds (SACs) produced by Gordonia amicalis grown on the medium containing 1% diesel oil. Using a 2:1 (v/v) solution of chloroform:methanol for extraction, Type I SACs were isolated and shown to produce oil in water (O/W) emulsions. Type II SACs were isolated by precipitation with ammonium sulfate and produced predominantly water in oil emulsions (W/O). The crude Type I and II preparations were able to produce a significant reduction in the surface tension of water; however, the crude Type II preparation had 10-25 fold higher emulsification activity than the Type I preparation. Both SAC preparations were analyzed by the TLC and each produced two distinct bands with Rf 0.44 and 0.62 and Rf 0.52 and 0.62, respectively. The partially purified SACs were characterized by the ESI(+)-MS, FT-IR and NMR. In each one of these fractions, a mixture of 10 oligomers was found consisting of a series of compounds, with masses from 502 to 899, differing in molecular mass by a repeating unit of 44 Daltons. The mass spectra of these compounds did not appear to match other known biosurfactants and could represent a novel class of these compounds.

Successful treatment of incidental prostate cancer by radical transurethral resection of prostate cancer.

BACKGROUND: To evaluate the rationale for RTUR-PCa against pT1a/b cancer, we analyzed oncological and functional outcomes. PATIENTS AND METHODS: Fifty-six patients with incidental prostate cancer were included and the age ranged from 66 to 91 years (mean, 76.6; median, 75.0). Preoperative prostate specific antigen (PSA) levels were between 0.70 and 44.1 ng/mL (mean, 5.90; median, 4.60). We performed 69 RTUR-PCa's by resecting and fulgurating the residual prostate tissues after previous transurethral resection of the prostate. Prostate specific antigen nonrecurrence rate was calculated by Kaplan-Meier method. RESULTS: Follow-up duration of 51 patients was mean ± SD 64.1 ± 21.6 months (median, 67.8 months; range, 13.8-99.8) excluding 5 patients that were lost to follow-up. Prostate specific antigen failure developed in 3 patients (5.9%). In the other 48 patients, PSA stabilized as follows: PSA ≤ 0.01, 24 cases; ≤ 0.02, 5 cases; ≤ 0.03, 6 cases; ≤ 0.04, 3 cases; ≤ 0.1, 7 cases; and ≤ 0.4, 3 cases. Prostate specific antigen nonrecurrence rates were 100% for pT2a and 91.3% for pT2b at the mean follow-up period of 64.1 months. Nonrecurrence rate grouped by D'Amico classification system were 100% in the low-risk group, 94.7% in the intermediate-risk group, and 88.2% in the high-risk group, respectively. Water intoxication did not develop and no patients required transfusion. Bladder neck contracture, which developed in 22 out of 51 patients (43.1%), was the most frequent postoperative complication. Postoperative incontinence was temporary and disappeared within 3 months in all patients. CONCLUSION: Satisfactory oncologic and functional results suggest that RTUR-PCa could be a promising option for radical treatment against incidental prostate cancer.

Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy.

Background. We analyzed radical TUR-PCa against localized prostate cancer. Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients' age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients' age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL. Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months' follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction. Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

An Advanced but Traditional Technique of Transurethral Resection of the Prostate in Order not to Overlook Stage T1 Prostate Cancer.

INTRODUCTION: A little deeper resection was done during transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH) to fill the disparities of reported prevalence rates between latent and incidental prostate cancer, as well as in order not to overlook clinically significant incidental cancer. PATIENTS AND METHODS: We performed TURP in 995 patients who were diagnosed to have BPH. With a routine TUR setup, first most of the transition and central zones were resected. Then a slightly deeper resection of the residual adenoma and the peripheral zone than in the usual TURP was made. Pathological specimens were collected from 6 different parts. RESULTS: Incidental cancer was diagnosed in 226 patients (22.7%). Gleason scores were distributed as follows: 6 or less in 150 cases (66.4%), 7 in 68 cases (30.1%), and 8 in 8 cases (3.5%). Even in the patients with lower prostate specific antigen (PSA), patients with incidental cancer and Gleason scores of 7 or more were 142 (21.2%) and 41 (28.9%) respectively at 0 < PSA < 4.0 ng/ml, and 95 (18.7%) and 26 (27.4%) respectively at 0 < PSA < 2.5 ng/ml. Multifocal/diffuse cancer was detected in 84 (37.2%) patients. CONCLUSIONS: With our method of advanced TURP, we detected incidental cancer at almost the same rate as reported in latent cancer. When TURP is performed, incidental cancer as well as to relieve voiding difficulties must not be overlooked, because there must be a considerable number of clinically significant incidental cancer of higher Gleason scores, and of multifocal/diffuse lesions.

Comparison of modified Das De procedure with Du Vries procedure for traumatic peroneal tendon dislocation.

BACKGROUND: For peroneal tendon dislocation, various surgical procedures have been described. Das De et al. reported good clinical results using retinaculum repair. However, their reports are limited to case series. We have simplified the Das De procedure since 1996. The purpose of this study is to investigate the clinical outcomes of our modified Das De procedure (MD) and compare these clinical outcomes to those of the Du Vries procedure (DV) that was performed in our hospital until 1996. PATIENTS: From 1996 to 2007, 19 patients were treated by MD and from 1988 to 1996, 15 patients were treated by DV. RESULTS: A mean preoperative Ankle-Hindfoot Scale was 78.4 points (range: 65-84) in the MD group and 77.2 points (range: 67-87) in the DV group. A mean postoperative Ankle-Hindfoot Scale was 93.4 points in the MD group and 89.4 points in the DV group. Two patients (13.3%) in the DV group suffered postoperative peroneal tendon redislocation. In the MD group, there was no postoperative peroneal tendon redislocation or complication related to skin incision. In athletes, 80.0% in the MD group and 54.5% in the DV group were able to return to their previous sports. The mean duration to return to sports was 2.9 months in the MD group and 3.9 months in the DV group (p < 0.05). CONCLUSIONS: MD provided similar or slightly better clinical outcomes with less complication as compared to DV. For athletes, the rate of return to sports was higher and the duration to return to sports was significantly shorter in the MD group.

Nanoporous polymer--clay hybrid membranes for gas separation.

Nanohybrid organo-inorgano clay mineral-polydimethylsiloxane (PDMS) membranes were prepared by the reaction of pure and/or modified natural clay minerals (Sepiolite and montmorillonite) with PDMS in hexane, followed by evaporation of the solvent at 70 degrees C. The membranes were characterized by means of XRD, SEM, ATD-TG and solid state (29)Si magic angle spinning (MAS) and cross-polarization (CP) CP/MAS NMR. The morphology of the membranes depends on the content loading of clay mineral. For low content, the membrane composition is homogeneous, with well dispersed nanoparticles of clay into the polymer matrix, whereas for higher clay content, the membranes are constituted also of a mixture of well dispersed nanoparticles into the polymer, but in the presence of agglomerations of small clay particles. Quantitative (29)Si MAS NMR demonstrated a strong correlation between the clay content of the membrane and the average length of the PDMS chain, indicating that the nanohybrid material is made of clay particles covalently linked to the PDMS structure. This is particularly the case for Sepiolite with has a high density of Q(2) silanol sites. The separation performances of the prepared membranes were tested for CO(2)/CH(4) and O(2)/N(2) mixtures. The observed separation factors showed an increase of the selectivity in the case of CO(2)/CH(4) in comparison with membranes made from PDMS alone under the same conditions.

Bilateral osteochondritis dissecans of the lateral femoral condyle following bilateral total removal of lateral discoid meniscus: a case report.

Osteochondritis dissecans (OCD) of the lateral femoral condyle sometimes occurs with a discoid lateral meniscus. Recently, it was reported that OCD of the lateral femoral condyle occurred after total removal of the lateral meniscus. We report the case of a 12-year-old boy with bilateral OCD of the lateral femoral condyle following bilateral total removal for discoid lateral meniscus. Valgus deviation of the knee after total removal and increased sporting activity might have concentrated excessive stress on the lateral condyles in the standing position. As a result, bilateral OCD might have occurred. Drilling of the areas of OCD on the bilateral lateral femoral condyles was done and the patient wore inner wedge arch supports postoperatively. After 2 years, neither knee pain nor arthrosis has occurred so far, but long-term follow-up of this patient is considered to be necessary.

Venous abnormalities incidentally accompanied by renal tumors.

We retrospectively examined the cases of renal tumors experienced between 1993 and 2002 to evaluate the rates of incidence and preoperative identification by imaging techniques, mainly CT, of retroperitoneal venous abnormalities. Among a total of 178 renal cell carcinomas and 13 renal benign tumors, the incidence of multiplicity of renal veins was 5.3%, restricted to operatively confirmed cases (9 out of 170 cases). None of these multiplicities could be detected by preoperative radiological examinations. Other major venous abnormalities included duplications of inferior vena cava and retroaortic left renal vein and spontaneous splenorenal shunt which were all correctly diagnosed preoperatively. The incidence of these abnormalities was 0.52% (1 out of 191 cases for each). A retroperitoneal venous anomaly is common, but urologists must have sufficient knowledge about acquired retroperitoneal venous abnormalities, which seem rather uncommon, to be prepared for the potential hazards which may occur during urological operations.

Development of vitellogenin assay for endocrine disrupters using medaka (Oryzias latipes).

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of the egg yolk precursor vitellogenin (VTG) in the liver of medaka (Oryzias latipes) and was employed to establish an in vivo testing system for estrogen and estrogenic compounds using liver homogenates. Results of 3-month-old fish exposed to three reference chemicals (ethynylestradiol, methyltestosterone and flutamide) recommended by Organisation for Economic Co-operation and Development (OECD) for the validation showed the induction and decrease of vitellogenic responses, making the assay using the liver VTG of medaka a possible screening method for not only estrogens but also androgens. In addition, 21-day exposure of male fish to 4-tert-octylphenol and 4-nonylphenol produced concentration-dependent inductions of liver vitellogenin, with the lowest observed effect concentrations of 64.1 microg/L and 22.5 microg/L, respectively, while no significant VTG responses were observed in male and female fish exposed to tributyltin chloride and dibutyl phthalate. This study demonstrates that the VTG assay using liver homogenates from small fish such as medaka can be used as a screening method for environmental estrogens. This is because the sensitivity of the VTG response in medaka may be almost the same as that of other fish using blood samples.

[Statistics on operations at the Department of Urology, Nippon Telegraph and Telephone West Osaka Hospital during a ten-year period from 1992 to 2001].

A 10-year clinical statistic survey was made on the operations performed at the department of urology, NTT West Osaka Hospital between 1992 and 2001. The total number of operations was 2,540, comprising 1,899 males and 641 females, and a total of 1,559 ESWL was performed. The number of operations per year was chronologically constant. Major operations were transurethral resection of prostate (299 cases). The number of operations for malignant tumors, for examples radical nephrectomy and enucleation for renal cancer, nephroureterectomy for upper urinary tract cancer and transurethral resection of bladder tumor, has increased since 1997 year after year. The number of ESWL has decreased since 1994. Renal transplantation was introduced in 1995, and laparoscopic adrenalectomy also in 1997.

[Evaluation of the management of blunt renal trauma and indication for surgery].

OBJECTIVES: Appropriate management of renal trauma is still controversial. Many of the patients have minor injuries and conservative treatment can achieve excellent outcomes without any complications. For major injuries of deep lacerations or ruptures, we have been performing early surgical treatment to salvage the kidney in the selected cases after the precise evaluation of the injury. To obtain the optimal management options, we evaluated the clinical results of our procedures. PATIENTS AND METHODS: We conducted a retrospective study, which included 106 cases of blunt renal trauma with evident etiology over the past 22 years and 9 months. The severity of the injury was evaluated mainly by CT scanning. The indication of renal exploration included persistent renal bleeding, large hematoma around the kidney, dislocated fragments, nonviable tissue, massive urinary extravasation and vascular injury. With the patients who required an operation, we first controlled the bleeding by clamping the hilar vessels. Then, the final decision whether to repair or remove the kidney was made based on the direct inspection of the injured kidney after the complete removal of the hematoma. The severity of renal trauma was classified by the classifications found in The Organ Injury Committee of the American Association for the Surgery of Trauma. RESULTS: Sixty-three patients were managed conservatively without any interventions, while 22 surgical repairs and 21 nephrectomies were performed. Of the 63 patients, 35 patients (81.4%) were operated on within 2 days after the injury. Judging from systolic blood pressure, red cell count, blood loss during surgery and transfusion requirements, surgically treated patients were more severely injured than conservatively treated patients. And nephrectomized patients than surgically repaired patients. All the surgically repaired cases were confirmed to have preserved renal functions postoperatively. In all of the 50 patients with Grade I injuries, conservative treatment was successful. Eight out of the 19 Grade II and III cases, who were indicated for kidney exploration because of multiple lacerations or considerable bleeding, were also successfully repaired. Localized hematoma with no urine leakage, even when it was large, settled spontaneously without complication. For the 37 Grade IV and V injuries, including 4 cases with hilar injuries, we implemented conservative procedures on 2 patients, surgical repair on 14 patients and nephrectomy on 21 patients. In the conservatively treated cases, one deep laceration with relatively large, but localized, hematoma, and minimal urine extravasation healed spontaneously. Atrophy of the segment and hypertension developed in the other ruptured kidney with dislocated fragments, large hematoma and urine leakage. This kidney, which also required later surgical exploration, did have good parenchymal blood flow. Hilar injury cases were all resulted in nephrectomy. CONCLUSION: In most of our cases the indication for surgical exploration or nephrectomy based on our criteria seemed to be properly decided. Several cases, though, might have received overtreatment. Recent advances in evaluations and strategies of renal trauma have decreased the need for surgical exploration. This may have overreached the indication for conservative management. Severely injured kidneys may be managed conservatively because in most cases bleeding settles after the full formation of large hematoma within the Gerota's fascia. In such cases, though, no one can predict whether the injury will heal spontaneously or not, and, moreover, whether a complication will develop or not. We think that the optimal management of the patient requires an accurate evaluation of the injured kidney. Therefore the indication for surgical exploration should be made based on the degree of the injury.