Blunt adrenal gland injury: The impact of extra-abdominal injury.

BACKGROUND: Blunt adrenal gland injuries are considered uncommon. Moreover, the factors associated with the mechanisms of the injury following blunt trauma are unclear. In this study, we determined the factors associated with blunt adrenal gland injury (BAGI). MATERIALS AND METHODS: A total of 315 patients with blunt abdominal trauma were admitted to our institution during a 12-year period. After excluding 26 patients who were under 18 years old and 27 patients who were in cardiopulmonary arrest on arrival, 262 eligible patients were retrospectively reviewed. Patient characteristics, mechanism of injury, intervention, and associated organ injuries were compared between those with and without BAGI. RESULTS: Blunt adrenal gland injury was identified in 38 of 262 patients (14.5%). The right side was the predominant site of injury (68%). There were no differences in vital sign, in-hospital mortality, intervention, and concomitant abdominal organ injuries between those with and without adrenal gland injury. Patients with BAGI had a higher frequency of fall and motorcycle collision as mechanisms of injury. In addition, patients with BAGI had a higher injury severity score and a higher frequency of concomitant severe head, chest, and pelvic injuries. CONCLUSION: The results of the present study suggest that the deceleration injury leading to concomitant head, chest, or pelvic injuries with blunt abdominal trauma may be associated with the mechanism of BAGI. LEVEL OF EVIDENCE: Prognostic study, level IV.

Hemorrhagic adrenal myelolipoma after trauma to left adrenal gland: A case report.

Myelolipomas are rare benign tumors comprised of mature adipose tissue and hematopoietic elements. Adrenal myelolipomas associated with traumatic adrenal injury are relatively rare and less common on the left due to the limited size and well-protected position of the gland. A 59-year-old female admitted to the emergency department with intermittent left flank pain radiating to the left abdomen after falling from the bed six hours earlier. Her vital signs were stable, and she had tenderness over the left flank area and left abdomen. Her initial hemoglobin level was 12.9 g/dL. Bedside focused assessment with sonography for trauma revealed unclear left kidney margins. Contrast abdominal computed tomography (CT) revealed a space-occupying mass, 11.6×10.4×8.8 cm in dimension, in the left suprarenal region with active bleeding in the lower pole. Angiography did not reveal any active contrast medium extravasation. The CT-guided biopsy, was well performed concomitantly with angiography. Pathological assessment of the biopsy specimen revealed the presence of mostly adipose tissue with few erythrocytes and leukocytes. She was diagnosed with adrenal myelolipoma and admitted to the urology ward for left adrenalectomy with tumor resection. Traumatic adrenal injury, an unusual presentation of adrenal myelolipoma incidentally found in less than 5% of all abdominal blunt injuries, should be considered in cases of bleeding with trauma to the flank for prompt treatment.

Diagnostic utility of cytology smears and cell block in adrenal lesions.

BACKGROUND: Cytology of the adrenal gland is a less performed technique even in tertiary care centres; yet cytological evaluation is an important diagnostic tool for assessment of adrenal lesions. Our objective was to evaluate the diagnostic utility of FNAC smears and cellblock with immunohistochemistry (IHC) in lesions of the adrenal. MATERIAL AND METHODS: We had a total of 50 cases over a period of 2 years where both FNAC smears and cellblocks were taken. The smears and cellblocks were examined for adequacy. They were subsequently categorised into four groups: unsatisfactory, benign, suspicious of malignancy and malignant. The diagnostic accuracy of FNAC smears and cellblock with IHC were evaluated and compared, taking histopathology, wherever available, as the gold standard, RESULT: We had 50 cases with age ranging from 6 to 53 years with a median of 7.5 years. Of these, 54% were cytologically malignant and neuroblastoma was the commonest lesion. Histopathology was available in 23 cases only, where the diagnostic accuracy was evaluated. The sensitivity and specificity of FNAC smear was 100% and 85.71%, respectively whereas the sensitivity and specificity of cellblock with IHC was 100% and 92.86%, respectively. CONCLUSION: Cellblock together with IHC provides a higher degree of specificity, reduces the unsatisfactory rate and improves the diagnostic accuracy in lesions of the adrenal gland. Immunohistochemistry is an important adjunctive tool.

Development of multiple adrenal myelolipomas after trauma-induced adrenal haemorrhage.

Adrenal myelolipomas represent a benign neoplasm with known associations with many chronic diseases, 21-hydroxylase deficiency and cancer. However, the aetiology of adrenal myelolipomas remains unknown. Here, we present a case of a patient with image-proven bilateral adrenal haemorrhages caused by trauma with the subsequent development of bilateral adrenal myelolipomas several years later. Resection and pathological analysis of left adrenal gland confirmed the presence of multiple adrenal myelolipomas. Our case strongly suggests that trauma was the inciting event that led to the formation of these lesions.

Adrenalectomía derecha videoasistida por metástasis de adenocarcinoma sigmoides / Video-assisted right adrenalectomy for sigmoid adenocarcinoma metastasis

Las glándulas suprarrenales son sitios frecuentes de enfermedad y presentan algún tipo de alteración en 9 por ciento de la población. La detección de lesiones suprarrenales ha aumentado significativamente con el uso cada vez más frecuente de la tomografía axial computarizada y la resonancia magnética. Muchas de ellas son detectadas en forma incidental. Las lesiones más comunes son el adenoma y las metástasis. El adenoma es la enfermedad más frecuente en los pacientes sin antecedente neoplásico. Además, se pueden encontrar feocromocitomas, carcinomas, linfomas, mielolipomas, quistes y pseudoquistes, hemangiomas y hematomas. El objetivo del trabajo es mostrar el resultado del tratamiento quirúrgico de una metástasis en glándula suprarrenal derecha de un adenocarcinoma de sigmoides. La diseminación metastásica de un adenocarcinoma de colon a las glándulas suprarrenales es poco frecuente, muy poco reportado a nivel mundial. Es posible utilizar la vía videoasistida para el tratamiento de lesiones únicas suprarrenales con resultado satisfactorio(AU)

The adrenal glands are frequent sites of disease and present some type of alteration in 9 percent of the population. Its detection has increased significantly with the increasingly frequent use of CT and MRI, in which many of these lesions are detected incidentally. The most common lesions are adenoma and metastasis; Adenoma is the most frequent disease in patients without a neoplastic history. In addition, pheochromocytomas, carcinomas, lymphomas, myelolipomas, cysts and pseudocysts, hemangiomas and hematomas can be found. To show the result of the surgical treatment of a metastasis in the right adrenal gland of a sigmoid adenocarcinoma. A review of the literature, indications and techniques in the treatment of metastases in the adrenal gland was performed and the results of a patient diagnosed and operated at Hermanos Ameijeiras Clinical Surgical Hospital in 2016 are presented. Metastatic dissemination of adenocarcinoma of the colon to the adrenal glands is infrequent, rarely reported worldwide. A video-assisted adrenalectomy technique wasperformed with satisfactory results. There were no complications related to the procedure(AU)

Adrenal Function After Laparoscopic Nephrectomy: The Zurich Clinical Trial.

This manuscript reviews the outcomes of a European clinical trial to evaluate the effects of living kidney donation on adrenal function. The study shows that left-sided donor nephrectomy is associated with transiently reduced adrenocortical responsiveness, which returns to baseline after 28 d.

Lesões de adrenais em 300 cães / Adrenal lesions in 300 dogs

Foram estudadas as adrenais de 300 cães submetidos à necropsia no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria, no período de março de 2012 a junho de 2013. Os tecidos coletados foram fixados em formol 10% e encaminhados ao processamento his­tológico de rotina para confecção e análise de lâminas histológicas. Posteriormente, foram revisados os protocolos de necropsia e dados epidemiológicos referentes aos cães que tiveram as adrenais coletadas foram anotados. Dos 300 cães analisados, 82% tinham uma ou mais alterações nas adrenais, que foram classificadas de acordo com a patogênese e a prevalência. Lesões hiperplásicas foram as mais prevalentes, com 91,5% das ocorrências, seguido de lesões degenerativas (26,%), circulatórias (20,3%), neoplásicas (15%), inflamatórias (4,1%) e outras lesões (14,2%). Macroscopicamente, as hiperplasias caracterizavam-se por variável quantidade de nódulos brancacentos, de até 1,5cm de diâmetro. Em 72,9% dos casos de hiperplasia, os nódulos eram constituídos de células da camada glomerulosa. A maioria dos animais que apresentou lesões hiperplásicas era constituída de fêmeas (60,4%), idosos (46,9%) e cães com raça definida (55,6%). A degeneração gordurosa foi a lesão degenerativa mais prevalente (54,7%) e era caracterizada por células da zona fasciculada e da zona reticular com grandes vacúolos citoplasmáticos. Entre as alterações neoplásicas, tumores primários foram mais prevalentes (75,7%), com predomínio de adenomas (57,1%), seguido de feocromocitomas (25%) e carcinomas corticais (17,9%). Os tumores metastáticos perfizeram 24,3% dos casos de alterações neoplásicas. As adrenais foram sítio de metástase de carcinoma mamário, osteossarcoma, melanoma, linfoma, colangiocarcinoma, sarcoma histiocítico e adenocarcinoma pulmonar. No item "outras lesões", adrenal de estresse foi a alteração mais prevalente (37,1%). Essa alteração era caracterizada histologicamente por córtex de aspecto variegado, com áreas de fina vacuolização citoplasmática das células da camada fasciculada, intercaladas por grupos de células hipereosinofílicas. Este estudo possibilitou concluir que lesões nas adrenais de cães são extremamente frequentes, de modo que a avaliação cuidadosa desse órgão se faz necessária na rotina de diagnóstico em patologia.(AU)

The adrenal glands of 300 dogs, underwent to necropsy in the Laboratório de Patologia Veterinária at the Universidade Federal de Santa Maria (LPV/UFSM), were studied from March 2012 to June 2013. The collected tissues were fixed in 10% buffered formalin and sent to the routine histological processing in order to preparation and analysis of histological slides. Subsequently, it was reviewed the necropsy reports and the epidemiological data of the dogs which had the adrenal glands collected. Out of the 300 dogs examined, 82% had one or more adrenal lesions that were classified according to the pathogenesis and prevalence. The hyperplastic lesions were the most prevalent, comprising 91.5% of the cases, followed by degenerative (26%), circulatory (20.3%), neoplastic (15%), inflammatory (4.1%) and other lesions (14.2%). Grossly, hyperplasia was characterized by a variable amount of whitish nodules, ranging from 0.2-1.5 cm of diameter. In 72.9% of the hyperplasia cases, the nodules were composed by cells of the glomerulosa zone. Most of the animals that showed hyperplastic lesions consisted of females (60.4%), elderly (46.9%) and purebred dogs (55.6%). Fatty degeneration was the most prevalent degenerative lesions (54.7%), characterized by cells of the fasciculata and reticularis zones with large cytoplasmic vacuoles. Among the neoplastic changes, primary tumors were the most prevalent (75.7%), with predominance of adenomas (57.1%), followed by pheochromocytomas (25%) and cortical carcinomas (17.9%). Metastatic tumors corresponded to 24.3% of all cases of neoplastic changes. The adrenal glands were the site of metastasis of mammary gland carcinoma, osteosarcoma, melanoma, lymphoma, cholangiocarcinoma, histiocytic sarcoma and lung adenocarcinoma. Under "other lesions", adrenal of stress was the most prevalent change (37.1%). It was characterized histologically by a cortex with irregular appearance, with areas of mild cell vacuolation in the fasciculata zone, interspersed with hypereosinophilic cell groups. This study allowed the conclusion that the lesions in adrenal glands of dogs are extremely common, highlighting the importance of a careful evaluation of this organ in the routine of pathological diagnostic.(AU)

Feocronocitoma: diagnóstico y tratamiento / Feocromocytoma: Diagnosis And Treatment

Antecedentes. El Feocromocitoma es un tumor de baja prevalencia que se origina en las células cromafines de la médula de las glándulas suprarrenales. Estos tumores como el tejido simpático normal se originan del neuroectodermo, siendo su principal locali - zación intraadrenal. A nivel extra adrenal se conocen también como parangangliomas que son de 3 tipos 1, 3, 4, y se deben a mutaciones génicas que codifican para las subunidades B, C, y D de la succinato deshidrogenasa, enzima mitocondrial que interviene en el ciclo de Krebs, siendo frecuentes en enfermedad de Von Hippel Lindau, neoplasia endocrina múltiple tipo 2Ay 2B y neurofibromatosis tipo 1. Ob- jetivo : El presente escrito se enfoca en mostrar al lector la evidencia acumulada hasta la actualidad mediante una revisión exhaustiva del Feocromocitoma para orientar clínicamente a estos pacientes y así llegar a un diagnóstico y tratamiento adecuado. Métodos: Se realizó una búsqueda de artículos originales, revisiones sistemáticas, y artículos de revisión en bases de revista PUBMED, SCIELO, e HINARI con años de cobertura de 2010 a 2016. Desarrollo y Conclusión. El feocromocitoma en una enfermedad amenazante por su morbilidad cardiovascular, estas manifestaciones están asociadas a las hormonas que producen las catecolaminas. El tratamiento quirúrgico por vía abierta o laparoscópica representa la cura definitiva a este padecimiento dependiendo de las características del tumor y del paciente, tiene resultados satisfactorios y comparables para diagnosticar a tiempo el tumor y evitar complicaciones...(AU)

Genitourinary injuries after traffic accidents: Analysis of a registry of 162,690 victims.

BACKGROUND: Traffic accidents are the most frequent cause of genitourinary injuries (GUI). Kidney injuries after trauma have been well described. However, there exists a paucity of data on other traumatic GUI after traffic accidents. The objective of this study was to analyze the frequency and type of all GUI, by user category, after traffic accidents. METHODS: Patient cases were extracted from the trauma registry of the French department of Rhone from 1996 to 2013. We assessed the urogenital injuries presented by each of road user's categories. Severity injuries were coded with the Abbreviated Injury Scale and the Injury Severity Score. Kidney trauma was mapped with the classification of the American Association for the Surgery of Trauma. Multivariate prediction models were used for analysis of data. RESULTS: Of 162,690 victims, 963 presented with GUI (0.59%). 47% were motorcyclists, 22% were in a car, 18% on bicycles, and 9% were pedestrians. The most common organ injury was kidney (41%) followed by testicular (23%). Among the 208 motorists with a GUI, kidney (70%), bladder (10%), and adrenal gland (9%) were the most frequent lesions. Among the 453 motorcyclist victims with GUI, kidney (35%) and testicular (38%) traumas were the most frequent and 62% of injuries involved external genitalia. There were 175 cyclists with GUI, 70% of injuries involved external genitalia; penile traumas (23%) were the most frequent. In total, there were 395 kidney injuries, most being low grade. According to the American Association for the Surgery of Trauma kidney injuries were grade I, 59%; grade II, 11%; grade III, 16%; grade IV, 9%; grade V, 3%; and indeterminate, 2%. CONCLUSION: GUI is an infrequent trauma after traffic accidents, with kidneys being the most commonly injured. Physicians must maintain a high awareness for external genitalia injuries in motorcyclists and cyclists. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.

Blunt cardiac injury due to trauma associated with snowboarding: a case report.

BACKGROUND: Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all trauma admissions. Here we report blunt trauma of the left atrium due to snowboarding trauma. CASE PRESENTATION: A 45-year-old Asian man collided with a tree while he was snowboarding and drinking. He lost consciousness temporarily. An air ambulance was requested and he was transported to an advanced critical care center. On arrival, a pericardial effusion was detected by a focused assessment with sonography for trauma. His presenting electrocardiogram revealed normal sinus rhythm and complete right bundle branch block. Laboratory findings included a white blood cell count of 13.5 × 103/µl, serum creatine kinase level of 459 IU/l, and creatine kinase-myocardial band level of 185 IU/l. Enhanced computed tomography showed a large pericardial effusion and bleeding from his left adrenal gland. There were no pelvic fractures. A diagnosis of cardiac tamponade due to blunt cardiac injury and left adrenal injury due to blunt trauma was made. Subsequently, emergency thoracic surgery and transcatheter arterial embolization of his left adrenal artery were performed simultaneously. A laceration of the left atrial appendage in the lateral wall of his left ventricle was detected intraoperatively and repaired. His postoperative course progressed favorably, although a pericardial effusion was still detected on chest computed tomography on hospital day 35. His electrocardiogram showed normal sinus rhythm and the complete right bundle branch block pattern changed to a narrow QRS wave pattern. He was discharged on hospital day 40. CONCLUSIONS: The present case report illustrates two points: (1) severe injuries resulted from snowboarding, and (2) complete right bundle branch block was caused by blunt cardiac injury. The present report showed blunt trauma of the left atrium with complete right bundle branch block as an electrocardiogram change due to snowboarding trauma. To detect cardiac trauma in snowboarding accidents, an examination of an electrocardiogram is required in all patients who might have a bruised chest.

Adrenal Injuries: Historical Facts and Modern Truths.

BACKGROUND: Prior to the advent of whole body computed tomography, injuries of the adrenal gland were almost exclusively identified on postmortem examinations and were associated with severe injury. Recent literature has continued to identify an association between adrenal injuries and high ISS. The purpose of this study was to assess the influence of adrenal trauma on ISS and mortality while controlling for potential confounding factors. METHODS: A 15-year retrospective review for all adrenal gland injuries from a Level 1 Trauma Center's Trauma Registry was performed. Based on the characteristics of that patient population, the same Trauma Registry was then queried for case-matched patients, and the two groups compared to assess the influence of adrenal gland injuries on mortality. RESULTS: Seventy-two patients with adrenal injuries were identified and compared to 1026 case-matched patients. The adrenal gland injury was not a contributing factor in any of the study group mortalities. The mean ISS for the adrenal gland injured group was higher than the overall Registry ISS (18.7 vs 10.6) but almost identical to the ISS of patients case matched for abdominal injuries. CONCLUSION: Case-matched analysis based on multiple clinical variables demonstrates that the ISS of patients with adrenal gland injuries were similar to the ISS of patients with other injuries to the abdominal region and were in fact associated with a 0.02% decrease in mortality.

The pituitary adenylate cyclase-activating polypeptide (PACAP) protects adrenal function in septic rats administered etomidate.

BACKGROUND: Both hyperinflammation during sepsis and etomidate can suppress adrenal function. In this study, we explored whether treatment with pituitary adenylate cyclase-activating polypeptide (PACAP) relieves adrenal suppression in cecal ligation and puncture (CLP)-induced septic rats. MATERIALS AND METHODS: Female Sprague-Dawley rats were randomly divided into five groups (n=7 per group), including the sham group, sepsis group (CLP group), sepsis and etomidate group (CLP+ETO group), PACAP group, and etomidate alone group (ETO group). Rats were sacrificed on the third day of sepsis, and blood and adrenal gland samples were obtained for further testing. RESULTS: The PACAP reduced the apoptosis rate of adrenal cells and peripheral lymphocytes, improving adrenal function, inhibiting the secretion of interferon gamma (IFN-γ) from peripheral lymphocytes, and slightly relieving the suppression of the adrenal function induced by the injection of etomidate in sepsis. CONCLUSION: In septic conditions, the PACAP protects the adrenal gland by regulating peripheral inflammation, which slightly relieves the toxic effects of etomidate on adrenal function.

Epidemiology of Traumatic Adrenal Injuries Requiring Surgery.

OBJECTIVE: To analyze adrenal injuries using the National Trauma Data Bank. Adrenal trauma is rare and current literature is lacking in data from large case series. METHODS: A retrospective analysis of the National Trauma Data Bank from the years 2007-2011 was performed. Patient demographics, Injury Severity Score (ISS), mechanism of injury, type of trauma, associated injuries, and development of shock were assessed. Multivariable models were used to determine association with outcomes, such as characterization of injury, need for adrenalectomy, intensive care unit admission, and death. RESULTS: Of the 1,766,606 trauma cases recorded, 7791 involved 1 or both adrenal glands (0.44%). Common associated injuries were to the ribs (50.9%), thorax (50.0%), and liver (41.6%). Eighty adrenal injuries required surgery (80/7791, 1.0%), none of which were isolated adrenal injuries (0/120, P = .63). Higher ISS (P = .009), Black race (P = .031), penetrating injury (P < .001), and splenic (P < .001) and intestinal injuries (P = .018) were associated with need for adrenalectomy. No isolated adrenal injuries were associated with death (12% vs 0%, P < .0001). Older age (P < .001), higher ISS (P < .001), chronic kidney disease (P = .009), penetrating injuries (P < .001), and injuries to the aorta/vena cava (P = .008), peripheral vasculature (P < .0001), thorax (P = .029), brain/spinal cord (P < .001), and abdominal polytrauma (P = .005) were associated with mortality. CONCLUSIONS: Adrenal injuries are rare, comprising 0.44% of recorded traumatic injuries. Isolated adrenal injuries were not fatal and did not require surgery, and thus should be managed conservatively. Detection of adrenal injury in polytrauma patients is key, particularly penetrating trauma and concurrent splenic and/or intestinal injuries, as these patients are more likely to require adrenalectomy.

Traumatic and non-traumatic adrenal emergencies.

Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.

Imaging of adrenal and renal hemorrhage.

Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms. Angiomyolipoma and renal cell carcinoma are the neoplasms most commonly associated with hemorrhage in the kidneys and adrenal cortical carcinoma, metastases, and pheochromocytoma are associated with hemorrhage in the adrenal glands. Understanding the computed tomography and magnetic resonance imaging features, and causes of hemorrhage in the kidneys and adrenal glands is critical. It is also important to keep in mind that mimickers of hemorrhage exist, including lymphoma in both the kidneys and adrenal glands, and melanoma metastases in the adrenal glands. Appropriate imaging follow-up of renal and adrenal hemorrhage should occur to exclude an underlying malignancy as the cause. If there is suspicion for malignancy that cannot be definitively diagnosed on imaging, surgery or biopsy may be warranted. Angiography may be indicated when there is a suspected underlying vascular disease. Unnecessary intervention, such as nephrectomy, may be avoided in patients with benign causes or no underlying disease. Appropriate management is dependent on accurate diagnosis of the cause of renal or adrenal hemorrhage and it is incumbent upon the radiologist to determine the etiology.

Adrenal gland trauma: is extravasation an absolute indication for intervention?

BACKGROUND: Adrenal gland trauma (AGT) is potentially devastating if unrecognized during the treatment of trauma patients. Because of the adrenal glands' rich vascularity, they often hemorrhage upon traumatic impact. However, there has been no conclusion about the indications for intervention in cases of hemorrhage after AGT. METHODS: We conducted a prospective collection with a retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the patients who suffered from AGT from May 2008 to May 2013. We retrieved and analyzed the patient demographic data, clinical presentation, AGT grade, injury severity score, management, hospital stay, and mortality. RESULTS: The cohort consisted of 60 patients. The mean age was 31.0 ± 15.9 years. There were 32 patients (53.3 %) with extravasated AGT, which was associated with a high injury severity score, a high possibility of associated lung injury, and more than one accompanying trauma. Most of the patients could be treated conservatively. Five of these patients needed surgical hemostasis, and four of them needed angiographic embolization. Extravasation combined with a mean arterial pressure <70 mmHg was a predictor of the need for intervention (relative risk: 9.52, 95 % CI 1.64-55.56, p = 0.011). CONCLUSION: In conclusion, AGT is a rare injury with a good prognosis. Most AGT patients can be treated conservatively. Extravasation in AGT is not only a sign of hemorrhage, but also an indicator of severe associated injuries. However, extravasation in AGT does not always require further treatment. When intractable hypotension simultaneously occurs, further treatment should be considered.

The current status and management of blunt adrenal gland trauma.

BACKGROUND: Blunt adrenal gland trauma (BAGT) is a potentially devastating event if unrecognized during the treatment course of patients with trauma. Because of its rarity, no current algorithm or consensus exists for BAGT. In the present study, we demonstrated the feasibility and safety of transcatheter angiographic embolization (TAE) in BAGT and analyzed the clinical presentation and outcome of BAGT. METHODS: We conducted a prospective collection and retrospective review at a level I trauma center in Taiwan. This study included all of the patients that sustained BAGT from May 2004 to May 2013. We retrieved and analyzed the patient demographic data, clinical presentation, BAGT grade, injury severity score, management, hospital stay, and mortality. RESULTS: The cohort consisted of 77 patients: 59 men and 18 women. The mean age was 34.3 ± 15.5 years. The right side was the predominant site of injury (59/77; 76.6%). Six patients underwent operation; 18 patients underwent angiography, including four TAEs, and the remaining patients underwent conservative management. The mortality rate was 9.1% (7/77), and a high injury severity score was an independent factor to predict mortality. CONCLUSION: In conclusion, BAGT is a rare injury with a benign prognosis. Most patients can be treated conservatively. Furthermore, this study demonstrates that both TAE and operation can be used to achieve hemostasis. The mortality of BAGT was related to severe associated injuries. BAGT is an indicator of severe multiple trauma; however, it does not increase mortality or prolong hospital stay.

Abdominal solid organ injury in trauma patients with pelvic bone fractures.

BACKGROUND: We analyzed the clinical progression of trauma patients with pelvic bone fractures so to determine the risk factors associated with sustaining concurrent abdominal solid organ injuries. METHODS: This study was a retrospective chart review. Subjects were categorized based on injury type: solid organ versus non-solid organ injury groups. These study groups were compared based on demographics, treatments, and clinical outcomes. Potential risk factors that may contribute to the occurrence of abdominal solid organ injury in trauma patients with pelvic bone fractures were evaluated. RESULTS: The solid organ injury group included 17.4% of all the patients in the study (n=69). Fall from height occurred at greater distances in patients that sustained solid organ injuries as opposed to patients with non-solid organ injuries. Initial blood pressure and Revised Trauma Scores were lower in the solid organ injury group. Shock diagnosed immediately upon emergency department arrival was a risk factor for intra-abdominal solid organ injuries in trauma patients with pelvic bone fractures. Clinical prognosis for patients in the solid organ injury group was poorer and more invasive treatments were performed for patients in this group. CONCLUSION: Traumatic pelvic fracture patient prognosis needs to be improved through early diagnosis and prompt delivery of aggressive treatments based on rapid identification of abdominal solid organ injuries.

Localización infrecuente del quiste hidatídico suprarrenal primario / Uncommon location of the primary adrenal hydatid cyst

El quiste hidatídico suprarrenal primario es una patología muy infrecuente por su localización y se encuentra en este órgano en menos del 0,5 por ciento de los casos, incluso en países con presencia endémica del Echinococcus. La mayoría de los quistes hidatídicos suprarrenales son asintomáticos, siendo el diagnóstico un hallazgo incidental. Las pruebas serológicas para el diagnóstico pueden ser negativas en muchos casos y el tratamiento es en su mayoría quirúrgico, con múltiples vías de abordaje. Es una patología poco común; el diagnóstico, manejo, tratamiento y vías de abordaje no se encuentran aún muy establecidos. Con este artículo tratamos de realizar un acercamiento más certero en cuanto a estos aspectos(AU)

The primary adrenal hydatid cyst is a very rare disease for its location and it is found in less than 0.5 percent of the cases, even in countries with endemic presence of Echinococcus. Most adrenal hydatid cysts are asymptomatic, and the diagnosis is an incidental finding, the serological tests for the diagnosis are negative in many cases and the treatment is mostly surgical, with multiple surgical approaches. It is a rare pathology whose diagnosis, management, treatment and surgical approaches are not yet well established. This article was intended to address these aspects in a more accurate way(AU)