Stan Monstrey

Renal trauma and hypertension.

A retrospective study (1972-1983) was made of 622 consecutive patients who suffered renal trauma, in order to assess the incidence and prevalence of post-traumatic renal hypertension. In 435 (76%) of the 569 survivors long-term followup data and blood pressure recordings were obtained, 13 months to 12 years after trauma (mean, 5.6 years). Renal trauma could not be linked to an increased incidence of hypertension: on first control, only 94 patients (21%) demonstrated a casual elevated blood pressure (greater than 140/90 mm Hg). The presence of a fixed hypertension was validated in only 14 patients. Twelve of them were extensively screened in the Department of Internal Medicine. In none of these patients could a definite relationship between hypertension and renal trauma be documented. Furthermore, an extensive review was done of 223 cases of post-traumatic renal hypertension reported in the literature from 1951 until 1984. Careful analysis of these previously described cases (71 publications) leads us to criticize the widespread accepted cause-effect condition with regard to post-traumatic renal hypertension. It is concluded that adequate management of renal injuries with early diagnosis and individualised surgical treatment can prevent this extremely rare complication.

Rational guidelines in renal trauma assessment.

Optimal management in renal trauma necessitates an adequate delineation of location and extent of the renal injury. However, as a result of the rapid rise in the costs of medical care, a complete and elaborate radiographic evaluation of all patients with suspected renal injury no longer seems justified. We reviewed our experience with 622 consecutive cases of renal injury to find the most economical diagnostic sequence with the clearest findings. An intravenous pyelography (IVP) still is the first and mostly the sole examination to do in patients with clinical or laboratory evidence of renal trauma. Microscopic hematuria alone is no longer an indication to perform urography. If indicated, an IVP should be performed as an emergency procedure in all cases and especially in the patient with multiple trauma. Children are more susceptible to renal trauma and require a higher index of suspicion. In the few patients with indeterminate findings on urography, renal angiography must be considered (especially when renal pedicle injury is suspected) or a computerized tomography (CT) scan (especially in the patient with multiple trauma). Ultrasound and CT examinations are not to be done on a routine basis in the initial assessment or the follow-up of renal trauma.

Renal trauma in children

SummaryTo develop an appropriate scheme for the treatment of children afflicted with a renal trauma, we evaluated 121 consecutive cases who suffered a blunt (n=120) or a penetrating (n=1) abdominal trauma in the period from 1972 to 1989. All patients with a minor (grade I) [8] lesion and no pre-existent anomalies were successfully treated in a conservative way. In the group of patients with critical (grade III) lesions, no kidney could be saved (n=5). In those with major (grade II) lesions (n=22), treatment was also conservative in the majority of cases (n=13). In eight cases, operative intervention was carried out as an elective, delayed kidney-saving procedure, enabling a good clinical stabilization of the patients and a thorough, conclusive radiological assessment before the operation.

SCAR-LENGTH REDUCTION BY RING-SHAPED EXPANSION.

Conventional tissue expansion with rectangular or round expanders often results in considerable dog-ear formation and, after resection, in lengthening of the final scar. The resulting scar is, always much longer than the maximal diameter of the skin lesion. These disadvantages are partially avoided by the use of croissant-shaped expanders. Taking the idea of the croissant-shaped expander and thinking further in terms of differential expansion, a new expander has been designed. It consists of a ring-shaped expander that is placed under the normal skin around the lesion. When the appropriate expansion is reached, the skin lesion is excised and the defect is closed with a running subcuticular suture, pulling as much skin as possible centripetally. The resulting scar is shorter than the maximal diameter of the skin lesion. The new expander has been tested in two patients in regions that are reputed for poor scar quality (the back and the upper arm). The results are encouraging.

The management of orbital trauma from the maxillofacial point of view

Trauma to the orbital region can consist of soft tissue lesions, fractures or a combination of both. the fractures can be isolated orbital fractures or part of Lefort III and II fractures. the aim of the treatment is functional and esthetic restoration. Our experience is based upon 759 patients with 944 fractured orbits. of these, 681 patients were operated. the indications, timing and technique of the operations are discussed. Solid reconstruction of the orbital frame with coverage of wall defects with autogenous bonegrafts is advocated. the soft tissue lesions must be repaired meticulously. Complications have been fairly rare.

Hämaturie bei schweren Kombinationstraumata

Bei Polytrauma und sicher bei stumpfen Bauchtraumen ist Hamaturie ein haufiger Befund. Der Grad dieser Hamaturie steht nicht im direkten Verhaltnis zu dem Ernst der unterliegenden Verletzung. Retrospektiv haben wir die Bedeutung der Hamaturie beim schweren Kombinationstrauma analysiert.