Need For Exploration In Patients Research Articles

Analysis of the Characteristics of Ovarian Tumors

Ovarian tumor is a condition where the ovaries experience abnormal growth, disrupting their function as the site for follicles and the production and secretion of estrogen and progesterone, which regulate the menstrual process and women's hormones. This makes ovarian tumors highly dangerous. The purpose of this research is to understand the characteristics of ovarian tumor disease. This study is qualitative descriptive research using the literature study method through a review of literature from previous research journals. The results of this research explain that there are three types of ovarian tumors: benign tumors, borderline tumors, and malignant tumors. These tumors can develop into cancer in advanced stages, spreading to other organs, and their growth often goes unnoticed, earning them the nickname "silent killer." The characteristics of each tumor stage differ, emphasizing the need for exploration in patients affected by ovarian tumors. Based on the conducted research, it is recommended that further studies be conducted on the clinicopathological characteristics of ovarian tumors.

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

We determined which children sustaining blunt grade IV renal trauma are at greatest risk for failing nonoperative management and in what time frame they will likely present. We retrospectively reviewed children presenting with nonvascular grade IV blunt renal trauma between 2003 and 2012. We compared characteristics on computerized tomography, reasons for intervention, type and timing of surgery, length of hospital stay and need for readmission between children undergoing early intervention (less than 72 hours after admission) and those managed conservatively (with any subsequent intervention undertaken more than 72 hours after admission). A total of 26 children were identified with nonvascular grade IV blunt renal trauma. Conservative management was attempted in 16 cases (62%). Seven of these patients (44%) required intervention (ureteral stent and/or percutaneous drain placement), with a mean time to intervention of 11 days. Collecting system clot and larger urinoma (1.45 cm in cases with successful and 4.29 cm in those with failed conservative management) significantly predicted failure of conservative management (p<0.05). Presence of dissociated renal fragments (57% vs 11%) and interpolar contrast extravasation (57% vs 0%) were increased in the early intervention group compared to the conservatively managed group (p>0.05), as was rehospitalization (43% vs 0%), mean length of stay (7.9 vs 5.4 days) and transfusion (14% vs 0%, p>0.05). Collecting system hematoma and urinoma size significantly predicted failure of conservative management, with a mean time to intervention of 11 days. Children with failed conservative management had a greater incidence of dissociated renal fragments and interpolar extravasation. Early identification of these patients may decrease hospital readmissions, length of stay and prolonged morbidity.

Operative Management of Wartime Genitourinary Injuries at Balad Air Force Theater Hospital, 2005 to 2008

We detail the 3-year experience of operative combat urology of genitourinary surgeons stationed at Balad Air Force Theater Hospital, Balad, Iraq. We performed an institutional review board approved, retrospective review of operative logs of the 9 urologists deployed to Balad Air Force Theater Hospital from June, 1 2005 to June 1, 2008. All operative cases performed by the urologists deployed to this facility were reviewed. Patients were grouped by injury location and operative approach. Analysis included the calculation of relative injury rates by location and the incidence of organ preservation. During the 36 months reviewed 273 patients underwent a total of 361 operative and 25 endoscopic procedures for 1 or more genitourinary injuries. Of the patients 227 (83.1%) had wounds to the lower genitourinary tract, 39 (14.3%) had wounds to the upper genitourinary tract and 7 (2.6%) had upper and lower genitourinary injuries. Exploration, débridement and repair of soft tissue injury to the external genitalia were the most commonly performed procedures. Of the 88 testicular injuries explored testicular salvage was achieved in 45 (51.1%). Nephrectomy was required in 17 of the 27 operative renal injury cases (63.0%). Most genitourinary injuries treated at Balad Air Force Theater Hospital involve the lower genitourinary tract. The high frequency of genital trauma often requires staged reconstructive procedures. Acceptable renal and testicular salvage rates are attainable. This study highlights the diverse array of surgical treatment modalities needed to manage genitourinary trauma during Operation Iraqi Freedom.

Development of a Highly Accurate Nomogram for Prediction of the Need for Exploration in Patients With Renal Trauma

To develop and validate a nomogram for predicting the need for renal exploration after renal trauma. From 1995 through 2004, 419 consecutive patients presented to our institution with traumatic renal injury. All were randomly divided into a development (50%, n = 210) and a split sample validation cohort (50%, n = 209). Logistic regression models were used to develop a nomogram for prediction of the need for renal exploration after renal trauma. Internal (200 bootstrap resamples) and 50% split sample validations were performed. Overall, 89 patients (21.2%) underwent renal exploration, from which 60.7% (54 of 89) underwent nephrectomy and 39.3% (35 of 89) underwent renorrhaphy. Nine percent of patients with grade II injury underwent renal exploration, 16% with grade III injuries, 41% with grade IV injuries, and 100% of grade V injuries. The kidney injury scale, the mechanism of injury, the need for transfusion, blood urea nitrogen level, and serum creatinine represented the most informative predictors and were included in the nomogram. The split sample accuracy of the nomogram for prediction of the need for renal exploration was 96.9%. It significantly (p < 0.001) exceeded the accuracy of each of its components including the American Association for the Surgery of Trauma kidney injury scale (87.7%). The nomogram generates highly accurate and reproducible predictions of the probability for renal exploration according to our decision-making. It could help standardize the management of patients with renal trauma (i.e., inclusion criteria for clinical trials) and serves as a proof-of-principle that predictive tools can be applied to the trauma setting. Its use may improve the management of renal trauma patients at institutions with limited trauma experience.

21: Development of a Highly Accurate Nomogram for Prediction of the Need for Exploration in Patients with Renal Trauma

21: Development of a Highly Accurate Nomogram for Prediction of the Need for Exploration in Patients with Renal Trauma

Perilymphatic Fistula and Its Interest to Audiologists

Forty-one patients who had sudden hearing loss associated with spontaneous perilymphatic fistllas were reviewed in this investigation. A history of physical exertion or an upper respiratory infection prior to the onset of hearing loss strongly suggests the presence of spontaneous perilymphatic fistula. However, absence of such a history does not necessarily preclude the possibility of membrane rupture. A great variation in audiologic and vestibular findings was observed. Tinnitus was present for most patients and vertigo or disequilibrium was reported by some. Findings support the need for surgical exploration in patients with sudden hearing loss when a perilymphatic fistula is suspected. Postoperative success in restoring hearing function in cases with perilymphatic fistula is good if the fistula is closed within two weeks after the initial insult. Delay in closure of such fistulas can cause irreversible loss of hearing.

Abdominal involvement at the onset of Hodgkin's disease

One hundred consecutive staging laparotomies were performed in untreated patients with Hodgkin's disease without an operative death. Abdominal involvement was documented in each of 16 patients with grossly positive lymphangiograms (clinical stage III). In patients with negative lymphangiograms, 12 of 50 (24 per cent) without symptoms (clinical stages I and IIA) and 16 of 34 (47 per cent) with symptoms (clinical stages I and IIB) were found to have abdominal disease. Of the 44 patients with abdominal involvement, in 15 disease was identified only in the spleen and celiac nodes; in 19 the spleen and paraaortic nodes were involved; and in 5 disease was present in the liver, spleen and paraaortic nodes. In only two patients was abdominal Hodgkin's disease restricted to the paraaortic nodes, but in an additional patient involvement was limited to the paraaortic and celiac nodes. One patient had disease in the liver and a common duct node, and another patient had disease in the liver, celiac and paraaortic nodes. Except for a few patients in whom the disease presented in the mediastinum or groin, or with lymphocyte predominance histology, patients with an insignificant risk of abdominal Hodgkin's disease could not be identified preoperatively. Neither site of presentation (neck versus axilla, or the right versus the left side of the neck), spleen size, alkaline phosphatase level nor histologic subtype (nodular sclerosis versus mixed cellularity) accurately predicted abdominal disease. Patients with clinical stage I or II Hodgkin's disease must either be explored, or treated for abdominal involvement; the need for exploration in patients with clinical stage III disease depends on the treatment plan.