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Wed, 2 Apr 2003 17:27:20 -0300

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Thanks for the comments. In fact, a Foley catheter was inserted and bed rest
recommended. The urine became clear after five days. No creatinine elevation
or hematocrit drop was observed and the pain improved progressively. No sign
of peritonitis. The patient was discharged on the 7th post trauma day. He's
being followed ambulatorialy (15 days post trauma) and is doing quite well.
As Dr. Fry mentioned, there's no data concerning the control CT. Provided
the patient is doing well, with no sign of complications, do you think
there's need to order a CT at all? Isn't it enough clinical follow-up?

Pedro Gustavo R. Teixeira
General Surgery
Trauma Surgery

Minas Gerais, Brazil
  -----Mensagem original-----
  De: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]Em
nome de meredith mcbride
  Enviada em: terca-feira, 1 de abril de 2003 21:56
  Para: trauma-list@trauma.org
  Assunto: Re: Renal Trauma

  Foley cath, bedrest until urine becomes clear. Follow Hb, exam, serum
creatinine. Low elevation in creatinine can indicate urinoma or unilateral
loss of kidney function.

  Consider IVP to confirm patent ureter (blood clot common). Urine
extravasation often responsive to stenting, drainage.

   DocRickFry@aol.com wrote:

    In a message dated 4/1/2003 4:19:15 PM Eastern Standard Time,
pedrogrt@uol.com.br writes:

      irritation sign. He spontaneously urinated (frank hematuria). An
abdominal
      CT was ordered and showed a right kidney augmented in size and with a
slow
      captation of contrast. There was no sign of parenquimal disruption or
      extravasation of contrast. Excretion was slow but present. The CT also
      showed blood clots inside the bladder and right renal pelvis. Left
kindey
      normal on CT.

      What next? Angiogram? Observe?

      When are we supposed to order a control CT (early and late)?

    Observe--operate if becomes unstable or peritonitis develops.  Repeat
abdominal CT at some point in the near future (the last not based on any
data--just would like to confirm no worsening )
    ERF

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<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =
size=3D2>Thanks=20
for the comments. In fact, a Foley catheter was inserted and bed rest=20
recommended. The urine became clear after five days. No creatinine =
elevation or=20
hematocrit drop was observed and the pain improved progressively. No =
sign of=20
peritonitis. The patient was discharged on the 7th post trauma day. He's =
being=20
followed ambulatorialy (15 days post trauma) and is doing quite well. As =
Dr. Fry=20
mentioned, there's no data concerning the control CT. Provided the =
patient is=20
doing well, with no sign of complications, do you think there's need to =
order a=20
CT at all? Isn't it enough clinical follow-up?</FONT></SPAN></DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =

size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =
size=3D2>Pedro=20
Gustavo R. Teixeira</FONT></SPAN></DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =

size=3D2>General Surgery</FONT></SPAN></DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =
size=3D2>Trauma=20
Surgery</FONT></SPAN></DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =

size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D130131620-02042003><FONT face=3DArial color=3D#0000ff =
size=3D2>Minas=20
Gerais, Brazil</FONT></SPAN></DIV>
<BLOCKQUOTE>
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Mensagem original-----<BR><B>De:</B> =
trauma-list-admin@trauma.org=20
  [mailto:trauma-list-admin@trauma.org]<B>Em nome de </B>meredith=20
  mcbride<BR><B>Enviada em:</B> ter&ccedil;a-feira, 1 de abril de 2003=20
  21:56<BR><B>Para:</B> trauma-list@trauma.org<BR><B>Assunto:</B> Re: =
Renal=20
  Trauma<BR><BR></FONT></DIV>
  <P>Foley cath, bedrest until urine becomes clear. Follow Hb, exam, =
serum=20
  creatinine. Low elevation&nbsp;in creatinine can&nbsp;indicate urinoma =
or=20
  unilateral loss of kidney function.=20
  <P>Consider IVP to confirm patent ureter (blood clot common). Urine=20
  extravasation often responsive to stenting, drainage.=20
  <P>&nbsp;<B><I>DocRickFry@aol.com</I></B> wrote:=20
  <BLOCKQUOTE=20
  style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px =
solid"><FONT=20
    face=3Darial,helvetica><FONT size=3D2>In a message dated 4/1/2003 =
4:19:15 PM=20
    Eastern Standard Time, pedrogrt@uol.com.br writes: <BR><BR><BR>
    <BLOCKQUOTE=20
    style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff =
2px solid; MARGIN-RIGHT: 0px"=20
    TYPE=3D"CITE">irritation sign. He spontaneously urinated (frank =
hematuria).=20
      An abdominal <BR>CT was ordered and showed a right kidney =
augmented in=20
      size and with a slow <BR>captation of contrast. There was no sign =
of=20
      parenquimal disruption or <BR>extravasation of contrast. Excretion =
was=20
      slow but present. The CT also <BR>showed blood clots inside the =
bladder=20
      and right renal pelvis. Left kindey <BR>normal on CT. <BR><BR>What =
next?=20
      Angiogram? Observe? <BR><BR>When are we supposed to order a =
control CT=20
      (early and late)? <BR><BR></FONT><FONT lang=3D0 face=3DArial =
color=3D#000000=20
      size=3D3 FAMILY=3D"SANSSERIF"></BLOCKQUOTE><BR></FONT><FONT =
lang=3D0 face=3DArial=20
    color=3D#000000 size=3D2 FAMILY=3D"SANSSERIF"><BR>Observe--operate =
if becomes=20
    unstable or peritonitis develops. &nbsp;Repeat abdominal CT at some =
point in=20
    the near future (the last not based on any data--just would like to =
confirm=20
    no worsening ) <BR>ERF</FONT> </BLOCKQUOTE></FONT>
  <P><BR>
  <HR SIZE=3D1>
  Do you Yahoo!?<BR><A=20
  =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/3D"http://us.rd.yahoo.com/finance/mailsig/*http://tax.yahoo.com">Yah=
oo! Tax=20
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