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Ruptured Adrenocortical Carcinoma as a Cause of Paediatric Acute Abdomen
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TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE Ruptured Adrenocortical Carcinoma as a Cause of Paediatric Acute Abdomen L. Y. J. LEUNG, W. Y. LEUNG, K. F. CHAN, T. W. FAN, K. W. CHUNG AND C. H. S. CHAN, Departments of Radiology and Imaging, and Surgery, Queen Elizabeth Hospital, Hong Kong, China Pediatr Surg Int, 18: 730 –732, 2002 Permission to Publish Abstract Not Granted Editorial Comment: This is a report on a 5-year-old overweight boy who had an adrenocortical carcinoma that ruptured. The patient underwent exploratory laparotomy, during which free blood was found in the peritoneal cavity. Although this is the first known report of such an occurrence in a child, a ruptured kidney and/or adrenal in the adult, although rare, is not unheard of. The usual cause is carcinoma, followed by collagen vascular disease. In the past tuberculosis was the cause. W. Scott McDougal, M.D.
TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION Functional Outcome of Nonoperatively Managed Renal Injuries in Children M. S. KELLER, C. E. COLN, J. J. GARZA, K. H. SARTORELLI, M. C. GREEN AND T. R. WEBER, Departments of Surgery, Cardinal Glennon Children’s Hospital, St. Louis, Missouri, and Fletcher Allen Health Care, Burlington, Vermont J Trauma, 57: 108 –110, 2004 Background: This study aimed to define better the functional outcome of nonoperatively managed renal injuries in children. Methods: All children who had blunt renal trauma managed nonoperatively were reviewed for injury grade, blood urea nitrogen (BUN), creatinine, blood pressure, and percentage of function according to technetium-99m-dimercaptosuccinic acid renal scan after complete healing. Results: Over a 2-year period, 17 children (mean age, 10.4 years) were managed conservatively for their renal injuries. There were two grade 2, two grade 3, nine grade 4, and four grade 5 injuries. Complete healing was documented in all cases within 3 months after injury. Renal scarring and volume loss were evident for all healed high-grade injuries (grades 4 to 5) at follow-up imaging. Technetium-99mdimercaptosuccinic acid scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (44.7 ⫾ 8.4% function for grades 2 and 3, 41.8 ⫾ 9.2% for grade 4 vs 29.5 ⫾ 7.9% for grade 5). Only two children (22%), however, with grade 4 injury had severe compromise of function (⬍30%). At the follow-up visit, all the children were asymptomatic and normotensive. None had abnormal BUN or creatinine (mean BUN, 10.5 ⫾ 5.1 mg/dL; mean creatinine, 0.6 ⫾ 0.2 mg/dL). Conclusions: The functional outcome for children with nonoperatively managed kidney injuries is good and correlates with injury grade. Children with grades 2 to 4 injuries managed conservatively retain near normal function. Those with grade 5 injuries have a loss of function attributable to scarring and parenchymal volume loss. Long-term follow-up evaluation of these children may be warranted. Editorial Comment: While nonoperative management of blunt renal injuries is now accepted as the standard of care in most instances, few studies provide quantitative functional data by which to assess outcomes. In this series, 99mtechnetium dimercapto-succinic acid renal scanning was performed in children who had recovered from blunt renal trauma. Among 13 children with high grade injuries (grade 4 or 5) only 4 (31%) had “severe impairment” (less than 30% contribution) even though most had more than 50% of the renal parenchymal mass nonperfused on admission computerized tomography. No patient had development of hypertension. This is strong evidence that conservative treatment of renal injuries in children usually leads to good functional results. Allen F. Morey, M.D.
TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION
ADRENAL AND RENAL PHYSIOLOGY, AND MEDICAL RENAL DISEASE Ruptured Adrenocortical Carcinoma as a Cause of Paediatric Acute Abdomen L. Y. J. LEUNG, W. Y. LEUNG, K. F. CHAN, T. W. FAN, K. W. CHUNG AND C. H. S. CHAN, Departments of Radiology and Imaging, and Surgery, Queen Elizabeth Hospital, Hong Kong, China Pediatr Surg Int, 18: 730 –732, 2002 Permission to Publish Abstract Not Granted Editorial Comment: This is a report on a 5-year-old overweight boy who had an adrenocortical carcinoma that ruptured. The patient underwent exploratory laparotomy, during which free blood was found in the peritoneal cavity. Although this is the first known report of such an occurrence in a child, a ruptured kidney and/or adrenal in the adult, although rare, is not unheard of. The usual cause is carcinoma, followed by collagen vascular disease. In the past tuberculosis was the cause. W. Scott McDougal, M.D.
TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION Functional Outcome of Nonoperatively Managed Renal Injuries in Children M. S. KELLER, C. E. COLN, J. J. GARZA, K. H. SARTORELLI, M. C. GREEN AND T. R. WEBER, Departments of Surgery, Cardinal Glennon Children’s Hospital, St. Louis, Missouri, and Fletcher Allen Health Care, Burlington, Vermont J Trauma, 57: 108 –110, 2004 Background: This study aimed to define better the functional outcome of nonoperatively managed renal injuries in children. Methods: All children who had blunt renal trauma managed nonoperatively were reviewed for injury grade, blood urea nitrogen (BUN), creatinine, blood pressure, and percentage of function according to technetium-99m-dimercaptosuccinic acid renal scan after complete healing. Results: Over a 2-year period, 17 children (mean age, 10.4 years) were managed conservatively for their renal injuries. There were two grade 2, two grade 3, nine grade 4, and four grade 5 injuries. Complete healing was documented in all cases within 3 months after injury. Renal scarring and volume loss were evident for all healed high-grade injuries (grades 4 to 5) at follow-up imaging. Technetium-99mdimercaptosuccinic acid scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (44.7 ⫾ 8.4% function for grades 2 and 3, 41.8 ⫾ 9.2% for grade 4 vs 29.5 ⫾ 7.9% for grade 5). Only two children (22%), however, with grade 4 injury had severe compromise of function (⬍30%). At the follow-up visit, all the children were asymptomatic and normotensive. None had abnormal BUN or creatinine (mean BUN, 10.5 ⫾ 5.1 mg/dL; mean creatinine, 0.6 ⫾ 0.2 mg/dL). Conclusions: The functional outcome for children with nonoperatively managed kidney injuries is good and correlates with injury grade. Children with grades 2 to 4 injuries managed conservatively retain near normal function. Those with grade 5 injuries have a loss of function attributable to scarring and parenchymal volume loss. Long-term follow-up evaluation of these children may be warranted. Editorial Comment: While nonoperative management of blunt renal injuries is now accepted as the standard of care in most instances, few studies provide quantitative functional data by which to assess outcomes. In this series, 99mtechnetium dimercapto-succinic acid renal scanning was performed in children who had recovered from blunt renal trauma. Among 13 children with high grade injuries (grade 4 or 5) only 4 (31%) had “severe impairment” (less than 30% contribution) even though most had more than 50% of the renal parenchymal mass nonperfused on admission computerized tomography. No patient had development of hypertension. This is strong evidence that conservative treatment of renal injuries in children usually leads to good functional results. Allen F. Morey, M.D.