Background: Isolated renal trauma in case of blunt trauma abdomen (BTA) is not common. Renal artery occlusion by thrombosis in such cases is seen very rarely. These cases had been traditionally treated by early nephrectomy, but nowadays, renal preservation is considered whenever possible. Treatment options to do so are being developed. Methods: Recently we came across one such case of isolated unilateral renal artery thrombosis (RAT) because of BTA. Relevant literature especially on various therapeutic techniques has been critically reviewed briefly along with case presentation. Results: Isolated blunt traumatic RAT has an incidence of less than 1%. Only about 400 cases have been reported. It must be diagnosed and treated as soon as possible to avoid progressive permanent loss of renal function. Contrast-enhanced CT scanning is the preferred modality for evaluation and follow-up of RAT. Conservative treatment is reserved for unilateral cases. For bilateral cases and when RAT occurs in a solitary kidney, revascularization either surgically or more preferably by less invasive percutaneous techniques has been recommended. Conclusion: Renal arterial thrombosis because of blunt abdominal trauma is still an underreported entity, treatment for which has not yet been established. Both early nephrectomy and delayed revascularization are not justified treatment options.
Background: Dysglycaemia in hospital inpatients is associated with harm. However, bedside capillary glucose monitoring often occurs with inadequate frequency, with inappropriate action taken when dysglycaemia occurs.Aims: To assess whether the introduction of a colour coded blood glucose monitoring chart had an impact on glycaemic control, documentation of action taken, length of stay and mortality in an unselected cohort of hospital inpatients.Methods: A cross-sectional study before (2014) and after (2017) the introduction of the new chart was undertaken. Data were collected for the 24 hours prior to inclusion in the study.Results: Data from 56 individuals were collected in 2014 and from 161 in 2017. 57% and 22% experienced dysglycaemia in 2014 and 2017, respectively. Action was taken in 24.2% of cases in 2014 and in 56.8% in 2017. Median length of stay was 16.1 days (IQR 8.4–39.4) in 2014 and 13.1 days (5.7–25.3) in 2017. For those who experienced dysglycaemia and in whom action was not recorded, mortality was 30% and 20% in 2014 and 2017 compared with 6% and 15%, respectively, for those who had no dysglycaemia.Conclusions: The introduction of a colour coded blood glucose monitoring chart led to more action being recorded when dysglycaemia occurred and reduced length of hospital stay and mortality.
Snodgrass introduced the concept of tubularized incised plate (TIP) urethroplasty repair with excellent short-term results and cosmesis almost replacing all other hypospadias repair and simplifying decision making. The ABSTRACT Background: To report short term results of Snodgrass tubularized incised plate (TIP) urethroplasty in distal penile hypospadias (DPH) repair. The complications and outcomes of the procedure are discussed. Methods: We reviewed the results of 30 cases of Snodgrass TIP urethroplasty for distal penile hypospadias (DPH) treated between November 2003 and April 2005 in paediatric patients. Observations were recorded to note the associated anomalies, cosmesis, complications and final outcome of the procedure. Results: The age of the study participants ranged from 2 to 12 years. About half (52%) of the cases presented early below 5 years of age and barely few (12%) reported late after 10 years of age. Meatal configuration, overall cosmesis and functional results were good in 26 cases (86%). Minor fistulas occurred in 5 cases whereas major fistula occurred in 2 cases (7%). Overall complications rate, requiring specific intervention was 2 cases (7%). Conclusions: In our experience, Snodgrass TIP urethroplasty is technically simple, easy to learn, single stage procedure with excellent functional and cosmetic outcomes for DPH. It has simplified the algorithm for distal penile hypospadias.
ObjectiveMyositis ossificans is a rare non-neoplastic form of heterotopic ossification most commonly described after trauma or surgery, in the diabetic foot.DesignWe provide a review of the literature including three illustrative cases.ParticipantsIndividuals presenting to the foot clinic.SettingSingle centre, tertiary multidisciplinary specialist diabetes foot clinic.ResultsWe review the literature surrounding Myositis ossificans, and describe three cases of Myositis ossificans following foot surgery in people with diabetes. All of the imaging was consistent with the descriptions of Myositis ossificans reported elsewhere in large muscle groups. These are the first reports of Myositis ossificans occurring in the feet of people with diabetes.ConclusionsMyositis ossificans has only very rarely been described in the foot and, as far as we are aware, never in people with diabetes. Given that the prevalence of diabetes is increasing, and the foot problems requiring surgery are also rising, we suggest that clinicians should be more aware of this condition because it may occur more frequently.
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