Browsing by Author "Kirkpatrick, Andrew W."
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Item Open Access 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy(2021-06-10) de’Angelis, Nicola; Catena, Fausto; Memeo, Riccardo; Coccolini, Federico; Martínez-Pérez, Aleix; Romeo, Oreste M.; De Simone, Belinda; Di Saverio, Salomone; Brustia, Raffaele; Rhaiem, Rami; Piardi, Tullio; Conticchio, Maria; Marchegiani, Francesco; Beghdadi, Nassiba; Abu-Zidan, Fikri M.; Alikhanov, Ruslan; Allard, Marc-Antoine; Allievi, Niccolò; Amaddeo, Giuliana; Ansaloni, Luca; Andersson, Roland; Andolfi, Enrico; Azfar, Mohammad; Bala, Miklosh; Benkabbou, Amine; Ben-Ishay, Offir; Bianchi, Giorgio; Biffl, Walter L.; Brunetti, Francesco; Carra, Maria C.; Casanova, Daniel; Celentano, Valerio; Ceresoli, Marco; Chiara, Osvaldo; Cimbanassi, Stefania; Bini, Roberto; Coimbra, Raul; Luigi de’Angelis, Gian; Decembrino, Francesco; De Palma, Andrea; de Reuver, Philip R.; Domingo, Carlos; Cotsoglou, Christian; Ferrero, Alessandro; Fraga, Gustavo P.; Gaiani, Federica; Gheza, Federico; Gurrado, Angela; Harrison, Ewen; Henriquez, Angel; Hofmeyr, Stefan; Iadarola, Roberta; Kashuk, Jeffry L.; Kianmanesh, Reza; Kirkpatrick, Andrew W.; Kluger, Yoram; Landi, Filippo; Langella, Serena; Lapointe, Real; Le Roy, Bertrand; Luciani, Alain; Machado, Fernando; Maggi, Umberto; Maier, Ronald V.; Mefire, Alain C.; Hiramatsu, Kazuhiro; Ordoñez, Carlos; Patrizi, Franca; Planells, Manuel; Peitzman, Andrew B.; Pekolj, Juan; Perdigao, Fabiano; Pereira, Bruno M.; Pessaux, Patrick; Pisano, Michele; Puyana, Juan C.; Rizoli, Sandro; Portigliotti, Luca; Romito, Raffaele; Sakakushev, Boris; Sanei, Behnam; Scatton, Olivier; Serradilla-Martin, Mario; Schneck, Anne-Sophie; Sissoko, Mohammed L.; Sobhani, Iradj; ten Broek, Richard P.; Testini, Mario; Valinas, Roberto; Veloudis, Giorgos; Vitali, Giulio C.; Weber, Dieter; Zorcolo, Luigi; Giuliante, Felice; Gavriilidis, Paschalis; Fuks, David; Sommacale, DanieleAbstract Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.Item Open Access 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery(2023-09-09) de’Angelis, Nicola; Schena, Carlo A.; Marchegiani, Francesco; Reitano, Elisa; De Simone, Belinda; Wong, Geoffrey Y. M.; Martínez-Pérez, Aleix; Abu-Zidan, Fikri M.; Agnoletti, Vanni; Aisoni, Filippo; Ammendola, Michele; Ansaloni, Luca; Bala, Miklosh; Biffl, Walter; Ceccarelli, Graziano; Ceresoli, Marco; Chiara, Osvaldo; Chiarugi, Massimo; Cimbanassi, Stefania; Coccolini, Federico; Coimbra, Raul; Di Saverio, Salomone; Diana, Michele; Dioguardi Burgio, Marco; Fraga, Gustavo; Gavriilidis, Paschalis; Gurrado, Angela; Inchingolo, Riccardo; Ingels, Alexandre; Ivatury, Rao; Kashuk, Jeffry L.; Khan, Jim; Kirkpatrick, Andrew W.; Kim, Fernando J.; Kluger, Yoram; Lakkis, Zaher; Leppäniemi, Ari; Maier, Ronald V.; Memeo, Riccardo; Moore, Ernest E.; Ordoñez, Carlos A.; Peitzman, Andrew B.; Pellino, Gianluca; Picetti, Edoardo; Pikoulis, Manos; Pisano, Michele; Podda, Mauro; Romeo, Oreste; Rosa, Fausto; Tan, Edward; Ten Broek, Richard P.; Testini, Mario; Tian Wei Cheng, Brian A.; Weber, Dieter; Sacco, Emilio; Sartelli, Massimo; Tonsi, Alfredo; Dal Moro, Fabrizio; Catena, FaustoAbstract Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.Item Open Access Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis(BioMed Central, 2014-01-04) Roberts, Derek J.; Leigh-Smith, Simon; Faris, Peter D.; Ball, Chad G.; Robertson, Helen Lee; Blackmore, Christopher; Dixon, Elijah; Kirkpatrick, Andrew W.; Kortbeek, John B.; Stelfox, Henry ThomasItem Open Access Correct the Coagulopathy and Scoop It Out: Complete Reversal of Anuric Renal Failure through the Operative Decompression of Extraperitoneal Hematoma-Induced Abdominal Compartment Syndrome(2012-12-17) McBeth, Paul B.; Dunham, Michael; Ball, Chad G.; Kirkpatrick, Andrew W.We report two cases of extraperitoneal compression of the intra-abdominal space resulting in abdominal compartment syndrome (ACS) with overt renal failure, which responded to operative decompression of the extra-peritoneal spaces. This discussion includes patient presentation, clinical course, diagnosis, interventions, and outcomes. Data was collected from the patient’s electronic medical record and a radiology database. ACS appears to be a rare but completely reversible complication of both retroperitoneal hematoma (RH) and rectus sheath hematoma (RSH). In patients with large RH or RSH consideration of intra-abdominal pressure (IAP) monitoring combined with aggressive operative drainage after correction of the coagulopathy should be considered. These two cases illustrate how a relatively benign pathology can result in increased IAP, organ failure, and ultimately ACS. Intervention with decompressive laparotomy and evacuation of clot resulted in return to normal physiologic function.Item Open Access Correction: Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health(2023-05-04) Kirkpatrick, Andrew W.; McKee, Jessica L.; Ball, Chad G.; Ma, Irene W. Y.; Melniker, Lawrence A.Item Open Access A decade of experience with injuries to the gallbladder(BioMed Central, 2010-04-15) Ball, Chad G.; Dixon, Elijah; Kirkpatrick, Andrew W.; Sutherland, Francis R; Laupland, Kevin B.; Feliciano, David VItem Open Access Does trauma team activation associate with the time to CT scan for those suspected of serious head injuries?(BioMed Central, 2013-11-18) Rados, Alma; Tiruta, Corina; Xiao, Zhengwen; Kortbeek, John B.; Tourigny, Paul; Ball, Chad G.; Kirkpatrick, Andrew W.Item Open Access Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)(2024-01-18) Picetti, Edoardo; Demetriades, Andreas K.; Catena, Fausto; Aarabi, Bizhan; Abu-Zidan, Fikri M.; Alves, Oscar L.; Ansaloni, Luca; Armonda, Rocco A.; Badenes, Rafael; Bala, Miklosh; Balogh, Zsolt J.; Barbanera, Andrea; Bertuccio, Alessandro; Biffl, Walter L.; Bouzat, Pierre; Buki, Andras; Castano-Leon, Ana M.; Cerasti, Davide; Citerio, Giuseppe; Coccolini, Federico; Coimbra, Raul; Coniglio, Carlo; Costa, Francesco; De Iure, Federico; Depreitere, Bart; Fainardi, Enrico; Fehlings, Michael J.; Gabrovsky, Nikolay; Godoy, Daniel A.; Gruen, Peter; Gupta, Deepak; Hawryluk, Gregory W. J.; Helbok, Raimund; Hossain, Iftakher; Hutchinson, Peter J.; Iaccarino, Corrado; Inaba, Kenji; Ivanov, Marcel; Kaprovoy, Stanislav; Kirkpatrick, Andrew W.; Klein, Sam; Kolias, Angelos; Konovalov, Nikolay A.; Lagares, Alfonso; Lippa, Laura; Loza-Gomez, Angelica; Luoto, Teemu M.; Maas, Andrew I. R.; Maciejczak, Andrzej; Maier, Ronald V.; Marklund, Niklas; Martin, Matthew J.; Melloni, Ilaria; Mendoza-Lattes, Sergio; Meyfroidt, Geert; Munari, Marina; Napolitano, Lena M.; Okonkwo, David O.; Otomo, Yasuhiro; Papadopoulos, Marios C.; Petr, Ondra; Peul, Wilco C.; Pudkrong, Aichholz K.; Qasim, Zaffer; Rasulo, Frank; Reizinho, Carla; Ringel, Florian; Rizoli, Sandro; Rostami, Elham; Rubiano, Andres M.; Russo, Emanuele; Sarwal, Aarti; Schwab, Jan M.; Servadei, Franco; Sharma, Deepak; Sharif, Salman; Shiban, Ehab; Shutter, Lori; Stahel, Philip F.; Taccone, Fabio S.; Terpolilli, Nicole A.; Thomé, Claudius; Toth, Peter; Tsitsopoulos, Parmenion P.; Udy, Andrew; Vaccaro, Alexander R.; Varon, Albert J.; Vavilala, Monica S.; Younsi, Alexander; Zackova, Monika; Zoerle, Tommaso; Robba, ChiaraAbstract Background The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. Methods A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. Results A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). Conclusions This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.Item Open Access Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health(2022-01-03) Kirkpatrick, Andrew W.; McKee, Jessica L.; Ball, Chad G.; Ma, Irene W. Y.; Melniker, Lawrence A.Abstract Background SARS-CoV-2 infection, manifesting as COVID-19 pneumonia, constitutes a global pandemic that is disrupting health-care systems. Most patients who are infected are asymptomatic/pauci-symptomatic can safely self-isolate at home. However, even previously healthy individuals can deteriorate rapidly with life-threatening respiratory failure characterized by disproportionate hypoxemic failure compared to symptoms. Ultrasound findings have been proposed as an early indicator of progression to severe disease. Furthermore, ultrasound is a safe imaging modality that can be performed by novice users remotely guided by experts. We thus examined the feasibility of utilizing common household informatic-technologies to facilitate self-performed lung ultrasound. Methods A lung ultrasound expert remotely mentored and guided participants to image their own chests with a hand-held ultrasound transducer. The results were evaluated in real time by the mentor, and independently scored by three independent experts [planned a priori]. The primary outcomes were feasibility in obtaining good-quality interpretable images from each anatomic location recommended for COVID-19 diagnosis. Results Twenty-seven adults volunteered. All could be guided to obtain images of the pleura of the 8 anterior and lateral lung zones (216/216 attempts). These images were rated as interpretable by the 3 experts in 99.8% (647/648) of reviews. Fully imaging one’s posterior region was harder; only 108/162 (66%) of image acquisitions was possible. Of these, 99.3% of images were interpretable in blinded evaluations. However, 52/54 (96%) of participants could image their lower posterior lung bases, where COVID-19 is most common, with 99.3% rated as interpretable. Conclusions Ultrasound-novice adults at risk for COVID-19 deterioration can be successfully mentored using freely available software and low-cost ultrasound devices to provide meaningful lung ultrasound surveillance of themselves that could potentially stratify asymptomatic/paucisymptomatic patients with early risk factors for serious disease. Further studies examining practical logistics should be conducted. Trial Registration: ID ISRCTN/77929274 on 07/03/2015.Item Open Access Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review(2021-03-11) Roberts, Derek J.; Bobrovitz, Niklas; Zygun, David A.; Kirkpatrick, Andrew W.; Ball, Chad G.; Faris, Peter D.; Stelfox, Henry T.Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.Item Open Access High Mobility Group Box-1 Protein and Outcomes in Critically Ill Surgical Patients Requiring Open Abdominal Management(2017-02-14) Malig, Michelle S.; Jenne, Craig N.; Ball, Chad G.; Roberts, Derek J.; Xiao, Zhengwen; Kirkpatrick, Andrew W.Background. Previous studies assessing various cytokines in the critically ill/injured have been uninformative in terms of translating to clinical care management. Animal abdominal sepsis work suggests that enhanced intraperitoneal (IP) clearance of Damage-Associated Molecular Patterns (DAMPs) improves outcome. Thus measuring the responses of DAMPs offers alternate potential insights and a representative DAMP, High Mobility Group Box-1 protein (HMGB-1), was considered. While IP biomediators are being recognized in critical illness/trauma, HMGB-1 behaviour has not been examined in open abdomen (OA) management. Methods. A modified protocol for HMGB-1 detection was used to examine plasma/IP fluid samples from 44 critically ill/injured OA patients enrolled in a randomized controlled trial comparing two negative pressure peritoneal therapies (NPPT): Active NPPT (ANPPT) and Barker’s Vacuum Pack NPPT (BVP). Samples were collected and analyzed at the time of laparotomy and at 24 and 48 hours after. Results. There were no statistically significant differences in survivor versus nonsurvivor HMGB-1 plasma or IP concentrations at baseline, 24 hours, or 48 hours. However, plasma HMGB-1 levels tended to increase continuously in the BVP cohort. Conclusions. HMGB-1 appeared to behave differently between NPPT cohorts. Further studies are needed to elucidate the relationship of HMGB-1 and outcomes in septic/injured patients.Item Open Access Hospital mortality among major trauma victims admitted on weekends and evenings: a cohort study(BioMed Central, 2009-07-27) Laupland, Kevin B.; Ball, Chad G.; Kirkpatrick, Andrew W.Item Open Access Intensive care unit-acquired urinary tract infections in a regional critical care system(BioMed Central, 2005-01) Laupland, Kevin B.; Bagshaw, S. M.; Gregson, D. B .; Kirkpatrick, Andrew W.; Ross, T.; Church, D. L.Item Open Access Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery(2024-06-08) Sartelli, Massimo; Barie, Philip; Agnoletti, Vanni; Al-Hasan, Majdi N.; Ansaloni, Luca; Biffl, Walter; Buonomo, Luis; Blot, Stijn; Cheadle, William G.; Coimbra, Raul; De Simone, Belinda; Duane, Therese M.; Fugazzola, Paola; Giamarellou, Helen; Hardcastle, Timothy C.; Hecker, Andreas; Inaba, Kenji; Kirkpatrick, Andrew W.; Labricciosa, Francesco M.; Leone, Marc; Martin-Loeches, Ignacio; Maier, Ronald V.; Marwah, Sanjay; Maves, Ryan C.; Mingoli, Andrea; Montravers, Philippe; Ordóñez, Carlos A.; Palmieri, Miriam; Podda, Mauro; Rello, Jordi; Sawyer, Robert G.; Sganga, Gabriele; Tattevin, Pierre; Thapaliya, Dipendra; Tessier, Jeffrey; Tolonen, Matti; Ulrych, Jan; Vallicelli, Carlo; Watkins, Richard R.; Catena, Fausto; Coccolini, FedericoAbstract Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient’s clinical condition, and the host’s immune status should be assessed continuously to optimize the management of patients with complicated IAIs.Item Open Access Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review(Springer Open, 2012-07-05) Chun, Rosaleen; Kirkpatrick, Andrew W.Item Open Access Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression(2021-05-30) Kirkpatrick, Andrew W.; McKee, Jessica L.; Conly, John M.Abstract COVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.Item Open Access Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill(BioMed Central, 2009-06-12) Khosravani, Houman; Shahpori, Reza; Stelfox, H Thomas; Kirkpatrick, Andrew W.; Laupland, Kevin B.Item Open Access Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota’s fascia(2022-06-20) Clements, Thomas W.; Ball, Chad G.; Nicol, Andrew J.; Edu, Sorin; Kirkpatrick, Andrew W.; Navsaria, PradeepAbstract Background Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds. Methods A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate. Results A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8–99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. Conclusions NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.Item Open Access Percutaneous bladder catheterization in microgravity(Canadian Journal of Urology, 2007-04) Jones, Jeffrey A.; Kirkpatrick, Andrew W.; Hamilton, Douglas R.; Sargsyan, Ashot E.; Campbell, Mark; Melton, Shannon; Barr, Yael R.; Dulchavsky, Scott A.Item Open Access 'Progression towards the minimum': the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures(BioMed Central, 2006-07) Ball, Chad G; Kirkpatrick, Andrew W.