Traumatic brain injury and posttraumatic stress disorder: overlap in underlying substrates.

Abstract

To the Editor: We read with interest the article titled “Routine Follow-Up Imaging of Kidney Injuries May Not Be Justified” written by Bukur et al. and wish to comment respectfully on the use of nephrectomy verses renorrhaphy in this interesting report. In this series, there seems to be a 100% nephrectomy rate in patients with blunt trauma who underwent operative management. This included 5 out of 5 patients with highgrade injury and the only patient with low-grade blunt trauma who underwent surgery.1 This is interesting in the light of an overall greater tendency toward renal repair rather than removal in academic centers.2 In their series of 94 patients with grade III-IV blunt renal injury, Shirazi et al. had a 41% rate of operative management, 31 cases (75%) of which underwent nephrorrhaphy. This higher rate of renal repair can however partly be explained by lower overall grade of injury in this series.3 In addition, no comment was made about whether gunshot wounds were also included in the series. In our opinion, the 21% nephrectomy rate in grade I-III renal injuries was suggestive of possible presence of gunshot wounds. As a conclusion, although the overall trend is obviously toward less invasive measures,4 the mentioned comparison seems to support institutional tendencies toward various management protocols in this ever-evolving topic, a fact pointing to a need for further standardization.