Fernando Turégano Fuentes - Academia.edu (original) (raw)

Papers by Fernando Turégano Fuentes

Research paper thumbnail of Personal Protection Equipment and Emergency Surgery during the COVID-19 Pandemic in Spain

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2020

Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, an... more Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, and in January 2020, the first case was diagnosed in Spain. In April, Spain had reported more than 200,000 cases, 38,000 of which were health workers, representing more than 16% of the volume of contagion in the general population. The objective of our study was to determine the availability, characteristics of use, and the need for improvisation of personal protective equipment (PPE) during the first wave of the COVID-19 pandemic in Spain. Materials and methods: An online, anonymous, prospective survey was carried out from April 2 to 15 by an e-mail invitation to 562 of the Trauma and Emergency Surgery sections of the Spanish Association of Surgeons. The survey collected demographic data, the region of clinical practice, patterns of PPE use in emergency surgeries, and the improvisation of equipment. Results: Total 58 health workers from 12 communities completed the survey, 95% surgeons. Total 28% received training with PPE during the pandemic, and 44% rated it as insufficient. The PPE used in surgery were double glove (74%), face shield (72%), surgical glasses (67%), waterproof gown (67%), and boot covers (32%). Lack of N95/FPP2/3 was reported by 82% and other elements of PPE by 68%. More than half of the respondents (51%) improvised PPE. Conclusion: The results reflect a low degree of training on PPE use before and during the first wave of the pandemic, the lack of PPE, especially masks, and the need to use nonapproved material as a protection mechanism.

Research paper thumbnail of Sutura laparoscópica frente a sutura por laparotomía en úlceras gastroduodenales perforadas

Revista chilena de cirugía, 2018

Laparoscopic suture facing laparotomy suture in perforated gastroduodenal ulcers Introduction: Ga... more Laparoscopic suture facing laparotomy suture in perforated gastroduodenal ulcers Introduction: Gastroduodenal perforation continues to be a relatively frequent surgical emergency, despite advances in the medical treatment of ulcer disease. Its laparoscopic approach has been increasing in the last years, although it has not been generalized. Objective: Was to analyze the postoperative results in patients with perforated ulcer treated with laparoscopic suture, and to compare them with a similar group with laparotomy suture. Our hypothesis was that laparoscopic suture is a safe option and with less morbidity than the laparotomy approach. Material and Methods: Comparative retrospective analysis of two patient cohorts: one treated with laparoscopic suture during 2014 and 2015, a period in which this approach was fully implanted in the emergency room in our hospital, and another comparable group treated by suture for open surgery during the period 2001-2003. Complications were analyzed according to Clavien-Dindo classification, conversion rate, mean stay and mortality. Results: The groups were comparable in age, sex, comorbidities and anesthetic risk. There was a trend towards superiority in favor of the laparoscopic approach in certain variables analyzed, with a conversion rate of 3%. The presence of early postoperative complications was greater in the laparotomy suture group: post-surgical septic shock (15.2% vs 6%) and wound infection (15.2% vs 3%), as well as medical complications, although not significantly. The group with laparoscopic suture had a longer surgical time, lower mean stay and lower mortality. Conclusion: The laparoscopic suture of the gastroduodenal ulcer in our center has had a very low conversion rate and a somewhat lower morbidity to the laparotomy suture, with a lower rate of reinterventions and a mean stay, despite a longer surgical time.

Research paper thumbnail of Dolor lumbar como manifestación de un tumor intra-abdominal desmoplásico de células pequeñas y redondas

Revista Portuguesa De Pneumologia, Jul 1, 2010

... tumor intra-abdominal desmoplásico de células pequeñas y redondas Camarero-Mulas C,1 Andrés G... more ... tumor intra-abdominal desmoplásico de células pequeñas y redondas Camarero-Mulas C,1 Andrés García-Marín A,1 Sánchez-Rodríguez T,1 Vaquero-Rodríguez A,1 Fábregues-Olea A,1 Pino-Jiménez A,2 Turégano-Fuentes F3 Correspondencia: Dra. Celia Camarero Mulas. ...

Research paper thumbnail of Stomach and Duodenum

Describe the most frequent emergency surgery situations involving the stomach and duodenum (perfo... more Describe the most frequent emergency surgery situations involving the stomach and duodenum (perforated and bleeding gastroduodenal ulcer disease)

Research paper thumbnail of Leading Symptoms and Signs

Categorize different abdominal clinical conditions in relation to the characteristics of the pain... more Categorize different abdominal clinical conditions in relation to the characteristics of the pain and the presence or absence of tenderness

Research paper thumbnail of The Acute Care Surgery Model in the World, and the Need for and Implementation of Trauma and Emergency Surgery Units in Spain

Cirugía Española (english Edition), 2019

Abstract The Acute Care Surgery model groups trauma and emergency surgery with surgical critical ... more Abstract The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country.

Research paper thumbnail of Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos

Cirugia Espanola, Oct 1, 2020

c i r e s p. 2 0 1 9 ; x x (x x) : x x x-x x x * Autor para correspondencia.

Research paper thumbnail of Survival after prehospital advanced life support in severe trauma

European Journal of Emergency Medicine, Dec 1, 1995

Research paper thumbnail of Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion

European Journal of Trauma and Emergency Surgery, Dec 9, 2015

Conclusions Patients with TMP were more severely injured and more often needed surgery, ICU hospi... more Conclusions Patients with TMP were more severely injured and more often needed surgery, ICU hospitalization and need for transfer to a level I trauma center. The observation that all those who died in hospital and most of those who were unstable were not examined by the ENT services suggests that impact of TMP as an indicator of severity may be underestimated.

Research paper thumbnail of Hemorragia digestiva baja secundaria a tumor del estroma gastrointestinal rectal

Revista Portuguesa De Pneumologia, 2010

Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but ... more Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but represent only 1 to3% of all GI tract neoplasms. We report an uncommon case of stromal rectal tumor because of its atypical location.

Research paper thumbnail of Resección local y radiofrecuencia en hemangioendotelioma epitelioide hepático

Revista Portuguesa De Pneumologia, 2010

1Martin-Gil J, 1 Nofuentes-Riera C, 1* Vaquero-Rodriguez A, 1 Sanz-Sanchez M, 2 Turegano-Fuentes F 3

Research paper thumbnail of Percutaneous Interventions

Emergency Surgery Course (ESC®) Manual, 2016

Research paper thumbnail of Giant abdominal recurrent liposarcoma with multiple histological types

Revista Española de Enfermedades Digestivas, 2010

Research paper thumbnail of Invaginación intestinal en el adulto. Una causa infrecuente de obstrucción mecánica

Revista de Gastroenterología de México, 2012

Research paper thumbnail of Dolor abdominal agudo secundario a endometrioma ovárico roto con elevación de CA 125 y CA 19–9

Clínica e Investigación en Ginecología y Obstetricia, 2011

Resumen Una mujer de 47 años fue atendida en el servicio de urgencias por dolor abdominal de 72 h... more Resumen Una mujer de 47 años fue atendida en el servicio de urgencias por dolor abdominal de 72 h de evolución con una elevación de los niveles plasmáticos de leucocitos, CA 19-9 y CA 125. La paciente fue intervenida encontrando un endometrioma roto en el ovario izquierdo. Los altos niveles de ambos marcadores tumorales nos obligaron a descartar una neoplasia de ovario en este caso.

Research paper thumbnail of Pitfalls to avoid in the medical management of mass casualty incidents following terrorist bombings: the hospital perspective

European Journal of Trauma and Emergency Surgery, 2014

Background The unique patterns of injury following explosions together with the involvement of nu... more Background The unique patterns of injury following explosions together with the involvement of numerous physicians, most of whom are not experienced in trauma, may create problems in the medical management of mass casualty incidents. Methods Four hundred patient files admitted in 19 mass casualty events following bombing incidents were reviewed and possible areas which could impact survival were defined. Results Forty-nine (9.3 %) patients had an Injury Severity Score C16. Of 205 patients in whom triage decisions were available, 5 of 25 severely injured patients were undertriaged by the triage officers at the door of the hospital. Following primary evaluation inside the emergency department critical injuries in two patients were missed due to distracting, less serious injuries. Of 68 (16.1 %) patients who were operated, 28 were in need of either immediate, urgent or high-priority operations. Except for neurosurgical cases which needed to be transferred to other hospitals, there was no delay in surgery. One patient underwent negative laparotomy. There were 15 in-hospital deaths, 6 of which were deemed as either anticipated or unanticipated mortality with possibility for improvement. Conclusion Medical management should be evaluated following MCIs as this may illustrate possible problems which many need to be addressed in contingency planning.

Research paper thumbnail of Abdominal blast injuries: different patterns, severity, management, and prognosis according to the main mechanism of injury

European Journal of Trauma and Emergency Surgery, 2014

Purpose To review the frequency, different patterns, anatomic severity, management, and prognosis... more Purpose To review the frequency, different patterns, anatomic severity, management, and prognosis of abdominal injuries in survivors of explosions, according to the main mechanism of injury. Methods A MEDLINE search was conducted from January 1982 to August 2013, including the following MeSH terms: blast injuries, abdominal injuries. EMBASE was also searched, with the same entries. Abdominal blast injuries (ABIs) have been defined as injuries resulting not only from the effects of the overpressure on abdominal organs, but also from the multimechanistic effects and projectile fragments resulting from the blast. Special emphasis was placed on the detailed assessment of ABIs in patients admitted to GMUGH (Gregorio Marañón University General Hospital) after the Madrid 2004 terrorist bombings, and in patients admitted to HYMC (Hillel Yaffe Medical Centre) in Hadera (Israel) following several bombing episodes. The anatomic severity of injuries was assessed by the abdominal component of the AIS, and the overall anatomic severity of casualties was assessed by means of the NISS. Results Abdominal injuries are not common in survivors of terrorist explosions, although they are a frequent finding in those immediately killed. Primary and tertiary blast injuries have predominated in survivors from explosions in enclosed spaces reported outside of Israel. In contrast, secondary blast injuries causing fragmentation wounds were predominant in suicide bombings in open and/or semi-confined spaces, mainly in Israel, and also in military conflicts. Multiple perforations of the ileum seem to be the most common primary blast injury to the bowel, but delayed bowel perforations are rare. Secondary blast injuries carry the highest anatomic severity and mortality rate. Most of the deaths assessed occurred early, with hemorrhagic shock from penetrating fragments as the main contributing factor. The negative laparotomy rate has been very variable, with higher rates reported, in general, from civilian hospitals attending a large number of casualties. Conclusions The pattern, severity, management, and prognosis of ABI vary considerably, in accordance with the main mechanism of injury.

Research paper thumbnail of Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma

European Journal of Trauma and Emergency Surgery, 2010

Background Following trauma, the number of preventable deaths is low. Outcome should also be meas... more Background Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. Methods This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). Results Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p \ 0.001). Conclusion Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.

Research paper thumbnail of Bullhorn and bullfighting injuries

European Journal of Trauma and Emergency Surgery, 2014

Purpose Our purpose was to present our hospital experience with bullhorn injuries. Methods A retr... more Purpose Our purpose was to present our hospital experience with bullhorn injuries. Methods A retrospective analysis of patients in our Trauma Registry (1993-2012). Results Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6 ± 6 and 15.9 ± 9, respectively. Seven had an ISS [ 15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT ? PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16 days. Conclusions Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

Research paper thumbnail of Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon

British Journal of Surgery, 1998

Background Palliative colostomy is still unavoidable in many patients with malignant obstruction ... more Background Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. Methods Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. Results The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patie...

Research paper thumbnail of Personal Protection Equipment and Emergency Surgery during the COVID-19 Pandemic in Spain

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2020

Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, an... more Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, and in January 2020, the first case was diagnosed in Spain. In April, Spain had reported more than 200,000 cases, 38,000 of which were health workers, representing more than 16% of the volume of contagion in the general population. The objective of our study was to determine the availability, characteristics of use, and the need for improvisation of personal protective equipment (PPE) during the first wave of the COVID-19 pandemic in Spain. Materials and methods: An online, anonymous, prospective survey was carried out from April 2 to 15 by an e-mail invitation to 562 of the Trauma and Emergency Surgery sections of the Spanish Association of Surgeons. The survey collected demographic data, the region of clinical practice, patterns of PPE use in emergency surgeries, and the improvisation of equipment. Results: Total 58 health workers from 12 communities completed the survey, 95% surgeons. Total 28% received training with PPE during the pandemic, and 44% rated it as insufficient. The PPE used in surgery were double glove (74%), face shield (72%), surgical glasses (67%), waterproof gown (67%), and boot covers (32%). Lack of N95/FPP2/3 was reported by 82% and other elements of PPE by 68%. More than half of the respondents (51%) improvised PPE. Conclusion: The results reflect a low degree of training on PPE use before and during the first wave of the pandemic, the lack of PPE, especially masks, and the need to use nonapproved material as a protection mechanism.

Research paper thumbnail of Sutura laparoscópica frente a sutura por laparotomía en úlceras gastroduodenales perforadas

Revista chilena de cirugía, 2018

Laparoscopic suture facing laparotomy suture in perforated gastroduodenal ulcers Introduction: Ga... more Laparoscopic suture facing laparotomy suture in perforated gastroduodenal ulcers Introduction: Gastroduodenal perforation continues to be a relatively frequent surgical emergency, despite advances in the medical treatment of ulcer disease. Its laparoscopic approach has been increasing in the last years, although it has not been generalized. Objective: Was to analyze the postoperative results in patients with perforated ulcer treated with laparoscopic suture, and to compare them with a similar group with laparotomy suture. Our hypothesis was that laparoscopic suture is a safe option and with less morbidity than the laparotomy approach. Material and Methods: Comparative retrospective analysis of two patient cohorts: one treated with laparoscopic suture during 2014 and 2015, a period in which this approach was fully implanted in the emergency room in our hospital, and another comparable group treated by suture for open surgery during the period 2001-2003. Complications were analyzed according to Clavien-Dindo classification, conversion rate, mean stay and mortality. Results: The groups were comparable in age, sex, comorbidities and anesthetic risk. There was a trend towards superiority in favor of the laparoscopic approach in certain variables analyzed, with a conversion rate of 3%. The presence of early postoperative complications was greater in the laparotomy suture group: post-surgical septic shock (15.2% vs 6%) and wound infection (15.2% vs 3%), as well as medical complications, although not significantly. The group with laparoscopic suture had a longer surgical time, lower mean stay and lower mortality. Conclusion: The laparoscopic suture of the gastroduodenal ulcer in our center has had a very low conversion rate and a somewhat lower morbidity to the laparotomy suture, with a lower rate of reinterventions and a mean stay, despite a longer surgical time.

Research paper thumbnail of Dolor lumbar como manifestación de un tumor intra-abdominal desmoplásico de células pequeñas y redondas

Revista Portuguesa De Pneumologia, Jul 1, 2010

... tumor intra-abdominal desmoplásico de células pequeñas y redondas Camarero-Mulas C,1 Andrés G... more ... tumor intra-abdominal desmoplásico de células pequeñas y redondas Camarero-Mulas C,1 Andrés García-Marín A,1 Sánchez-Rodríguez T,1 Vaquero-Rodríguez A,1 Fábregues-Olea A,1 Pino-Jiménez A,2 Turégano-Fuentes F3 Correspondencia: Dra. Celia Camarero Mulas. ...

Research paper thumbnail of Stomach and Duodenum

Describe the most frequent emergency surgery situations involving the stomach and duodenum (perfo... more Describe the most frequent emergency surgery situations involving the stomach and duodenum (perforated and bleeding gastroduodenal ulcer disease)

Research paper thumbnail of Leading Symptoms and Signs

Categorize different abdominal clinical conditions in relation to the characteristics of the pain... more Categorize different abdominal clinical conditions in relation to the characteristics of the pain and the presence or absence of tenderness

Research paper thumbnail of The Acute Care Surgery Model in the World, and the Need for and Implementation of Trauma and Emergency Surgery Units in Spain

Cirugía Española (english Edition), 2019

Abstract The Acute Care Surgery model groups trauma and emergency surgery with surgical critical ... more Abstract The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country.

Research paper thumbnail of Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos

Cirugia Espanola, Oct 1, 2020

c i r e s p. 2 0 1 9 ; x x (x x) : x x x-x x x * Autor para correspondencia.

Research paper thumbnail of Survival after prehospital advanced life support in severe trauma

European Journal of Emergency Medicine, Dec 1, 1995

Research paper thumbnail of Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion

European Journal of Trauma and Emergency Surgery, Dec 9, 2015

Conclusions Patients with TMP were more severely injured and more often needed surgery, ICU hospi... more Conclusions Patients with TMP were more severely injured and more often needed surgery, ICU hospitalization and need for transfer to a level I trauma center. The observation that all those who died in hospital and most of those who were unstable were not examined by the ENT services suggests that impact of TMP as an indicator of severity may be underestimated.

Research paper thumbnail of Hemorragia digestiva baja secundaria a tumor del estroma gastrointestinal rectal

Revista Portuguesa De Pneumologia, 2010

Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but ... more Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but represent only 1 to3% of all GI tract neoplasms. We report an uncommon case of stromal rectal tumor because of its atypical location.

Research paper thumbnail of Resección local y radiofrecuencia en hemangioendotelioma epitelioide hepático

Revista Portuguesa De Pneumologia, 2010

1Martin-Gil J, 1 Nofuentes-Riera C, 1* Vaquero-Rodriguez A, 1 Sanz-Sanchez M, 2 Turegano-Fuentes F 3

Research paper thumbnail of Percutaneous Interventions

Emergency Surgery Course (ESC®) Manual, 2016

Research paper thumbnail of Giant abdominal recurrent liposarcoma with multiple histological types

Revista Española de Enfermedades Digestivas, 2010

Research paper thumbnail of Invaginación intestinal en el adulto. Una causa infrecuente de obstrucción mecánica

Revista de Gastroenterología de México, 2012

Research paper thumbnail of Dolor abdominal agudo secundario a endometrioma ovárico roto con elevación de CA 125 y CA 19–9

Clínica e Investigación en Ginecología y Obstetricia, 2011

Resumen Una mujer de 47 años fue atendida en el servicio de urgencias por dolor abdominal de 72 h... more Resumen Una mujer de 47 años fue atendida en el servicio de urgencias por dolor abdominal de 72 h de evolución con una elevación de los niveles plasmáticos de leucocitos, CA 19-9 y CA 125. La paciente fue intervenida encontrando un endometrioma roto en el ovario izquierdo. Los altos niveles de ambos marcadores tumorales nos obligaron a descartar una neoplasia de ovario en este caso.

Research paper thumbnail of Pitfalls to avoid in the medical management of mass casualty incidents following terrorist bombings: the hospital perspective

European Journal of Trauma and Emergency Surgery, 2014

Background The unique patterns of injury following explosions together with the involvement of nu... more Background The unique patterns of injury following explosions together with the involvement of numerous physicians, most of whom are not experienced in trauma, may create problems in the medical management of mass casualty incidents. Methods Four hundred patient files admitted in 19 mass casualty events following bombing incidents were reviewed and possible areas which could impact survival were defined. Results Forty-nine (9.3 %) patients had an Injury Severity Score C16. Of 205 patients in whom triage decisions were available, 5 of 25 severely injured patients were undertriaged by the triage officers at the door of the hospital. Following primary evaluation inside the emergency department critical injuries in two patients were missed due to distracting, less serious injuries. Of 68 (16.1 %) patients who were operated, 28 were in need of either immediate, urgent or high-priority operations. Except for neurosurgical cases which needed to be transferred to other hospitals, there was no delay in surgery. One patient underwent negative laparotomy. There were 15 in-hospital deaths, 6 of which were deemed as either anticipated or unanticipated mortality with possibility for improvement. Conclusion Medical management should be evaluated following MCIs as this may illustrate possible problems which many need to be addressed in contingency planning.

Research paper thumbnail of Abdominal blast injuries: different patterns, severity, management, and prognosis according to the main mechanism of injury

European Journal of Trauma and Emergency Surgery, 2014

Purpose To review the frequency, different patterns, anatomic severity, management, and prognosis... more Purpose To review the frequency, different patterns, anatomic severity, management, and prognosis of abdominal injuries in survivors of explosions, according to the main mechanism of injury. Methods A MEDLINE search was conducted from January 1982 to August 2013, including the following MeSH terms: blast injuries, abdominal injuries. EMBASE was also searched, with the same entries. Abdominal blast injuries (ABIs) have been defined as injuries resulting not only from the effects of the overpressure on abdominal organs, but also from the multimechanistic effects and projectile fragments resulting from the blast. Special emphasis was placed on the detailed assessment of ABIs in patients admitted to GMUGH (Gregorio Marañón University General Hospital) after the Madrid 2004 terrorist bombings, and in patients admitted to HYMC (Hillel Yaffe Medical Centre) in Hadera (Israel) following several bombing episodes. The anatomic severity of injuries was assessed by the abdominal component of the AIS, and the overall anatomic severity of casualties was assessed by means of the NISS. Results Abdominal injuries are not common in survivors of terrorist explosions, although they are a frequent finding in those immediately killed. Primary and tertiary blast injuries have predominated in survivors from explosions in enclosed spaces reported outside of Israel. In contrast, secondary blast injuries causing fragmentation wounds were predominant in suicide bombings in open and/or semi-confined spaces, mainly in Israel, and also in military conflicts. Multiple perforations of the ileum seem to be the most common primary blast injury to the bowel, but delayed bowel perforations are rare. Secondary blast injuries carry the highest anatomic severity and mortality rate. Most of the deaths assessed occurred early, with hemorrhagic shock from penetrating fragments as the main contributing factor. The negative laparotomy rate has been very variable, with higher rates reported, in general, from civilian hospitals attending a large number of casualties. Conclusions The pattern, severity, management, and prognosis of ABI vary considerably, in accordance with the main mechanism of injury.

Research paper thumbnail of Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma

European Journal of Trauma and Emergency Surgery, 2010

Background Following trauma, the number of preventable deaths is low. Outcome should also be meas... more Background Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. Methods This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). Results Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p \ 0.001). Conclusion Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.

Research paper thumbnail of Bullhorn and bullfighting injuries

European Journal of Trauma and Emergency Surgery, 2014

Purpose Our purpose was to present our hospital experience with bullhorn injuries. Methods A retr... more Purpose Our purpose was to present our hospital experience with bullhorn injuries. Methods A retrospective analysis of patients in our Trauma Registry (1993-2012). Results Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6 ± 6 and 15.9 ± 9, respectively. Seven had an ISS [ 15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT ? PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16 days. Conclusions Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

Research paper thumbnail of Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon

British Journal of Surgery, 1998

Background Palliative colostomy is still unavoidable in many patients with malignant obstruction ... more Background Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. Methods Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. Results The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patie...