FERNANDO TUREGANO | Universidad Complutense de Madrid (original) (raw)
Papers by FERNANDO TUREGANO
European Journal of Trauma and Emergency Surgery, Apr 25, 2017
part, kept short and concise, with a short list of important messages to take home at the end of ... more part, kept short and concise, with a short list of important messages to take home at the end of each chapter, and a list of recommended reading. Section I deals with Prehospital care, Diagnostic tools and Resuscitation Strategies, and starts with a well-balanced discussion of the several controversies on the subject. Many of the first chapters are devoted to this neverending controversy of BLS vs. ALS in urban vs rural environments, and some concepts are excessively repeated throughout this section. The chapters on Airway Management, Resuscitation, ABC Heuristics, Intensive Care, VAT Surgery, and Ballistics, are to be highlighted. Section II deals with Surgical Strategies in Penetrating Trauma to the Head, Face and Neck. The chapter on penetrating injuries to the Face, an area not particularly familiar to the average general or trauma surgeon, is worth of mention, as are the chapters on injuries to the Pharynx and Cervical Esophagus, and to Blood Vessels. The vast experience of general and trauma surgeons trained and/or working in South Africa, as said, is clearly shown in this latter chapter. Again, the number of chapters devoted to similar topics makes for some repeated statements, specifically regarding the surgical anatomy of the neck, and maneuvers to control bleeding. Section III deals with Surgical Strategies in Penetrating trauma to the Chest. Of particular interest is the chapter on trauma to the Subclavian Vessels, which provides a very detailed anatomic description of the different steps to deal with these difficult, although infrequent injuries, and the chapter on trauma to the thoracic esophagus. This latter chapter also provides some very useful tips for the management of this infrequent trauma injury, which can also be applied to non-trauma esophageal perforations and damage. The chapter on Cardiac trauma nicely reflects the extensive practical experience of its authors.
Cirugia Espanola, Mar 1, 1999
European Journal of Gastroenterology & Hepatology, Jun 1, 1997
43 Congreso de la Sociedad Española de Endoscopia Digestiva (Libro de Comunicaciones), 2021
Hepatobiliary & Pancreatic Diseases International, 2016
BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and ... more BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratified by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies. RESULTS: We identified 611 533 cholecystectomies (71.3% laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/10 5 vs 41.1/10 5) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecystectomies was almost 2-fold higher (195.2/10 5 vs 111.8/10 5) in patients with T2DM. The annual rate of laparoscopic procedures showed an 11-year relative increase of 88.3% (from 117.0/10 5 to 220.3/10 5) in T2DM and 49.2% (from 79.2/10 5 to 118.2/10 5) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cholecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy [OR=1.18 (1.03-1.35)]. Time-trend analyses showed a significant reduction in IHM in patients with or without T2DM after the two procedures. CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emergency cholecystectomies.
Gastroenterología y hepatología, 2000
Neurocirugía, 1999
ABSTRACT
Pathology International, 1996
A case Is presented of localized malignant peritoneal mesothelioma appearing as a liver neoplasm.... more A case Is presented of localized malignant peritoneal mesothelioma appearing as a liver neoplasm. The patient underwent tumor resection but developed a recurrent growth and died 10 months after the Initial surgery. The primary tumor showed sarcomatous features with rhabdoid cells. Examination revealed the presence of hyaluronic acid, co‐Immunoreactivlty for cytokeratln epithelial membrane antigen and vlmentln, cellular contacts with small desmosomes, and intracytoplasmic lumina. These findings supported the mesothelial nature of this tumor. The recurrent tumor was composed of predominantly tubulopaplllary proliferation. It was concluded that the present tumor was a localized malignant mesothelioma of a blphasic type showing a predominantly sarcomatous component in the primary tumor.
International Journal of Radiation Oncology*Biology*Physics, 2009
Receiver operating characteristic (ROC) curves, plots of sensitivity (true positive rate) versus ... more Receiver operating characteristic (ROC) curves, plots of sensitivity (true positive rate) versus 1-specificity (false positive rate) for a collection of cut points, were generated to predict risk for renal atrophy. The approximate area under the curve (AUC) for each ROC plot was estimated to assess the predictive ability of dose volume parameters for renal atrophy. An AUC of 1.0 indicates perfect discriminatory ability. Results: Of 130 patients, median age was 64 years and 51.5% were male. Majority of primary disease sites were pancreas and periampullary tumors (77.7%). Median radiation dose was 50.4 Gy. Mean dose to the PK was 18.6 Gy. One year following RT, mean size of PK decreased from 105.02 mm preRT to 100.88 mm, p \ 0.0001. Compensatory hypertrophy of the non-PK was not seen. Creatinine clearance declined from 91.09 ml/min preRT to 77.61 ml/min over the same time period, p \ 0.0001. Age, gender, hypertension, diabetes, smoking, chemotherapy, preRT creatinine clearance, and preRT renal size were not associated with renal atrophy postRT. Percent volumes of the PK receiving $10 Gy (V 10), V 15 , and V 20 were significantly associated with renal atrophy (p = 0.0030, 0.0029, and 0.0028 respectively). AUC for V 10 , V 15 , and V 20 to predict.5% decrease in PK size were 0.760, 0.760, and 0.762. Using V 15 ROC plot, a cut off for V 15 of 50% was predictive for risk of developing renal atrophy with 80% sensitivity and 70% specificity. Conclusions: To our knowledge, this is the first report applying ROC curve analyses to predict radiation-induced kidney complications. Significant decline in PK size and renal function were seen following abdominal chemoradiation. The areas under the ROC curves in this study suggest that larger volumes of kidneys irradiated to lower doses (V 10 , V 15 , or V 20 Gy) may be as important in predicting adverse events as smaller volumes treated to higher doses. The significance of lower dose renal irradiation on late effects has potential implications for RT delivery techniques such as IMRT and arc therapy in the abdomen.
European Journal of Trauma and Emergency Surgery, 2011
Anatomic delineation of a gastrointestinal fistula is essential in assessing the likelihood of sp... more Anatomic delineation of a gastrointestinal fistula is essential in assessing the likelihood of spontaneous closure or to plan the surgical management. Computed tomography (CT) enterography and/or fistulograms provide invaluable information. The surgical strategy should carefully consider the when and how, as well as the special clinical situations that may arise following radiotherapy, the inaccessible or ''frozen abdomen'', and enteroatmospheric fistulas (EAFs). New operations like those performed in bariatric surgery, and the wide acceptance of the damage-control philosophy in severe trauma, have given rise to new types of fistulas and increased the occurrence of others. When confronted with this difficult complication, the surgeon must always exercise patience and restraint, and be open-minded about the different surgical alternatives to solve the problem.
Diseases of the Colon & Rectum, 1995
In their extensive and comprehensive review, the authors fail to mention intra-arterial fibrinoly... more In their extensive and comprehensive review, the authors fail to mention intra-arterial fibrinolytic treatment as a therapeutic option in acute occlusive arterial syndromes, which, in our opinion and that of others, holds much promise in selected cases. The high mortality rate and overall poor prognosis of mesenteric ischemia are attributed not only to late diagnosis and treatment but also to the elderly and debilitated cardiac patients frequently involved, who are poor candidates for surgery and second-look procedures. Recent successful results with urokinase and other thrombolytic agents in arterial disease at other sites have prompted this nonsurgical approach to an old problem, with more than ten encouraging reports from European centers 1-3 and also from North American institutions. 4 Since our first and recent report of two successful cases, 5 we have had the oppol"tunity to treat two additional patients with excellent results, thus completely avoiding a laparotomy. We must stress, however, that candidates must be carefully selected. The complete absence of peritoneal signs on physical examination and a normal x-ray film showing no ileus must be considered absolute prerequisites for this form of therapy, together with 24-hour angiography availability at the institution. Careful monitoring and frequent clinical reassessment, together with sequential angiograms, are mandatory after the initial bolus of fibrinolytic agents, because some of these patients may ultimately need a segmental bowel resection. 4 We are convinced that, as further clinical evidence accumulates, future reviews on the subject will certainly pay deserved attention to this therapeutic option.
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.
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
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.
Cirugía Española, 2019
INTRODUCTION Two areas of controversy in the management of bleeding pelvic fractures are the need... more INTRODUCTION Two areas of controversy in the management of bleeding pelvic fractures are the need to perform angioembolization (AE) in patients with a retroperitoneal hematoma (RPH) but no contrast extravasation (CE) on Computerized Tomography (CT) and/or angiography, and the delay to AE. Our main objective was to assess whether there had been differences in the percentage and delay to AE between patients admitted on weekdays versus off-hours (weekends and admission after 3pm) at our hospital. Our hypothesis was that angiography and AE would be more frequent on weekdays, and the time delay would be longer during off-hours, with a higher mortality in this latter group for a similar overall severity. A secondary objective was to assess the correlation between CE on CT scan and angiography. METHODS Retrospective review of two cohorts of patients with RPH from a pelvic fracture during a period of 24 years. Patients were divided depending on the time of arrival (Group A: weekdays, and Group B: off-hours). The decision to perform angiography and AE was made by the general surgeons on call, in consensus with the interventional radiologist. We analyzed demographics, mechanism of injury, associated injuries, physiologic and anatomic trauma scores, CE on CT scan, need of AE, Intensive Care Unit (ICU) stay and mortality. RESULTS 104 patients were admitted with RPH from a pelvic fracture. We performed AE in 63 cases (61%). The groups were comparable in the variables analyzed. In 70% of patients in group A, angiography was done, vs 57% in group B, with the same median time delay. CE on CT scan was seen in 53 out of 96 patients and confirmed by angiography in 45 (85%) of them. No significant differences were found in mortality between the two groups. CONCLUSIONS There was a short delay from admission to AE, even during off-hours, and a good correlation of CE on CT scan and angiography.
European Journal of Trauma and Emergency Surgery, 2016
Retrospective study of all postoperative visceral PA diagnosed in our hospital between 2008 and 2... more Retrospective study of all postoperative visceral PA diagnosed in our hospital between 2008 and 2014. Age, gender, type of procedure, surgical complications, location, time to diagnosis, clinical presentation, diagnostic procedures, management, and outcome are described. We have considered as haemobilia the direct visualization of bleeding through the ampulla and/or the clinical triad of fluctuating jaundice (biliary obstruction by clots),
Radiotherapy and Oncology, 2013
To analyze prognostic factors associated with survival in patients after intensified radio-surgic... more To analyze prognostic factors associated with survival in patients after intensified radio-surgical rescue of oligorecurrent pelvic cancer, particularly the influence of external beam radiation therapy (EBRT). Materials and Methods: From January 1995 to december 2011, 81 patients [colorectal (46%); gynecologic (26%); retroperitoneal sarcoma (18%)] underwent extended surgery [multiorgan (58%), bone (23%), vascular (9%), soft tissue (43%)] and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. 35 (43%) of these patients also received EBRT (30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Median follow-up was 34 months (3-189 months), and the 1-3-, and 5-year rates of locoregional control (LRC) were 83%, 53%, and 41%, respectively. Univariate Cox proportional hazard analysis revealed worse LRC for those patients who did not received integrated EBRT treatment for the pelvic recurrence rescue (p=0.003), and had non-radical resection (p=0.01). On multivariate analysis, integrated EBRT treatment, non-radical resection, and tumor fragmentation retained significance (p=0.002,p=0.004, and p=0.05, respectively). Conclusions: EBRT treatment integrated for rescue, radical resection, and abscence of tumor fragmentation are associated with improved LRC in patients with oligorecurrent pelvic cancer. Present results suggest that patients with oligorecurrent pelvic disease ma ybenefit from EBRT treatment integrated with extended surgery and IOERT.
Radiotherapy and Oncology, 2013
To analyze prognostic factors associated with survival in patients after intensified radio-surgic... more To analyze prognostic factors associated with survival in patients after intensified radio-surgical rescue of oligorecurrent pelvic cancer, particularly the influence of external beam radiation therapy (EBRT). Materials and Methods: From January 1995 to december 2011, 81 patients [colorectal (46%); gynecologic (26%); retroperitoneal sarcoma (18%)] underwent extended surgery [multiorgan (58%), bone (23%), vascular (9%), soft tissue (43%)] and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. 35 (43%) of these patients also received EBRT (30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Median follow-up was 34 months (3-189 months), and the 1-3-, and 5-year rates of locoregional control (LRC) were 83%, 53%, and 41%, respectively. Univariate Cox proportional hazard analysis revealed worse LRC for those patients who did not received integrated EBRT treatment for the pelvic recurrence rescue (p=0.003), and had non-radical resection (p=0.01). On multivariate analysis, integrated EBRT treatment, non-radical resection, and tumor fragmentation retained significance (p=0.002,p=0.004, and p=0.05, respectively). Conclusions: EBRT treatment integrated for rescue, radical resection, and abscence of tumor fragmentation are associated with improved LRC in patients with oligorecurrent pelvic cancer. Present results suggest that patients with oligorecurrent pelvic disease ma ybenefit from EBRT treatment integrated with extended surgery and IOERT.
European Journal of Trauma and Emergency Surgery, Apr 25, 2017
part, kept short and concise, with a short list of important messages to take home at the end of ... more part, kept short and concise, with a short list of important messages to take home at the end of each chapter, and a list of recommended reading. Section I deals with Prehospital care, Diagnostic tools and Resuscitation Strategies, and starts with a well-balanced discussion of the several controversies on the subject. Many of the first chapters are devoted to this neverending controversy of BLS vs. ALS in urban vs rural environments, and some concepts are excessively repeated throughout this section. The chapters on Airway Management, Resuscitation, ABC Heuristics, Intensive Care, VAT Surgery, and Ballistics, are to be highlighted. Section II deals with Surgical Strategies in Penetrating Trauma to the Head, Face and Neck. The chapter on penetrating injuries to the Face, an area not particularly familiar to the average general or trauma surgeon, is worth of mention, as are the chapters on injuries to the Pharynx and Cervical Esophagus, and to Blood Vessels. The vast experience of general and trauma surgeons trained and/or working in South Africa, as said, is clearly shown in this latter chapter. Again, the number of chapters devoted to similar topics makes for some repeated statements, specifically regarding the surgical anatomy of the neck, and maneuvers to control bleeding. Section III deals with Surgical Strategies in Penetrating trauma to the Chest. Of particular interest is the chapter on trauma to the Subclavian Vessels, which provides a very detailed anatomic description of the different steps to deal with these difficult, although infrequent injuries, and the chapter on trauma to the thoracic esophagus. This latter chapter also provides some very useful tips for the management of this infrequent trauma injury, which can also be applied to non-trauma esophageal perforations and damage. The chapter on Cardiac trauma nicely reflects the extensive practical experience of its authors.
Cirugia Espanola, Mar 1, 1999
European Journal of Gastroenterology & Hepatology, Jun 1, 1997
43 Congreso de la Sociedad Española de Endoscopia Digestiva (Libro de Comunicaciones), 2021
Hepatobiliary & Pancreatic Diseases International, 2016
BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and ... more BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratified by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies. RESULTS: We identified 611 533 cholecystectomies (71.3% laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/10 5 vs 41.1/10 5) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecystectomies was almost 2-fold higher (195.2/10 5 vs 111.8/10 5) in patients with T2DM. The annual rate of laparoscopic procedures showed an 11-year relative increase of 88.3% (from 117.0/10 5 to 220.3/10 5) in T2DM and 49.2% (from 79.2/10 5 to 118.2/10 5) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cholecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy [OR=1.18 (1.03-1.35)]. Time-trend analyses showed a significant reduction in IHM in patients with or without T2DM after the two procedures. CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emergency cholecystectomies.
Gastroenterología y hepatología, 2000
Neurocirugía, 1999
ABSTRACT
Pathology International, 1996
A case Is presented of localized malignant peritoneal mesothelioma appearing as a liver neoplasm.... more A case Is presented of localized malignant peritoneal mesothelioma appearing as a liver neoplasm. The patient underwent tumor resection but developed a recurrent growth and died 10 months after the Initial surgery. The primary tumor showed sarcomatous features with rhabdoid cells. Examination revealed the presence of hyaluronic acid, co‐Immunoreactivlty for cytokeratln epithelial membrane antigen and vlmentln, cellular contacts with small desmosomes, and intracytoplasmic lumina. These findings supported the mesothelial nature of this tumor. The recurrent tumor was composed of predominantly tubulopaplllary proliferation. It was concluded that the present tumor was a localized malignant mesothelioma of a blphasic type showing a predominantly sarcomatous component in the primary tumor.
International Journal of Radiation Oncology*Biology*Physics, 2009
Receiver operating characteristic (ROC) curves, plots of sensitivity (true positive rate) versus ... more Receiver operating characteristic (ROC) curves, plots of sensitivity (true positive rate) versus 1-specificity (false positive rate) for a collection of cut points, were generated to predict risk for renal atrophy. The approximate area under the curve (AUC) for each ROC plot was estimated to assess the predictive ability of dose volume parameters for renal atrophy. An AUC of 1.0 indicates perfect discriminatory ability. Results: Of 130 patients, median age was 64 years and 51.5% were male. Majority of primary disease sites were pancreas and periampullary tumors (77.7%). Median radiation dose was 50.4 Gy. Mean dose to the PK was 18.6 Gy. One year following RT, mean size of PK decreased from 105.02 mm preRT to 100.88 mm, p \ 0.0001. Compensatory hypertrophy of the non-PK was not seen. Creatinine clearance declined from 91.09 ml/min preRT to 77.61 ml/min over the same time period, p \ 0.0001. Age, gender, hypertension, diabetes, smoking, chemotherapy, preRT creatinine clearance, and preRT renal size were not associated with renal atrophy postRT. Percent volumes of the PK receiving $10 Gy (V 10), V 15 , and V 20 were significantly associated with renal atrophy (p = 0.0030, 0.0029, and 0.0028 respectively). AUC for V 10 , V 15 , and V 20 to predict.5% decrease in PK size were 0.760, 0.760, and 0.762. Using V 15 ROC plot, a cut off for V 15 of 50% was predictive for risk of developing renal atrophy with 80% sensitivity and 70% specificity. Conclusions: To our knowledge, this is the first report applying ROC curve analyses to predict radiation-induced kidney complications. Significant decline in PK size and renal function were seen following abdominal chemoradiation. The areas under the ROC curves in this study suggest that larger volumes of kidneys irradiated to lower doses (V 10 , V 15 , or V 20 Gy) may be as important in predicting adverse events as smaller volumes treated to higher doses. The significance of lower dose renal irradiation on late effects has potential implications for RT delivery techniques such as IMRT and arc therapy in the abdomen.
European Journal of Trauma and Emergency Surgery, 2011
Anatomic delineation of a gastrointestinal fistula is essential in assessing the likelihood of sp... more Anatomic delineation of a gastrointestinal fistula is essential in assessing the likelihood of spontaneous closure or to plan the surgical management. Computed tomography (CT) enterography and/or fistulograms provide invaluable information. The surgical strategy should carefully consider the when and how, as well as the special clinical situations that may arise following radiotherapy, the inaccessible or ''frozen abdomen'', and enteroatmospheric fistulas (EAFs). New operations like those performed in bariatric surgery, and the wide acceptance of the damage-control philosophy in severe trauma, have given rise to new types of fistulas and increased the occurrence of others. When confronted with this difficult complication, the surgeon must always exercise patience and restraint, and be open-minded about the different surgical alternatives to solve the problem.
Diseases of the Colon & Rectum, 1995
In their extensive and comprehensive review, the authors fail to mention intra-arterial fibrinoly... more In their extensive and comprehensive review, the authors fail to mention intra-arterial fibrinolytic treatment as a therapeutic option in acute occlusive arterial syndromes, which, in our opinion and that of others, holds much promise in selected cases. The high mortality rate and overall poor prognosis of mesenteric ischemia are attributed not only to late diagnosis and treatment but also to the elderly and debilitated cardiac patients frequently involved, who are poor candidates for surgery and second-look procedures. Recent successful results with urokinase and other thrombolytic agents in arterial disease at other sites have prompted this nonsurgical approach to an old problem, with more than ten encouraging reports from European centers 1-3 and also from North American institutions. 4 Since our first and recent report of two successful cases, 5 we have had the oppol"tunity to treat two additional patients with excellent results, thus completely avoiding a laparotomy. We must stress, however, that candidates must be carefully selected. The complete absence of peritoneal signs on physical examination and a normal x-ray film showing no ileus must be considered absolute prerequisites for this form of therapy, together with 24-hour angiography availability at the institution. Careful monitoring and frequent clinical reassessment, together with sequential angiograms, are mandatory after the initial bolus of fibrinolytic agents, because some of these patients may ultimately need a segmental bowel resection. 4 We are convinced that, as further clinical evidence accumulates, future reviews on the subject will certainly pay deserved attention to this therapeutic option.
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.
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
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.
Cirugía Española, 2019
INTRODUCTION Two areas of controversy in the management of bleeding pelvic fractures are the need... more INTRODUCTION Two areas of controversy in the management of bleeding pelvic fractures are the need to perform angioembolization (AE) in patients with a retroperitoneal hematoma (RPH) but no contrast extravasation (CE) on Computerized Tomography (CT) and/or angiography, and the delay to AE. Our main objective was to assess whether there had been differences in the percentage and delay to AE between patients admitted on weekdays versus off-hours (weekends and admission after 3pm) at our hospital. Our hypothesis was that angiography and AE would be more frequent on weekdays, and the time delay would be longer during off-hours, with a higher mortality in this latter group for a similar overall severity. A secondary objective was to assess the correlation between CE on CT scan and angiography. METHODS Retrospective review of two cohorts of patients with RPH from a pelvic fracture during a period of 24 years. Patients were divided depending on the time of arrival (Group A: weekdays, and Group B: off-hours). The decision to perform angiography and AE was made by the general surgeons on call, in consensus with the interventional radiologist. We analyzed demographics, mechanism of injury, associated injuries, physiologic and anatomic trauma scores, CE on CT scan, need of AE, Intensive Care Unit (ICU) stay and mortality. RESULTS 104 patients were admitted with RPH from a pelvic fracture. We performed AE in 63 cases (61%). The groups were comparable in the variables analyzed. In 70% of patients in group A, angiography was done, vs 57% in group B, with the same median time delay. CE on CT scan was seen in 53 out of 96 patients and confirmed by angiography in 45 (85%) of them. No significant differences were found in mortality between the two groups. CONCLUSIONS There was a short delay from admission to AE, even during off-hours, and a good correlation of CE on CT scan and angiography.
European Journal of Trauma and Emergency Surgery, 2016
Retrospective study of all postoperative visceral PA diagnosed in our hospital between 2008 and 2... more Retrospective study of all postoperative visceral PA diagnosed in our hospital between 2008 and 2014. Age, gender, type of procedure, surgical complications, location, time to diagnosis, clinical presentation, diagnostic procedures, management, and outcome are described. We have considered as haemobilia the direct visualization of bleeding through the ampulla and/or the clinical triad of fluctuating jaundice (biliary obstruction by clots),
Radiotherapy and Oncology, 2013
To analyze prognostic factors associated with survival in patients after intensified radio-surgic... more To analyze prognostic factors associated with survival in patients after intensified radio-surgical rescue of oligorecurrent pelvic cancer, particularly the influence of external beam radiation therapy (EBRT). Materials and Methods: From January 1995 to december 2011, 81 patients [colorectal (46%); gynecologic (26%); retroperitoneal sarcoma (18%)] underwent extended surgery [multiorgan (58%), bone (23%), vascular (9%), soft tissue (43%)] and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. 35 (43%) of these patients also received EBRT (30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Median follow-up was 34 months (3-189 months), and the 1-3-, and 5-year rates of locoregional control (LRC) were 83%, 53%, and 41%, respectively. Univariate Cox proportional hazard analysis revealed worse LRC for those patients who did not received integrated EBRT treatment for the pelvic recurrence rescue (p=0.003), and had non-radical resection (p=0.01). On multivariate analysis, integrated EBRT treatment, non-radical resection, and tumor fragmentation retained significance (p=0.002,p=0.004, and p=0.05, respectively). Conclusions: EBRT treatment integrated for rescue, radical resection, and abscence of tumor fragmentation are associated with improved LRC in patients with oligorecurrent pelvic cancer. Present results suggest that patients with oligorecurrent pelvic disease ma ybenefit from EBRT treatment integrated with extended surgery and IOERT.
Radiotherapy and Oncology, 2013
To analyze prognostic factors associated with survival in patients after intensified radio-surgic... more To analyze prognostic factors associated with survival in patients after intensified radio-surgical rescue of oligorecurrent pelvic cancer, particularly the influence of external beam radiation therapy (EBRT). Materials and Methods: From January 1995 to december 2011, 81 patients [colorectal (46%); gynecologic (26%); retroperitoneal sarcoma (18%)] underwent extended surgery [multiorgan (58%), bone (23%), vascular (9%), soft tissue (43%)] and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. 35 (43%) of these patients also received EBRT (30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Median follow-up was 34 months (3-189 months), and the 1-3-, and 5-year rates of locoregional control (LRC) were 83%, 53%, and 41%, respectively. Univariate Cox proportional hazard analysis revealed worse LRC for those patients who did not received integrated EBRT treatment for the pelvic recurrence rescue (p=0.003), and had non-radical resection (p=0.01). On multivariate analysis, integrated EBRT treatment, non-radical resection, and tumor fragmentation retained significance (p=0.002,p=0.004, and p=0.05, respectively). Conclusions: EBRT treatment integrated for rescue, radical resection, and abscence of tumor fragmentation are associated with improved LRC in patients with oligorecurrent pelvic cancer. Present results suggest that patients with oligorecurrent pelvic disease ma ybenefit from EBRT treatment integrated with extended surgery and IOERT.