Historia de las heridas penetrantes de abdomen / History of penetrating abdominal wounds

A lo largo de la historia la conducta habitual frente a las heridas penetrantes de abdomen fue la de no intervenirlas quirúrgicamente y, con suerte, algunos no morían. Los antiguos hindúes, que desarrollaron una asombrosa cirugía, intentaron con éxito cerrar las víscerasabdominales extruidas con decapitadas cabezas de hormigas gigantes, en un arte que pocos cientos de años después se perdió. Celso, el gran romano del siglo I, nos ha dejado la minuciosa descripción de un tratamientointervencionista y poco más sucedió hasta la Edad Media, cuando Roger de Salerno comenzó a suturar vísceras sobre un trozo de madera de saúco. Ugo Borgognoni, Lanfranco y Henri deMondeville, con atrevidas suturas, llevaron la cirugía abdominal medieval hasta el cenit hacia fines del siglo XIV.Más allá de algunas excepciones, operar en lugar de esperar debió aguardar a lasoperaciones pioneras de ûentre muchosû Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars y de un cometa en el cielo siberiano, la cirujana y princesa rusaVera Gedroits. La Gran Guerra terminó con las discusiones y, a partir de 1915, explorar fue la consigna en todas las heridas penetrantes de abdomen. En Uruguay, la tesis de Justo Duarte sobre el tema nos ilustra acerca del conservadurismo imperante en el país hasta por lo menos 1892. Siete años después, Luis Pedro Lenguas, Alfredo Navarro y Gerardo Arrizabalaga se pronunciaron ya definitivamente a favor de operar. Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo y Velarde Pérez Fontana, a comienzos del siglo XX, fueron algunas de las sobresalientes figuras quirúrgicasde la nueva generación, que, con trabajo y genio, sentaron las bases de la moderna cirugía abdominal de urgencia en Uruguay...

Throughout history, penetrating abdominal wounds were usually not managed through surgery, and out of luck, a few patients did not die. Ancient Hindus who excelled at sugery, successfully tried to close extruded abdominal internal organs with the heads of giant ants, an art that was lost a few centuries later. Celso, the great Roman if the 1st Century, provided uswith a detailed description of an interventionist treatment and not much happened until the Middle Ages, whenRoger of Salerno started sewing internal organs on a small elderberry board. The brave sutures of Ugo Borgognoni,Lanfranco and Henri de Mondeville led Medieval abdominal surgery to is zenith towards the end of the XIV century.Except for a few exceptions, managing wounds through surgery instead of waiting only came true with the pioneer surgeries by Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars and the outstanding Vera Gedrotis, a Russian surgeon and Princess who standed out in the Siberian reality, û among others. The debate came to an end with the great WWI, and as from 1915 exploration was the standard for all penetrating abdominal wounds. In Uruguay, Justo DuarteÆs thesis on this issue illustrates the approach that ruled the country until at least 1892. Seven years after, Luis Pedro Lenguas, AlfredoNavarro and Gerardo Arrizabalaga admitted the convenience of operating such patients. In the early XX century, Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo and Velarde Pérez Fontana were some of the outstanding surgeons of the new generation who, thanks to their hard work and talent, provided the grounds for modern emergency abdominalsurgery in Uruguay...

Historicamente nos casos de feridas penetrantes de abdômen a conduta mais freqüente era não realizar umaintervenção cirúrgica, e em poucos casos os pacientes não morriam. Os antigos hindus, que desenvolveram umatécnica cirúrgica muito avançada, fechavam as vísceras abdominais com cabeças de formigas gigantes, uma arteque foi perdida alguns séculos depois. Celso, o grande romano do século I, deixou uma descrição minuciosa de um tratamento cirúrgico. Pouca coisa mais aconteceu até a Idade Médica quando Roger de Salerno começou a suturar vísceras sobre um pedaço de madeira de sabugueiro. Ugo Borgognoni, Lanfranco eHenri de Mondeville, com suturas atrevidas, fizeram com que a cirurgia abdominal medieval chegasse ao seu ponto mais alto no final do século XIV.Com poucas exceções, a decisão de operar ao invés de aguardar teve que esperar pelas operações pioneiras de,entre muitos outros, Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars e deuma estrela solitária dos céus siberianos a cirurgiã e princesa russa Vera Gedroits. A I Guerra Mundial colocou fim às discussões e a partir de 1915 explorar é a palavra de ordem nos casos de feridas penetrantes de abdômen.No Uruguai, a tese de Justo Duarte sobre o tema nos ilustra sobre o conservadorismo imperante no país atépelo menos 1892. Sete anos depois, Luis Pedro Lenguas, Alfredo Navarro e Gerardo Arrizabalaga declararam serdefinitivamente favoráveis à realização de cirurgia. No começo do século XX Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo e Velarde Pérez Fontana foram algumas das figuras destacadas da nova geração de cirurgiões, que com trabalho e gênio, estabeleceram as bases da moderna cirurgia abdominal de urgência no Uruguai..

Analysis of the reported symptoms that preceded the death of King Rajasinghe of Sithawake (1592 AD).

A copy of an ola leaf manuscript, the original of which was written around the late 1590s, was published recently. It describes the sequence of events leading to the death of the warrior King Rajasinghe of the Sithawake Kingdom (1521-1593). A study of the contents of this letter is presented. The dressing applied to a wound on the foot of the King is described in that letter. It is likely that this dressing would have been an ideal medium to produce the highly potent tetanus exotoxin. The toxin would have diffused into the open wound and produced the sequence of symptoms and signs mentioned in the letter. An analysis of the symptoms and signs noted during the King's last illness as described in the letter is presented. Laryngospasm, and tonic and clonic spasms are easily identified. In addition, a group of symptoms attributed in the 1960s to sympathetic over-activity in tetanus are also recognisable. The conclusion is drawn that the King died of tetanus. The intriguing possibility of the wilful use of a lethal dressing on an open wound as a biological contact poison is left open for discussion.