ABSTRACT
INTRODUCTION: Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity. OBJECTIVE: To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico. METHOD: Consecutive patients included in the local registry GDL-SHOT were analyzed. RESULTS: From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%. CONCLUSION: In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.
INTRODUCCIÓN: El trauma es una de las principales causas de morbimortalidad en el mundo. El abdomen es, en frecuencia, la tercera región anatómica más afectada, y el compartimento intraabdominal es un sitio de hemorragia difícil de identificar, por lo que cobra importancia el conocimiento de las posibles lesiones tras un traumatismo. OBJETIVOS: Describir y analizar el perfil sociodemográfico y las lesiones encontradas en pacientes con trauma abdominal en un hospital de referencia del occidente de México. MÉTODO: Se seleccionaron para su análisis los pacientes incluidos en el registro hospitalario local GDL-SHOT. RESULTADOS: De 4961 pacientes, el 91.4% fueron hombres, con un promedio de edad de 28.7 años. Respecto al mecanismo, el 39.7% correspondió a arma blanca, el 33% a trauma cerrado y el 27.3% a arma de fuego. Los órganos más afectados fueron el intestino delgado (20.9%), el hígado (18.2%) y el colon (14.2%). La estancia hospitalaria promedio fue de 6.95 días, con una mortalidad del 6.74%. CONCLUSIONES: En México, el trauma abdominal representa una causa importante de morbimortalidad, en especial en pacientes jóvenes, y predomina el mecanismo penetrante; el manejo más común es no conservador. La frecuencia de lesiones encontradas es discordante con la literatura de otros países y predominan las de vísceras huecas, probablemente por la diferencia en los mecanismos implicados.
Subject(s)
Abdominal Injuries/epidemiology , Wounds, Gunshot/epidemiology , Wounds, Nonpenetrating/epidemiology , Wounds, Stab/epidemiology , Abdominal Injuries/etiology , Abdominal Injuries/mortality , Adult , Colon/injuries , Female , Hospital Mortality , Humans , Intestine, Small/injuries , Length of Stay/statistics & numerical data , Liver/injuries , Male , Mexico/epidemiology , Sex Distribution , Socioeconomic Factors , Spleen/injuries , Wounds, Gunshot/etiology , Wounds, Gunshot/mortality , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/mortality , Wounds, Stab/etiology , Wounds, Stab/mortalityABSTRACT
BACKGROUND: The aim of this work was to determine and compare plasma levels of proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha), C-reactive protein (CRP) and lipoperoxides in patients submitted to laparoscopic cholecystectomy under general anesthesia or regional anesthesia. METHODS: Two groups of 15 patients of both sexes were submitted to laparoscopic cholecystectomy either with general or regional anesthesia. In all cases we obtained three samples of plasma. The first sample was collected immediately before surgery, whereas the other samples were collected 60 min and 24 h after the cholecystectomy. Using commercial kits, plasma levels of IL-1beta, IL-6 and TNF-alpha were quantified by ELISA, whereas lipoperoxides were determined by a colorimetric method. The ultrasensitive CRP was determined in the hospital by the Prestige 24I automated method. RESULTS: In all determinations, proinflammatory cytokines increased 24 h after surgery except plasma levels of IL-1beta in the regional anesthesia group. Comparison of the two different groups showed that the general anesthesia group had a similar or higher quantity of proinflammatory cytokines and oxidative stress when compared to the regional anesthesia group (p <0.05). In contrast, plasma levels of CRP were lower in the general anesthesia group (p <0.005). CONCLUSIONS: The type of anesthesia influences in a different manner the secretion of soluble mediators of inflammation. These observations may have important clinical repercussions.
