Traumatismo esplénico en España: ¿en qué punto estamos? / Spleen injuries in Spain: At what point are we?

IntroducciónAunque el tratamiento del traumatismo esplénico ha cambiado en las últimas décadas, no existen datos de la actitud que los cirujanos españoles adoptamos frente a este tipo de lesión tan frecuente. El propósito de este estudio es determinar el perfil del traumatismo esplénico en los adultos con traumatismo abdominal severo y el tratamiento que se realiza en nuestro medio.MétodoEstudio de datos de registros de trauma de 6 hospitales españoles: Hospital Gregorio Marañón, Hospital de Getafe, Hospital Doce de Octubre, Hospital Virgen de la Vega, Hospital de Torrevieja y Corporació Sanitària Parc Taulí.ResultadosSe analizó a 566 pacientes con lesiones esplénicas (448 hombres y 118 mujeres). El tipo de traumatismo fue fundamentalmente cerrado (94%) y el mecanismo lesional más frecuente fue el accidente de tráfico El ISS medio de la serie fue de 25,2. El tratamiento fue inicialmente quirúrgico en el 56,6%, siendo en el 43,4% restante, conservador. De estos, el 6,5% de los pacientes requirió finalmente cirugía y en el 8,8% se realizó angioembolización esplénica. De los pacientes intervenidos al inicio, en el 85,3% de los casos se realizó esplenectomía, y cirugía conservadora de bazo en el 14,7%, de los que el 4,6% fracasaron y requirieron nueva intervención quirúrgica con esplenectomía.ConclusiónEl tratamiento en España para el traumatismo esplénico continúa siendo en su mayoría quirúrgico (fundamentalmente esplenectomía). La angioembolización y el tratamiento conservador continúan teniendo escasa presencia (AU)

IntroductionManagement of spleen trauma has changed over last decades, although there is no data on its treatment in Spain. The aim of this study is to determine the characteristics of spleen injuries in adults with severe abdominal injuries and how we manage them.MethodsA prospective study using the databases of six Spanish hospitals: Gregorio Marañón Hospital, Virgen de la Vega Hospital, Torrevieja Hospital, Getafe Hospital, Doce de Octubre Hospital and Corporació Sanitària Parc Taulí.ResultsA total of 566 patients who had sustained spleen injuries were analyzed (448 males and 118 females), most of them were due to blunt trauma (94%), and the most frequent mechanism of injury was motor vehicle accident. The mean Injury Severity Score (ISS) was 25.2. The initial treatment was surgical in 56.6% of the patients (85.3% total splenectomy and 14.7% other conservative surgical procedures, of which 4.6% finally failed and required total splenectomy). The remaining 43.4% were initially managed conservatively, but 6.5% of them finally required surgical splenectomy, and in 8.8% angio-embolization was performed.ConclusionIn Spain, management of spleen trauma is mainly surgical (particularly splenectomy). Angio-embolization and conservative surgical procedures are now hardly used (AU)

[Spleen injuries in Spain: at what point are we?]. / Traumatismo esplénico en España: ¿en qué punto estamos?

INTRODUCTION: Management of spleen trauma has changed over last decades, although there is no data on its treatment in Spain. The aim of this study is to determine the characteristics of spleen injuries in adults with severe abdominal injuries and how we manage them. METHODS: A prospective study using the databases of six Spanish hospitals: Gregorio Marañón Hospital, Virgen de la Vega Hospital, Torrevieja Hospital, Getafe Hospital, Doce de Octubre Hospital and Corporació Sanitària Parc Taulí. RESULTS: A total of 566 patients who had sustained spleen injuries were analyzed (448 males and 118 females), most of them were due to blunt trauma (94%), and the most frequent mechanism of injury was motor vehicle accident. The mean Injury Severity Score (ISS) was 25.2. The initial treatment was surgical in 56.6% of the patients (85.3% total splenectomy and 14.7% other conservative surgical procedures, of which 4.6% finally failed and required total splenectomy). The remaining 43.4% were initially managed conservatively, but 6.5% of them finally required surgical splenectomy, and in 8.8% angio-embolization was performed. CONCLUSION: In Spain, management of spleen trauma is mainly surgical (particularly splenectomy). Angio-embolization and conservative surgical procedures are now hardly used.

[Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center]. / Fracturas de pelvis graves, lesiones asociadas e inestabilidad hemodinámica: incidencia, manejo y pronóstico en nuestro medio.

INTRODUCTION: The aim of this study was to review the incidence, treatment and outcome of severe pelvic fractures, as well as associated injuries, in our center. PATIENTS AND METHOD: We performed a retrospective study of patients included in our trauma registry between June 1993 and January 2005. Pelvic fractures were classified according to the system proposed by Tile. Clinical and demographic data such as age, gender, mechanism of injury, transfer time, hemodynamic status, and trauma scores were compared and analyzed statistically. Shock was defined as a systolic blood pressure of < or = 90 mmHg during the primary assessment. Mortality and associated risk factors were analyzed, with emphasis on patients in shock on admission. RESULTS: Of 1274 patients with severe trauma admitted during the study period, 192 (15%) had pelvic fracture. Only 6.7% were isolated fractures and 6% were open fractures. Twenty percent of the patients were in shock on admission. The mean Injury Severity Score of the series was 28.5 +/- 14 and that of patients in shock was 38 +/- 16. The most frequently associated injuries were thoracic (70%), abdominal (55%), long bone fractures (52%), and head injuries (40%). Twenty-three percent of the patients had retroperitoneal hematoma. Arteriograms were performed in 16 patients, with four embolizations. Eight patients underwent external orthopedic fixation, and none posterior orthopedic fixation. Five patients underwent pelvic packing and two patients underwent ligation of hypogastric arteries. Overall mortality was 30% and mortality in patients in shock was 61%. Predictors of mortality were shock on admission, a Glasgow Coma Scale score of < or = 8, ISS > 25 and age > 55 years. CONCLUSIONS: Patients in shock with pelvic fractures have a poor prognosis in our center, frequently related to the severity of associated injuries, the relative rarity of these fractures, and the lack of a clearly defined management protocol. The main cause of death was massive hemorrhage.

Fracturas de pelvis graves, lesiones asociadas e inestabilidad hemodinámica: incidencia, manejo y pronóstico en nuestro medio / Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center

Introducción. El objetivo de esta revisión ha sido conocer la incidencia, lesiones asociadas, tratamiento y resultados obtenidos en el manejo de los pacientes con fracturas graves de pelvis en nuestro centro. Pacientes y método. Estudio retrospectivo de los pacientes incluidos en nuestro registro de traumatizados graves entre junio de 1993 y enero de 2005. La clasificación de las fracturas pelvianas se ha realizado con los criterios de Tile. Se comparan y analizan estadísticamente aspectos demográficos y clínicos, incluidos la edad, el sexo, el mecanismo lesivo, tiempo de traslado, la situación hemodinámica al ingreso y las escalas de gravedad. Se ha definido el estado de shock como una presión arterial sistólica ≤ 90 mmHg durante la revisión primaria. Se analizan la mortalidad y los factores de riesgo asociados, con especial énfasis en el grupo de pacientes en shock. Resultados. De los 1.274 politraumatizados graves atendidos en el período de estudio, 192 (15%) presentaban fractura pelviana. Muy pocas fracturas se han presentado como lesiones aisladas (6,7%), y el porcentaje de fracturas abiertas ha sido del 6%. El 20% de los pacientes presentaba shock al ingreso. El Injury Severity Score (ISS) medio de la serie fue de 28,5 ± 14, y el de los pacientes en shock fue de 38 ± 16. Las lesiones asociadas más frecuentes fueron las torácicas (70%), seguidas por las abdominales (55%), fracturas de huesos largos (52%) y craneoencefálicas (40%). El 23% de los pacientes presentaba hematoma retroperitoneal. Se realizaron 16 arteriografías y 4 embolizaciones pelvianas. Se colocaron 8 fijadores externos anteriores y ninguno posterior. Se realizaron 5 taponamientos pelvianos y 2 ligaduras de arterias hipogástricas. La mortalidad general fue del 30%, y del 61% en los pacientes en shock al ingreso. El shock a la llegada, una escala de coma de Glasgow ≤ 8, un ISS > 25 y la edad > 55 años se correlacionaron con la mortalidad. Conclusiones. El pronóstico de los pacientes en shock y con fracturas de pelvis graves en nuestro medio es sombrío y, con frecuencia, está condicionado por la gravedad de las lesiones asociadas, la relativa escasa incidencia de estas fracturas y la heterogeneidad de criterios de manejo de los equipos de guardia. La hemorragia masiva incontrolada ha sido la causa principal de muerte (AU)

Introduction. The aim of this study was to review the incidence, treatment and outcome of severe pelvic fractures, as well as associated injuries, in our center. Patients and method. We performed a retrospective study of patients included in our trauma registry between June 1993 and January 2005. Pelvic fractures were classified according to the system proposed by Tile. Clinical and demographic data such as age, gender, mechanism of injury, transfer time, hemodynamic status, and trauma scores were compared and analyzed statistically. Shock was defined as a systolic blood pressure of ≤ 90 mmHg during the primary assessment. Mortality and associated risk factors were analyzed, with emphasis on patients in shock on admission. Results. Of 1274 patients with severe trauma admitted during the study period, 192 (15%) had pelvic fracture. Only 6.7% were isolated fractures and 6% were open fractures. Twenty percent of the patients were in shock on admission. The mean Injury Severity Score of the series was 28.5 ± 14 and that of patients in shock was 38 ± 16. The most frequently associated injuries were thoracic (70%), abdominal (55%), long bone fractures (52%), and head injuries (40%). Twenty-three percent of the patients had retroperitoneal hematoma. Arteriograms were performed in 16 patients, with four embolizations. Eight patients underwent external orthopedic fixation, and none posterior orthopedic fixation. Five patients underwent pelvic packing and two patients underwent ligation of hypogastric arteries. Overall mortality was 30% and mortality in patients in shock was 61%. Predictors of mortality were shock on admission, a Glasgow Coma Scale score of ≤ 8, ISS > 25 and age > 55 years. Conclusions. Patients in shock with pelvic fractures have a poor prognosis in our center, frequently related to the severity of associated injuries, the relative rarity of these fractures, and the lack of a clearly defined management protocol. The main cause of death was massive hemorrhage (AU)

[Intraoperative therapeutic intensification techniques in locally advanced abdominal sarcomas]. / Intensificación terapéutica intraoperatoria en el tratamiento de los sarcomas abdominales localmente avanzados.

INTRODUCTION: Sarcomas are rare tumors that develop from mesenchymal cells. Their management is difficult due to their changing histology, location, and behavior. In this article, we discuss the use of two intraoperative therapeutic intensification techniques, intraoperative radiotherapy (IORT) and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC), in the treatment of locally advanced abdominal sarcomas and peritoneal sarcomatosis. MATERIAL AND METHODS: We analyzed a series of 20 consecutive patients diagnosed with advanced abdominal sarcoma and 5 patients with a diagnosis of peritoneal sarcomatosis who were evaluated and treated in our department from December 1996 to October 2005. In advanced abdominal sarcoma, we performed complete or maximal resection followed by IORT. In peritoneal sarcomatosis we performed massive cytoreduction followed by HIIC. RESULTS: The survival rate in advanced abdominal sarcomas without sarcomatosis was 65% at 26 months. Among the 5 patients diagnosed with peritoneal sarcomatosis, 3 were alive, and 2 were without recurrence at 20 months of follow-up. CONCLUSIONS: IORT associated with radical surgery seems to improve local control and survival in advanced abdominal sarcomas. Maximal cytoreduction plus HIIC used as treatment of peritoneal sarcomatosis is a feasible technique that offers a therapeutic option with curative intent.

Intensificación terapéutica intraoperatoria en el tratamiento de los sarcomas abdominales localmente avanzados / Intraoperative therapeutic intensification techniques in locally advanced abdominal sarcomas

Introducción. Los sarcomas son tumores infrecuentes que se desarrollan a partir de células mesenquimales. Su estudio y tratamiento es difícil debido a una histopatología, localización y comportamiento variables. En este artículo estudiamos el papel de las técnicas de intensificación terapéutica intraoperatoria: radioterapia intraoperatoria (RIO) y quimioterapia intraperitoneal intraoperatoria hipertérmica (QIOH), en el tratamiento de los sarcomas abdominales localmente avanzados y la sarcomatosis peritoneal. Material y métodos. Analizamos una serie de 20 pacientes consecutivos diagnosticados de sarcoma abdominal avanzado y 5 diagnosticados de sarcomatosis peritoneal, evaluados y tratados en nuestro servicio entre diciembre de 1996 y octubre de 2005. En el sarcoma localmente avanzado se realizó resección completa o máxima asociada a RIO. En sarcomatosis peritoneal se llevó a cabo la máxima citorreducción asociada a QIOH. Resultados. La tasa de supervivencia de los sarcomas abdominales avanzados sin sarcomatosis fue del 65% a los 26 meses. De los 5 pacientes con sarcomatosis peritoneal, 3 estaban vivos y 2 de ellos libres de enfermedad a los 20 meses de seguimiento. Conclusiones. La RIO asociada a cirugía radical parece mejorar el control local y la supervivencia en sarcomas abdominales avanzados. La citorreducción máxima más QIOH usada como tratamiento de la sarcomatosis peritoneal es una técnica factible y que ofrece una opción terapéutica con intención curativa (AU)

Introduction. Sarcomas are rare tumors that develop from mesenchymal cells. Their management is difficult due to their changing histology, location, and behavior. In this article, we discuss the use of two intraoperative therapeutic intensification techniques, intraoperative radiotherapy (IORT) and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC), in the treatment of locally advanced abdominal sarcomas and peritoneal sarcomatosis. Material and methods. We analyzed a series of 20 consecutive patients diagnosed with advanced abdominal sarcoma and 5 patients with a diagnosis of peritoneal sarcomatosis who were evaluated and treated in our department from December 1996 to October 2005. In advanced abdominal sarcoma, we performed complete or maximal resection followed by IORT. In peritoneal sarcomatosis we performed massive cytoreduction followed by HIIC. Results. The survival rate in advanced abdominal sarcomas without sarcomatosis was 65% at 26 months. Among the 5 patients diagnosed with peritoneal sarcomatosis, 3 were alive, and 2 were without recurrence at 20 months of follow-up. Conclusions. IORT associated with radical surgery seems to improve local control and survival in advanced abdominal sarcomas. Maximal cytoreduction plus HIIC used as treatment of peritoneal sarcomatosis is a feasible technique that offers a therapeutic option with curative intent (AU)