Juan Javier Rodríguez Martínez

DAMAGE CONTROL TECHNIQUES IN THE MANAGEMENT OF SEVERE LUNG TRAUMA

BACKGROUND Damage control (DC) has improved survival from severe abdominal and extremity injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries are scarce. METHODS This is a retrospective review of patients treated with DC for thoracic/pulmonary complex trauma at two Level I trauma centers from 2006 to 2010. Subjects 14 years and older were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. RESULTS A total of 840 trauma thoracotomies were performed. DC thoracotomy (DCT) was performed in 31 patients (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 years (interquartile range [IQR], 20–34 years), Revised Trauma Score (RTS) was 7.11 (IQR, 5.44–7.55), and Injury Severity Score (ISS) was 26 (IQR, 25–41). Nineteen patients had gunshot wounds, four had stab wounds, and two had blunt trauma. Pulmonary trauma was managed by pneumorrhaphy in 3, tractotomy in 12, wedge resection in 1, and packing as primary treatment in 8 patients. Clamping of the pulmonary hilum was used as a last resource in seven patients. Five patients returned to the intensive care unit with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 hours to 90 hours after the initial DCT. Four of them survived. Bleeding from other intrathoracic sources was found in 20 patients: major vessels in nine, heart in three, and thoracic wall in nine. DCT mortality in pulmonary trauma was 6 (24%) of 25 because of coagulopathy, or persistent bleeding in 5 patients and multiorgan failure in 1 patient. CONCLUSION This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries and the use of packing as a definitive method for hemorrhage control. LEVEL OF EVIDENCE Epidemiologic study, level V.

Two dimensional fractional projectile motion in a resisting medium

In this paper we propose a fractional differential equation describing the behavior of a two dimensional projectile in a resisting medium. In order to maintain the dimensionality of the physical quantities in the system, an auxiliary parameter k was introduced in the derivative operator. This parameter has a dimension of inverse of seconds (sec)−1 and characterizes the existence of fractional time components in the given system. It will be shown that the trajectories of the projectile at different values of γ and different fixed values of velocity v0 and angle θ, in the fractional approach, are always less than the classical one, unlike the results obtained in other studies. All the results obtained in the ordinary case may be obtained from the fractional case when γ = 1.

Tumor fibroso solitario pararrenal

Resumen es: Objetivo: Anadir a la literatura un caso clinico poco frecuente de tumor fibroso solitario pararrenal, analizando las caracteristicas anatomo-patologicas...

Relación entre síntomas del tracto urinario inferior y calidad de vida

Resumen es: OBJETIVOS: Evaluar el impacto de los sintomas del tracto urinario inferior (STUI) referidos en el cuestionario IPSS sobre la calidad de vida y determinar...

REGRESIÓN ESPONTÁNEA DE TROMBOSIS VENOSA EN UN CASO DE CARCINOMA RENAL.

Resumen es: OBJETIVO: Describir el primer caso de regresion espontanea de trombosis de vena renal y cava inferior en un paciente con carcinoma de celulas renales. ME...

Tumor desmoide mesentérico simulando una recidiva de cáncer testicular

Resumen es: Objetivo: Presentar un caso de un tumor desmoide en un paciente tratado de un seminoma testicular que simulaba una recidiva del tumor testicular. Metodo:...