LESIONES VASCULARES TRAUMÁTICAS DE CUELLO, TÓRAX Y ABDOMEN / Traumatic vascular injuries of the neck, thorax and abdomen

Introduction and Objectives: Vascular injuries have been described since the ancient times. They represent 3 percent of traumatisms; and the most worrisome aspect is their dangerousness, because more than half of the patients die within the first 24 hours due to the hemorrhages they cause. This investigation was carried out with the objective of determining the incidence of the different types of vascular injuries at the Arnaldo Milian Castro Hospital. Method: A retrospective study in 21 patients who were hospitalized with diagnoses of vascular injuries in the neck, thorax and abdomen was carried out. The medical histories of the patients were analyzed, as well as the surgery reports and the necropsy protocols in the case of the deceased. Results: There was a predominance of penetrating wounds in the abdomen (38.9 %) and in the thorax (19.05 %), as well as thoracic and abdominal closed traumas. The accidental cause was present in 57.2 percent of the patients. The most affected anatomical region was the abdomen (42.86 %), and the most used surgical procedure was the exploratory laparotomy (76.2 %). An average of 1.21 procedures per patient was carried out. The hypovolemic shock was the complication with the highest incidence, because it appeared in 11 patients (52.38 %), this represents 68.75 percent of all complications. Eleven patients (52.38 %) stayed less than 3 days in hospital. The lesions of the spleen and its vascular pedicle appeared in 23.81 percent of the patients. Conclusions: Penetrating wounds in the abdomen, accidents as a cause of them, and the exploratory laparotomy were predominant. The most affected anatomical area was the abdomen and the hypovolemic shock was the most common complication

LESIONES VASCULARES TRAUMÁTICAS DE CUELLO, TÓRAX Y ABDOMEN

Introduction and Objectives: Vascular in-juries have been described since the ancient times. They represent 3 percent of trauma-tisms; and the most worrisome aspect is their dangerousness, because more than half of the patients die within the first 24 hours due to the hemorrhages they cause. This investigation was carried out with the objective of deter-mining the incidence of the different types of vascular injuries at the Arnaldo Milian Castro Hospital. Method: A retrospective study in 21 patients who were hospitalized with diagnoses of vascular injuries in the neck, thorax and abdomen was carried out. The medical histories of the patients were analyzed, as well as the surgery reports and the necropsy protocols in the case of the deceased. Results: There was a predominance of pene-trating wounds in the abdomen (38.9 %) and in the thorax (19.05 %), as well as thoracic and abdominal closed traumas. The accidental cause was present in 57.2 percent of the patients. The most affected anatomical region was the abdomen (42.86 %), and the most used surgical procedure was the exploratory laparotomy (76.2 %). An average of 1.21 procedures per patient was carried out. The hypovolemic shock was the complication with the highest incidence, because it appeared in 11 patients (52.38 %), this represents 68.75 percent of all complications. Eleven patients (52.38 %) stayed less than 3 days in hospital. The lesions of the spleen and its vascular pedicle appeared in 23.81 percent of the patients. Conclusions: Penetrating wounds in the abdomen, accidents as a cause of them, and the exploratory laparotomy were predominant. The most affected anatomical area was the abdomen and the hypovolemic shock was the most common complication.Introducción y objetivos: Las lesiones vascu-lares han sido descritas desde la antigüedad. Estas ocupan el 3 % de los traumatismos; lo más preocupante es su peligrosidad pues más de la mitad de los pacientes fallecen en las primeras 24 horas, debido a la hemorragia que ocasionan. Esta investigación se realizó con el objetivo de determinar la incidencia de los diferentes tipos de lesiones vasculares en el Hospital �Arnaldo Milián Castro�. Método: Se realizó un estudio retrospectivo, en 21 pacien-tes ingresados con diagnóstico de lesiones vasculares en cuello, tórax y abdomen. Se analizaron los expedientes clínicos de los lesionados, el informe operatorio y los protoco-los de necropsias, en los casos fallecidos. Resultados: Predominaron las heridas pene-trantes en el abdomen (38,09 %) y en el tórax (19,05 %), así como los traumas torácicos o abdominales cerrados. La causa accidental apareció en el 57,2 % de los pacientes. La región anatómica más afectada fue el abdo-men (42,86 %), y la laparotomía exploradora, el procedimiento quirúrgico más empleado (76,2 %). Se realizó 1.21 procedimientos por paciente. El choque hipovolémico fue la com-plicación de más incidencia, pues apareció en 11 pacientes (52,38 %), lo que representa el 68,75% del total de complicaciones. De los enfermos, 11 (52,38 %), tuvieron una estadía hospitalaria menor de 3 días. Las lesiones del bazo y su pedículo vascular aparecieron en el 23,81 % de los pacientes. Conclusiones: Las heridas penetrantes en abdomen, la etiología accidental y la laparotomía exploradora fueron predominantes. La zona anatómica más afec-tada fue el abdomen y el choque hipovolémico fue la complicación más encontrada

Therapeutic developments in pancreatic cancer: current and future perspectives

The overall 5-year survival for pancreatic cancer has changed little over the past few decades, and pancreatic cancer is predicted to be the second leading cause of cancer-related mortality in the next decade in Western countries. The past few years, however, have seen improvements in first-line and second-line palliative therapies and considerable progress in increasing survival with adjuvant treatment. The use of biomarkers to help define treatment and the potential of neoadjuvant therapies also offer opportunities to improve outcomes. This Review brings together information on achievements to date, what is working currently and where successes are likely to be achieved in the future. Furthermore, we address the questions of how we should approach the development of pancreatic cancer treatments, including those for patients with metastatic, locally advanced and borderline resectable pancreatic cancer, as well as for patients with resected tumours. In addition to embracing newer strategies comprising genomics, stromal therapies and immunotherapies, conventional approaches using chemotherapy and radiotherapy still offer considerable prospects for greater traction and synergy with evolving concepts