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Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.

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INTRODUCCIÓN: El objetivo final del tratamiento quirúrgico en la obesidad mórbida es el descenso de la morbimortalidad asociada al exceso de peso. En este sentido debemos centrarnos en la enfermedad cardiovascular y el síndrome metabólico, que son las causas principales de mortalidad. El objetivo del estudio es valorar el efecto del bypass gástrico sobre el riesgo cardiovascular estimado en los pacientes sometidos a cirugía bariátrica. MATERIAL Y MÉTODOS: Estudio clínico retrospectivo y observacional desarrollado en 402 pacientes sometidos a bypass gástrico por laparoscopia. La variable principal a estudio es el riesgo cardiovascular estimado, que se mide en el preoperatorio y a los 12 meses. Para el cálculo del riesgo estimado se utiliza la ecuación REGICOR, que se expresa en forma de porcentaje y calcula el riesgo a 10 años de presentar enfermedad cardiovascular. RESULTADOS: En situación basal observamos como media un índice REGICOR de 4,1 ± 3,0. A los 12 meses de la intervención la estimación del riesgo cardiovascular disminuyó significativamente a 2,2 ± 1,6 (p < 0,001). En los sujetos con el diagnóstico de síndrome metabólico según definición del ATP-III, el REGICOR basal fue de 4,8 ± 3,1, mientras que en aquellos sin síndrome fue de 2,2 ± 1,8. A los 12 meses observamos una reducción significativa en ambos grupos (síndrome metabólico y no síndrome) con un REGICOR medio de 2,3 ± 1,6 y 1,6 ± 1,0 respectivamente. CONCLUSIÓN: Los resultados observados en nuestro estudio demuestran los efectos favorables del bypass gástrico sobre los factores de riesgo cardiovascular incluidos en la ecuación REGICOR

INTRODUCTION: The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery. MATERIAL AND METHODS: We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10-year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages. RESULTS: We reported an overall 4.1 ± 3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2 ± 1,6 (P < .001). In patients with metabolic syndrome according to ATP-III criteria, basal REGICOR score was 4.8 ± 3.1 whereas in no metabolic syndrome patients 2.2 ± 1.8. Evaluation 12 months after surgery, determined a significant reduction in both groups (metabolic syndrome and non metabolic syndrome) with a mean REGICOR score of 2.3 ± 1.6 and 1.6 ± 1.0 respectively. CONCLUSION: The results of our study demonstrate favorable effects of gastric bypass on the cardiovascular risk factors included in the REGICOR equation

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INTRODUCTION: The liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management. MATERIALS AND METHODS: We performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications. RESULTS: During the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management. CONCLUSION: The need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.

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Objetivo: Determinar la eficacia diagnóstica de la angiotomografía multidetectores en el diagnóstico del trauma arterial de las extremidades en pacientes con sospecha de lesión arterial sin indicación de cirugía inmediata. Métodos Durante 44 meses, entre agosto del 2004 y abril del 2008, se realizó angiotomografía multidetectores de 64 canales a 99 extremidades con sospecha de lesión vascular traumática. Los estudios fueron interpretados por el radiólogo de turno y sus hallazgos se compararon con los de cirugía o los del seguimiento clínico. Se evaluó la variabilidad interobservador comparando la lectura de la angiotomografía realizada por el radiólogo de turno con la lectura retrospectiva de un radiólogo experto en trauma. Resultados La angiotomografía multidetectores como método diagnóstico del trauma vascular de las extremidades interpretada por el radiólogo general demostró una sensibilidad del 98% (IC 95%: 93-100), una especificidad del 88% (IC 95%: 77-99), un valor predictivo positivo del 91% (IC 95%: 82-99), un valor predictivo negativo del 97% (IC 95%: 90-100), una razón de verosimilitud positiva de 8,24 (3,6-18,7) y una razón de verosimilitud negativa de 0,02 (0-0,15). La variabilidad interobservador comparando la interpretación de la angiotomografía del radiólogo de turno con la del radiólogo experto en trauma tuvo una kappa de 0,869.ConclusiónLa angiotomografía con multidetectores es un método de imagen con una alta precisión diagnóstica en el trauma arterial de las extremidades permitiendo un adecuado y oportuno enfoque terapéutico. Podría considerarse como nuevo patrón de oro para el diagnóstico del trauma arterial de extremidades (AU)

Objective: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. Methods: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on99 limbs suspected of having a traumatic vascular injury over a 44-monthperiodbetween August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Interobserver variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. Results: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI:77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97%(95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869.Conclusion: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate (..) (AU)

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OBJECTIVE: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.

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OBJECTIVE: To determine the best timing for thoracoscopic drainage of clotted hemothorax in order to ensure safe and effective results and to identify risk factors associated with drainage failure. MATERIALS AND METHODS: Cohort retrospective study of 139 consecutive patients who underwent thoracoscopic retained hemothorax drainage between April 1997 and May 2005. RESULTS: The procedure was successful in 102 patients (73.4%), in whom complete evacuation was achieved, with no accumulation of fluid in the pleural cavity requiring reintervention. Conversion to thoracotomy was required in 22 patients (15.8%) because of the inability to attain adequate drainage of clots and collections and lung re-expansion. Fifteen patients (10.8%) required reintervention as a result of fluid accumulation in the pleural cavity and lung collapse, and thoracotomy was performed in all those cases. The best results were obtained when thoracoscopic drainage was performed before the fifth day. There were 33 major post-operative complications including 20 cases of empyema of which 10 required thoracotomy, and 13 bronchopleural leaks, four of which required open surgery. There were no fatal outcomes in the study group. CONCLUSIONS: Videothoracoscopy must be considered the procedure of choice for the treatment of retained post-traumatic hemothorax. It is a safe and effective procedure allowing the successful treatment of up to 73.4% of patients. Best results are obtained when drainage is performed within the first five days after trauma.

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As has been demonstrated, significant differences exist in demographics and the likelihood of accidents among Latin American countries; however, when figures were standardized, they showed a clear similarity in all the reviewed features of vascular trauma. A total of 66.4% of cases were managed solely on a clinical basis, with 78.9% of surgical procedures being performed within 6 hours of injury. Vascular repair was attempted in 84% of arterial injuries and 43% of venous injuries. Results are extremely good, with an 89% rate of success, especially considering that 63% of injuries were gunshot wounds and that the largest series, from Brazil, had a 21.3% rate of abdominopelvic injuries. The mortality rate amounted to 12.7%, but associated injuries, and particularly multiple trauma, account for 50.0% of the deaths.

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Trauma has become a major health problem in Colombia. The large number of trauma patients has made San Vicente de Paul Hospital of Medellín a major national referred trauma center. Under-reporting is a major problem in Colombia, as in other underdeveloped countries, because of the absence of automated information systems. Despite this and limited financial health resources, time to definitive treatment, morbidity, and mortality are similar to those of centers in developed countries. This article has covered the authors' experience with vascular injuries over a period of 5 years, representing 664 patients; the results were shown in this article. In addition, advances made in the development of new tools for the diagnosis of vascular trauma, such as helical CT angiography, were discussed.

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