Cirugía española
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Editorial Review
[Permissive hypotension in resuscitation of trauma patients].
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The introduction of laparoscopic surgery in a hospital is a slow process requiring the involvement of a multidisciplinary team. ⋯ The controlled development of laparoscopic surgery allows satisfactory results to be obtained in colorectal disease.
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Perioperative management is one of the fields of surgery most hide bound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. ⋯ Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice.
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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 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.
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Although the high mortality rate from infectious causes in asplenic patients has been well known since the beginning of the twentieth century, rates of antibiotic prophylaxis in these patients continue to be worryingly low. Consequently, we reviewed the causes of these high mortality rates with a view to recommending preventive measures. The attitude to prophylaxis in these patients depends on age and the cause of splenectomy both in vaccination and antibiotic prophylaxis. The immune status of these patients is decisive in antibiotic prophylaxis, as this treatment will differ in patients splenectomized after a traffic accident and in those splenectomized for lymphoma.