Cir Cir
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Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. ⋯ Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.
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Intraoperative neurophysiological monitoring (IOM) during spine surgery consists of several functional tests including somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), dermatomal potentials (DPs) and EMG (electromyography). Permanent neurological damage after spine surgery performed without intraoperative neurophysiological monitoring is frequent and often very costly. The main goal of IOM is the immediate detection, prevention and correction of neurological damage during surgery, which may go unnoticed without using these tests. ⋯ Intraoperative neurophysiological monitoring may help avoid certain neurological risks during spine surgery, which may go unnoticed without the use of this technique.
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Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. ⋯ Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.
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There is great inconsistency on how "Clinical Guideline Developers" worldwide rate the quality of evidence and strength of recommendations because there are several classification systems in use. Therefore, medical guideline users face profound challenges in understanding articles on Clinical Guidelines. ⋯ The GRADE system has advantages over previous rating systems including being developed by a representative group of guideline developers, patent separation between quality of evidence and strength of recommendations, explicit evaluation of the importance of outcomes of alternative management strategies, and others. Consequently, in this brief review, we describe the reasons underlying the adoption of GRADE.