Background: The population-based Cancer Registry of Cali Colombia operates continuously since 1962, disseminating incidence information in the XI volumes of Cancer Incidence in Five Continents.
Aim: To describe the incidence and mortality rates for the period 2011-2020 and the changes in the trend of incidence rates (1962-2017) and mortality rates from cancer (1986-2020).
Methods: The Joinpoint model and the annual percentage change (APC) were used as summary measures of the changes in the trends of incidence rates (ASR-I) and mortality (ASR-M) standardized by age with the direct method.
Results: Trough 1988-2017 the ASR-I for all locations increased 0.4% annually (95% CI: 0.2, 0.6) in men and decreased annually 0.2% (95% CI: -0.3; -0.1) in women. The ASR-Is of cancers related to opportunity screening activities (prostate and breast) increased until the early 21st century and then decreased. The ASR-I of cancers related to infectious agents continue to decrease (cervix, vulva, and stomach). There is evidence of control of cancer related to tobacco consumption (lung, oral cavity, bladder). In both sexes, the ASR-I of thyroid, colorectal and lymphoma cancers increased and those of ovarian cancer decreased. Between 1984-2020 the ASR-M for all locations decreased annually 0.7% (95% CI: -0.9, -0.5) in men and 1.1% (95% CI: -1.3, -0.9) in women. For both sexes, ASR-M decreased for cancers of the esophagus, stomach, lung, bladder, lymphomas, and leukemias; and increased in colorectal cancer. The ASR-M for cervical and prostate cancer decreased annually by 3.5% (95% CI: -3.9, -3.2) and 0.1% (95% CI: -0.5, -0.3), respectively.
Comment: This information allows the construction of some indicators to monitor the City Cancer Challenge initiative and the current 10-year plan for cancer control in Colombia, 2011-2021.
{"title":"Cancer epidemiology in Cali, 60 years of experience.","authors":"Luis Eduardo Bravo, Luz Stella García, Paola Collazos, Edwin Carrascal, Elvia Karina Grillo Ardila, Erquinovaldo Millan, Jorge Holguín","doi":"10.25100/cm.v53i1.5050","DOIUrl":"10.25100/cm.v53i1.5050","url":null,"abstract":"<p><strong>Background: </strong>The population-based Cancer Registry of Cali Colombia operates continuously since 1962, disseminating incidence information in the XI volumes of Cancer Incidence in Five Continents.</p><p><strong>Aim: </strong>To describe the incidence and mortality rates for the period 2011-2020 and the changes in the trend of incidence rates (1962-2017) and mortality rates from cancer (1986-2020).</p><p><strong>Methods: </strong>The Joinpoint model and the annual percentage change (APC) were used as summary measures of the changes in the trends of incidence rates (ASR-I) and mortality (ASR-M) standardized by age with the direct method.</p><p><strong>Results: </strong>Trough 1988-2017 the ASR-I for all locations increased 0.4% annually (95% CI: 0.2, 0.6) in men and decreased annually 0.2% (95% CI: -0.3; -0.1) in women. The ASR-Is of cancers related to opportunity screening activities (prostate and breast) increased until the early 21st century and then decreased. The ASR-I of cancers related to infectious agents continue to decrease (cervix, vulva, and stomach). There is evidence of control of cancer related to tobacco consumption (lung, oral cavity, bladder). In both sexes, the ASR-I of thyroid, colorectal and lymphoma cancers increased and those of ovarian cancer decreased. Between 1984-2020 the ASR-M for all locations decreased annually 0.7% (95% CI: -0.9, -0.5) in men and 1.1% (95% CI: -1.3, -0.9) in women. For both sexes, ASR-M decreased for cancers of the esophagus, stomach, lung, bladder, lymphomas, and leukemias; and increased in colorectal cancer. The ASR-M for cervical and prostate cancer decreased annually by 3.5% (95% CI: -3.9, -3.2) and 0.1% (95% CI: -0.5, -0.3), respectively.</p><p><strong>Comment: </strong>This information allows the construction of some indicators to monitor the City Cancer Challenge initiative and the current 10-year plan for cancer control in Colombia, 2011-2021.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/79/1657-9534-cm-53-01-e2005050.PMC9651077.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40720674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-05eCollection Date: 2022-01-01DOI: 10.25100/cm.v53i1.4966
Mariela Garau, Rafael Alonso, Carina Musetti, Enrique Barrios
Background: Uruguay has the highest cancer incidence and mortality rates in Latin America. The National Cancer Registry of Uruguay, which has been in operation since 1992, provides epidemiological information on incidence and mortality at the country level.
Objective: The objective of this article is to update the incidence and mortality figures by reporting the information for the period 2013-2017.
Methods: All incident cases of invasive neoplasias except non melanoma of the skin and all cancer deaths occurred in from 2013 to 2017 were analyzed. Age standardized rates were calculated by the direct method, using the world standard population. Complementary, incidence (2002-2017) and mortality (1990-2017) trends were studied for the leading sites.
Results: Among females, the most common cancers are breast, colon and rectum, lung, cervix and thyroid. The most frequent cancers in males are prostate, lung, colon and rectum, bladder and kidney. Lung, prostate and colorectal cancer are the leading causes of cancer death in males while breast cancer is the first cause of cancer death among females.
Conclusions: Although cancer mortality has declined monotonously since 1990, cancer control is a challenge for Uruguay, wherein breast, lung and prostate cancer have very high incidence while the country must still make an effort to reduce other cancers that are very common in economically less favored countries.
{"title":"Cancer incidence and mortality in Uruguay: 2013-2017.","authors":"Mariela Garau, Rafael Alonso, Carina Musetti, Enrique Barrios","doi":"10.25100/cm.v53i1.4966","DOIUrl":"https://doi.org/10.25100/cm.v53i1.4966","url":null,"abstract":"<p><strong>Background: </strong>Uruguay has the highest cancer incidence and mortality rates in Latin America. The National Cancer Registry of Uruguay, which has been in operation since 1992, provides epidemiological information on incidence and mortality at the country level.</p><p><strong>Objective: </strong>The objective of this article is to update the incidence and mortality figures by reporting the information for the period 2013-2017.</p><p><strong>Methods: </strong>All incident cases of invasive neoplasias except non melanoma of the skin and all cancer deaths occurred in from 2013 to 2017 were analyzed. Age standardized rates were calculated by the direct method, using the world standard population. Complementary, incidence (2002-2017) and mortality (1990-2017) trends were studied for the leading sites.</p><p><strong>Results: </strong>Among females, the most common cancers are breast, colon and rectum, lung, cervix and thyroid. The most frequent cancers in males are prostate, lung, colon and rectum, bladder and kidney. Lung, prostate and colorectal cancer are the leading causes of cancer death in males while breast cancer is the first cause of cancer death among females.</p><p><strong>Conclusions: </strong>Although cancer mortality has declined monotonously since 1990, cancer control is a challenge for Uruguay, wherein breast, lung and prostate cancer have very high incidence while the country must still make an effort to reduce other cancers that are very common in economically less favored countries.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/21/1657-9534-cm-53-01-e2014966.PMC9651076.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40720673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
El cáncer representa un problema de enorme relevancia a nivel internacional. De acuerdo con las últimas estimaciones de la IARC (International Agency for Research on Cancer, por sus siglas en inglés), se diagnostican más de 19 millones de casos nuevos y se registran casi 10 millones de muertes anualmente. En Latinoamérica, el cáncer da cuenta de unas 670000 muertes anuales, con una gran heterogeneidad en sus tasas en los distintos países. El cáncer es la segunda causa de muerte luego de las enfermedades cardiocirculatorias en la mayoría de estos países, y en muchos de ellos es actualmente la primera causa de muerte prematura (aquella ocurrida antes de los 70 años).(1) El impacto humano, sanitario y socioeconómico de estas cifras conmueve a nuestros países y sus proporciones son crecientes. Nuestra región dispone en general, de recursos humanos y materiales más limitados que los países desarrollados, además de notorias y persistentes desigualdades en el acceso a la salud. Los gobiernos, están entonces, enfrentados a un enorme desafío. Para el control del cáncer es absolutamente indispensable disponer de información confiable y detallada. No se puede diagnosticar apropiadamente la situación, implementar las medidas y programas necesarios y menos aún evaluar sus impactos si se carece de la información de registros de base poblacional que sean además, estables y confiables. De acuerdo con información de la Iniciativa Global para el Registro del Cáncer (GICR: Global Initiative for Cancer Registry), solo un 23.3% de la población latinoamericana está cubierta por registros de base poblacional, pero apenas el 2.4% está cubierta por registros de base poblacional de alta calidad.
{"title":"Cancer represents a challenge of increasing scale in the region: Do we have high-quality information to confront it?","authors":"Enrique Barrios Herrera","doi":"10.25100/cm.v53i1.5428","DOIUrl":"https://doi.org/10.25100/cm.v53i1.5428","url":null,"abstract":"El cáncer representa un problema de enorme relevancia a nivel internacional. De acuerdo con las últimas estimaciones de la IARC (International Agency for Research on Cancer, por sus siglas en inglés), se diagnostican más de 19 millones de casos nuevos y se registran casi 10 millones de muertes anualmente. \u0000En Latinoamérica, el cáncer da cuenta de unas 670000 muertes anuales, con una gran heterogeneidad en sus tasas en los distintos países. El cáncer es la segunda causa de muerte luego de las enfermedades cardiocirculatorias en la mayoría de estos países, y en muchos de ellos es actualmente la primera causa de muerte prematura (aquella ocurrida antes de los 70 años).(1) \u0000El impacto humano, sanitario y socioeconómico de estas cifras conmueve a nuestros países y sus proporciones son crecientes. Nuestra región dispone en general, de recursos humanos y materiales más limitados que los países desarrollados, además de notorias y persistentes desigualdades en el acceso a la salud. Los gobiernos, están entonces, enfrentados a un enorme desafío. \u0000Para el control del cáncer es absolutamente indispensable disponer de información confiable y detallada. No se puede diagnosticar apropiadamente la situación, implementar las medidas y programas necesarios y menos aún evaluar sus impactos si se carece de la información de registros de base poblacional que sean además, estables y confiables. \u0000De acuerdo con información de la Iniciativa Global para el Registro del Cáncer (GICR: Global Initiative for Cancer Registry), solo un 23.3% de la población latinoamericana está cubierta por registros de base poblacional, pero apenas el 2.4% está cubierta por registros de base poblacional de alta calidad.","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/f5/1657-9534-cm-53-01-e1005428.PMC9651075.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10845370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-30eCollection Date: 2021-10-01DOI: 10.25100/cm.v52i3.5047
Carlos Reina, Miyerlandi Torres, Edgar Muñoz, Elvia Karina Grillo Ardila, Rodrigo Guerrero Velasco, Luis Eduardo Bravo
{"title":"Mortality due to COVID-19 during the vaccination plan against the SARS-CoV-2 virus in Cali, Colombia.","authors":"Carlos Reina, Miyerlandi Torres, Edgar Muñoz, Elvia Karina Grillo Ardila, Rodrigo Guerrero Velasco, Luis Eduardo Bravo","doi":"10.25100/cm.v52i3.5047","DOIUrl":"https://doi.org/10.25100/cm.v52i3.5047","url":null,"abstract":"","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes
Background: qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are like those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU.
Objective: Compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia at increased risk of mortality or intensive care unit (ICU) admission.
Methods: Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five Colombian hospitals. Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures.
Results: Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores.
Conclusions: None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. Furthermore, the CRB 65 exhibited the lowest discriminative ability.
{"title":"Community-acquired pneumonia: comparison of three mortality prediction scores in the emergency department.","authors":"Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes","doi":"10.25100/cm.v52i4.4287","DOIUrl":"https://doi.org/10.25100/cm.v52i4.4287","url":null,"abstract":"<p><strong>Background: </strong>qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are like those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU.</p><p><strong>Objective: </strong>Compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia at increased risk of mortality or intensive care unit (ICU) admission.</p><p><strong>Methods: </strong>Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five Colombian hospitals. Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures.</p><p><strong>Results: </strong>Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores.</p><p><strong>Conclusions: </strong>None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. Furthermore, the CRB 65 exhibited the lowest discriminative ability.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/4e/1657-9534-cm-52-04-e2044287.PMC9015018.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9285272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30eCollection Date: 2021-04-01DOI: 10.25100/cm.v52i2.4802
Alfredo Martínez Rondanelli, María Antonia Gómez-Sierra, Arley Alberto Ossa, Rubén Darío Hernández, Mauricio Torres
In Orthopedics, damage control is indicated in patients with pelvic and/or long bone fractures associated with hemodynamic instability. It is inappropriate to perform a complex definitive reduction and fixation surgery for severely injured trauma patients with hemodynamic instability. In these cases, it is recommended to perform minimally invasive procedures that temporarily stabilize the fractures and bleeding control. Closed or open fractures of the long bones such as femur, tibia, humerus, and pelvis can lead to hemodynamic instability and shock. Thus, orthopedic damage control becomes a priority. However, if the patient is hemodynamically stable, it is recommended to stabilize all fractures with an early permanent internal fixation. These patients will have a shorter hospital length of stay and a reduction in mechanical ventilation, blood components transfusions and complications. Therefore, the concept of orthopedic damage control should be individualized according to the hemodynamic status and the severity of the injuries. Open fractures, dislocations, and vascular injuries could lead to permanent sequelae and complications if a correct management and approach are not performed.
{"title":"Damage control in orthopaedical and traumatology.","authors":"Alfredo Martínez Rondanelli, María Antonia Gómez-Sierra, Arley Alberto Ossa, Rubén Darío Hernández, Mauricio Torres","doi":"10.25100/cm.v52i2.4802","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4802","url":null,"abstract":"<p><p>In Orthopedics, damage control is indicated in patients with pelvic and/or long bone fractures associated with hemodynamic instability. It is inappropriate to perform a complex definitive reduction and fixation surgery for severely injured trauma patients with hemodynamic instability. In these cases, it is recommended to perform minimally invasive procedures that temporarily stabilize the fractures and bleeding control. Closed or open fractures of the long bones such as femur, tibia, humerus, and pelvis can lead to hemodynamic instability and shock. Thus, orthopedic damage control becomes a priority. However, if the patient is hemodynamically stable, it is recommended to stabilize all fractures with an early permanent internal fixation. These patients will have a shorter hospital length of stay and a reduction in mechanical ventilation, blood components transfusions and complications. Therefore, the concept of orthopedic damage control should be individualized according to the hemodynamic status and the severity of the injuries. Open fractures, dislocations, and vascular injuries could lead to permanent sequelae and complications if a correct management and approach are not performed.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39696167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30eCollection Date: 2021-04-01DOI: 10.25100/cm.v52i2.4810
Mónica Vargas, Alberto García, Yaset Caicedo, Michael W Parra, Carlos A Ordoñez
Damage control surgery has transformed the management of severely injured trauma patients. It was initially described as a three-step process that included bleeding control, abdominal cavity contamination, and resuscitation in the intensive care unit (ICU) before definitive repair of the injuries. When the patient is admitted into the ICU, the physician should identify all the physiological alterations to establish resuscitation management goals. These strategies allow an early correction of trauma-induced coagulopathy and hypoperfusion increasing the likelihood of survival. The objective of this article is to describe the physiological alterations in a severely injured trauma patient who undergo damage control surgery and to establish an adequate management approach. The physician should always be aware and correct the hypothermia, acidosis, coagulopathy and hypocalcemia presented in the severely injured trauma patients.
{"title":"Damage control in the intensive care unit: what should the intensive care physician know and do?","authors":"Mónica Vargas, Alberto García, Yaset Caicedo, Michael W Parra, Carlos A Ordoñez","doi":"10.25100/cm.v52i2.4810","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4810","url":null,"abstract":"<p><p>Damage control surgery has transformed the management of severely injured trauma patients. It was initially described as a three-step process that included bleeding control, abdominal cavity contamination, and resuscitation in the intensive care unit (ICU) before definitive repair of the injuries. When the patient is admitted into the ICU, the physician should identify all the physiological alterations to establish resuscitation management goals. These strategies allow an early correction of trauma-induced coagulopathy and hypoperfusion increasing the likelihood of survival. The objective of this article is to describe the physiological alterations in a severely injured trauma patient who undergo damage control surgery and to establish an adequate management approach. The physician should always be aware and correct the hypothermia, acidosis, coagulopathy and hypocalcemia presented in the severely injured trauma patients.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/8c/1657-9534-cm-52-02-e4174810.PMC8634272.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39725858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30eCollection Date: 2021-04-01DOI: 10.25100/cm.v52i2.4807
José Julián Serna, Carlos A Ordoñez, Michael W Parra, Carlos Serna, Yaset Caicedo, Alberto Rosero, Fernando Velásquez, Carlos Serna, Alexander Salcedo, Adolfo González-Hadad, Alberto García, Mario Alain Herrera, Luis Fernando Pino, Maria Josefa Franco, Fernando Rodríguez-Holguín
Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.
{"title":"Damage control in penetrating carotid artery trauma: changing a 100-year paradigm.","authors":"José Julián Serna, Carlos A Ordoñez, Michael W Parra, Carlos Serna, Yaset Caicedo, Alberto Rosero, Fernando Velásquez, Carlos Serna, Alexander Salcedo, Adolfo González-Hadad, Alberto García, Mario Alain Herrera, Luis Fernando Pino, Maria Josefa Franco, Fernando Rodríguez-Holguín","doi":"10.25100/cm.v52i2.4807","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4807","url":null,"abstract":"<p><p>Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/97/1657-9534-cm-52-02-e4054807.PMC8634279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39815004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30eCollection Date: 2021-04-01DOI: 10.25100/cm.v52i2.4611
Michael W Parra, Carlos A Ordoñez, Luis Fernando Pino, Mauricio Millán, Yaset Caicedo, Víctor Rafael Buchelli, Alberto García, Adolfo González-Hadad, Alexander Salcedo, José Julián Serna, Laureano Quintero, Mario Alain Herrera, Fabian Hernández, Fernando Rodríguez-Holguín
Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.
{"title":"Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA.","authors":"Michael W Parra, Carlos A Ordoñez, Luis Fernando Pino, Mauricio Millán, Yaset Caicedo, Víctor Rafael Buchelli, Alberto García, Adolfo González-Hadad, Alexander Salcedo, José Julián Serna, Laureano Quintero, Mario Alain Herrera, Fabian Hernández, Fernando Rodríguez-Holguín","doi":"10.25100/cm.v52i2.4611","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4611","url":null,"abstract":"<p><p>Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/88/1657-9534-cm-52-02-e4054611.PMC8634276.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39815003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-30eCollection Date: 2021-04-01DOI: 10.25100/cm.v52i2.4805
David Mejia, Salin Pereira Warr, Carlos Andrés Delgado-López, Alexander Salcedo, Fernando Rodríguez-Holguín, José Julián Serna, Yaset Caicedo, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, Michael W Parra, Alberto García, Carlos A Ordoñez
Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.
{"title":"Reinterventions after damage control surgery.","authors":"David Mejia, Salin Pereira Warr, Carlos Andrés Delgado-López, Alexander Salcedo, Fernando Rodríguez-Holguín, José Julián Serna, Yaset Caicedo, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, Michael W Parra, Alberto García, Carlos A Ordoñez","doi":"10.25100/cm.v52i2.4805","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4805","url":null,"abstract":"<p><p>Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/5e/1657-9534-cm-52-02-e4154805.PMC8634277.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39725855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}