Case and Research Letter
Sheathed goring: The paradox of combined blunt and penetrating trauma. Clinical case
Cornada envainada: la paradoja de un trauma contuso-penetrante. Caso clínico
C. García-Rayo
, Á. Tejido Sánchez, A. Rodríguez Antolín, J. Téigell Tobar
Corresponding author
Hospital Universitario Doce de Octubre, Madrid, Spain
Read
4
Timeswas read the article
2
Total PDF
2
Total HTML
Share statistics
array:23 [ "pii" => "S2173578624001057" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2024.09.001" "estado" => "S200" "fechaPublicacion" => "2024-10-08" "aid" => "1654" "copyright" => "AEU" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0210480624000652" "issn" => "02104806" "doi" => "10.1016/j.acuro.2024.04.003" "estado" => "S200" "fechaPublicacion" => "2024-05-24" "aid" => "1654" "copyright" => "AEU" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Cornada envainada: la paradoja de un trauma contuso-penetrante. Caso clínico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sheathed goring: the paradox of combined blunt and penetrating trauma. Clinical case" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 367 "Ancho" => 1000 "Tamanyo" => 33866 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Evisceración contenida en flanco izquierdo. B) <span class="elsevierStyleItalic">Stop</span> del flujo arterial renal izquierdo con infarto y sangrado perirrenal asociados.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. García-Rayo, Á. Tejido Sánchez, A. Rodríguez Antolín, J. Téigell Tobar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "García-Rayo" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Tejido Sánchez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez Antolín" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Téigell Tobar" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578624001057" "doi" => "10.1016/j.acuroe.2024.09.001" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578624001057?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480624000652?idApp=UINPBA00004N" "url" => "/02104806/unassign/S0210480624000652/v1_202405240427/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173578624001082" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2024.09.004" "estado" => "S200" "fechaPublicacion" => "2024-10-14" "aid" => "1668" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Clinical application of the UroLift® prostatic urethral lift in Spain: consensus on the treatment of lower urinary tract symptoms associated with urinary flow obstruction and secondary to benign prostatic hyperplasia (BPH)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aplicación clínica del sistema de liberación uretral UroLift en España®: consenso sobre el tratamiento de los síntomas del tracto urinario inferior asociados a la obstrucción del flujo urinario por hiperplasia benigna de próstata (HBP)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1024 "Ancho" => 2458 "Tamanyo" => 212413 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Steps of the PUL Procedure.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The UroLift Implant is delivered in four basic steps using the Delivery Device. Needle Safety Lock (1) is released. Needle Trigger (2) is depressed, deploying the needle and Capsular Tab to the capsular side of the prostate. The needle extends 33 mm from the tip of the device. Retraction Lever (3) is retracted, resulting in the delivery of the Capsular Tab with suture under tension. Urethral Release (4) is pressed, deploying the Urethral End-Piece and cutting excess suture.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Fernández Arjona, L. López Martín, L.M. Herranz Fernández, B. Sinues Ojas, J.M. Campá Bortoló, J. Extramiana Cameno, E. López Alcina, I. Povo Martín, A. Budía Alba, G. Ordaz Jurado, J.M. Osca García, M. Perán Teruel, V. Gimeno Argente, A. Navarro Beltrán, J. Benejam Gual, Y.E. Hernández Martínez, C. González Enguita" "autores" => array:17 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Fernández Arjona" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "López Martín" ] 2 => array:2 [ "nombre" => "L.M." "apellidos" => "Herranz Fernández" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Sinues Ojas" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Campá Bortoló" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Extramiana Cameno" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "López Alcina" ] 7 => array:2 [ "nombre" => "I." "apellidos" => "Povo Martín" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Budía Alba" ] 9 => array:2 [ "nombre" => "G." "apellidos" => "Ordaz Jurado" ] 10 => array:2 [ "nombre" => "J.M." "apellidos" => "Osca García" ] 11 => array:2 [ "nombre" => "M." "apellidos" => "Perán Teruel" ] 12 => array:2 [ "nombre" => "V." "apellidos" => "Gimeno Argente" ] 13 => array:2 [ "nombre" => "A." "apellidos" => "Navarro Beltrán" ] 14 => array:2 [ "nombre" => "J." "apellidos" => "Benejam Gual" ] 15 => array:2 [ "nombre" => "Y.E." "apellidos" => "Hernández Martínez" ] 16 => array:2 [ "nombre" => "C." "apellidos" => "González Enguita" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480624001037" "doi" => "10.1016/j.acuro.2024.06.003" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480624001037?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578624001082?idApp=UINPBA00004N" "url" => "/21735786/unassign/S2173578624001082/v1_202410140408/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173578624000611" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2024.05.001" "estado" => "S200" "fechaPublicacion" => "2024-05-17" "aid" => "1636" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "What is the relationship between penile cancer and the microbiome? A scoping review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cuál es la relación entre el cáncer de pene y el microbioma? Una revisión exploratoria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 730 "Ancho" => 1333 "Tamanyo" => 155817 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H.A. García-Perdomo, V. Granados-Duque, P.E. Spiess" "autores" => array:3 [ 0 => array:2 [ "nombre" => "H.A." "apellidos" => "García-Perdomo" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Granados-Duque" ] 2 => array:2 [ "nombre" => "P.E." "apellidos" => "Spiess" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0015"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480624000184" "doi" => "10.1016/j.acuro.2024.01.012" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480624000184?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578624000611?idApp=UINPBA00004N" "url" => "/21735786/unassign/S2173578624000611/v1_202405170457/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Sheathed goring: The paradox of combined blunt and penetrating trauma. Clinical case" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. García-Rayo, Á. Tejido Sánchez, A. Rodríguez Antolín, J. Téigell Tobar" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "García-Rayo" "email" => array:1 [ 0 => "clara.gre.105@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Tejido Sánchez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez Antolín" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Téigell Tobar" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario Doce de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cornada envainada: la paradoja de un trauma contuso-penetrante. Caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1076 "Ancho" => 800 "Tamanyo" => 87295 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal hematoma without solution of continuity of the skin tissue.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bull horn injuries are frequent in Spain, especially during the summer season, when events involving bulls are mostly celebrated.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Any patient with a bull horn injury should be considered a polytraumatized patient and receive the corresponding treatment.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In certain cases, the severity of injuries caused by these accidents is not evident on initial evaluation. Sheathed goring is one of these cases. It is a subtype of goring in which the horn hits and penetrates deep tissues – possibly leading to eventrations and severe visceral injuries – without perforating the skin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A 45-year-old male with no relevant medical history was transferred to our center after receiving a bull horn goring during a bull run (<span class="elsevierStyleItalic">encierro</span>). He was conscious, oriented and hemodynamically stable on arrival. He presented multiple abrasions and hematomas on the face, thorax and four limbs. Abdominal examination revealed a circular, swollen hematoma on the left flank (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), accompanied by signs of peritoneal irritation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given the patient’s stable condition, an emergency computed tomography (CT) scan was performed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The CT scan ruled out cranial and cervical abnormalities but revealed fractures of five bilateral costal arches and a sternal fracture. At the abdominal area, there was intestinal evisceration contained in the left flank with no evidence of affected bowel loops, a renal vascular injury with associated renal infarction, and evidence of active perirenal hemorrhage.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In face of these CT findings, immediate surgical exploration was performed through a midline xiphopubic laparotomy. The left abdominal wall presented severe evisceration with dehiscence of the parietal peritoneum, muscle fibers and anterior aponeurosis. The integrity of the intestinal loops contained in the evisceration was verified. A left nephrectomy was performed through a transperitoneal transmesocolic approach with early control of the renal vessels. A large hematoma contained within the Gerota’s fascia was revealed. A preperitoneal polypropylene mesh was placed to repair the abdominal wall defect.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Postoperative recovery was uneventful and the patient was discharged on the fifth day.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Bull horn injuries are common in regions with a bullfighting tradition. These injuries have unique characteristics such as a large area of tissue damage, multiple paths of injuries, inoculation of anaerobic germs and transmission of tetanus.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There are several types of injuries resulting from bull horn wounds.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Sheathed goring is characterized by the absence of skin dehiscence, as the elasticity of the skin prevents tearing when the horn penetrates the body, resulting in minor injuries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This particularity may lead to underestimate these wounds during examination, as their penetrating mechanism is not evident. However, such injuries are often serious and frequently require emergency surgery.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Focusing on the renal vascular injury and its treatment, it was classified as grade V according to the AAST (American Association for the Surgery of Trauma) classification. There is an increasing tendency towards conservative management of renal trauma, even in cases of high-grade injuries in hemodynamically stable patients.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Keihani et al. developed a nomogram that predicts the need for surgical intervention in cases of high-grade renal trauma, evaluating factors such as the mechanism of injury (penetrating or not), hemodynamic stability and presence of contrast extravasation, among others.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this case, despite the hemodynamic stability of the patient, several factors such as the presence of active bleeding foci in the perirenal area, the mechanism of trauma, and the need for surgery to address bowel evisceration led to an emergency laparotomy. According to the nomogram, the patient’s likelihood of needing emergency surgery due to bleeding was estimated to be between 40% and 50%, considering that the mechanism of injury was penetrating. Although there was no solution of continuity of the skin tissue, this type of injury produces characteristics typical of penetrating wounds and tears, thus it falls into this category.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The anterior transperitoneal approach to reach the renal pedicle through the mesentery allows faster control of the main renal vessels, which contributes to a safer management of the patient. This approach subsequently allows exploration of the kidney and retroperitoneal region with vascular control. The decision to perform total or partial nephrectomy or renorrhaphy – in cases where the lesions allow for a more conservative approach –<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> depends on the findings.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although sheathed goring is uncommon, this injury deserves special attention as it can mask underlying lesions that are more significant than they initially appear. When these involve the kidney, despite the current trend towards conservative management of renal trauma, there are still situations in which surgery is imperative. Surgical intervention can be critical in preventing further complications and even preserving the patient’s life.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1076 "Ancho" => 800 "Tamanyo" => 87295 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal hematoma without solution of continuity of the skin tissue.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 367 "Ancho" => 1000 "Tamanyo" => 33866 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Evisceration contained within the left flank. (B) Blockage of left renal arterial flow with associated infarction and perirenal hemorrhage.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cornada envainada. Una lesión poco evidente pero devastadora" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Martínez-Ramos" 1 => "C. Villegas-Cánovas" 2 => "I. Rivadulla-Serrano" 3 => "J.L. Salvador-Sanchís" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2007" "volumen" => "19" "paginaInicial" => "347" "paginaFinal" => "349" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heridas por asta de toro en el Hospital General de Castellón. Estudio de 387 pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Martínez-Ramos" 1 => "J. Manuel Miralles-Tena" 2 => "J. Escrig-Sos" 3 => "G. Traver-Martínez" 4 => "I. Cisneros-Reig" 5 => "J. Luis Salvador-Sanchís" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0009-739x(06)70910-1" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2006" "volumen" => "80" "paginaInicial" => "16" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16796948" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 10-year review of blunt renal artery injuries at an urban level I trauma centre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J.D. Chow" 1 => "K.J. Thompson" 2 => "J.F. Hartman" 3 => "M.L. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2008.11.022" "Revista" => array:7 [ "tituloSerie" => "Injury" "fecha" => "2009" "volumen" => "40" "paginaInicial" => "844" "paginaFinal" => "850" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19486971" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1078588421000903" "estado" => "S300" "issn" => "10785884" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal trauma: the current best practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Erlich" 1 => "N.D. Kitrey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1756287218785828" "Revista" => array:6 [ "tituloSerie" => "Ther Adv Urol" "fecha" => "2018" "volumen" => "10" "paginaInicial" => "295" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30186367" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of major blunt renal lacerations: surgical or nonoperative approach?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Robert" 1 => "N. Drianno" 2 => "G. Muir" 3 => "O. Delbos" 4 => "J. Guiter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000474192" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "1996" "volumen" => "30" "paginaInicial" => "335" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8931966" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A nomogram predicting the need for bleeding interventions after high-grade renal trauma: results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Keihani" 1 => "D.M. Rogers" 2 => "B.E. Putbrese" 3 => "R.A. Moses" 4 => "C. Zhang" 5 => "A.P. Presson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000002222" "Revista" => array:7 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2019" "volumen" => "86" "paginaInicial" => "774" "paginaFinal" => "782" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30741884" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673621019103" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early vascular control for renal trauma: a critical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. Carroll" 1 => "P. Klosterman" 2 => "J.W. McAninch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0022-5347(17)41022-6" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1989" "volumen" => "141" "paginaInicial" => "826" "paginaFinal" => "829" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2926873" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/unassign/S2173578624001057/v1_202410080947/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735786/unassign/S2173578624001057/v1_202410080947/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578624001057?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 2 | 2 | 4 |
