1
|
Luna Aufroy A, Rebasa Cladera P, Montmany Vioque S. Barrett's esophagus and esophageal cancer after sleeve gastrectomy. Myth or reality? Cir Esp 2023; 101 Suppl 4:S39-S42. [PMID: 37979936 DOI: 10.1016/j.cireng.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.
Collapse
Affiliation(s)
- Alexis Luna Aufroy
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Sandra Montmany Vioque
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
2
|
Montmany Vioque S, Rebasa Cladera P, Campos Serra A, Gràcia Roman R, Luna Aufroy A, Navarro Soto S. Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture. Cir Esp 2021; 99:433-439. [PMID: 34053901 DOI: 10.1016/j.cireng.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION FAST is essential to decide whether trauma patients need laparotomy, but it has a notable decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. METHODS Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died. The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. RESULTS Over the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs 14%, P < .05). Patients with positive FAST died more than negative FAST (43% vs 26%); and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. CONCLUSION FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduced notably by applying preperitoneal packing.
Collapse
Affiliation(s)
- Sandra Montmany Vioque
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Andrea Campos Serra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Raquel Gràcia Roman
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Alexis Luna Aufroy
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Salvador Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
3
|
Montmany Vioque S, Rebasa Cladera P, Serra AC, Gràcia Roman R, Luna Aufroy A, Navarro Soto S. Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture. Cir Esp 2020. [PMID: 32972713 DOI: 10.1016/j.ciresp.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION FAST is essential to decide if trauma patients need laparotomy, but has a notably decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. METHODS Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who were fallecimiento. FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. RESULTS Over the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs. 14%, p <0.05). Patients with positive FAST died more than negative FAST (43% vs. 26%); and 4 of 10 hemodynamically unstable patients who underwent non therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. CONCLUSION FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduce notably applying a preperitoneal packing.
Collapse
Affiliation(s)
- Sandra Montmany Vioque
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Andrea Campos Serra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Raquel Gràcia Roman
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Alexis Luna Aufroy
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Salvador Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| |
Collapse
|
4
|
Campos Serra A, Montmany Vioque S, Rebasa Cladera P, Criado Paredes E, Navarro Soto S. [Venous bullet embolism]. Emergencias 2016; 28:206-210. [PMID: 29105458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Andrea Campos Serra
- Departamento de Cirugía General, Hospital Parc Taulí, Sabadell, Barcelona, España
| | | | - Pere Rebasa Cladera
- Departamento de Cirugía General, Hospital Parc Taulí, Sabadell, Barcelona, España
| | - Eva Criado Paredes
- Departamento de Radiología Intervencionista, Hospital Parc Taulí, Sabadell, Barcelona, España
| | | |
Collapse
|
5
|
Serracant Barrera A, Montmany Vioque S, Llaquet Bayo H, Rebasa Cladera P, Campos Serra A, Navarro Soto S. Prospective registry of severe polytrauma. Analysis of 1200 patients. Cir Esp 2015; 94:16-21. [PMID: 25870078 DOI: 10.1016/j.ciresp.2015.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Polytrauma continues to be one of the main causes of death in the population between 10-40 years of age, and causes severe discapability in surviving patients. The aim of this study is to perform an analysis of the quality of care of the polytrauma patient using an epidemiological study. METHOD Prospective registry of all polytrauma patients treated at our hospital over 16 years of age, admitted to the critical care area or dead before admission. RESULTS From March 2006 to August 2014, we registered 1200 polytrauma patients. The majority were men (75%) with a median age of 45. The mean ISS was 20,9±15,8 and the most common mechanism of injury was blunt trauma (94% cases), The global mortality rate was 9.8% (117 cases), and neurological death was the most frequent cause (45.3%), followed by hypovolemic shock (29,1%). In 17 cases (14,5% of deaths) mortality was considered evitable or potentially evitable, A total of 327 patients (27.3%) needed emergency surgery and 106 patients (8,8%) needed emergency treatment using interventional radiology. 18,5% of patients (222) presented an inadverted injury, with a total of 318 inadverted injuries. CONCLUSION Trauma care at our centre is adequate. A prospective registry of the global care of polytrauma patients is necessary to evaluate the quality of care and improve results.
Collapse
Affiliation(s)
- Anna Serracant Barrera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Sandra Montmany Vioque
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Heura Llaquet Bayo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Andrea Campos Serra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Salvador Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| |
Collapse
|
6
|
Llaquet Bayo H, Montmany Vioque S, Rebasa P, Navarro Soto S. [Results of conservative treatment in patients with occult pneumothorax]. Cir Esp 2015; 94:232-6. [PMID: 25804518 DOI: 10.1016/j.ciresp.2015.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/10/2015] [Accepted: 01/25/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. METHODS A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. RESULTS In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. CONCLUSION Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients.
Collapse
Affiliation(s)
- Heura Llaquet Bayo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España.
| | - Sandra Montmany Vioque
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España
| | - Pere Rebasa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España
| | - Salvador Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
7
|
Gómez Díaz CJ, Rebasa Cladera P, Navarro Soto S, Hidalgo Rosas JM, Luna Aufroy A, Montmany Vioque S, Corredera Cantarín C. [Validation of abdominal wound dehiscence's risk model]. Cir Esp 2013; 92:114-9. [PMID: 23648044 DOI: 10.1016/j.ciresp.2012.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/04/2012] [Accepted: 12/25/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study is to determine the usefulness of the risk model developed by van Ramshorst et al., and a modification of the same, to predict the abdominal wound dehiscence's risk in patients who underwent midline laparotomy incisions. MATERIALS AND METHODS Observational longitudinal retrospective study. SAMPLE Patients who underwent midline laparotomy incisions in the General and Digestive Surgery Department of the Sabadell's Hospital-Parc Taulí's Health and University Corporation-Barcelona, between January 1, 2010 and June 30, 2010. Dependent variable: Abdominal wound dehiscence. INDEPENDENT VARIABLES Global risk score, preoperative risk score (postoperative variables were excluded), global and preoperative probabilities of developing abdominal wound dehiscence. RESULTS SAMPLE 176 patients. Patients with abdominal wound dehiscence: 15 (8.5%). The global risk score of abdominal wound dehiscence group (mean: 4.97; IC 95%: 4.15-5.79) was better than the global risk score of No abdominal wound dehiscence group (mean: 3.41; IC 95%: 3.20-3.62). This difference is statistically significant (P<.001). The preoperative risk score of abdominal wound dehiscence group (mean: 3.27; IC 95%: 2.69-3.84) was better than the preoperative risk score of No abdominal wound dehiscence group (mean: 2.77; IC 95%: 2.64-2.89), also a statistically significant difference (P<.05). The global risk score (area under the ROC curve: 0.79) has better accuracy than the preoperative risk score (area under the ROC curve: 0.64). CONCLUSION The risk model developed by van Ramshorst et al. to predict the abdominal wound dehiscence's risk in the preoperative phase has a limited usefulness. Additional refinements in the preoperative risk score are needed to improve its accuracy.
Collapse
Affiliation(s)
- Carlos Javier Gómez Díaz
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| | - Salvador Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| | - José Manuel Hidalgo Rosas
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| | - Alexis Luna Aufroy
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| | - Sandra Montmany Vioque
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| | - Constanza Corredera Cantarín
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria y Universitaria Parc Taulí , Sabadell, Barcelona, España
| |
Collapse
|
8
|
Montmany Vioque S, Navarro Soto S, Rebasa Cladera P, Luna Aufroy A, Gómez Díaz C, Llaquet Bayo H. [Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality]. Cir Esp 2011; 90:107-13. [PMID: 22206654 DOI: 10.1016/j.ciresp.2011.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 07/07/2011] [Accepted: 07/16/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. MATERIAL AND METHOD A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24 hours of the trauma and associating it with the patient morbidity and mortality. RESULTS A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24 hours after the trauma, lactic acid of 27.8 mg/dl and 17.9 mg/dl, respectively, (normal values less than 22 mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24 hours in those who had MOF (17.8 vs 26.7). The patients with a lactic acid that got worse or remained abnormal at 24 hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%). In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24 hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%). CONCLUSIONS The lactic acid results in the first 24 hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable.
Collapse
Affiliation(s)
- Sandra Montmany Vioque
- Servicio de cirugía general y del aparato digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
| | | | | | | | | | | |
Collapse
|
9
|
Hermoso Bosch J, García Monforte N, Luna Aufroy A, Montmany Vioque S. [Multiple splenic abscesses]. Cir Esp 2009; 88:187. [PMID: 19766992 DOI: 10.1016/j.ciresp.2009.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 05/24/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Judit Hermoso Bosch
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Parc Taulí, Sabadell, España.
| | | | | | | |
Collapse
|
10
|
Serra Aracil X, Navarro Soto S, Aparicio Rodríguez O, Hermoso Bosch J, Montmany Vioque S, Carmona Navarro D, Corredera Cantarin C, Gómez Diaz C. Cuatro años de experiencia con el libro informático del residente de la AEC. Cir Esp 2009; 86:147-53. [DOI: 10.1016/j.ciresp.2009.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/04/2009] [Indexed: 10/20/2022]
|
11
|
Serra Aracil X, Navarro Soto S, Artigau Nieto E, Rebasa Cladera P, Hernando Tavira R, Moreno Matías J, Aparicio Rodríguez O, Hermoso Bosch J, Montmany Vioque S. ¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente. Cir Esp 2006; 80:145-50. [PMID: 16956549 DOI: 10.1016/s0009-739x(06)70942-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.
Collapse
Affiliation(s)
- Xavier Serra Aracil
- Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
| | | | | | | | | | | | | | | | | |
Collapse
|